Patient Education

WHAT IS A DENTAL IMPLANT?

A dental implant is a substitute tooth root that serves the same function as a natural tooth root. It preserves bone and provides a stable foundation for a replacement tooth that look, feel and function like a natural tooth. Dental implants are made of titanium, which is a biocompatible material used in orthopedic implants.

WHY ARE DENTAL IMPLANTS BETTER THAN BRIDGES, PARTIALS AND DENTURES?

Dental implants can last a lifetime, unlike bridges, partials and dentures that may need to be replaced several times. Since dental implants prevent the bone resorption that occurs when teeth are missing, the natural appearance of the smile is preserved. With implant treatment, there is no compromise to adjacent teeth; they are not cut down to place a bridge, or loosened by the hooks on removable partials. Dentures and partials have the added disadvantage of accelerating the bone resorption process, which causes the appearance of premature aging.

WILL MY NEW TEETH LOOK NATURAL?

Your new replacement teeth will look, feel and function like natural teeth. And since implant treatment is the only solution that prevents bone resorption, which can cause your smile to look unnatural, the long term esthetics will be superior to any other treatment option.

WHO IS A CANDIDATE FOR DENTAL IMPLANT TREATMENT?

Nearly everyone who is missing one or more teeth and in general good health is a candidate for dental implant treatment. There are a few medical conditions that can undermine the success of implant treatment, such as uncontrolled diabetes. However, there are very few conditions that would keep someone from having implant treatment altogether. Quality and quantity of available bone for implant placement is more often a factor in qualifying for dental implants than medical conditions. However, even people who have lost a significant amount of bone can qualify for dental implant treatment with additional procedures to add bone or create new bone. Advances in this type of treatment have made it possible for most people who would not previously have been considered candidates to have successful implant treatment.

IS ANYONE EVER CONSIDERED TOO OLD FOR DENTAL IMPLANTS?

Overall health and a desire to improve the quality of life are much more important considerations than age. When dental implants were first developed, back in the 1950's, implant supported replacement teeth were originally designed as a solution for older patients who were missing all of their teeth. Since then, many patients well into their nineties have had dental implant treatment without a single problem.

HOW LONG DOES IT TAKE TO COMPLETE TREATMENT?

The length of treatment time depends largely upon whether someone is a candidate for Immediate Function procedures. Patients who qualify for this type of treatment receive their replacement teeth the same day implants are placed. For the majority of patients, treatment can take anywhere from several weeks to several months,depending upon the quality of the bone in which the implants are placed. If procedures are needed to augment the bone, the total treatment time is usually somewhere between six to nine months.

IS THE SURGICAL PROCEDURE PAINFUL?

Most implant patient’s report that the discomfort is far less than they expected, and is much like having a tooth extracted. And although everyone is different with regard to pain tolerance, most patients are very comfortable simply taking Tylenol afterward.

IS IT NECESSARY TO HAVE ONE IMPLANT PLACED FOR EACH TOOTH THAT IS MISSING?

No. In fact, it is possible to replace all of the lower teeth with an overdenture that is supported by only 2-4 implants. On the other hand, some dental specialists feel that it is advantageous to replace missing posterior teeth with individual implants to provide additional strength to withstand the forces of chewing for patients who have most of their natural teeth. Each patient's situation is unique and should be evaluated by a dental specialist to determine the appropriate number of implants required to support the replacement teeth that will meet the patient's functional and esthetic needs.

HOW LONG DO IMPLANTS LAST?

Documented clinical research demonstrates that implant supported replacement teeth have been successful for over 50 years. These were some of the first root-form implant cases ever completed and they have been closely monitored from the beginning. It is highly likely that these cases will be successful throughout the lifetime of those patients. Dental implants are designed to be permanent; however many factors contribute to the long term success of implant treatment, such as home care and regular maintenance visits to the dentist or dental specialist.By comparison, research demonstrates that the typical tooth supported bridge lasts from 7-10 years and that partials and dentures are functional for approximately 5 years. Insurance statistics indicate that bridges, partials and dentures last 5 years and they generally pay for replacements every 5 years.

DO DENTAL IMPLANTS EVER FAIL?

Dental implant treatment is one of the most successful procedures in the medical-dental field, with documented success rates over 95%. Although successful treatment is very predictable, there are rare occasions where the bone does not completely bond to the implants. When this occurs, new implants are placed, and the success rates for the replacement implants are even higher.Smoking or putting too much pressure on newly placed implants, as with excessive grinding of the teeth, can cause problems with the bone bonding to the implants and should be avoided.

DOES THE BODY EVER REJECT DENTAL IMPLANTS?

