Dental Implants Are The Best Tooth Replacement Options For Your Missing Teeth

INTRODUCTION TO REPLACEMENT OF MISSING TEETH

Tooth loss can occur due to various reasons, such as trauma and caries, and must be replaced with artificial means. When you visit a dentist to discuss the options you have for replacing your missing teeth, the dentist will examine your oral hygiene, including bone health, and will also consider your budget and expectations. 

Generally, a dentist will provide his patient with the following options to replace missing teeth:

1. Dentures
Dentures can either be for your full mouth or just to replace a few missing teeth. A denture consists of a pink part that mimics the gums, metal clasps that take support from adjacent teeth (in a partial denture), and acrylic teeth. This is the cheapest teeth replacement option, but it is very cumbersome to deal with dentures.

2. Bridges
A bridge is used to replace one or more missing teeth, by taking support from adjacent teeth. The only problem with a bridge is that two healthy teeth have to be trimmed to allow the replacement of the missing teeth. In most cases, the healthy teeth have to be root canal treated so that they can be trimmed without causing any discomfort, such as sensitivity, for the patient.

3. Implants
Implants are the most expensive tooth replacement option available. It can be used to replace only one tooth, without the need to trim any adjacent healthy teeth. Implants consist of three components that are placed over a few months. One part is drilled into the bone and after waiting for a few months, the crown is loaded on top of the implant. The components and mechanism of the implants are discussed in detail below.

DENTAL IMPLANTS

 
Implants are the most preferred tooth replacement option by dentists. If the patient is a suitable candidate for implants and can afford them, dentists recommend them right away. To help you understand the implants better, a few of the most frequently asked questions regarding implants have been discussed below:

—What are Dental Implants?

 
Implants are dental prostheses that are metal titanium alloy screws, that are drilled into the bone- sounds scary doesn’t it? In reality, the implant drills are as smooth as a hot knife is to butter. The patient only feels slight pressure, which is completely normal, but no pain at all. This is because the patient has been injected with local anesthesia to help keep the patient pain-free during the procedure.

—What are the components of an implant?

The implant has three components that are usually incorporated over a period of 3 to 6 months. The part that is drilled into the bone is the screw that is called the implant. Then, after a waiting period of 3 to 6 months, the second component, called the abutment, is installed onto the implant. The abutment plays an important role in the aesthetics part of the implant. 

Once that is installed, the crown, which is the artificial tooth, is ready to be installed on top of the implant and abutment. This crown is fabricated by the laboratory and seated in the patient’s mouth by the dentist. Unlike other tooth replacement options, the waiting time for implants is longer. This is due to the mechanism the implants work in.

—Why is the waiting period for implants so long?

The implant, that is drilled into the bone, mimics the root of the tooth. This root has to stabilize before it can take the weight of the crown. Think of the implant as a foundation of a building; if the foundation is weak, how can you construct the whole building on it? Thus, for the building to be strong, you have to wait for the foundation to be strong first, otherwise, the whole building will collapse.

This brings us to the next question: how does the implant gain a strong foundation? 

If you look at the structure of an implant, it has a rough surface with tiny threads all around it in length. This helps to increase the surface area is to volume ratio for the osteointegration of the implant. The waiting time for the implant is longer as we wait for the implant to embed itself in the bone. In a healthy individual, the process of osteointegration lasts for about 6 months in the upper jaw (maxilla), and about 6 months in the lower jaw (mandible).

The difference in time for the osteointegration of the upper and lower jaw is due to the difference in bone density and bone type. The bone of the mandible is less porous and harder, and vice versa for the maxilla. Thus, after when the osteointegration is completed, the foundation is strong enough to bear the weight of the whole building. While placing the implant, if there is a lot of space between the implant and surrounding bone, artificial bone is added to help in the process of osteointegration.

—Am I the perfect candidate for dental implants?

To find out if a patient is a perfect candidate for dental implants, a dentist will request for a few blood tests to be conducted. 

