Elite Dental Associates - Premier Dentist in Uptown Dallas

Elite Choice Dental Implant Center

Dental Implant Guide


A dental implant is a small screw or cylinder which looks like a thin metal rod. This acts as a replacement 'root' of a tooth and is able to support a single or several false teeth, known as 'restorations'. These implants can fuse with the bone of the patient's jaw via a healing process called 'osseointegration'. Once a suitable period of time has elapsed to allow healing, you will be ready for the placement of your replacement tooth/teeth or restoration. The screw form of implant looks very similar to the screws used in normal, everyday activities. It is comprised of a main body and a 'collar' which sits at the top of the implant. There are several types of collar such as 'external hex', 'internal hex' and 'internal taper' which all allow the dentist to join the implant to a replacement tooth (or teeth). There are many different brands of implant such as Nobel Biocare, Intra-Lock and Straumann. As with any industry, marketing plays a big part and all these brands have their advantages and disadvantages. Some brands are long established such as Nobel Biocare who was the first to manufacture dental implants. Sterri-Oss is another established brand. And then we have newcomers such as Intra-Lock. You will find that your dentist will have his or her favorite type of brand. Implant treatment often involves crowns, bridges or dentures: these are used as replacements for missing teeth and behave in much the same way as natural teeth. Most people have heard of these dental items but are not always familiar with what they actually are..

Types of Dental Implants

Root Form Dental Implants

implants root form Also known as 'Endosteal' or 'Endosseous implants': this type of implant involves the insertion of the implant directly into the jawbone. This is the most popular type of implant and comes in two forms: cylinder and screw. The implants can hold a single tooth or several artificial teeth. They are an ideal choice for those patients who have removable dentures or a bridge. The procedure involves the dentist making an incision in your gums in order to expose the jawbone. He or she will insert the implant and close the incision with tiny stitches. You are asked to wait for 3 to 6 months to allow healing or osseointegration to take place. In that time, the implant will have fused with the bone of your jaw. Once done so, you will return for a second procedure in which the incision is opened up to allow access to the implant. Your dentist will then fit a special attachment called an abutment to the end of the implant. This forms a strong, solid unit which is then ready for the replacement teeth. These are considered to be the easiest and most versatile form of implant. The implant itself is constructed of titanium and lends itself well to fusion with living bone. The most suitable candidates for this implant are those with a wide, deep jawbone. If your jawbone is small or thin then don't worry; root form implants are still an option although you will require a bone graft to build up the jawbone area. If your dentist feels that your jawbone is far too narrow and bone grafting is not an option then he or she may recommend a plate form implant. There is another type of endosteal implant called 'endosseous blade implants'. These have been in existence for some time now and take the form of long, flat pieces of metal which are inserted via a channel, into the bone. These metal implants can be bent or manipulated in a variety of ways to fit an individual patient's anatomy. However, they have been reported as having a high failure rate and because of this, are not generally recommended.

Plate Form Dental Implants

implants root form This takes the form of a narrow metal plate which is inserted into the jawbone. Your dentist will expose the area of your jawbone for treatment before preparing the bone to receive the implant. He or she will make a series of incisions in the gums before inserting the implants. The number of incisions made will depend on the number of implants. The implants are inserted and the incisions closed with tiny stitches. The dentist will advise you to wait for a set period of time to allow osseointegration to take place. However, in some cases you can have restorations directly after the implant procedure. This is known as 'immediate loading'. If your jawbone is not deep or wide enough to support root form or plate form implants, and there is too much bone loss, then consider having a subperiosteal implant.

Subperiosteal Implants

subperiosteal This implant takes the form of a lightweight framework which is designed to your anatomical requirements. In other words, the size and shape of your mouth. This framework is inserted underneath the gum tissue and sits over the jawbone, acting as a series of tooth roots. This enables it to act as an 'anchor' for the subsequent restorations. The restorations are attached to this implant via a series of posts which protrude through the gum tissue. This is a custom made implant which is produced in two ways:
  1. Single surgery method: this involves the dentist arranging a special CAT scan of your jawbone. The data from this scan along with advanced computer modelling software will be used to construct a model of your jawbone. This model is then passed to a dental laboratory that will use this to design the subperiosteal implant that will fit onto your jawbone. The procedure involves the dentist exposing your jawbone and placing the implant on top before closing the incision with tiny stitches. This is ready for the placement of the restorations.
  2. Dual surgery method: this surgical procedure involves the dentist exposing your jawbone, under anaesthesia, in order to take an 'impression'. He or she will use special materials to do so. The model is then passed to a dental laboratory who will construct a subperiosteal implant, which is specially designed to fit your jaw and no one else's. The dentist will carry out a second procedure in which he/she will again, expose your jawbone and place the implant. This sits on top of your jawbone, under the gums. The incisions are closed with small stitches. Restorations can now be put in place.

Are these an option?

Unfortunately, these also have a high failure rate and as a result, are not recommended. There is another form of implant called a 'Trans-Osseous Implant' which involves attaching a plate via a series of screws on top of the jawbone. The implants are inserted into the jawbone and stick out above the gums, ready for the restorations. However, the implants for this procedure are both costly and difficult to produce. As a result of this, this procedure is not usually recommended. The Endosteal or Root Form Implant is the preferred type of implant. To summarise, the main advantages of implants over bridges and dentures are:
  • Prevent bone loss and shrinkage (resorption) of the jawbone following tooth loss.
  • Comfortable and more natural looking.
  • No slipping or unnecessary movement as compared to conventional dentures.
  • A good alternative to bridgework

What happens if I can't afford dental implants?

There are some patients who for financial reasons are unable to afford dental implants. In these cases, the mini implant is a good, affordable option.

