Dental Implant Treatment Options
What are the various dental implant options available:
Single Tooth or Multiple Implants / Figure 1.
- Fixed single implant crown (figure 1): missing a single tooth.
- Fixed multiple implant crowns/bridge (figure 1): multiple individual teeth that are either separate or connected. In the back jaws where most of the bite force is located, we may connect the implants together like a bridge for added strength. For the same reason, we sometimes utilize more than one implant per tooth if we are replacing areas where there are no back teeth.
Removable Upper Tissue Supported Overdenture / Figure 2.
- Removable upper jaw tissue supported overdenture (figure 2): missing all upper teeth. Denture snaps onto bar or ball attachments connected to implants in jawbone but denture touches gums in back of jaw. Future relines necessary. Minimum of four implants.
Removable Lower Tissue Supported Overdenture / Figure 3.
- Removable lower jaw tissue supported overdenture (figure 3): missing all lower teeth. Denture snaps onto bar or ball attachments connected to implants in front of jawbone but denture touches gums in back of jaw. Future relines necessary. Minimum of two implants.
- Removable upper jaw implant supported overdenture: missing all upper teeth. Denture snaps onto bars connected to implants in jawbone and denture does not touch gums in back of jaw. Maximum protection from bone resorption. No relines necessary. Minimum of six implants.
- Removable lower jaw implant supported overdenture: missing all lower teeth. Denture snaps onto bars connected to implants in jawbone and denture does not touch gums in back of jaw. Maximum protection from bone resorption. No relines necessary. Minimum of four implants.
Fixed Upper Implant Bridge / Figure 6.
- Fixed upper jaw implant supported bridge (figure 6): missing all upper teeth. Bridge connected to implants in jawbone and bridge does not touch gums in back of jaw. No relines necessary. Maximum protection from bone resorption. Minimum of six implants.
Fixed Lower Implant Bridge / Figure 7.
- Fixed lower jaw implant supported bridge (figure 7): missing all lower teeth. Bridge connected to implants in jawbone and bridge does not touch gums in back of jaw. Maximum protection from bone resorption. No relines necessary. Minimum of five implants.
How long does it take and what is the treatment sequence:
The timing for completion of an implant crown, implant bridge, or implant denture is based on the individuals case and on standard healing periods. For those patients that need bone grafting, this is the first part of treatment. The bone graft will need to heal for four to six months depending on how hard the bone is. For those patients without the need for bone grafts, they proceed directly to implant placement (called phase I) and the bone around the implant will need to heal for six weeks to six months, depending upon how hard the bone is. The gum is covered up and after four days, you are allowed to wear a temporary denture to fill in the space of the missing tooth/teeth during the healing period if you so desire. When this initial phase of healing is completed, a post called a temporary healing abutment will be placed onto the implant itself (called phase II) and will protrude through the gums to allow gums to heal for one month. Then a custom ordered permanent abutment will be placed along with a new implant crown, bridge or denture (called phase III). Bone grafting, phase I and phase II procedures are performed at our office. Phase III procedures are performed at your restorative dentists office.
Advantages of implants over bridges or dentures:
The single most important advantage of implants is the prevention of bone resorption ( ie shrinking or melting away of bone). As you have seen in some elderly patients without teeth, the lower third of their faces are many times collapsed due to loss of bone support because there are no teeth present. When teeth or implants are present in the jawbone, the implants connect intimately with bone (called osseointegration), the bone surrounding the implants are stimulated during function (called internal loading) and the process of bone resorption is virtually eliminated. Implants help prevent the shrinking of bone and prevent the loss of facial support thus maintaining the youthful appearance. Many implants patients state that their self-esteem and self confidence have been restored as result of the improved appearance, function, comfort, and health that implant have provided.
How do implants compare to bridges:
Implants are not only critical in maintaining beauty and youth, but it is also the most conservative of replacement options available. Compared to a bridge, the teeth adjacent to the implants do not need to be permanently prepared (shaved-down). Compared to a bridge, the implant will never form tooth decay since it is metal. Bridges usually are replaced anywhere from 5-15 years due to the cement breakdown and subsequent tooth decay (dependent on hygiene) forming under the crowns. Replacement of bridges may also many times include shaving down additional teeth to add to the bridge if the condition of the original bridge teeth have deteriorated. Implants stimulate and preserve bone unlike traditional bridges. This is particularly important in the front of your mouth, where preventing a visible bone defect is critical for a natural appearance.
The implant structure that is embedded in bone should last a lifetime with only the crown or post portion of the implants being susceptible to wear and tear. There is long term cost savings of implants vs. bridges since multiple replacement of bridges throughout life costs much more than replacement of the implant crown or post.
