A New Beginning with Dental Implants. A Guide to Understanding Your Treatment Options

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1 A New Beginning with Dental Implants A Guide to Understanding Your Treatment Options

2 Why Should I Replace My Missing Teeth? Usually, when you lose a tooth, it is best for your oral health to have it replaced. Missing teeth can affect your bite as well as your ability to speak and chew. Their loss can increase the burden on your remaining teeth and can cause muscle pain in your jaws and headaches. And of course, losing a tooth can affect your appearance. The good news is that, most of the time, replacing a missing tooth is not an emergency. You have time to consider what replacement option is best for you and to make an informed decision. This booklet discusses your general treatment options. Extraction site of upper front tooth. What Are My Tooth Replacement Options? If you are missing one or more teeth and choose to have it or them replaced, several treatment options are available. A flipper is a removable plastic tooth that is inexpensive but fragile and temporary. A cast partial denture also is removable but is precision cast in metal for longer service life. Wire clips help hold it in place. A fixed bridge is cemented into place using crowns or caps on the teeth adjacent to the open space for support. Crown placement usually requires removing or reducing the outer layer of the tooth. In some cases, a Maryland bridge, a fixed bridge that does not need crowns, is glued onto the back of the teeth adjacent to the space so that minimal tooth structure is removed. Complete dentures or plates are the traditional solution for people who have lost all their teeth in one or both jaws. The success of a complete denture depends upon the individual s jaw size and shape, his or her oral habits, and his or her adaptability. Some people adapt well to dentures, while others are not able to adapt. Dental implants can be used to provide support for the replacement of one tooth or all of an individual s teeth. After years of research and clinical trials, we can now provide this option in addition to the traditional treatments just described. Implant-supported teeth can be cemented, screw-retained, or removable and can be made attractive, stable, and comfortable for almost any patient. Missing front tooth. Implant supported replacement tooth.

3 Flipper (removable). Fixed Bridge (cemented in place). Cast partial denture (removable). Maryland Bridge (cemented in place). Lower complete denture Any other replacement options will be discussed with you before treatment begins. Implant supported replacement tooth.

4 Are Dental Implants An Option For Me? If you are considering dental implants, your mouth will be examined thoroughly and your dental and medical history will be reviewed to ensure that dental implants are appropriate for you. Dental x-rays and, frequently, panoramic (or complete) x-rays of your jaws will be taken to evaluate your jawbone and to determine if it will accommodate implants. Occasionally, more detailed information is required and can be provided by special x-rays. They will help determine if additional tests or procedures are needed to place your implants properly. Frequently panoramic x-rays of your jaw are taken. What Is A Dental Implant? A thorough examination of your mouth is required. The best way to describe a dental implant is to compare it to a real tooth. A natural tooth consists of a root and a crown. The part of the tooth that you see and eat with is called the crown. Beneath the crown is the root, which anchors the tooth through the gum tissue to the jawbone. When you lose a tooth, you lose both the root and the crown. To replace a tooth, we first have to replace the root. Essentially, a dental implant is a new root. This titanium root is fitted into a socket that we create in your jaw, replacing the lost root of your natural tooth. Dental implants come in various shapes and sizes and have different types of surfaces. The actual implant selection will depend on a variety of factors related to your specific treatment needs and the most appropriate one(s) will be used. Once an implant has been placed in the jaw, the bone around the implant will need to heal for up to six months, depending upon how hard the bone is. When this initial phase of healing is completed, a support post called an abutment will be placed on the implant itself and then a new crown will be placed on top. If all of your teeth are missing, a variety of treatment options are available to support the replacement teeth.