Mini Dental Implants

implants mini The mini implant is as the name says: it is smaller than the normal sized implant and were originally designed as a temporary measure. The idea was that these would be inserted as a temporary implant and then removed at a later date, replaced by the full sized implant. However, they were found to be a useful type of implant in their own right. They tend to work best as a replacement for small teeth or incisors. They are placed in the jawbone but because of their limited height do not fuse easily with the jaw bone (osseointegration). But, they do last a long time and tend to be used as a means of stabilising the lower denture, especially in older patients. If a patient's x-ray shows bone loss then they normally require a bone graft before the implant is inserted. However, they may be reluctant to do so, either for reasons of age or health. If this is the case then a mini dental implant may be an acceptable choice of implant. It is a solid although smaller form of implant and does not require the patient to undergo a bone graft beforehand. The mini implant is comprised of a slim titanium rod that has a retaining fixture which can be incorporated into a denture. The head of the implant is shaped like a ball and the retaining attachment contains a rubber 'O-ring' that acts like a socket. This holds a denture in place by means of the rubber 'O-ring' which snaps over the ball at the top of the implant. This enables the denture to rest nicely on top of the gum tissue. These are fast becoming a popular choice of implant for many patients who are uncomfortable with the thought of a full implant or are worried about the cost! If you do decide to have an implant then you will find that you have a choice of two techniques:
  • Immediate loading
  • Delayed Placement

Dental Implant Treatments

Overview of Implant Treatments

Implant Treat Overview Implants are a very versatile form of treatment and are effective both on their own and as part of an extensive body of work. There are several forms of implant treatment available, which vary according to whether you have lost a single tooth, several teeth, or all your teeth (also known as edentulous). A great many implant procedures typically involve a bone graft: this is a commonly performed technique in which the dentist adds extra bone to build up a narrow or thin jawbone. Why? Your jawbone needs to be deep and wide enough to hold an implant in place. However, many people find that they have a varying degree of bone loss, often as a result of a missing tooth or teeth. In order to provide a solid foundation for the implant the dentist will carry out a bone graft to restore any bone loss. If the bone loss is in the upper jaw or maxillary then he or she may perform a sinus lift. Visit the bone graft and sinus graft pages to learn more about these techniques. Implant treatments can range from a single tooth, such as lateral incisor replacement through to crown and bridge restorations and even major reconstruction work. These and other procedures are categorised into the following treatment categories:
  • single tooth
  • few/several teeth
  • no teeth
To find out more, visit the single tooth, few/several teeth and no teeth pages.

Single Tooth Dental Implants

Single Implant Single Implant Desciption Single Implant Diagram You may have lost a single tooth as a result of an accident or injury. This can be replaced with an implant and in fact, having a dental implant in between your natural teeth is the most successful dental procedure. Success rates are nearly 100% perfect. A single tooth implant does not affect your other teeth, looks better and is easy to keep clean. It is kept clean in exactly the same way as your other teeth. If your jawbone is not deep or strong enough for an implant then a bone graft will be required. Single tooth implants can be carried out on both front and back teeth. Mini implants can be used although some dentists prefer the normal, full sized ones. The procedure is as normal: the dentist will make a tiny incision in your gum in order to access your jawbone. He or she will then drill a small hole in this bone before inserting the implant. The implant will look like a small metal rod and is either cylinder or screw shaped. This is inserted into the jaw. The incision is closed and given time to heal. This is usually a period of 3 to 6 months. During that time the implant will fuse with the jawbone in a process called osseointegration. A temporary tooth or crown will be fitted during that time, purely for cosmetic reasons. Once this has happened, a second procedure will be carried out. The dentist will open up the original wound before fixing a small attachment or abutment to the implant. This will enable him/her to fasten an artificial tooth or restoration to the abutment. This is usually done in two stages although there is the option of having this done all in one go, known as 'immediate loading'.

Are there likely to be any problems with this procedure?

Single tooth implants are usually straightforward but there is a condition called 'poor soft tissue result'. If the tissues of the gum have not been properly dealt then you can end up with a dark line around your restoration. In some cases, the gum is so thin that the implant itself is visible. From an aesthetic point of view this looks unattractive and unwanted. Not to mention the fact that it can make the patient feel self-conscious and reluctant to smile. The only way of dealing with this is by soft tissue grafting. This means taking thicker gum tissue from the palate of the mouth and grafting this onto the area which holds the implant. There are different types of single tooth implants.

All Ceramic Central Incisor

This is a type of artificial tooth, made of ceramic which is strong and natural looking. It is also biocompatible: by this we mean it works well with the human body, with no risk of rejection or an allergic reaction. They are non-metallic as well which replaces the old PFM or 'porcelain to metal' type restorations. The advantage of this is no risk of ugly, 'metallic' lines on show if the gum recedes, which is often the case. They look and act in much the same way as natural teeth and so need the same amount of looking after! This means cleaning them twice a day and regular check ups at your dentist. This treatment involves several stages from the initial consultation through to the final restorations. It starts with an initial consultation with your dentist in which your reasons for an implant are discussed in a frank and honest manner. X-rays and/or a CT scan are arranged to show the exact position of the intended implant. If your jaw shows sign of bone loss or 'bone resorption' then you will be advised to have a bone graft. This treatment can be undertaken as a two stage process. The first stage can involve implant insertion plus taking an impression of the patient's jaw in order to produce a cast. This cast can be used to build a temporary restoration. The second stage involves the fitting of an abutment followed by the placing of the restoration.

Anterior Implant Crown

This refers to a type of restoration which is used to replace a loose or missing tooth at the front of the mouth. In the case of a loose tooth the dentist will replace this with a dental implant and allow time for it to fuse before fitting a crown (a type of 'cap).

Front Tooth Replacement (Maxillary Lateral Incisor/s)

The maxillary lateral incisor is a tooth located in the bottom jaw, usually around the midline of your face. Its main function is for chewing. However, these can be missing, often due to an injury or as a congenital defect. If this happens then they will need to be replaced and the best means of doing so is via implants. These are inserted in the usual manner.

Front Tooth Replacement (Maxillary Central Incisor/s)

These teeth are also situated in the front of your lower jaw and are the most easily seen of all your teeth. If one or more of these are missing, or require removal then implants can be used to replace them. The procedure is carried out in the usual way.