Several years ago there was quite a scare about certain types of breast implants, which has caused a number of people to ask if the same thing is possible with dental implants. As indicated above, the success rates for dental implants are extremely high. This is due in part to the fact that root-form implants are made of a biocompatible material, titanium. Because titanium is accepted so well by the human body, it also is used for orthopedic implants, such as hip and knee replacements.

IS IT POSSIBLE TO USE AN EXISTING DENTURE WITH DENTAL IMPLANTS?

Sometimes it is possible to use a patient's existing denture, as opposed to fabricating a new denture to snap onto dental implants, by altering it to accommodate the necessary attachments. However, there are a number of factors that must be considered. Since each patient's situation is unique, the possibility of using an existing denture can only be determined in consultation with a dentist or dental specialist.

IF DENTAL IMPLANTS PRESERVE BONE, WHY WOULD A DENTIST RECOMMEND

Naturally, since dental implants preserve bone, if a patient qualifies as a candidate, implant treatment is usually considered the treatment of choice. Now that implants are considered standard of care, it is much less common for dentists to recommend fixed bridges instead of implants. Some dentists recommend bridges for patients who are not candidates for implants, or when patients insist on having the lowest possible fee for tooth replacement. However, even in cases where the teeth adjacent to the missing tooth/teeth have restorations, many dentists do not want to grind these teeth down into peg shapes to fit a bridge, as this compromises the long term health of those teeth. And most dentists abhor the idea of grinding down perfect teeth without restorations to place a traditional bridge, and therefore, will almost always recommend dental implant treatment in these cases.

WILL THERE BE ANY RESTRICTIONS TO MY LIFESTYLE?

No. You will be able to undertake any activity that you would with normal teeth. This includes eating and drinking whatever you choose. Your new replacement teeth will look, feel and function like natural teeth, which will allow you to forget about them and enjoy life as it was meant to be enjoyed.

ARE THERE SITUATIONS WHERE A DENTAL SPECIALIST WOULD RECOMMEND EXTRACTING A TOOTH AND REPLACING IT WITH AN IMPLANT SUPPORTED CROWN?

There are many situations where natural teeth are either failing, or are about to fail. This includes severe periodontal disease (gum disease) that has eroded the bone that supports teeth. Sometimes in these cases, it is preferable to extract the teeth; eliminate the disease and infection and replace the teeth with implant supported crowns/bridges. There are also situations where a tooth has had a root canal (nerves have been removed from the tooth) leaving the tooth brittle and susceptible to fracture. In cases where the tooth needs to be retreated and the prognosis is not favorable, it is preferable to extract the tooth and replace it with an implant supported crown.Teeth with severe fractures are usually extracted and are ideal candidates for replacement with dental implant treatment.

WHAT IS INVOLVED WITH TAKING CARE OF DENTAL IMPLANTS?

The home care recommended varies depending upon the type of implant supported replacement teeth. For example, a single implant supported crown is cleaned like a natural tooth, with regular brushing and flossing. Implant supported bridges that replace a few teeth are cleaned like tooth supported bridges, brushing and flossing with a floss threader. Home care is a little more complicated for people who are missing all of their teeth, in that special brushes and floss are often recommended. With overdentures, it is necessary to clean the implant attachments, as well as the overdenture. Permanently fixed implant supported replacement teeth are cleaned like all other bridges. In all cases, it is recommended that patients see their regular dentist and hygienist at least twice each year unless they routinely see the periodontist, in which case they would continue to alternate visits. It is usually recommended that the patient see the surgical specialist who places the implant(s) at least once each year as well. These visits, combined with proper home care, are essential to the long term success of implant treatment.

WHAT IS THE COST OF IMPLANT TREATMENT?

An investment in dental implant treatment is an investment in overall health, appearance and well being, as it involves preserving the integrity of facial structures, as well as replacing missing teeth.

The actual cost of implant treatment is based on a number of factors, such as the number of missing teeth being replaced, the type of implant supported teeth (treatment option) recommended and whether additional procedures are necessary to achieve the proper esthetic and functional result. There is often a misconception that there is a set cost for each implant. The fees are calculated based on the amount of time the dental specialist anticipates spending to complete treatment (implant placement, other surgical procedures, fabrication of replacement teeth) as well as the estimated cost of implants, other components and materials necessary to complete treatment - and dental laboratory fees. The fee is usually comparable to other methods of tooth replacement; however, long-term, implant treatment is generally more cost effective than other options, such as bridges, partials and dentures that need to be replaced every 5-10 years. The only way to accurately estimate the cost for an individual patient is to have an examination and consultation with a dental specialist.

IS DENTAL IMPLANT TREATMENT COVERED BY DENTAL INSURANCE?

