Dental Implant Care

When Are Implants Placed?

Approximately three months after the tooth is removed, the implant is placed where the missing tooth was located. Once a tooth is removed, if your socket walls of bone are intact and fairly thick, your body will grow new bone to replace or refill the empty socket. Your socket will usually be completely filled in with bone by the time you are ready for placement of your implant (about three months later). Occasionally, it is possible to take out the tooth and place the implant at the same time. This may involve a little more risk, but it simplifies the process—you won’t have to wait three months for the bone to refill the socket. Again, there are times when this is appropriate and other times (when infection or other problems with the bone are present) when immediate implant placement is not the best treatment.

If your tooth has been missing for some time, the adjacent bone is likely to grow thinner because the root of the tooth itself has stimulated the bone. Once the tooth root is removed, the bone loses this stimulation and starts to disappear. As much as one third of your jaw’s thickness can be lost in the year following tooth extraction. If you are missing quite a bit of bone, you may need to have additional bone grafted into the area so that the implant will be supported adequately when it is placed.

How Many Implants Do I Need?

Most frequently, one implant per missing tooth is placed. Because many of the larger teeth in the back of your jaws have two or three roots, the most common approach is to replace missing back teeth with larger implants or more than one implant per tooth, especially if there has been moderate bone loss or if there is evidence of excessive biting force.

What If I’m Missing All Of The Teeth In My Lower Jaw?

If you are missing all of the teeth in your lower jaw, you may consider a number of treatment options. Although many patients have no problem wearing an upper denture, some find it difficult to wear lower dentures.

The first option is to have two implants placed in your lower jaw and a denture made that snaps onto these implants. This option allows your lower denture to be more stable while chewing than without implants. This is a viable option if your jaw’s support ridge is big enough. There will still be movement of your lower denture, however, and you can still get sore spots if any food particles, especially seeds, are caught under it. As with all removable replacement teeth, you still will need periodic appointments for denture adjustment.

A second option involves placing four to six implants, depending on your jaw size or shape, into your lower jaw. After healing is complete, the implants are connected with a custom-made support bar. Your denture will be made with special retention clips inside that attach onto the support bar, allowing the denture to snap firmly into place. This is called an “overdenture.” The advantage of this option is that it is much more stable than the first option, allowing very little denture movement. Your denture still will be removable for easy cleaning and maintenance.

A third option involves placing five or more implants in your jaw and attaching a permanent denture. Your denture is held in place by screws or clasps that secure it to the support posts or bar. It doesn’t touch the gum tissue, which allows you to clean under the denture without removing it. This denture will replace all your missing lower teeth and will not be removed except at maintenance visits. Although cleaning under your denture without removing it is more time consuming and requires more dexterity, many patients who want a permanent denture prefer this option.

The final option is to have all your teeth individually replaced so that they will appear to be growing out of your gum tissue and will most closely resemble the appearance of your natural teeth. This option usually requires eight or more implants. Separate abutments or support posts for each one of these implants will be made and crowns for each missing tooth will be placed. The teeth are then frequently joined together for strength and support. Overall, this is the most costly option, because (among other reasons) it requires the most implants. In addition, your options may be limited by the current size and shape of your jawbone

What If I’m Missing All Of My Upper Teeth?

A similar range of treatment options is also available for your upper jaw. However, because the bone is not as hard as that in the lower jaw, people often need more implants to support their replacement teeth.

Depending upon the number of implants to be placed, it may be possible to eliminate the need for covering the roof of your mouth with the denture. This option will allow you to better taste your food and to better sense food temperature, and it will make your denture feel more natural. You will still have a removable denture, which makes cleaning the support bar and denture much easier. If you want a restoration that is similar to your natural teeth and therefore not removable, you probably will need eight to ten implants placed. This is followed after healing by the placement of the abutments and crowns.

What Can I Use For Teeth While The Implants Are Healing?

Many options are available, and they are tailored to your specific needs. If you need a replacement tooth while the implants are healing, temporary removable teeth or a temporary bridge can be made. If all your teeth are missing, we can usually modify your present complete denture or make you a new temporary denture. If you would prefer nonremovable teeth during the healing phase, temporary transitional implants usually can be placed along with the permanent implants, and temporary teeth may be made and inserted the same day.

What Are The Potential Problems?

Although it is natural to be concerned about the pain that may be caused by these procedures, most patients do not experience severe or significant postoperative pain. Pain medication and antibiotics will be prescribed for you to make your recovery as easy as possible. Occasionally, some people develop postoperative infections that require additional antibiotic treatment. In addition, there is a chance that the nerve in the lower jaw, which provides sensation to your lower lip and chin, may be affected. If you are missing quite a lot of bone, it might be difficult to place an implant without infringing on the nerve space. Although we take great care to avoid this nerve, occasionally it is irritated during the procedure, resulting in tingling, numbness or a complete lack of sensation in your lip, chin or tongue. Although these altered sensations will usually resolve with time, they can be permanent and/or painful. If you notify us of postoperative numbness as soon as possible, it will allow us to manage your care in the most appropriate way.