How do implants compare to dentures:
Compared to a removable denture, implants do not have visible wire clasps that are visible when you speak or laugh. Implants do not have visible wire clasps that hook onto adjacent teeth, putting pressure on them as the partial rocks back and forth. Implants avoid the embarrassing times that the dentures come out of the mouth when eating, speaking, or sneezing. You no longer need messy denture adhesives when dental implants hold the implant dentures. For patients missing all of their upper teeth, dental implants now make it possible to have the pink plastic covering the palate to be removed so that food tastes dramatically better, you minimize the gagging reflex caused by the plastic on your palate, and you are finally able to feel the roof of your mouth again with your tongue. Implants have given patients back the power to really chew their food much like when they had their naturally teeth. There is also long term cost savings of implants vs. dentures. Over a lifetime, the cost of maintaining implants bridges compared to conventional dentures is much less due to the multiple relines necessary for tissue supported dentures. It is the uneven pressure of partial and full/complete dentures onto the gums and bone that most often accelerates the natural process of resorption (bone-melting away).
WHAT ARE BONE GRAFTS AND WHY ARE THEY SOMETIMES NECESSARY
An implant needs to be covered by bone and to be completely immobile in the jawbone in order for it to heal successfully.
The purpose of a bone graft is to reconstruct the amount of bone that had been lost due to either trauma or atrophy to allow for placement of implants that are covered by bone and immobile.
If there is inadequate height of bone in the back of the upper jaw, then a sinus-lift bone graft may be necessary to reconstruct adequate height of bone before implant placement.
If there is inadequate width of bone in the proposed implant site, then a ramus veneer bone graft may be necessary to reconstruct adequate width of bone before implant placement. Dr. Shimane will describe those procedures in detail with you if they are part of your customized treatment plan.
Does age or health problems affect implants:
There is no age limit for implants because bone quality and quantity are the determining factors. The minimum age of dental implants for children is based on the cessation of facial growth. Dr. Shimane would evaluate multiple factors and tests to determine this information on an individual basis.
The vast majority of health problems do not affect implant success. There are three main health concerns that may have some impact on implant success are but not limited to:
- severe immunosuppression from certain drugs or diseases
- patients on strong blood thinning agents (ie coumadin) / certain hemophiliacs (Aspirin and other mild blood thinning agents are not included)
- chronic smokers.
Dr. Shimane would evaluate any health concerns on an individual basis.
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: a) options of local anesthesia, nitrous oxide (laughing gas) or intravenous anesthesia (general anesthesia), b) Using specially designed instruments, a space (socket) is created for the implant, c) The titanium implant is then inserted into the socket, d) Finally, if necessary, sutures will be used.
How comfortable is the surgery and recovery:
General anesthesia has now made implant surgery so comfortable that most patients do not remember the surgery at all. Most implant patients state that recovery is similar to having teeth removed and that they feel fine after 4-7 days. Dr. Shimane takes special care to minimize post-surgical swelling by providing anti-swelling medications and ice-packs held by our special head wraps. Our office takes pride in informing you the best possible with a four page hand-out on the specifics of what to expect and how to take care of yourself after surgery.
After the implant is placed, the area will need to heal for six weeks to six months. The length of time is determined by a variety of factors, including how hard your bone is.
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.
How successful are implants:
Dental implant treatment is one of the most successful procedures in the medical/dental field, with documented success rates over 95% in most areas of the jaw. Success rates in the posterior upper jaw are slightly less due to the softer medullary bone. Dr. Shimane will review your individualized treatment plan.
What Does It Cost-And Does Insurance Cover It?
Before treatment begins, you will be given an accurate estimate of all the expenses involved in placing your dental implants by our office. This includes pre-surgical planning, fabrication of a surgical template to assist in accurate placement, implant placement itself, and any additional procedures that are necessary.
In addition to the consultation fee, there may an initial charge for study models/diagnostic wax-ups and x-rays.
You will be given an accurate estimate of the expenses involved in restoring your dental implants by your restorative dentists team. They will place any temporary restorations (if necessary), the support posts, and the replacement teeth (crowns or dentures).
Regular maintenance visits with our office and your restorative dentist are vital to success of your implant/s.
What If I Have Questions Before Surgery?
If this information, combined with information you receive at your consultation appointment, does not answer all of your questions, please call Dr. Shimane’s office at Castro Valley Office Phone Number 510-885-8720 to speak to one of the Patient Care Coordinators. Please visit Dr. Shimane’s web site at www.ShimaneOralSurgery.com or www.CastroValleyImplants.com for more information regarding dental implants. The dental implant module on our website has a highly educational/streamline video presentation of the various aspects of implants. We recommend viewing the online dental implant module before your consultation appointment.