Immediate Single Tooth Replacement (Lateral Incisor Replacement)

This treatment is similar to above but, is completed in one session rather than a two stage process; in other words, 'immediate loading'. By that we mean that you undergo the insertion of the implant, followed by the attaching of the abutment and then, the placing of the restoration, all in a single procedure. You need to have healthy teeth and a jawbone with enough depth and width to hold the implants. This instant procedure is becoming more popular but be aware that there is a greater risk of failure than with the normal 'two stage' procedure. If you are having just the one tooth replaced then you will find that your dentist will use a crown as a replacement. This crown can be made of porcelain, ceramic or metal and will blend in well with your other teeth.

Several missing teeth (partially edentulous)

Partial Implant Bridge This section is aimed at those patients who are missing a few or several teeth. The technical term for this is 'partially edentulous'. If you have lost a few teeth, either as a result of an accident or an injury then you are basically looking at a crown and bridge implant system. If, however, you are missing quite a few teeth then you could be looking at extensive dental work. This type of treatment will involve implants but will also include bone/sinus grafts and quite possibly some major reconstructive work.

Are you missing just a few teeth?

If so then there are several different ways of performing this treatment although they all involve attaching crowns or a bridge onto an implant. These can be cemented or screwed onto the implants. Crowns and bridges are constructed from a variety of materials such as ceramic, porcelain or a combination of metal and porcelain. The traditional crown and bridge system was a short term answer to the problem of missing teeth but required the dentist to file down a couple of healthy teeth to act as 'posts' to support the bridge. Another issue is that of bone loss. The traditional crown and bridge system does not prevent bone loss. Bone loss tends to happen when a tooth or teeth are lost and are not replaced. The jawbone becomes thinner and less dense and results in a sunken cheeked appearance. The only way to prevent this is to combine the crown and bridge system with dental implants. The implants stimulate the bone cells within the jaw and stop any bone loss. This procedure can be performed as part or all of the following:

Implant crown and bridge

Major maxillary reconstruction Major reconstruction Replacement of a failed blade implant Total dental care Implant crown and bridge This procedure involves several stages which start with the initial diagnosis, x-ray and wax impression of the patient's jaw. Once this has been completed then the next stage is that of the insertion of the implant itself. Once sufficient time has elapsed for osseointegration then the final stage is that of the restorations. The patient will have had temporary restorations during this time, but once the implants have completely fused then they are ready for the final restorations. A bridge is required to span the gap left by the missing teeth along with laboratory constructed crowns.

Are you missing several teeth?

If you have lost several or nearly all of your teeth, or have a problem with your jaw joint, then you may require extensive reconstruction work. This can involve a bone graft, sinus lift, several implants and heavy restoration work.

Major Maxillary Reconstruction

This is an extensive procedure, designed to treat problems with teeth in the upper jaw or maxilla. If you have missing maxillary teeth, for whatever the reason then this procedure is an option. This procedure is carried out on those patients who have been diagnosed with a tumour or have a maxilla related injury such temporomandibular disorder. The procedure involves implants, a cast and restorations.

Major reconstruction

The same rules apply as above. The patient can be looking at the insertion of several implants, bone augmentation (possible) and/or sinus lift, and temporary restorations before the placement of the final restorations. It can involve either the upper or lower jaw, or both.

So, what does it involve?

It involves bone grafting and/or sinus lifting, dental implants and plenty of restorative work in general. If you require this type of procedure then please be aware that it can be both expensive and time consuming. In some cases it can take up to two years to complete! It also requires a high degree of skill and expertise on the part of the dentist. A major reconstruction can take many different forms. It can involve a bone graft, a sinus lift or a condylar replacement. A condlyar replacement is a procedure in which the dentist will insert a synthetic alternative to the mandibular condyle. The latter is a procedure in which the dentist inserts stabilisation plates into the lower jaw. These plates are made of titanium and are designed to help the action of the mandibular condyles. A mandibular condyle is the technical name for the joint in the lower jaw which controls the opening and closing movement. Think of it as a type of 'hinge' which will allow a smooth opening and closing action. These can be damaged as a result of an accident or injury and will require a replacement. This is a complex procedure which requires a dentist with a great deal of experience and competence.

Replacement of Failing Blade Implant

A blade implant or plate form implant is a type of endosteal implant (implanted into the bone) which is less commonly used than the root form implant. It consists of a flat piece of metal (blade) with two prongs on one side of this metal. It is inserted into the jaw in such a way to support a bridge or crowns. These along with other types of implants enjoy a high degree of success, usually around the 95% mark. But, failure can happen in a tiny minority of cases. This is usually due to a failure to fuse or 'osseointegrate' with the bone, inflammation (peri-implantitis) or fracture. Sometimes, implants can move around or shift out of position. Whatever the reason an implant which is said to have 'failed', needs to be removed and replaced with a new one. In this scenario, the failing blade implant will be removed and replaced by root form implants as part of a two stage process. The first stage will involve the removal of the defective implant and the second stage will be the placement of the new teeth or restorations.

Total Dental Care

This is the 'full works' in regard to dental treatment. It involves implants, crown and bridge restorations and porcelain veneers (also known as laminates). This comprehensive treatment will involve a sinus lift plus a cast for the crown and bridge restorations. The veneers (laminates) are wafer thin shells, comprised of porcelain or ceramic, which are fitted over the front of the teeth in order to improve their appearance. If your teeth are stained or damaged then consider this as an option.

Bilateral Sinus Lift

A bilateral sinus lift is surgery undertaken to build up the bone of the upper jaw. If the upper jawbone is too thin then implants cannot be inserted because there is not enough bone to hold them in place. A further complication is the fact that above this upper jaw is an air space or sinus which is unable to hold any type of implant. The answer is to increase the width and depth of the upper jaw so that it will hold an implant firmly in place. There are several types of sinus lift procedures and one of these is the bilateral lift. Bilateral in this case means two surgical procedures: the first is the actual sinus lift and the second is the insertion of dental implants. Once the implants are in place and have fused then new teeth or restorations can be fitted.

