Implanting some Dental Implant Knowledge

Dental implants have been helping to replace missing teeth since Cupid's bow struck Dr. George Sr! 

They can be utilized to replace a single tooth, or multiple implants can replace a section of teeth, all upper and lower teeth, and can even help dentures stay in place.  Dental implants are an extremely valuable, viable, and durable prosthesis. In fact, they are our best technology to mimic natural teeth.  However, dental implants are not for everyone and require a great deal of planning and time to achieve a successful result!

Similar in many respects to a joint prosthesis, dental implants are a biocompatible medical device placed in the body. Just like a total knee or hip replacement, diagnosis and treatment planning are vital to the long-term success of a dental implant. Furthermore, dental implants require a healing period before use (due to the laws of biology), may need future revisions, and can possibly be lost due to infection or bodily rejection. 

Dental implants rely on a biological phenomenon called osseointegration. During initial surgical placement, the body’s natural healing process produces new bone that becomes fused to the implant. If successful, the dental implant will become anchored within the jaw bone allowing for the support and function of a dental prosthesis. However, if this process is inhibited by disease or habits, the implant will fail to integrate. Furthermore, an integrated implant is still subject to gum disease and bone loss and can be lost even years down the road!  

While some general dentists surgically place dental implants, many will refer you to a specialist- such as an oral surgeon or periodontist. After placement, your dentist will oversee the healing phase, transitional prosthesis, and the fabrication and maintenance of your implant system. Yet, before any of this can occur, your dentist will review and discuss a list of topics similar to the one below to see if dental implants are the right option for you:

1. Health History and Habits- Patients who have active dental disease/ infection, disease promoters, poor healing, or a weak bone foundation are at a higher risk for implant failure. These include a history of periodontal (gum) disease, smoking/tobacco use, heavy “clenching and grinding”, diabetes, bone diseases, extensive treatments with bisphosphonates, head and neck radiation and/or liver diseases. Also, all dental cavities and gum disease must be addressed before a dental implant can be

2. Quality of Bone- Not all bone is created equal.  Bone density greatly differs in each individual patient- based on gender, age, history of gum disease or dental abscesses and even location in the mouth (the lower jaw bone is much more dense than the upper jaw bone).  In general, for dental implants, the harder the bone, the greater the blood supply, and greater amount of bone, the better the primary stability of the implant and the better chance for osseointegration.  A cone beam CT radiograph is a 3D “x-ray” that allows your dentist or dental specialist to evaluate the quality and amount of bone available for implant placement.  This imaging technology is quickly becoming the gold standard for planning dental implant placement and most likely will be requested by your dental professional.

3. Timeline-   Many implants can be placed immediately after extracting a tooth or if there is enough bone present at the existing site. Typically, a dental implant will then have a four month healing period allowing for osseointegration to occur. During this healing period, the top of the implant will be covered with a metal healing cap, temporary tooth colored crown for esthetic areas, or an Essix appliance- a thin, clear mouth piece with a plastic tooth.
If you are looking to replace a tooth that has been missing for many years or there is not enough bone to support an immediate implant, an additional bone graft procedure may need to be completed BEFORE the implant can be surgically placed.  Bone graft replacement therapy on average takes 3-4 months, but can take up to an excess of one year to reach the density needed for implant placement. Therefore, implant prostheses can take anywhere from 4 months to over a year to complete.

4.Success and Maintenance- There have been more research studies than you can imagine regarding the success and survival rates of dental implants.  Most of the studies report a ten year success rate of 80-90+ percent.  Most failures occur very early, due to lack of osseointegration. However, implant loss often occurs between 3-9 years, due to bone loss from peri-implantitis (bacterial infection similar to periodontal or gum disease) and mechanical failures.  Excellent daily oral hygiene and regular dental visits are paramount to retaining a successful dental implant.

5. Cost- It is very difficult to determine the cost of an implant because each individual case is so customized and cost varies based on an area's cost of living.  Additional surgical procedures, such as bone graft therapies, will increase the price.  However, as a general estimate, each individual dental implant supported restoration can cost between $3,500-4,000.  This includes the 3-D cone beam image, dental implant, healing phase cap or temporary crown, final abutment (connection between the implant and crown), final crown, taxes, lab costs and lab parts.  Also, many dental insurance plans will cover some costs associated with dental implant supported restorations.

Dental implants are a phenomenal esthetic and functional restoration that can eliminate the need for removable restorations and other more aggressive fixed restorations. They require extensive planning, time, maintenance, and meticulous care to achieve long lasting results. Dental implants are an excellent investment that can lead to a happier, healthier you!

Dr. George R. Williams is a general dentist at Williams Family Dental Group in Canton, Ohio. He is a graduate of The Ohio State University College of Dentistry and Canton Mercy Medical Center General Practice Residency.  For questions or suggestions for blog posts, please feel free to contact him at drgrw@williamsdentalgroup.com