5 How Are Dental Implants Placed? Usually, the office procedure to place a dental implant takes about an hour for one implant and no more than two or three hours for multiple implants. The placement process consists of the following steps: If indicated, you will be given medication such as antibiotics prior to the surgery. You may be offered sedation with nitrous oxide ( laughing gas ) or intravenous medications. Then, a local anesthetic will be administered to numb the areas where the implant(s) will be placed. After you are comfortable, a small incision is made into the gum tissue, revealing the bone into which the implant will be placed. Using special instruments, a socket is created carefully, avoiding damage to the bone. The titanium implant is then inserted into the socket. Finally, if necessary, sutures will be used. Once the implant is inserted, it is completed in one of two ways: First, the gum tissue will be closed (or sutured) over the implant, allowing the implant to heal for up to six months. Then a second procedure, called uncovering surgery, will be performed after a local anesthetic has been used to numb the gum tissue. Next, the gum is moved out of the way, the implant located, and a healing cap placed into it. The gum tissue is then sutured around the healing cap. Generally, after two to four weeks, you will return to have the healing cap removed, the abutment (or support post) placed, and impressions made in order for the final crown (replacement tooth) to be fabricated. This is called a two-stage or two-step approach to implant placement and is the more traditional approach. For more aesthetically important areas, we may ask that you wait up to 12 weeks to begin the final restorative process. During this time, you will be fitted with temporary teeth. Occasionally, impressions are made at the time the implant is placed in order to have a crown ready when the implants have healed. After the implant is placed, the area will need to heal for as long as six months. How long your mouth will need to heal will be determined by a variety of factors. Follow-up care (one to four appointments) is usually needed to ensure that your mouth is healing well and to determine when you are ready for the restorative phase of your treatment. After you lose a tooth, we generally allow the extraction site to heal. The implant is then placed into the mature site.

6 When Are The Implants Placed? Healing cap in place. An alternative approach is called the singlestage or one-step approach, in which a healing cap is added at the same time as the implant is placed and the gum tissue is sutured around it. If the entire process occurs during one step, a second surgery to place the healing cap is unnecessary. Because only one surgical appointment usually is all that is needed, both patients and doctors often prefer this approach. However, it is not always the best method for placing implants. We will use the most appropriate approach to meet your particular needs. On occasion, it may be necessary to perform a soft tissue graft to obtain stronger, more easily cleaned and natural appearing gum tissue in the area around the implant. This process involves moving a small amount of gum tissue from one part of your mouth to the area around the implant. Most often, it is a brief and relatively comfortable procedure. 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. Original bone and tooth relationship. Bone loss occurs over time.

7 Do I Have Enough Bone? Sinus grafting to replace bone height. Again, if after tooth extraction the walls of the socket are very thick, they will usually fill with bone in three months. However, if the walls of your socket are very thin (such as in your upper and lower front teeth), then this type of healing will not be as predictable. After waiting three months for the bone to fill in, you may have only a very thin ridge of bone. Sometimes, a bone graft is placed at the time of tooth extraction to help your body fill in the socket with bone. This step will maintain the width or volume of bone you will need for implant placement. It is most commonly performed on thin-walled extraction sockets, especially in such visible areas as the front of the mouth. If your tooth was removed many years ago, then your bony ridge may be extremely thin and you may not have enough bone left for implant placement. In this case, a bone graft can be placed next to the thin bone and allowed to heal for three to nine months. After the graft has fused to your pre-existing bone, the ridge will be re-entered and the implant placed. Usually bone grafting is a relatively comfortable procedure. Many different bone-grafting materials are available, including your own bone. You also may need bone grafting if the sinus cavities in your upper jaw are very large or very low and extend into the tooth-bearing areas. This often occurs when teeth in the back of a person s upper jaw have been removed many years before, and the amount of bone available for implant placement is thus limited. This condition requires what is called a sinus grafting procedure. Most often, it is performed in the office with local anesthesia and perhaps sedation. During this procedure, the membrane that lines the sinus will be located and elevated. Bone will be added to restore the bone height and ensure that dental implants of an adequate length can be placed. This procedure often can be performed at the time of implant placement. Bone width restored with bone grafting. Implant and replacement tooth in place.

8 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. 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 3 Implants Replace 2 Lower Molars. 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. Custon made support bar and specialized lower denture with retention clips.

9 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. Implant Supported Upper Denture. 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 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 numbness or tingling in your lip, chin, or tongue. And although this numbness will usually resolve, it can be permanent. If you notify us of postoperative numbness as soon as possible, it will allow us to manage your care in the most appropriate way. Relationship of nerve to lower teeth.

10 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? A number of short appointments are needed to complete your treatment 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 the restorative phase of your treatment earlier in certain cases immediately 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 increase gradually 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, there 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.

11 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. A variety of toothbrushes and floss are available to help you clean your implants. 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. Each patient is unique, and it is not possible for us to discuss every option and every contingency for treatment outcome. This booklet is intended to help you understand the general treatment options available to you. If your specific treatment options are not clear, please contact us. We will be happy to answer any questions you have about your dental care.

12 To reorder in the United States, call PBHS Inc. at (800) Infoplant Communications, LLC

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