Complete Fixed Reconstruction

This is carried out in order to replace badly worn teeth. It can involve the creation of a removable partial denture,for both the upper and lower jaw. This denture is made from a cast which is made from an impression of the patient's mouth. False teeth (restorations) are then fixed to this denture and this acts in much the same way as natural teeth. However, a full reconstruction can involve work undertaken on both the maxillary (upper jaw) and mandibular (lower jaw) arches. A partial denture can then be used although patients may prefer fixed dental implants. What this means is the insertion of the implants in the usual way followed by the placing of the restorations.

Condylar Replacement

As mentioned before: the condylar mandibles are those parts of your jaw which act as a hinge, to enable your jaws to open and close. In effect, this is your 'jaw joint'. However, they can be damaged as a result of an accident or injury, for example a fracture and so will require treatment. If they are severely damaged then your ability to open and close your jaws will be affected. This can cause all sorts of problems, for example, chewing food. This can show itself in a wide range of symptoms such as pain and discomfort, headaches and difficulty with biting and chewing. Another reason for this surgery is that of 'temporomandibular disorder': this is a medical condition in which the patient experiences headaches, pain and jaw locking. This can be caused by a variety of factors, one of these being stress and nervous tension. Treatments for this include tightening, or releasing the muscles around the jaw, a dental splint or surgery, condylar replacement. Surgery is considered a last resort method. Condylar replacement can involve the insertion of specially constructed components into the jaw, followed by implants and restorations. As you can imagine this is a complex form of treatment and not one to be entered into lightly.

Crown and Bridge Reconstruction

This is another complex procedure in which treatment is required on the teeth in both the upper and lower jaw. This can involve the dentist having to make a special wax model of your current teeth in order to decide where to insert the dental implants. He or she will also take an x-ray of your mouth which is used to help with the positioning of the implants. It is vitally important that the implants are inserted correctly. One these have fused with the bone the dentist will then make a cast, from an 'impression' (wax or clay model) of your mouth which is used for the construction of your new false teeth. The process involves a series of stages which start with the initial diagnosis through to the insertion of the implants, and the placing of the new restorations. With the restorations; some patients prefer to have 'fixed' restorations whereas others prefer the 'removable' type.

What are these?

Fixed restorations are artificial teeth which are fixed in place by the dentist. They look and operate in exactly the same way as your normal teeth. A good way of thinking of these is as a permanent denture. Note: these can only be removed by your dentist. Removable restorations are teeth which you can take out. This means easy access to cleaning and caring for them in general. However, some people don't want the hassle of this and prefer the fixed sort.

Grafting for Implant Placement

There are patients who require a bone graft because their jawbone lacks sufficient depth to hold the implants in place. This means taking bone from one area of the body or a 'donor site' before grafting it into the jawbone. This is done to increase the width and depth of the bone. This bone is taken from either the chin or the hip. The dentist will build up the ridge of the jawbone before inserting the implant. There are 4 types of grafts available although the autogenous or allograft is the most popular choice of graft. The graft is held in place by tacks and a barrier membrane. Once the graft has taken place the site is ready for the implants. These are inserted in the normal manner.

Implant Reconstruction

This sounds like a major form of treatment and in many cases it can be as it can involve dental implants in both the upper and lower jaw, a sinus lift and the restorations. The dentist will use x-rays to help diagnose the problem as well as a template to aid with the placing of the implants. The implants will be inserted in the usual two stage process which can also include a sinus lift. Once the implants have fused to the jawbone, in a process called 'osseo-integration', they are ready for the placing of the restorations (artificial teeth). The restorations look and behave in exactly the same way as natural teeth.

Maxillofacial Reconstruction

This complex procedure is carried out when there is problem with both sets of teeth, and the palate. Note: the upper jawbone is referred to as the maxilla and the lower jawbone as the mandibular. There are a few stages to this treatment.

X-rays

This complex form of treatment starts with diagnostic x-rays in order to see the extent of the damage. You may then be asked to wear a temporary denture for a short period of time. This serves two purposes: the first is for aesthetic reasons in that you don't want unsightly gaps in your mouth. The second is so you have time to get used to having artificial teeth.

Implants

After a period of time you will then undergo dental implants. The usual method of treatment is for them to be inserted in a 'two stage' process: the first stage is where the implant is inserted into the jawbone, and the second is where the artificial teeth or restorations are fastened to the implants via the abutment. As several implants will be required the dentist will use a special type of device called a 'Hader Bar System'. This is a thin metal bar which clips onto the implants to hold them in place. Three or four implants can be held by a single Hader bar. A Lower Hader Bar is used in the lower jaw and an Upper Hader Bar in the upper jaw. If the dentist feels that your jawbone is too thin to support implants then he or she will recommend that you have a bone graft. There are four types of these grafts and they all involve the grafting of new bone into the jaw to increase its depth. This procedure is carried out before the insertion of the implants.

Restorations

Once the implants have been inserted and allowed time to fuse with the jawbone, the next stage is the placement of the new teeth. An overdenture is likely to be put in place. This is a type of denture, with artificial teeth, which fits over the implants.

Reconstruction with Sinus Lift

This treatment is carried out to resolve the problem of missing teeth. If you have missing teeth in your lower jaw then your dentist will advise you to have dental implants. He or she will also recommend a bone graft if your jawbone is too thin to hold the implants. This procedure is easier to perform on the lower jaw than the upper jaw.

Why is this?

The main reason is that the upper jaw tends to be thinner than the lower jaw plus there is the problem of the sinuses. The sinuses are 'air spaces' in your head and in this case, are situated above your upper jaw. If your upper jawbone is too thin then an implant cannot be inserted as there is not enough bone to hold it. In fact, it will be inserted into thin air! So, the dentist will have to build up the sinus area above your upper jaw. This means a procedure called a 'sinus graft'. Once this has been done the next step is the insertion of the implants. Your jawbone has extra depth and width as a result of the sinus lift which means that these implants will stay fixed in place. Once this has taken place then the implants are given time to heal and fuse with the jawbone. Then, your dentist will fix a small component or 'abutment' on the end of the implant which allows him/her to fix the restorations onto the implants.

