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IMPLANT AND BONE GRAFTING
PROCEDURES
Implant Procedures
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Dental
Implants are titanium roots that replace missing tooth roots
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Options of
Treatment: dental implants can replace a single tooth,
multiple teeth with bridges or support partial or full
dentures with great stability. Implants can be used as
orthodontic anchorage in the palate for adolescent and adult
patients TO INCREASE THE SPEED OF ORTHODONTIC treatment up
to 6-8 months faster
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Timing of
Implants:
Sinus Grafting & Ridge Augmentation Bone grafting
Dental Implants
Watch
the ADA video:
Dental Implants
Dental
Implants are now the standard of care in replacement of missing
teeth.
Historically: we used to replace teeth with dentures before
bridges came along. The disadvantage here was that the denture
would hook on the adjacent teeth and loosen them.
Excessive forces and stresses were placed on teeth which were not designed to take
them.
When bridges came along – they were the standard of care. But
today, implants are NOW the standard of care as they preserve
the bone while dentures and bridges DO NOT PRESERVE BONE.
The average bridge lasts 7-10 years. After 10 years, there is a
15-30% failure rate and then after 15 years there is a 50%
failure rate. In addition, there are irreversible negative
things that happen when a bridge is placed: you have to drill
down the adjacent natural teeth whether they have fillings in
them or not. The missing tooth space is initially small but
increases to a large gap after time. Recurrent cavities are very
common around the bridge abutments (supporting teeth) and then
the bridge needs to be redone – thus resulting in more tooth
drilling and destruction.
Dental implants are made from type IV commercially pure titanium
(CP type IV). The first dental implants were placed in the early
1960s. So today we have over 40 years of research to support
success rates. In addition, titanium does not decay and never
needs root canal therapy. In addition, titanium helps stimulate
the bone (just like muscle needs to be stimulated to maintain
bone).
Link to a journal article about
Titanium - the material of choice
(Word).
Not all dental implants used are CPT4 Titanium – questioning
your health care provider is vital! Now with newer nitrogen
environment manufacturing methods, Straumann ITI has patented an
even faster bond creation to the CPT4 titanium surface to allow
for faster healing and thus crowns being placed onto the
implants as early as six weeks in some cases!
Implant Diagnosis & Treatment Planning
In
planning the best treatment for you, implant records need to be
taken in order to plan the options of implant replacement for
you. Diagnostic records including Xrays, study models, photos
and possibly a CT scan. All this information including your
individual desires will determine the ideal treatment. It is
impossible to predict costs and time frame of treatment without
adequate records and information for treatment planning. Dr.
Desai will work hand in hand with your family dentist and
yourself to develop a treatment plan which will work with your
budget.
Occasionally, if a patient does not have adequate bone for
implant placement (ie not enough wood to place the drywall screw
in) then bone grafting can be done to “add this bone back” so
the implant has enough bone to live in.
a)
Immediate Implant
An
implant can often be placed at the same time as tooth extraction
in the front of the mouth.
An
implant provides the stable “root” replacement upon which a
crown can be placed 6-16 weeks later to look, feel and function
like your natural tooth. In addition, placing an implant will
also preserve bone, it is the most natural and long term replacement
of your natural missing tooth.
CASE 1
b)
Delayed Implant
An implant in the mouth can be placed any time
after 6-8 weeks once the tooth is removed if enough bone
is remaining.
The most common
dental implant placed today is the “endosseous” dental implant
or root form implant which osseointegrates or “fuses” to your
natural bone after a short period of time. The implants can be
restored with individual teeth, bridges on natural teeth,
partial dentures or full dentures. The implants are placed in
the bone under or at the gum level. The appointment for
placement is done in the dental office under local anaesthetic
just like when a filling or crown is done. The implants are then allowed to
“osseointegrate” for 6-16 weeks depending on many variables.
Sometimes the implant needs to be exposed at a brief 2nd
appointment prior to placing a post (abutment) inside by Dr.
Desai or your family dentist. The abutment then represents the
“shaved down crown portion” of the tooth upon which a crown can
be cemented or screwed. The total process can take up to 2 – 6
months.
Photo of implant
supported posterior crown
Photos of implant supported bridges
CASE 1
Left: patient
hated to wear a partial denture. Right: No need with 2
implants to replace 3 teeth!
CASE 2
2 implants to
replace 6 teeth stabilizes the bone loss
CASE 3:
Photo of implant supported full denture
an implant
supported lower denture is rock solid – it does not move – you
can eat steak, apples, nuts etc
CASE 4: Complete
Upper Denture
upper arch
locator implants upper denture does not cover roof
of the mouth
Sinus Lift/Augmentation
Grafting of the maxillary sinus provides us today with higher
success rates of implant placement in the upper back tooth area
where historically bone was of more porous quality.
Ridge Augmentation
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After tooth
extraction - if the tooth/teeth are extracted and no
socket preservation is done, an implant can be placed at a
minimum of 6weeks after the extraction site has some healing
time. If it is months or years after tooth extraction, then
bone grafting may be needed to add back some bone before an implant is placed.
Both
procedures have high predictability and only add a few months to
the overall length of the treatment plan.
Where does the bone come from?
The gold standard in bone grafting used to be "your own bone"
but today the best researchers and clinicians in the world feel
that the best bone is a combination of your bone and donor
bovine bone which is slow resorbing. The whole idea is to build
upon and strengthen your own bone which has shrunken away in
order to place the implant in a healthy, stable environment.
There are many sources of bone and each case calls for
individual requirements. Further discussion on this can be
undertaken in detail when you are in the office with Dr. Desai.
Implants as orthodontic anchorage in the palate for
adolescent and adult patients
The orthoimplant by
Straumann has now been accepted by the
orthodontic and periodontic community to reduce full mouth ortho
cases’ treatment time by 6 months in appropriate cases while the
overall costs are the same to the patient. The orthoimplant is
placed in a 30 minute local anaesthetic procedure 3 months prior
to bracketing of teeth and when the brackets are placed, the
orthoimplant is ready to be involved in active treatment. After
ortho is completed – the implant is removed in a 10 minute
procedure and the site heals perfectly! People think of it as a
temporary piercing!
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