This includes the following:

(i) CBC
The Complete Blood Count is a blood test that gives a complete picture of your blood to the dentist, including details about your red blood cells, white blood cells, and platelets.

(ii) INR
The International Normalised Ratio blood test is used to determine how fast the patient’s blood can clot. A higher INR means that your blood takes too long to form a blood clot, causing you to bleed for longer. This would result in a higher blood loss volume.

(iii) HbA1c
This test gives an aggregate of the patient’s blood sugar levels for the past 3 months. It is a great test for monitoring diabetes control in diabetic patients. A higher value suggests that the patient has uncontrolled diabetes. Since diabetes is known to cause delayed wound healing, a higher HbA1c test result would be a good indicator for delayed wound healing and osteointegration in the patient. If the value is too high, your dentist might not consider you to be a suitable candidate for implants, as implants are contraindicated in patients with uncontrolled diabetes.

(iv) Serum Vitamin D
Vitamin D facilitates the uptake of Calcium from the blood, helping in bone formation. A lower vitamin D result would cause delayed osteointegration, causing your dentist to refer you to your general physician to be prescribed some oral or injectable vitamin D.

If you have already been diagnosed with some bone disease, such as osteoporosis, your dentist might not go ahead with the procedure. Patients who have been taking steroids and bisphosphonates are not suitable candidates for implants either. You must discuss your medical history in great detail with your dentist to avoid any complications in the procedure.

—Why are implants considered to be the best tooth-replacement option?

As mentioned earlier, the implant replaces the root of the tooth, providing anchorage to the bone and preventing bone loss. In other tooth replacement options, only the crown part is replaced and there is no replacement for the root. This does not stop the bone loss that occurs over time under the crown. However, the bone loss does occur with implants too, but it is very minimal as compared to dentures and bridges.

—How much do implants cost?

The cost of an implant depends on your dentist’s experience, qualifications, the implant system he uses, and the area he practices in.

PROCEDURE OF DENTAL IMPLANTS

 
Now since most of the common implant queries have been answered, let’s discuss the procedure of the implants. To make the procedure simple, it has been broken down into various steps.

1. Consultation
This is the appointment where the dentist will clinically examine your teeth and supporting structures and prescribe any tests or X-Rays. You will be called in for a second consultation after all your test results and X-Rays have been collected. 

Once all reports are in hand, the dentist will give you a proper treatment plan which will be executed. The dentist will discuss the number of implants you would be needed, and whether you would be requiring separate crowns or bridges, or an implant retained denture in case of a full mouth rehabilitation. You can opt to get your implants done in local or general anesthesia, depending on your dental anxiety and cooperation level.

Implants are not just used to replace previously missing teeth; they are also used to replace those teeth that cannot be saved with a filling or a root canal treatment. Such a tooth is supposed to be extracted. Once this tooth is extracted, your dentist can place an implant right away in the extraction socket, or wait for a period of 3 months before placing an implant. This is the call of the dentist that is taken during the procedure if he cannot decide by viewing the X-Rays and CT scans.

2. The day of the surgery
Before the surgery starts, the patient is expected to come in with a full stomach and sterile drapes are placed over the head and body. The patient is expected to rinse with mouth wash for a minute and then his face is scrubbed with pyodine to create a sterile environment to work in. The patient is also given a loading dose of antibiotics and pain killers to help suppress any infection and pain after the surgery. The protocols for the operation theatre will be different from the ones followed in surgery.

By looking at the X-Rays and CT scans, the dentist generally has an idea of the implant size he would be placing. However, this gets even more clear once the flap has been raised. Once the patient has been anesthetized, the dentist is ready, to begin with, the surgery. As soon as the implant is placed into the bone, and has been torqued, the gum tissue is approximated and sutured to allow osteointegration to occur. 

However, in some cases, where the torque value is high, the dentist might place the abutment on top of the implant right away, and take an impression and send it to the lab. A higher torque value depicts a stabilized implant.