No Teeth - all missing (fully edentulous)

Full Implant Overdenture Bar Full Implant Mini Overdenture Edentulous is a dental term, used to describe a state in which a patient has no teeth at all. This may sound strange but there are a great many people who do not have any teeth, either as a result of an accident or illness. If you are in this position then dentures are often the only solution. This means having to use a messy 'glue' to fix their dentures in place which can be awkward and off-putting. Dentures are a tried and tested answer to the problem of missing teeth but they are not without their problems which include the tendency to become loose, soreness and irritation. These problems will resolve themselves over time as you become used to wearing dentures but there are some patients who never come to terms with denture wear. For that group of patients, dental implants are the answer. There are several treatment options available to the patient: Crown and bridge restoration Fixed/detached restoration Implant overdenture Mini implant overdenture Crown and bridge restoration This involves the use of restorations or crowns (artificial teeth) and a special bridge (a temporary denture). The crowns are attached to this bridge and are a permanent fixture unlike the usual removable restorations. Fixed restorations (teeth) are more realistic looking than the removable type of restoration but are also more expensive. And, they are more difficult to clean and generally, care for. A crown and bridge restoration can be carried out as part of a major reconstruction or as a means of converting from a removable restoration to a fixed restoration. This is an extensive process which includes initial diagnostics, the taking of an impression of your jaw, for purposes of casting, and the insertion of the implants. The second stage includes the fitting of the abutments and the final replacement teeth (crowns and bridge).

The advantages?

They are more realistic looking and feel like real teeth rather than the removal type.

Any disadvantages?

They are more difficult to clean and are expensive as well. They tend to be more expensive than the removable type.

What is the procedure?

It still involves the insertion of dental implants in the usual manner. Once these have been inserted, abutments are placed over them, ready for the attachment of the restorations. The denture itself will be created via a special cast. Your dentist will take an impression of your mouth by fitting a special 'tray' over your teeth. This tray is filled with a soft material which the patient bites into in order to leave an imprint.

Dental casts

This tray is left to set and is then filled with a casting material. A good way of thinking about this is like this: The mould is formed from clay and left to harden. Once it has done so, the plaster material can be poured into it and left to set. As soon as it has done so, the mould can be chipped away to leave a plaster cast 'impression'. It is very much the same procedure with dental casts. They can be formed out of wax and allowed to harden. Once they have done so, the dental technician will pour in a casting material. Dental casts can be made from ceramics, resins or metals such as gold or silver. Basically, a cast is an artificial model of your teeth. This cast is used as a guide when creating the dental restorations. Plus wax models can be created from this cast for the purposes of crowns, bridges and partial dentures. A crown is a device which looks identical to a real tooth and is fixed in place. It behaves in exactly the same way as a natural tooth. A bridge is a device which can hold a crown or crowns together by means of a thin metal bar. This is often called a partial denture.

Fixed/Detachable Restorations These are as the name says: they are a type of restoration which is fixed in place by a series of screws. It is a permanent fixture and can only be removed by your dentist. These tend to appeal to those patients who find dentures to be awkward or plain unattractive. Fixed restorations are harder to keep clean than removable ones. This restoration takes the form of a metal framework, dentures (teeth) and an acrylic resin.

Implant overdenture

This form of treatment combines dental implants with an overdenture and so may appeal to those patients who want a cheaper yet effective dental treatment. An overdenture is made to fit over existing tooth roots or dental implants. This is supported by the natural tissue of your mouth and is designed to work as a working alternative to natural teeth. One advantage of this over conventional dentures is that this stays firmly in place. This means no risk of 'slippage' or any other problems associated with a conventional denture; plus it is easy to look after. It is also cheaper than other types of hybrid restorations such as crown and bridge restorations.

How does it stay in place?

This is due to a connection between the dentures and the implants. There are two types of connection: The attachment of a gold bar which is screwed onto the implants and then fixed to the denture via a special connector. A series of individual attachments each screwed into an individual implant and a separate attachment in the denture. The aim is to find an attachment which you will find easy to use. These attachments tend to be 'self-locating' which means that they make it easy for you to insert your denture after a cleaning routine. There are several types of overdentures which include: A Bar Overdenture A Slant-Lock Overdenture A ZAAG Bar system Hader Bar system Maxillary Clip Bar system These are just a few types of overdenture which your dentist will discuss with you. Bar overdentures are as the name says. They are comprised of a thin metal bar (usually gold) which is attached to the dentures (false teeth). There are a variety of different designs which include: A Maxillary Bar Overdenture A Mandible Bar Overdenture An ERA Bar Overdenture The maxillary bar overdenture is used to replace missing teeth in the upper jaw (maxillary). The mandible bar overdenture is used to replace missing teeth from the lower jaw (or mandible). The ERA bar overdenture is a newer and less expensive form of overdenture. Slant Lock overdenture: manufactured by Pfisterer Auderer Dental Laboratory, this overdenture is marketed as being as stable as a fixed bridge. It is supported by a series of abutments and two slanted wedges and sleeves. The patient will find this easy to insert and remove. ZAAG bar system and attachment: this stands for Zest Anchor Advanced Generation and is a reliable form of bar system which features a universal joint design. This prevents undue pressure or stress on any parts of the attachment. It is available in three versions: standard, mini and 'cast-to'. Our 'links' section contains a link to the manufacturer and other related sites. Hader bar system: this is another bar and clip system which attaches the denture to the implants in the same way as the maxillary clip bar. It is known for its good clip rotation, flexibility and adaptability. Maxillary Clip Bar system: this is viewed as one of the most popular forms of an implant overdenture as compared to the keeper and magnet, stud and cap, coping, cone and bar and sleeve varieties. There are different varieties of bar system with either plastic or metal clips that connect the denture to the implants. It works by the clip snapping over the bar which then forms a connection between this and the denture. ERA bar system: this is marketed as one of the most popular attachment systems in the world. This bar system is sturdy and durable and includes a metal bar and two attachments, male and female. The 'male' attachment fits into the denture whereas the 'female' attachment is inserted into the implant. Whichever overdenture you choose, there are various factors to take into account such as ease of use, cost and durability.

