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Dental implants have been around since the 1960s and have revolutionized the way we do dentistry. For many patients, however, this procedure remains a mystery. Patients are unsure of what a dental implant is, what the procedure entails and why they would want an implant over a bridge or partial denture.
In this blog, we’ll provide a brief education on dental implants and cover everything from the benefits of dental implants to maintenance and care. Our goal, as always, is to ensure our patients are informed and educated on the procedures we recommend. Together, we can make the best decisions for you and your dental health and help you get to 100 with all your teeth.
What is a dental implant?
Dental implants are a procedure that is used to treat a missing tooth. It is a surgical procedure that involves placing a titanium screw in the jawbone followed by a porcelain crown. The entire procedure requires several appointments over the course of six to seven months.
During the first appointment, the dentist removes the tooth and places a bone graft, which takes about three months to heal. When the bone has healed, the titanium screw is placed, and a healing abutment is placed on top of the area during the second appointment. The bone must also heal for three months, at which time an impression can be taken for the final restoration during a third appointment. Three weeks later, the final abutment and crown are placed in the fourth and final appointment.
What are the benefits of dental implants?
When talking about the benefits of dental implants, the number one benefit is that implants allow us to perform single-tooth dentistry. Before implants, dentists used dentures, partial dentures or bridges to address missing teeth. Each of these required energy from nearby teeth to address the gap. For instance, a bridge hooks onto the two adjacent teeth and if one of those teeth fails then all three will essentially fail. An implant does not affect the nearby teeth.
It also cannot get a cavity because it is titanium and porcelain. This can be a huge benefit for patients with a high bio-risk who struggle with cavities. In addition, it is stronger than your natural teeth and allows you to maintain normal chewing function. The appearance of an implant is also much more natural and aesthetic than the alternatives.
In discussing the benefits of implants, it’s also important to look at the 5-to-10-year survival rate for screw-shaped dental implants. Based on the latest scientific literature, this is 90% and can be as high as 98% in some cases. As a dentist, if we place 100 implants, we may have 10 that fail, which are fantastic odds for the patient.
Risk Factors and Considerations
As with any dental procedure, there are several things we look at to determine if a patient is a good candidate for a dental implant and if the implant will be successful. These include risk factors such as their overall health, the quality of the bone, and other factors that can impact osteointegration and long-term success.
The following can negatively impact the success of a dental implant and should be discussed with your dentist before getting an implant.
Bruxism, or clenching and grinding
This is the number one cause of implant failure. Patients who clench or grind their teeth often have a very heavy bite, which can prevent the implant from having a strong integration with the bone. Constant, excess pressure on the implant can cause issues with the surrounding bone. This force essentially scares the bone cells away and can lead to failure.
If you are a clencher or grinder, you can still have an implant placed. But it’s important to talk to your dentist about managing these risks. Oftentimes, a bite guard can help prevent implant failure.
Smoking
Studies show that the more you smoke daily, the higher your chance is of implant failure. This is tied to the poor blood circulation that many smokers have. A dental implant is a surgery and following that surgery we need the incision site to heal. Strong circulation is critical to healing and smoking can have a negative impact on the patient’s ability to heal. If you are considering an implant, we strongly encourage you to cut back on or quit smoking. This can significantly decrease your risk of failure and improve your overall health.
Diabetes
Uncontrolled diabetes and high blood sugar can also negatively affect your body’s ability to heal. Ideally, we’d like to see a patient’s A1C at 7 or lower before we place an implant – the closer to 5 the better. If their A1C is higher than 7, we can see this in their gums and their dental health. Like smoking, this can be a good time to take control of your health to improve your chances of success.
Gum recession
For patients who have been missing a tooth for a long time, the quality of gum tissue is also something we look at. Overtime, the gum tissue can recede. To have a successful implant, we may need to consider supplementing the gum tissue with grafts. This can fortify the area and ensure there is a strong seal around the implant, thus increasing the chances of success.
Radiation to the head or neck
For patients who have had radiation to the head or neck, there is also a higher risk of implant failure. Radiation can negatively impact circulation and bone density in the treated area, which can impact how the implant integrates with the bone. This does not exclude you from having an implant, but it is something that we consider when determining your overall risk profile.
Taking bisphosphonates
Lastly, before placing an implant we want to know if a patient is taking a bisphosphonate. These medications are typically used to treat osteoporosis and are antiresorptive medications that affect the metabolism of bone. As a result, the bone might not be as dense, which can make it harder for the titanium to integrate with the bone.
If you have been prescribed a bisphosphonate, we recommend having a conversation with your doctor before having an implant placed. Taking these medications does not mean you cannot get a dental implant, but your doctor may recommend changing your dose or the type of bisphosphonate that you’re on.
Each of the above are risk factors we consider before placing an implant. They do not exclude you from having an implant, but without careful consideration and interventions where possible, they can cause an implant to fail. As always, it’s important to have these conversations with your dentist and understand your risk profile before treatment.
Post-operative care and maintenance
An implant is a surgical procedure and there is a chance of infection. Following each appointment, it’s important that you follow the post-operative instructions provided by your dentist.
It’s also important that you take care of your implant like you would a natural tooth. We’ve had patients who were excited about getting implants because they felt they could stop coming to the dentist and worrying about their teeth. That is simply not true. Implants must be cared for in the same way you care for your natural teeth – with regular brushing and flossing and semi-annual hygiene visits at your dentist.
Maintaining a regular cleaning schedule with your dentist will also be important to monitor the implant and its success. Your hygienist will ensure you’re cleaning it properly and make sure that there is no inflammation building around the implant or the surrounding teeth that could compromise the seal of the implant and lead to failure.
How does implant failure occur?
Implant failure can occur soon after the implant is placed, or years down the road. Let’s discuss how each of these can happen.
Failure in the first three months
When you think about the timeline for an implant, there is a three-month period between when the screw is placed and osteointegration happens. Early failure is due to the bone not attaching with the implant. The healing abutment that is placed is there to help prevent this failure and give the bone time to integrate with the titanium. However, if you’re putting a lot of pressure on the healing abutment or chewing hard or sticky foods it may hinder healing and osteointegration.
Failure after the first three months
Late-stage failure, or failure after the implant has integrated, is usually caused by periimplantitis. You’re probably familiar with gingivitis, which is a type of inflammation of the gums. There’s also periodontitis, which is inflammation around a natural tooth. Periimplantitis is a bacteria and inflammation that goes around the implant and can cause bone loss and implant failure if left untreated.
Need an implant?
Most adults will need a dental implant at some point in their life. Our hope is that this blog will provide you with the education you need to have a thoughtful productive conversation with your dentist when that time comes.
Whether you are a new patient or existing patient in need of an implant – you can schedule an appointment online, or call us at 813-689-4226.