Dental implants are the prostheses used to replace missing teeth and are the best tooth replacement option available. They are made of pure titanium or titanium alloy and closely resembles your natural teeth.
Frequently asked questions about dental implants and bone grafting
In this blog, I will answer the most frequently asked questions about dental implants and bone grafting. So, let’s get started.
Who can get a dental implant?
A tooth extracted due to a cavity, trauma, or fracture can be replaced with a dental implant. However, replacing a tooth lost due to periodontitis (advanced gum disease with bone loss) can be challenging. This is because there might be insufficient bone to support an implant. In patients with active periodontitis, bone augmentation might not last long, and the implant is more likely to fail within months or a few years.
For individuals with several missing teeth, an implant-supported denture is a suitable option.
Moreover, those who have lost all teeth in the jaw can opt for an All-on-4 denture. This involves placing four implants in the jaw, with a denture fixed on top. All-on-4 dentures are permanent and do not need to be removed every night. However, regular dental check-ups are essential for their maintenance and cleaning.
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who can’t get a dental implant?
The following patients are often not the best candidates for dental implant placement and need to be evaluated to determine their suitability:
- Pregnancy: Implant placement is delayed until after delivery.
- Mentally unstable patients: Require careful assessment.
- Chronic alcoholics: May have problems with blood clotting.
- Heavy smokers (more than 20 cigarettes/day): Experience more bone loss and delayed wound healing.
- Patients with atypical facial pain: Suffer from chronic, unexplained pain on the face.
- Growing individuals: Implant placement is delayed until growth is complete.
- Individuals with intellectual disabilities: Require special consideration.
- Uncontrolled diabetes: The implant failure rate is 20% within the first five years.
- Bone disorders: Conditions such as osteoporosis or osteomalacia can affect implant success.
- Recent heart attack: Surgery is delayed up to 12 months after a heart attack.
- Patients who underwent head and neck radiation therapy: The success rate is 26% within the first 5 years. The following patients are often not the best candidates for dental implant placement and need to be evaluated to determine their suitability.
- Pregnancy: Implant placement is delayed until after delivery.
- Mentally unstable patients: Require careful assessment.
- Chronic alcoholics: May have problems with blood clotting.
- Heavy smokers (more than 20 cigarettes/day): Experience more bone loss and delayed wound healing.
- Patients with atypical facial pain: Suffer from chronic, unexplained pain on the face.
- Growing individuals: Implant placement is delayed until growth is complete.
- Individuals with intellectual disabilities: Require special consideration.
- Uncontrolled diabetes: The implant failure rate is 20% within the first 5 years.
- Bone disorders: Conditions such as osteoporosis or osteomalacia can affect implant success.
- Recent heart attack: Surgery is delayed up to 12 months after a heart attack.
- Patients who underwent head and neck radiation therapy: The success rate is 26% within the first five years.
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What are the benefits of dental implants?
A dental implant is the best tooth replacement treatment available so far. Structurally and functionally, it closely resembles a natural tooth.
The implant consists of a body or abutment that is surgically placed inside the jawbone. This abutment acts like the root of a natural tooth, absorbing masticatory forces and transferring them to the surrounding bone. Additionally, the gums (epithelium) attach to the implant in a similar way as they do to natural teeth. The crown placed on the implant body closely matches the shape and color of the missing tooth.
An implant maintains your chewing efficacy because the heavy forces of mastication are transferred to the bone through the implant abutment, just like a natural tooth. However, individuals with two or more missing posterior teeth may experience a 30% reduction in chewing efficacy with denture placement.
Implants blend seamlessly with natural teeth, enhancing your smile and aesthetics. It is difficult for a layperson to differentiate between an implant and a natural tooth.
Dental implants are fixed to the jaw and require similar oral hygiene maintenance as natural teeth. The longevity and success rate of an implant are directly related to plaque control. Inadequate plaque removal around the implant can lead to inflammation in the surrounding soft tissues, known as peri-implantitis. Long-standing inflammation can destroy the bone supporting the implant, resulting in implant failure.
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How long does a dental implant procedure take?
On average, the dental implant procedure takes 4-7 months to complete. The process begins with placing an implant abutment in the prepared bony socket. This abutment is left for 3-6 months to fuse with the bone, a process known as osseointegration.
The sterile titanium surface of the implant allows bone to form around it. The quality of the bone formed and the close contact between the bone and implant hold it firmly in place.
After osseointegration, the gums are opened, and a healing cap is screwed onto the implant abutment. This healing cap promotes the healing of gums around the implant. The soft tissues take 4-6 weeks to heal, after which the crown is placed.