Mini Implant Overdenture

This is very similar to the normal sized overdentures: the only difference being that mini dental implants are used instead. Mini implants are cheaper than the standard sized ones and easier to insert but have usually been seen as a temporary measure. But, they have proved to be useful in situations where patients don't want the full implant, are unable to pay for a full implant or just need something to secure a loose denture. There are still ongoing discussions about mini implants as compared to the normal, full sized implants. Some sources view them as a suitable form of treatment if there are no other choices, or if normal implants are not an option. Other sources see them as providing a good, solid foundation for bridges, crowns and overdentures.

Dental Implant problems

Dental implants enjoy a high success rate and evidence shows that vast numbers of patients are extremely satisfied with the results. They are viewed as an excellent solution to the problem of missing or damaged teeth. As a result of this problems tend to be extremely rare although they do happen. Those that do are likely to be fractured implants, incorrect positioning, rejected implants and poor implant design. Failure to osseointegrate is one such problem which can happen if there is not enough bone for the site of the implant or as a result of an infection. Another factor is that of smoking: if the patient is a heavy smoker then this will increase their risk of implant failure and developing periodontal gum disease. Implants can fracture if they are subject to undue stress or overloading. This can also be caused by an inefficient or incorrect placement.

Fractured implants

If a patient presents with a fractured implant then this will need to be removed and then followed by a replacement implant. A trephine will remove this in much the same way an apple corer draws out the centre of an apple. A new, wider implant can be inserted, in the same procedure and allowed time to heal. Once osseo-integration has taken place then you will be ready for your replacement teeth.

Failure (or rejection)

There are a variety of factors which can cause this to happen, which include infection, overloading, bruxism and an inadequate bone supply. Infections can also occur, often as a result of contamination of the implant by bacteria already hidden in the jawbone. Other infections include mucositis and peri-implantitis. If osseointegration fails to take place or is 'faulty', then this can cause the implant to detach itself from the jawbone. If this happens to you then a new type of implant, extra bone grafting or a change in the type of restoration will be required. Failure can happen early on or during the period following your implant treatment. Failures which happen early on are often due to poor treatment preparation, bone graft rejection or a bad implant choice. In the latter case, it is important that the right type of implant is chosen based upon your individual needs and requirements. Doing so will guarantee success. Failures that happen later on can be attributed to occlusal factors such as changes in your 'bite' (the way your jaws come together), a tendency to teeth clenching or poor dental hygiene.

Incorrect positioning

If you have several implants then there could be a problem with their overall position and alignment. Any uneven pressure or overloading of the implants will cause one of them to break.

Other

Other examples include fractured abutments, broken or loose implant screws and defective or broken restorations.

Splinting maxillary implants

We know that bruxism and teeth clenching can contribute to implant failure. If you are prone to this then your dentist may recommend a bar system to splint several implants together. This will evenly distribute any forces through all the implants and prevent overloading.

Dental Implant Techniques

Immediate Loading Implants

This is the medical term used to describe the process in which a replacement tooth/teeth or restorations are placed right away rather than waiting for osseointegration. This is done as a single procedure rather than the traditional 'two stage placement' or 'delayed placement'. This is becoming a popular choice of procedure for patients who don't want to wait a period of months before getting their new teeth. This instant process allows them to have the implant followed by the attachment of the restorations, all in the one procedure. This procedure is often marketed as 'teeth in a day' or 'teeth today' and whilst it sounds very appealing, is not without its problems. There are pros and cons with every form of dental treatment and this is no exception. The standard two stage placement is still the preferred choice of procedure for many dentists. The reason for this is that it allows the implants to heal properly and osseointegration to take place which results in a strong foundation for the restorations. The problem with immediate loading is that the implants will not have healed and so, have not fused with the jawbone. This increases the risk of implant failure.

What are the advantages of this procedure?

Firstly, there is no waiting period whilst oseeointegration takes place. And secondly, there is no need for the patient to wear a complete denture whilst the implants are healing.

Disadvantages

You will require a greater number of implants - often as a result of the high risk of implant failure. Osseointegration will not be complete which can lead to the risk of failure or implant rejection. And, it costs more than the conventional delayed placement.

Delayed Placement Implants

This is the technical name for the standard 'two stage placement'. It involves the insertion of the implant, the 'first stage', followed by a second procedure in which the replacement tooth/teeth or restorations are attached to the implant.

How does this work?

The dentist will make an incision via the gums in order to expose the jawbone. He or she will then insert the implant before closing the incision with small stitches. This area of the gum is given time to heal, typically 3 to 6 months. The healing process also includes the fusion between the jawbone and implant, known as osseointegration. This unifying of the two leads to a strong structure which will then be used in the 'second stage' of the process. The second stage involves the dentist opening up the gum incision to allow access to the implant. He or she will then fix or screw an attachment called an 'abutment' to the implant which acts as an anchor for the restorations. The dentist can then attach a single or several restorations (dental prosthetics) to the abutment. These restorations look like your natural teeth and function in exactly the same way.

Advantages

The main advantage here is that of lower risk of implant failure. As a result of this there is less need for extra implants and better control over the existing ones. Osseointegration will have taken place which means a strong base for the implants, and the restorations. This is often seen as an easier procedure for dentists to master as compared to immediate loading. It also costs less than immediate loading.

Disadvantages

There is only one and that is the length of time you need to wait between the first stage (implantation) and the second stage (restorations). The average time between the two stages is 3 to 6 months, although it can take longer than this. Some patients find that this is too long to wait and so choose to undergo immediate loading.

Which procedure should you choose?

We would advise you to read up about both procedures, and learn as much as you can before making a decision. Make sure you get all the facts about immediate and delayed placement, and try not to be influenced by persuasive marketing and advertising. At the end of the day it is your decision and yours only.

Bone Grafting for implants

This is the process in which the dentist uses bone grafts to build up a thin or shrunken jawbone. If you are considering an implant but dental x-rays and/or CAT scan show that you have a thin jawbone as a result of bone loss then a graft will be necessary. Your jaw may show advanced bone loss as a result of the ageing process, prolonged denture wear, missing teeth, periodontal gum disease or as a result of an accident.

