Dental Implants

Dental implants are changing the way people live. They are designed to provide a foundation for replacement teeth which look, feel and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence.

Using the most recent advances in dental implant technology,Dr. Urban is able to place single stage implants. These implants do not require a second procedure to uncover them, but do require a minimum of six weeks of healing time before artificial teeth are placed. There are even situations where the implants can be placed at the same time as a tooth extraction further minimizing the number of surgical procedures. Advances in dental implant technology have made it possible, in select cases, to extract teeth and place implants with crowns at one visit. This procedure, called immediate loading, greatly simplifies the surgical process.

Who actually performs the implant placement?

Implants are a team effort between an Oral and Maxillofacial Surgeon and a Restorative Dentist. While Dr. Urban performs the actual implant surgery, and initial tooth extractions and bone grafting if necessary, the restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.

What types of prostheses are available?

A single prosthesis (crown) is used to replace one missing tooth each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) attaches to a bar or ball in socket attachments, whereas a fixed prosthesis is permanent and removable only by the dentist.

Dr. Urban performs in-office implant surgery in a hospital-style operating suite, thus optimizing the level of sterility. Inpatient hospital implant surgery is for patients who have special medical or anesthetic needs or for those who need extensive bone grafting from the jaw, hip or tibia.

Why dental implants?

Once you learn about dental implants, you finally realize there is a way to improve you life. When you lose several teeth whether its a new situation or something you have lived with for years chances are you have never become fully accustomed to losing such a vital part of yourself.

Dental implants can be your doorway to renewed self-confidence and peace of mind.

A Swedish scientist and orthopedic surgeon, Dr. Per-Ingvar Branemark, developed this concept for oral rehabilitation more than thirty-five years ago. With his pioneering research, Dr. Branemark opened the door to a lifetime of renewed comfort and self-confidence for millions of individuals facing the frustration and embarrassment of tooth loss.

Why would you select dental implants over more traditional types of restorations?

There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a partial at night may be inconvenient, not to mention that dentures that slip can be uncomfortable and rather embarrassing.

Are you a candidate for implants?

If you are considering implants, your mouth must be examined thoroughly and your medical and dental history reviewed. If you mouth is not ideal for implants, ways of improving outcome, such as bone grafting, may be recommended.

What type of anesthesia is used?

The majority of dental implants and bone grafts can be performed in the office under local anesthesia, with or without general anesthesia.

Do Implants need special care?

Once the implants are in place, they will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.

Can you tell in more detail what dental implants are?

A dental implant (also known as an endosseous implant or fixture) is a surgical component that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biologic process called osseointegration where materials, such as titanium, form an intimate bond to bone. The root portion of the dental implant fixture is placed first. After a period of healing of the bone to the dental implant interface, a process calledosseointegration is to occur. Then a dental prosthetic is added on to the top the implant (the root portion of the dental implant). A variable amount of healing time is required for osseointegration before either the dental prosthetic (a tooth, bridge or denture) is attached to the implant or an abutment is placed which will hold a dental prosthetic.

What determines the success of a dental implant?

Success or failure of implants depends on the health of the person receiving it, drugs which impact the chances of osseointegration and the health of the tissues in the mouth. The amount of stress that will be put on the implant and fixture during normal function is also a factor. Planning the position and number of implants is key to the long-term health of the prosthetic since biomechanical forces created during chewing can be overload an implant. The position of implants is determined by the position and angle of adjacent teeth, lab simulations or by using computed tomography with ConeBeam (CAD/CAM) simulations and surgical guides called stents. The prerequisites to long-term success of osseointegrated dental implants are healthy bone and gingiva. Since both bone and gingiva can deteriorateafter tooth extraction, pre-prosthetic procedures, such as sinus lifts or gingival grafts, are sometimes required to recreate ideal bone volume to provide mechanical support to the implant and gingiva.

What are the restorative options for dental implants?

The final prosthetic can be either fixed, where a person cannot remove the denture or teeth from their mouth or removable, where they can remove the prosthetic. In each case an abutment is attached to the implant fixture. Where the prosthetic is fixed, the crown, bridge or denture is fixed to the abutment with either lag-screws or cement. Cement is used in areas of high esthetic concern but cement can create bone loss and gingival recession if the excess sement is not properly removed. Where the prosthetic is removable, a corresponding adapter is placed in the prosthetic so that the two pieces can be secured together.

What are the complications of dental implants and the success rate of dental implants?

The risks and complications related to implant therapy are divided into those that occur during surgery (such as excessive bleeding or nerve injury), those that occur in the first six months (such as infection and failure to osseointegrate) and those that occur long-term (such as peri-implantitis and mechanical failures). In the presence of healthy tissues, a well integrated implant with appropriate biomechanical loads can have long term success rates of 93 to 98 percent for the fixtureand 10 to 15 year lifespans for the prosthetic teeth.

Can i have a dental implant, if i take a bisphosphonate medication?

The use of bone building drugs, like bisphosphonates and anti-RANKL drugs require special consideration with implants, because they have been associated with a disorder called Bisphosphonate-associated osteonecrosis of the jaw (BRONJ). The drugs change bone turnover, which is thought to put people at risk for death of bone when having minor oral surgery. At routine doses (for example, those used to treat routine osteoporosis) the effects of the drugs linger for months or years but the risk appears to be very low. Because of this duality, uncertainty exists in the dental community about how to best manage the risk of BRONJ when placing implants. A 2009 position paper by the American Association of Oral and Maxillofacial Surgeons, discussed that the risk of BRONJ from low dose oral therapy (or slow release injectable) as between 0.01 and 0.06 percent for any procedure done on the jaws (implant, extraction, etc.). The risk is higher with intravenous therapy, procedures on the lower jaw, people with other medical issues, those on steroids, those on more potent bisphosphonates and people who have taken the drug for more than three years. The position paper recommends against placing implants in people who are taking high dose or high frequency intravenous therapy for cancer care. Otherwise, implants can generally be placedand the use of bisphosphonates does not appear to have an impact on implant survival.