Insurance coverage of implant treatment depends on the individual policy. However, it is rare to receive any substantial coverage. Since the benefit coverage is determined strictly by the amount the employer wants to spend on the policy, and the insurance companies want to build in their profit margins, there are major limitations on most dental insurance plans. In reality, the plans are only designed to cover routine maintenance, emergencies and basic care. The insurance companies use statistical data to determine the most common procedures submitted on claims, and then they set their own usual and customary fee schedule for these procedures. They also determine the specific restrictions and limitations for each plan. Because the plans are only intended to cover the basics, there is an annual maximum allowable benefit of $1,000-$1,500 on most plans. Although most companies exclude implants as a covered benefit, many of the will pay the same benefit they would cover for the lowest cost alternative treatment option (partials and dentures) and some of the diagnostic records, if a specific request is made for alternative benefits. Even if an individual policy includes implants as a covered benefit, the amount of coverage is still limited to the annual maximum allowable.

DOES MEDICAL INSURANCE COVER IMPLANT TREATMENT?

There are a few cases where medical insurance is available for people who are missing all of their teeth, and as a result, have medical complications. This type of coverage depends solely on the individual policy. Other than these situations, medical coverage is very rare. Work related injuries and other types of accidents are the other cases that are sometimes covered by insurance. Medicare does not cover implant treatment. All in all, it is best to assume that there is no medical insurance coverage available.

Types of Bone Grafts Used for Dental Implants

AUTOGRAFTSAutografts are bone grafts taken from the patient’s own body. Autogenous bone grafting is always the first choice for the dentist because autografts give the best results amongst all types of dental implant bone grafts. That’s because the patient’s own bone marrow contains live cells that help continue bone growth and speed up the healing process.

Their disadvantage is that a second surgical site is needed from which the bone is taken ( a donor site). The most popular areas are the chin or the ramus (the vertical back part of the lower jawbone close to the temporomandibular joint). If larger quantities of dental implant bone graft are needed, the bone graft can be taken from other body areas, usually the hip bone. The hip is considered to be a good quality source because the hip bone has a lot of marrow, which contains bone-forming cells.

ALLOGRAFTSAutogenous Bone Grafts – Allografts are human bone grafts taken from another person and usually provided by bone banks. This type of dental implant bone graft provides an alternative for patients who want to avoid the surgical procedure required for taking the autografts, or when very large blocks of bone are needed. However, the patient must consider the additional cost for obtaining them from a bone bank.

Allografts have lower performance than autografts in bone regeneration, therefore, it is expected that the treatment time will be longer. Autografts have generally less failure rate than allografts. Disease transmission risks are diminished by tight screening protocol and advanced processing technologies followed by bone banks. The main advantages of allogenic bone grafts are that they are available in unlimited quantities and they do not require a second surgical procedure to harvest them.

XENOGRAFTSXenografts are bone grafts from other species, usually from bovine (cow) or porcine (pig) origin. The molecular structure of bone is the same across species, making it possible to use bone from animal sources for dental implant bone grafts with very good results. Xenografts contain only the sterilized non-organic materials of the animal bone. They are used a scaffold for the body which eventually tears down the bone graft and replaces it with natural bone.

ALLOPLASTSAlloplasts make use of synthetic materials for bone formation. Dental implant bone grafts made of synthetic material (calcium phosphates or hydroxy- apatite) work by stimulating the body to form natural bone at the site of the dental implant. These materials can be used in conjunction with growth factors or mixed with bone marrow to increase biological activity.

Alloplastic bone grafting is believed to be less effective than Autogenous bone grafting but it has much less risk for infections.

GROWTH FACTORSGrowth Factor Enhanced Grafts are produced using recombinant DNA technology. This means the exact Bone Morphogenic Protein molecule which exists in our bodies has been manufactured and is now available. When placed in a deficient bone area the protein signals our own stem cells to migrate into the area and grow new bone. In conjunction with a carrier medium, such as collagen, growth factor enhanced grafts can accelerate the bone formation process considerably. What is remarkable about this newly formed bone is the fact that you grow your own bone, with your own DNA makeup, and identical to other bone in your body.

BARRIER MEMBRANEBarrier membranes are very often used to guide the bone regeneration, with or without the use of bone grafts. After applying the dental implant bone graft material, a membrane made of biocompatible material is placed between the gum and bone in order to stabilize and “protect” the bone graft. Gum tissue grows much faster than bone tissue. Without using a membrane to isolate the bone graft, the gum tissue would invade and fill the area not allowing bone growth. Barrier membranes are a very useful tool in promoting the growth of new bone in a “Guided Bone Regeneration” process.

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