What causes bone loss?

If you lose a tooth through accident or injury then what tends to happen is that the area around the missing tooth recedes and the jawbone itself starts to shrink. Our teeth help to maintain bone density by a natural renewal process. This ensures normal bone growth and healthy tooth tissue. Another factor is that of aesthetics: if a person has lost several teeth and has not replaced them then their facial jaw line will appear lined and 'sunken in'. This aged appearance is both undesirable and unnecessary. One way of preventing this is via a dental implant but this may have to be combined with a bone graft. Bone grafts are a recent innovation and are highly successful. They involve the grafting of bone from one area of your body into your jawbone to increase its width and depth. Ideally, bone will be grafted from your own body although a synthetic alternative can be used. There are four types of bone grafts:
  • Autogenous or Autografts
  • Allografts
  • Xenografts
  • Alloplastic
  • Autogenous
This is the most popular and successful of all the grafting techniques and is often referred to as the 'gold standard' in bone grafting. It involves the removal or 'harvesting' of bone from a designated donor site such as the hip. The hip is the preferred source as this is rich in marrow which means a ready supply of bone cells. This bone is then grafted into the jawbone. This is the most successful of all four techniques as the grafted bone aids with the regeneration of the jawbone.

Allografts

This is similar to an autogenous graft in that it uses natural bone, although this is taken from a human donor rather than a part of your own body. There are special 'bone banks' for this purpose where people have donated bone samples, which are very similar to blood banks. If you are not keen to have an autogenous bone graft then this is an option. The donor bone is taken from a source of human cadavers via a special 'bone bank' and is rigorously checked and sterilised before grafting takes place. Donated bone is tested and then sterilised before being grafted into your jawbone. Your body then assimilates this donor bone into your natural bone (of your jaw).

Xenografts

This is a third option: The difference between this and the other two procedures is that the donated bone is harvested from animals rather than a human donor. Bovine (cow) is the preferred form of animal bone for this graft. You may feel uncomfortable about this and worry about the safety aspects but this undergoes a system of rigorous testing beforehand. This is to ensure that it is sterile and compatible with your anatomy and bone composition. This grafted bone acts as a 'stand in' which your body will replace with natural bone over time. This formation of new bone is called 'Osteoinduction' which uses a special protein called Bone Morphogenic Protein (BMP) to initiate this response.

Alloplastic

This is the fourth technique in the bone grating series. This differs from the other three in that it is a man made graft rather than natural bone. This graft is a synthetic version, made of calcium phosphate which looks almost identical to natural bone. There are two types of alloplastic grafts:
  • Resorbable
  • Non-resorbable
A resorbable graft means that it will be replaced by natural bone by your body. This doesn't happen with the resorbable type of graft but it can still be used to form a structure to hold the implants. This formation of a structure or 'scaffold' applies in both cases. If you require several implants then the amount of bone to be grafted will increase in proportion to the number of implants. This procedure is usually carried out in hospital and requires an overnight stay. Bone grafting is a very successful procedure although you do need to know that like all procedures there is a tiny risk of rejection. We cannot be 100% certain as to why this happens although we can highlight contributing factors such as smoking and certain medical conditions. These can predispose the patient to this risk. Bone graft failure can happen as a result of an infection or as a result of the grafted bone becoming loose and refusing to stabilise in the jaw. If you experience bone graft failure then you will have to undergo removal of the rejected graft followed a period of healing before a second graft can take place. There are other techniques available which can help with bone loss such as a sinus lift or elevation, ridge expansion and distraction osteogenesis.

Bone grafting procedure

This depends on the type of graft technique. If you are having the autogenous graft then the procedure involves the dentist making a small incision in the donor site (designated part of your body) to remove a small section of bone. This is usually the chin or the hip. This is the first part of the process. The second part involves the making a tiny incision in your gum to expose the jawbone. The dentist can then graft the harvested bone onto this area. The main advantage of this type of graft is that there in no risk of rejection as the bone is taken from your own body. You will experience some discomfort in both the donor area of your body and your jawbone although painkillers will control this. A bone graft can be carried out using a local anaesthetic and sedation (if required).

Are there any disadvantages?

No procedure is 100% successful and this includes bone grafts. The autogenous graft is seen as the best technique but fusion is not completely guaranteed. You may have to wait from 3 months to a year before your jaw is ready to take dental implants. If you have had a large amount of bone grafted then this will take longer than a small amount. This seems like a long time but you do need to be patient and wait until your jaw has healed before having the implants.

Platelet Rich Fibrin

Platelet Rich Fibrin or PRF is a type of 'glue', used in dental surgery, which helps to speed up the healing process. It is a key element in this process which stimulates new bone and tissue growth. It is seen as an important factor in wound healing as part of the implant treatment process.

Sinus Graft

What is a sinus lift/graft? This is a very similar procedure to bone grafting in that donor bone is used to build up an area of the jawbone which is considered to thin for implants. In this case, the upper jawbone is the area to be treated. The upper jaw is usually thinner than the lower which makes it more difficult to insert dental implants. Why? Just above your upper teeth are your 'maxillary sinuses' which are basically 'air spaces' in your jaw. And, very often there is only a thin wall of bone separating the sinuses from your teeth. Think of the sinus wall (or rear maxilla) as the 'roof' of your upper jaw. If this sinus wall is too thin then it is impossible to insert a dental implant as there is no solid foundation to hold it in place. The maxillary jaw (upper) will need to be built up via a bone graft in order to retain an implant. Previously, if you had advanced bone loss then your only option was dentures but thanks to new grafting techniques, implants are now an option. The dentist can bulk out the sinus wall by lifting the sinus membrane and then grafting donor bone onto the sinus wall. This will increase the depth and width of the sinus wall in preparation for the implants. The sinus wall will be given time to heal (osseointegration) before a second procedure, insertion of the implants. This graft can be performed as an autogenous graft.

