The problem: missing teeth

In the past, people with missing teeth had two choices of replacing them, fixed bridges or removable teeth. Having a fixed bridge placed requires grinding down the teeth on both sides of the missing ones and cementing a metal and porcelain bridge spanning the gap of the missing teeth. The main problem with this method is the grinding which is done on the healthy teeth. Teeth which have been ground down in order to support a bridge have a 1 in 7 probability of needing a root canal in the next 5 years, and teeth with root canals have a higher incidence of breaking (especially when supporting a bridge). Your teeth are really not designed to support bridges, but it is something that we as dentists have managed to work with for many years. A bridge is like any other dental work in your mouth; it will not last forever and it is susceptible to cavities and decay. If you have a bridge in your mouth and something should go wrong with just one of the teeth supporting it, the entire bridge is compromised and has to be replaced. Bridgework is also more difficult to clean and maintain than natural teeth or implants since you need to thread floss underneath them to clean them. Bridges have been used for many decades and have served millions of people well, but with the availability of dental implants and the superior service they provide, we have seen the need for bridges almost eliminated. Before implants became a part of dentistry, bridges were considered to be the finest treatment available for missing teeth, but they are now becoming a thing of the past for several reasons which we will go into.

Removable teeth (partials and dentures) are another option when replacing missing teeth. Dentures are used when a person has no teeth left in either the upper or lower jaw. Partials are used when only some teeth are missing. The main disadvantage to these appliances is practicality. They have to be taken out a night, make chewing food difficult, have to be removed and cleaned after eating, and can interfere with speech and sense of taste in some cases. Ask anyone who wears dentures or partials if they like them and see what they say. Many patients can never adjust to how a denture or partial feels in their mouth and are unable to wear them for that reason. Dentures and partials need to be replaced every 4 to 10 years because of changes in your mouth which cause them to not fit anymore.

There is another option, to do nothing and live with missing teeth. Missing teeth can be unattractive if in the front of the mouth, and the surrounding teeth will begin to shift and move around, changing the bite and possibly creating jaw problems. As teeth move around they become difficult to clean and maintain, leading to tooth decay and gum disease. Another problem is that when people lose too many back teeth, their ability to chew food becomes compromised which can lead to stomach problems. People who are missing their back teeth compensate by chewing their food with their front teeth which start to break down even faster because they were not designed for heavy chewing. Losing a tooth is like knocking over the first domino, starting a chain of events which can lead to more missing teeth.

The solution: Dental Implants

Today we can replace single or multiple teeth with dental implants, which are revolutionizing the way many dentists practice today. A dental implant is basically a replacement tooth. It is a titanium post which is implanted into the jawbone where the root of the missing tooth used to be. It is the same type of medical grade titanium which is used for knee and hip replacements. We can use implants to replace a single missing tooth, or multiple teeth by utilizing two or more implants and placing a bridge on the implants. Another use for implants is to stabilize dentures and partials.

An implant can be placed practically anywhere a tooth used to be, providing there is still enough bone to support it. When teeth are lost, the bone which used to support it gradually melts away, a process called resorption. This is why people who have no teeth and wear dentures have to have their dentures refitted (or relined) every few years. Eventually the bone resorbs so much that there is nothing left to support the denture which becomes extremely loose and difficult to eat with. Look at the two full mouth x-rays on the right and you can see what happens to the jawbone when there are no teeth left to support it. Although it is difficult to see, the same resorption has happened on the upper jaw as well. An interesting fact is that when implants are placed, the bone resorption stops. The upper and lower jawbone treat the implants as if the were natural teeth and the bone stays where it should. Another interesting fact is that dentures and partials actually accelerate the loss of bone underneath them because of the pressure they exert on the gum tissue. Implants stop this by transferring the pressure of chewing from the surface of the gums to the inside of the bone, exactly as your teeth do. This is the main reason why implants are a better choice than dentures and partials, and also why it is important to have implants placed in a timely manner before too much bone resorption has occurred.

If a person is just missing one tooth, all the concepts we just discussed still apply. The bone resorption will occur in the area of the missing tooth, eventually to the point that not enough bone is left to place an implant and you are stuck with having to place a bridge or undergo bone graft surgery to build more bone up for the implant. Ideally, we like to place an implant the same day a tooth is removed to eliminate any bone resorption.

Anatomy of a Dental Implant:

As we discussed, the implant is a titanium post placed in the bone. Since it is buried deep below the gums, the only way to see it is with an x-ray. The implant surface is specially prepared so that the bone cells of your body grow towards and attach to it. The implant has a screw hole inside for attaching other parts to it. The day we place an implant, we put a healing screw in the screw hole. This keeps material from getting inside the implant screw hole and allows the gums to heal nicely. After healing has occurred, the healing screw is removed and a piece called an abutment is screwed into the implant. We use different types of abutments depending on what the implant is supporting. If the implant is for a single tooth, the abutment is a small post onto which a crown will be placed. If the implant is to be used under a denture or partial, the abutment is some sort of attachment to which the denture or partial locks onto. There are too many parts and pieces to go into detail, but Dr. Sawyer or Dr. Diercks can answer any detailed questions about the implant parts. There are many implant companies out there, with practically none of their pieces being interchangeable which makes it important for us to know what type of implant you have, especially for patients coming from other offices with implants already in place. For this reason, we keep detailed records on all our implant patients.

How long do implants last?

Implants are not susceptible to cavities, but they can develop gum disease if not cared for properly. Just like natural teeth, the implant needs to be kept clean and checked by your dentist at regular intervals. If cared for properly, most implants (the titanium screw portion) will provide a lifetime of service, although the crown or appliance attached to the implant may need to be replaced from wear and tear. Out of all the services that we provide, an implant is by far the most reliable and longest lasting restoration available to dentistry today.

As a cost comparison, if you have a missing tooth and decide to have it replaced with a bridge, you can assume that the bridge will need to be replaced every 15 years (which is a conservative estimate). Compared to the cost of placing an implant, replacing the bridge several times over the course of a lifetime could cost four or five times as much as having the implant done. This does not even take into consideration the fact that the teeth used to support a bridge will very likely develop problems of their own over time.

Doesn’t it hurt?

Absolutely not. The process of having an implant placed is much easier and less traumatic to a person than having a tooth removed. Most implants can be placed in 45 minutes or less, and the procedure is done here in our office under local anesthetic. There is no need whatsoever to be sedated for this procedure, although we do have nitrous oxide (laughing gas) and/or oral sedatives for people who are really anxious. The bone into which the implant is placed does not have any sensory nerve endings in it, so the surgery has very little post-operative discomfort. We place implant patients on antibiotics for a few days before and after the surgery to ensure that the implant does not get infected before the bone has a chance to heal around it. How long we wait before removing the healing screw and proceeding depends on a few things. Bone density, implant location, presence of infection, and health issues all factor into how long the bone needs to attach to the implant. In approximately eight out of ten cases we can put a temporary tooth on the implant the same day it is placed, in other cases we may have to wait up to three months. Every case is different, and sometimes we really cannot say for sure until the day of surgery. Whether the bone is soft and spongy or hard and thick is not always easy to determine by x-ray alone, and softer bone requires a longer healing time. We offer a free digital panoramic film and a free implant consult for anyone interested in dental implants.

Here is a link to the patient education section of our website which you may find helpful. The discipline of dental implants is growing and changing rapidly, so some of the information in these links may be a bit outdated but the general concepts of implants are clearly explained.

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