How Long Will The Implants Last?

Implants last a long time. Of patients who were missing all of their teeth, long-term studies (more than 30 years) show an 80 to 90 percent success rate. For patients missing one or several teeth, six-year studies show a success rate of greater than 90 percent, which compares favorably with other areas in the body that receive implant replacement (such as hips or knees). However, if one of your dental implants either doesn’t heal properly or loosens after a period of time, you may need to have it removed. After the site heals (or on occasion at the time of removal), another implant usually can be placed.

What Happens After The Implants Have Healed?

In most cases, after four to six months of healing, your jawbone is firmly fused to the implants. The restorative phase of your treatment, when your missing teeth are actually replaced, is now ready to begin. Depending on a variety of factors, it may be possible to begin this phase of your treatment as early as six weeks after implant placement. We will review the most appropriate treatment sequence and timing for your particular situation.

In some cases, depending on the density or hardness of your bone, it is helpful to gradually increase the work on your implants. Various types of temporary replacement teeth are used during this phase. Information we obtain at the time of implant placement will help us to determine what is the most appropriate approach for you.

The dental work required to complete your treatment is complex. It is, however, considered more comfortable and more pleasant than conventional dental care. Frequently, most of the work can be done without using even local anesthesia.

Your restorative treatment begins with specialized impressions that allow us to produce a replica of your mouth and implants. We will also make “bite” records so that we see the relationship of your upper and lower jaws. With this information, we will make the abutments (support posts) that attach your replacement teeth to your implants. Various types of abutments exist.

Frequently, we can use “off the shelf” abutments. Other times, custom abutments must be made of gold or a tooth-colored ceramic material. As you can imagine, these custom-made abutments add to the cost and treatment time involved. Which abutment to use is a decision that often cannot be made until after healing is complete and impressions have been made.

The number of appointments and the amount of time required for each appointment is different for each patient. No two cases are exactly the same and regardless of the number of teeth replaced, the work must be completed with great precision and attention to detail. If you are having only a few teeth replaced, as few as three short appointments may be required. Between appointments, we will need time to complete the necessary lab work to make your replacement teeth.

If your final restoration is a removable denture, you will need to come to as many as five office appointments (although it may be fewer) over the following several months. During these appointments, we will perform a series of impressions, bites and adjustments in order to make your new teeth, as well as the custom support bars, snaps, magnets, or clips that will secure your teeth to the implants. During this period we will make every effort to make certain you have comfortable temporary replacement teeth.

In general, once your implants are placed, you can expect your treatment to be completed anywhere from two to 12 months. For these reasons, it is difficult for us to tell you exactly how much the restorative phase of your treatment will cost, although you should receive a reasonable estimate of costs . It also is difficult to give you a specific timeframe for completion of your treatment until after the implants are ready for restoration.

How Do I Clean My Implants?

As with natural teeth, it is important that you clean implant-supported restorations regularly with toothbrushes, floss and any other recommended aids. You also should visit your dentist several times each year for hygiene and maintenance. As with regular dentures and other tooth replacements, your implants and their associated components are subject to wear and tear and eventually will need repair, including clip replacement, relines, screw tightening, and other adjustments.

Will One Doctor Do Everything?

In some situations, your dental implants can be placed and restored in the same office. At other times, one dentist places the implant(s) and performs any other necessary additional surgical procedures while another dentist provides the temporary teeth and restores the dental implants after healing is complete. In this case, both doctors are involved in planning your dental treatment. Also, depending upon a variety of factors, different dental specialists will help with your dental care.

What Do These Services Cost?

Before treatment begins, every effort will be made to give you an accurate estimate of all the expenses involved in placing and restoring your dental implants. This includes the implant placement itself plus any bone and soft tissue grafting procedures that are needed. In many cases, there is an initial charge for the diagnostic work-up, including study models, x-rays, and the fabrication of a surgical template to ensure the best possible result. You also will be charged for the abutment or support post(s), plus the crown, dentures, or anything else that will be placed over the implants, including temporary restorations, as well as for periodic maintenance such as hygiene visits, tissue conditioners, denture relines and other repairs.

We will try to assist you in estimating what your actual payments will be after we evaluate your insurance coverage or other third party payments, if any. Your ultimate restorative choice should be guided by your sense of what is best for you based on the information we have provided you. You also should consider the financial impact of each treatment option as some insurance companies provide no or limited coverage. If different doctors are involved, they will charge you separately for their services.