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How painful is the dental implant procedure?
Dental implant placement is a painless surgical procedure because the entire surgical site is anesthetized beforehand. It is normal to feel pressure during the procedure, which should not be confused with pain. Pain medication will be prescribed at the end of the procedure to manage any post-operative discomfort.
The effect of anesthesia lasts for 2-3 hours. After it wears off, you may experience mild to moderate pain if you do not take the prescribed pain medication.
Slight discomfort may be felt during the healing period, which typically lasts 7-10 days after the surgery. Severe pain could indicate an infection, so it is important to report to the dental clinic if you experience severe pain at the wound site.
Avoid eating hard, crunchy food after the surgery, as it can injure the healing gums around the implant and cause pain.
Read more: 10 Signs of healthy gums
What is the best brand of dental implants?
The following are reliable dental implant brands known for providing sterile, durable, and varied implant designs:
- Nobel Biocare
- Straumann
- Zimmer Biomet
- Dentsply Sirona
- BioHorizons
- DIO Implant
- Neodent
- Southern Implants
- Astra Tech Implant System
- Osstem Implant
Are dental implants safe?
Yes, dental implants are safe. They are made of pure titanium, titanium alloy, or zirconia, which are biocompatible materials. These materials are tissue-friendly and well-tolerated by the human body, allowing healthy bone to build around the implant. The human body tends to reject foreign materials like stainless steel, but titanium is considered safe for placement inside the bone.
Titanium toxicity is rare. However, the release of titanium particles in the surrounding area may trigger an inflammatory response, and in extreme cases, this can loosen the implant. People with metal allergies or autoimmune diseases are more likely to develop titanium toxicity
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When do you need bone grafting for dental implants?
Bone augmentation may be necessary before implant placement in certain cases. After a tooth extraction, you can expect to lose 40-60% of the socket bone bone because the tooth’s root maintains the bone’s width and height. The most significant loss occurs within the first two years. The longer the teeth are missing, the more significant the bone loss. Significant bone atrophy is often seen in people over the age of 60, particularly in the lower jaw.
The following conditions indicate the need for a bone graft (bone augmentation) before implant placement:
- Horizontal or vertical bone loss: Insufficient bone width and height to place an implant abutment.
- Bony defect due to infection or trauma: Damage to the bone structure.
- Prophylactic socket filling: Done soon after tooth extraction to preserve the ridge, prevent future bone loss, and stimulate new bone formation. Some bone loss is expected even after bone grafting, but it helps prevent the need for future surgical bone augmentation.
- Bone defect due to peri-implantitis: Bone loss around an existing implant.
How do I know if my bone graft has been successful?
Several conditions are required for a successful bone graft:
Bone-forming cells
Bone grafts provide or stimulate bone-forming cells, which are essential for new bone formation.
Good blood supply
A good blood supply is necessary for clot formation and the recruitment of regenerative cells at the graft site. A clot acts as a foundation where regenerative bone cells anchor themselves and lay down new bone.
No mechanical stress on the implant
Mechanical stress on the bone graft should be avoided during implant osseointegration. Implant movement inside the bone leads to fibrous tissue formation, a consequence of tissue repair. At the graft site, bone regeneration is needed, which can be accomplished when there is zero stress on the implant.
You will be given a tooth-supported prosthesis after the soft tissue closure. You must not wear a tissue-supported partial denture for at least two weeks following implant surgery to avoid any stress.
An implant replacing a molar or premolar is left in the bone for six-months for the upper jaw and three-months for the lower jaw. The lower jawbone is dense and has a thick cortical plate that allows quicker osseointegration. The upper jawbone, on the other hand, is spongy with a thin cortical plate and, therefore, requires a longer period for successful osseointegration.
No tension in the soft tissues over the dental implant
There should be no pressure from the overlying soft tissues on the soft collagen secreted by bone cells. The soft tissues (dividing epithelium) go through the process of contraction when the wound edges meet and close the gap.
• The contracting soft tissues may collapse the underlying collagen framework and disrupt the new bone that’s being laid down. Bone formation is a slow process and takes 6-8 months to fill the socket. However, the soft tissues divide faster and bridge the gap in 2-3 weeks. A bone graft or tissue-guided regeneration matrix separates the new bone from the soft tissues and prevents its collapse.
Avoid smoking or irradiation
Smoking or irradiation during osseointegration diminishes blood supply of the bone and delays the healing process.
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How does the bone grafting procedure work for dental implants?