Onlay Graft

This is the technical term for a type of bone graft which takes place outside of the jaw. It is used to treat ridged or bony areas of the jaw which have started to shrink or 'resorb'. If a jaw has started to shrink then it will require bone grafting to increase its volume before considering dental implants. This means taking donor bone from a part of your body, such as your hip, and then grafting that onto your jaw to bulk out that area. This new bone is placed directly on top of the jaw. You will be advised to wait for a few months before having implants to allow the area to heal. In this time new bone will have formed which will strengthen the jaw and enable it to hold an implant securely in place.

Ridge expansion

If your jawbone lacks enough width to hold implants then a ridge expansion an option. This means splitting the jaw along the top (or ridge) before grafting bone into this era. Once this has healed then implants can be inserted. The implants can be inserted straightaway although many dentists prefer to wait for a few months until the ridge has healed before implant insertion.

Distraction osteogenesis

A new and innovative technique which was initially developed to lengthen the bones of the legs in patients who are abnormally short of stature. This successful technique has now been applied to the dentistry field. It involves making a series of incisions in the patient's jawbone in order to divide a section of bone from the rest of the jaw. A titanium device is used with screws or pins to keep this section apart from the rest of the jaw. This space is widened over time by unscrewing this device, which also causes the space between the pieces to fill with new bone. The separation of the bone is the 'distraction' part and the formation of new bone is called 'osteogenesis'. It tends to be used in patients who require a 'taller' jawbone although it is can be used to increase bone height in other directions.

Nerve Repositioning

This is the name given to the procedure in which the dentist moves a nerve in the lower jaw, called the inferior alveolar nerve, to one side. This enables him/her to insert a dental implant.

Why might this be needed?

This nerve runs through the lower jawbone and is responsible for sensation in the chin and lower lip. If someone has lost a fair amount of bone from their jawbone then this nerve is likely to be too near the surface. This means an implant cannot be inserted without damaging this nerve. Any damage to this would cause a loss of feeling in the lower lip or chin. One answer to this is for the dentist to drill a small hole in the jawbone before moving the nerve to one side. He or she can then insert a dental implant. However, this technique is not performed that often because there is a risk of damaging the nerve by moving it. If your dentist mentions about nerve repositioning then rest assured that he or she will consider it carefully. There is another addition to the bone grafting family called 'Barrier Membranes'. These are used to help with the formation of new bone.

Barrier Membranes

When bone loss occurs a 'competition' begins between three groups of cells - connective tissue cells, epithelial cells and existing bone cells. They fight amongst themselves to fill in the area where there is bone loss. The bone cells are usually the losers but a barrier membrane can block the connective and epithelial tissue cells which allow the bone cells to 'win' and so regenerate themselves.

What is a barrier membrane made of?

There are two types of barrier membrane: resorbable and non-resorbable. The first barrier membranes were the non-resorbable sort and were used for some time before the development of the resorbable type. Whichever is used the main issue here is that of stability. The membrane and the graft need to be fixed firmly in place. If they move or shift around then there is the danger of incomplete healing and bone regeneration. The end result is a soft, osteoid like tissue which is unable to stimulate the growth of new bone cells or build up the jawbone. Special 'tacks' are used which are very similar to the ones used in conventional DIY. They are pushed into the bone to help secure the graft and the membrane. If the membrane is the non-resorbable type then this will be removed along with these tacks.

Costs & finance

Dental Implant Costs

For many patients the cost of dental treatment is often seen as painful as the treatment itself. In other words, pain in both the mouth and the wallet! Dental implants are not cheap but they are a good alternative to dentures or a bridge and they enjoy a high success rate. They also result in natural looking teeth that will last for years as well as improving individual self-confidence. The vast majority of patients report high satisfaction levels with their implants. So, in the light of this, the next thing to think about is the cost. Costs of treatment do vary which is a result of the different fees charged by dentists, plus the type of implant used. If you require bone grafting because your jawbone is not deep or wide enough then this will increase the price even more. Many patients consider going abroad for this treatment as dental costs are a lot lower than in the USA. But, it's not without its risks and so you need to think very carefully about this. Our dental implants FAQs section contains useful information on dental treatment abroad (also know as 'dental tourism'). If you choose to stay in the USA for your treatment then it is a good idea to visit several dentistry centres and compare prices. Don't be swayed by what looks like a bargain or a cheap deal. Cheap doesn't always mean good and you want to be sure that you are getting the best treatment package for you. Bear in mind that the dental implant procedure includes the following:
  • Dental consultation
  • The implant
  • Bone grafting, if advised by the dentist
  • Gum grafting, if advised by the dentist
  • Restoration, crown, bridge (the replacement tooth/teeth)
  • The dental or implant consultation includes x-rays, moulds, the consultation itself plus a written report.

Dental Insurance

You could easily become frustrated with insurance coverage for dental implants if you expect too much from the insurance company. But if you remember that the company is in business to make money, you will find the issue easier to deal with.

The dental insurance company needs to compete, and it does this by trying to offer a satisfactory plan to the employer for a competitive price. Since dental implants are not needed by a majority of people, there isn't much incentive for the company to offer generous coverage. It's hard to sell that kind of plan to an employer.

What they do is, when you are missing teeth, they will pay benefits for the least expensive treatment option. So, let's say you're missing several teeth on the upper arch. The least expensive way to treat that would be with a removable partial denture. Well, you don't want that because it means you have to wear hardware in your mouth, and it moves when you chew, and it is hard on the teeth it attaches to. You feel they should cover dental implants because that is clearly a superior treatment. But they aren't a charitable organization and what is "best" for you isn't their concern. They're in business to make money for their shareholders, and it doesn't make sense for them to pay thousands of dollars for a treatment when they can pay a few hundred.

So if you can move away from the entitlement mentality and into the "you get what you pay for" mentality, you'll be much less frustrated and will be content for any help you can get from your dental insurance for implants.

Plus, be aware that all dental insurance plans will have an annual cap on the amount they will pay, and that this annual cap is set pretty low--around one or two thousand dollars. Again, this is to keep the plan economical for the employer.

Elite Dental Associates

Uptown Dallas

3600 McKinney Avenue Ste. 230
Dallas, TX 75204
Phone: 214-220-2424
Fax: 214-452-8237
appointments@elitedentalonline.com

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