After the completion of the surgery, you would be given a list of post-op. instructions and medicines by your dentist. The next day, you will be called in for a quick check-up. If the dentist feels everything is fine, you would be called in after the osteointegration period is over to start with the second stage.

3. Second Stage
Once the osteointegration period has been completed, and it has been verified on the X-Ray and clinically, the dentist is now ready to expose the implant. The implant, when it was drilled into the bone, had gum tissue going on top of it, now, that gum tissue will be removed to expose the implant so that the healing abutment can be placed on it to guide the gum tissue to grow around the abutment. This helps to get better aesthetic results of the gum, as this healing abutment is left in place for about 2 weeks.

4. Loading Stage
The healing abutment is removed after about 2 weeks and the other abutment is placed so that the impression can be taken and sent to the laboratory for the fabrication of the crown. Once the crown is back from the laboratory, it is placed on top of the abutment. Any minor chair-side adjustments that are required can be made by the dentist. After the crown has been placed, the patient is free to go out with his new tooth.

The type of crown the dentist suggests depends mostly on your budget and expectations. Mostly two types of crowns are suggested:

—Porcelain Fused To Metal (PFM)

A metallic crown is covered with porcelain on top to give a natural-looking color to the crown. The metal beneath the porcelain helps to improve the strength of the crown but does not provide the best aesthetics. Therefore, it is mostly preferred for posterior teeth, where aesthetics do not matter and higher strength and durability are required to withstand the chewing forces. In the anterior region, the metal beneath the porcelain reflects, providing the crown with a greyish tint. Moreover, the metallic borders of the crown are also visible near the gum margin, making it the least favorable option for anterior teeth crowns.

—Zirconium
Zirconium is a stone that provides the crowns with the best aesthetics. Hence, it is preferred for the anterior teeth over PFM crowns. Due to better aesthetic results, zirconium crowns are much more expensive than PFM crowns.

—Acrylic
This material is very lightweight and is only used in implant-retained dentures.

5. Aftercare
After the crown has been cemented, it does not mean that you would never have to visit your dentist. Since the implant is an artificial way of replacing something natural, extra care has to be taken. Initially, for the first year, you should visit your dentist every 3 months, then after that, you can visit every 6 months. You must take extra care of your oral hygiene and your dietary habits to help prolong the longevity of your implant.

COMPLICATIONS AND RISKS ASSOCIATED WITH THE IMPLANT SURGERY

 
It’s not always rainbows and butterflies; things can go south with implants too. The biggest risk associated with implants is implant failure. Although it happens rarely, it is the duty of the dentist and his team to inform the patient before the start of the surgery. This could be due to the inefficiency of the practitioner, the implant system, any systemic issues with the patient, or any other external cause. To prevent this failure, the patient is prescribed prophylactic anti-biotics.

A few of the other complications and risks that are associated with implant surgery are:

—Perforation of the sinus
—Fracture or breakage of the implant
—Fracture of bone
—Injury to adjacent teeth
—Nerve damage or injury
—Peri-implantitis
—Infection
—Bruising
—Swelling
—Limited mouth opening
—Excessive bleeding

Before the start of the surgery, a written consent form should be signed by the patient to help prevent any mishaps from happening later. This paperwork is extremely essential in the field of medicine as it helps to save the practitioner from any legal action that may be taken against him.

FINAL THOUGHTS

 
Although implants are expensive, they are considered to be a viable option for the replacement of missing teeth. Generally, it has been observed that the implants have better longevity than any other dental prosthesis. It is the closest man-made replacement for a natural tooth, with a root portion and a crown portion, helping to prevent bone loss. If it bothers you to be toothless while you wait for the osteointegration of the implant to occur, you can even ask your dentist for a denture that you can only wear socially. Consult your dentist today to find out if you are a suitable candidate for implants or not. 

If you are not a suitable candidate, then your dentist will provide you with an alternative treatment plan o help replace your missing teeth.