Bone grafting is done where there isn’t enough bone to support an implant. An artificial bone graft is placed to fill the bony defect or augment the bone, horizontally or/and vertically. The soft tissues are closed and left in situ for 1-3 months. The bone graft is either placed at the time of tooth extraction or at a missing tooth site before implant placement.
During bone grafting, an incision (a cut) is made on the gums to expose the bony defect. The chosen bone graft material is placed in the defect or over the desired bone, and the soft tissues are closed without tension.
There are four different types of graft materials available:
- Autograft – derived from the roof of the mouth or hip bone of the patient.
- Allograft – derived from a different individual (a cadaver or living person).
- Xenograft – derived from animals such as bovine or porcine.
- Alloplast – inorganic, synthetic or inert material placed at the surgical site.
Bone grafting stimulates new bone formation and not repair. The bone graft provides bone-forming cells or stimulates bone to make new bone-forming cells. The tension-free soft tissue closure prevents disruptive pressure from the contractile forces of the rapidly dividing soft tissues (epithelium) on the newly developed collagen in the bone.
In tissue-guided regeneration, a lattice or a framework is placed under the soft tissue that not only stimulates bone regeneration, but also separates the new bone from the pressure of rapidly dividing epithelium.
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Do implants need to be checked and maintained?
No, they don’t require regular check-ups. However, you have to control plaque build-up to prevent any inflammation around them. Annual check-ups, scaling, and root planning may prolong the life of an implant.
Why don’t implantologists do implants for wisdom teeth?
Wisdom teeth are additional teeth in the mouth, and our masticatory apparatus performs best with two premolars and two molars on each side of the jaw. If you have healthy premolars and molars, you don’t need wisdom teeth replacement.
The implant placement is an expensive, invasive procedure that causes a lot of patient discomfort, tissue damage, a long healing time to restore bite and esthetics. For these reasons, wisdom tooth replacement is considered an unnecessary procedure and is, therefore, avoided.
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How long does a dental implant last?
A dental implant can last 15-20 years if good oral hygiene is maintained. According to a study, 95% success rate was seen in implants placed in the lower jaw and 85-90% for the upper jaw after 5 years. Factors like bad oral hygiene, smoking, osteoporosis, and the habit of clenching and grinding can reduce their lifespan.
What are the risks associated with dental implants?
There are a few risks associated with dental implants.
Damage to sinus wall
The implants placed near the sinus may damage the sinus wall leading to sinus infection (maxillary sinusitis) or displacement of implant into the sinus cavity. This problem is often seen in patients with short roots, molar encroaching the sinus wall or patients who lost their tooth a long time ago. The dental implants require 2mm clearance from the sinus cavity to preserve their integrity. A sinus lift procedure is recommended in patients with a large sinus extending into the extracted root space.
Inferior alveolar nerve damage
The lower implants in the premolar region are close to mental nerve and molars to inferior alveolar nerve (IAN). IAN damage is the most common injury following an implant placement, followed by a lingual nerve injury. Injury inflicted due to traumatic local anesthetic injection or implant surgery can lead to temporary or permanent nerve damage.
A 2mm clearance is given between the implant and vital structures (nerves and blood vessels). A dental implant placed close to vital structures can cause nerve compression, leading to altered sensation (paresthesia) or numbness in the areas innervated (supplied) by these nerves.
Implants are placed after growth cessation
Implants can’t be placed in children or teenagers, and you have to wait until the growth of the face completes. The bone growth can submerge the implant and can lead to esthetic (spacing) and periodontal problems.
Allergy
Allergy to titanium is rare and accounts for 0.6% in the United States (US). An antigen-antibody test is done before implant placement to see if you’re hypersensitive to titanium. Most people tolerate it with no side effects.
Metallic discolration
The metallic gray color of implants may be visible in people with thin gums.
Are dentures better or worse than dental implants?
Dental implants are better than dentures. Dentures significantly reduce your chewing efficacy, and it will be challenging to eat hard and crunchy foods with dentures.
The dentures need to be removed before bed and soaked in water until next morning. That gives ample of time to the tissues to rest and relax.
Some dentures have clasps – wires encircling one or more neighboring natural teeth, that may increase the stress/load on the anchoring teeth, leading to loss of bone and periodontal support in the long run.
The upper partial dentures get support from the palatal bone (roof of the mouth). The area covered by denture creates speech difficulties; however, patients get used to it with time.
Implants, on the other hand, cost you an arm and a leg, but they are worth getting, and you won’t have to face the problems associated with dentures.