Over the past twenty years, dental implants have been
constantly improving. The science and technology for dental
implants now makes implants as predictable and reliable as
more traditional dental restorative procedures like crowns
and bridges.
Implants are a two stage process. A titanium artificial
tooth root is surgically placed into the jaw bone by an
oral surgeon, periodontist or general dentist with
specialized training. The titanium implant is just below
the level of gum tissue and a small hole is left in the gum
over the top of the implant. A "healing cap" is screwed
into the threads of the implant to prevent the gum tissue
from growing over or into the implant.
A period of 6 weeks to several months is required for the
titanium implant to "integrate" with the jaw bone. That
means that the bone actually attaches to the implant to
provide stability. It should be realized that this
attachment is NOT the same as with a natural tooth. There
is no periodontal ligament involved, which is the feature
in bone to tooth attachment that allows for tooth movement
through bone. Implants cannot be moved orthodontically nor
be exposed to forces that cause natural teeth to move in
response. For this reason, if implants are being considered
with multiple missing teeth, your dentist must plan the
number of implants and type of restoration placed on the
implants carefully.
The type of restoration placed on the implant are varied.
In the case of a single tooth, a piece called an abutment
is screwed into the implant to replace the healing cap when
osseo-integration of the implant has been accomplished. A
crown (or cap) is then cemented over the abutment just as
if this were a natural tooth that had been prepared for a
crown.
There can be several single tooth implants placed either
adjacent to one another or in various locations around the
mouth where teeth are missing. However, when the span of
missing teeth is too great, it becomes more cost effective
as well as biologically supportable to place two or three
implants and link them together with a fixed bridge. There
will be more teeth showing on the bridge than there are
implants, just like with traditional bridges on natural
teeth. These are also supported be abutments screwed into
the implants as with single tooth implants.
When there are many missing teeth (or all of them) implants
are usually used to support a removable denture. When this
is done, instead of an abutment screwed into the implant, a
post is used and the posts for several implants are linked
together with a cast metal bar. The denture is then made
with clip inserts that clip onto the bar between the
implants. A denture made this way is vastly more
comfortable than a traditional denture because it largely
rests on the bar instead of the tissue, thus eliminating
many of the sore spots caused by dentures. Additionally,
the denture is locked into place by the clips and is
extremely stable, unlike dentures which tend to slip and
shift or come completely out much more easily.
Although implants can be very expensive by comparison with
other more traditional dental prosthetics, the potential
benefits make them equally valuable. Most patients who have
had traditional dental prosthetics replaced by implant
supported prosthetics are so happy that they would never go
back.
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Steven J. Brazis DDS is a family and cosmetic dentist in
Sacramento, CA. He has been practicing for 35 years and has
written one book and many articles on dentistry. You can
visit his web site at:
http://www.toothhaven.com
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