Dental procedures explained… (Not quite sure what your dentist meant? Here it is explained in “layman’s terms”)
Implant supported crowns – what are dental implants?
We have previously mentioned “implants” being the best solution for a completely missing tooth or missing teeth. So what exactly are dental implants? You may have heard them referred to as “dentistry implants, dental implants or tooth implants”…
A dental implant is a prosthetic replacement for a tooth’s root. When you have a missing tooth, there is no root left, nor anything to bond a dental crown or dental bridge to. Your dentist will most likely recommend a dental implant as they provide a strong foundation for permanent replacement teeth, as well as removable replacement teeth (dentures). Implants are usually quite costly and this is why there are other options, as we have previously discussed – such as dental bridges and dentures. Before we start discussing the different types of implant supported restorations you can consider, let’s get a better picture about what a dental implant actually is…
Your natural tooth consists of a root and a crown – the tooth root, being the foundation, is the part of the tooth that extends into the jawbone, below the gum line – this provides the support for the crown – which is the part of your tooth that you see in your mouth. The root of your tooth is the part of the tooth that gets replaced by the implant.
A dental implant can typically be broken down into 3 sections – the implant itself – this is the part that gets inserted into your jaw bone. The dental restoration – this can be a dental crown, bridge or a milled bar for a denture – to name a few. And then there is the abutment – this is the part that connects the implant to the dental restoration.
Now days, implants are mostly made out of titanium, however there are other products on the market being used and researched too. Titanium is a bio-compatible metal which is highly resistant to corrosion in sea water and chlorine, and offers strength and durability. But most importantly – titanium fuses directly to the bone – which means that the implant will fuse to the jawbone and therefore offer the support needed to add the dental restoration to the abutment. The process where bone cells fuse or attach themselves to the titanium is called osseointergration.
There are different methods used to place implants in the mouth – there is one-stage surgery, three stage surgery and immediate loading, but regardless what method or treatment plan the dentist or specialists recommends is best for you, or which implant systems is used for the treatment – the basic procedure is still pretty much the same – here it is in lay-mans terms – a general idea about the procedure followed when placing implants in your mouth…
The dentist or prosthodontist will check if you are suitable for dental implants by means of a routine dental examination. With the use of x-rays and computer tomography, they will be able to tell if your have enough bone, or if the bone density is sufficient to hold an implant, or if you require bone grafting – sometimes referred to in lay-mans terms as a bone transplant. They will also check if your gums are healthy enough and that you as the patient are dedicated to regular dental check ups and good oral hygiene – at the same time, checking for other specific medical conditions.
If implants are the best treatment for you, the dentist or prosthodontist will then book you in for the surgery.
How do they place an implant/implants:
- They start by making an incision in your gum. They will either cut a flap and push it back to expose the bone or use a flapless technique where a small area of tissue is removed.
- The dentist will then drill into the bone to make an opening. The implant/implants are then screwed into the bone. A healing cap is placed over the implant and it is then left for 3 to 6 months to heal. Ideally, during this time, the implant needs to be protected from chewing forces in order to assure successful osseointergration. If the implant is situated at the back of the mouth then no one should notice and thus it isn’t necessary to have a temporary dental restoration – however, sometimes you may need an implant to support a front tooth and if immediate loading isn’t an option for you, you may have to use a denture, Maryland or dental bridge (see previous explanation) as a temporary measure during this healing period.
- Once the dentist or specialist is happy that enough healing time has passed, the implant needs to be surgically exposed by removing some of the gum that may have grown over the opening. He will check that the bone has successfully integrated with the titanium implant and, once satisfied, will remove the healing cap and screw in a part called an impression post.
- He will then take an impression of your mouth. After this is done the dentist or specialist unscrews the impression post and screws in another part called a healing abutment – this helps the gum grow into the “correct shape” in order for the dental crown to fit easily and correctly. He may decide to put a temporary dental crown here if, as mentioned above, it is one of your front teeth. If this is the case, instead of the healing abutment, he will screw in the temporary abutment with a temporary dental restoration, while your dental crown is being designed and manufactured at the dental laboratory.
- The impression that the dentist took is sent to the dental laboratory, with the impression post, so they can make a plaster model of your mouth. This is a replica of your mouth and the technician can work with it in order to make your new dental crown fit and look as natural as the rest of your teeth in your mouth do.
- An implant part, that we refer to as the lab analogue, is placed in the plaster model to mimic the implant that has been screwed into your jaw bone. We then order the corresponding part to the implant in your mouth, which is called an abutment. We build your crown to fit onto this particular abutment, and once done, we send the finished product back to your dentist to fit and bond.
- Once the dentist or specialist receives the work, he will then book an appointment for you so they can finish the process – in this appointment the dentist will unscrew the healing abutment and screw on the new abutment which the dental crown or dental restoration can then be bonded on to or clipped on to, depending on your treatment plan.
- In some cases the dentist will allow for immediate loading – simply put, the suitable abutment is placed at the same time as the implant. This method can eliminate the need for the second surgery – the part where they expose your gum to attach the healing abutment – however healing time is still required for the implant to fuse to the bone.
Implant dentistry is not only limited to implant supported dental crowns – as touched on above, there are numerous different types of implant supported dental restorations such as:
- Implant supported dental bridges: we have previously discussed what a dental bridge is – but spoke about them being bonded to prepped teeth – however your dental bridge can also be implant supported where the bridge is bonded onto implant abutments rather then prepped teeth.
- Dentures on implant supported milled bar/over-dentures.
- Implant supported Screw retained dentures.
Although dental implants have been clinically and scientifically researched for many years, they still do not have 100% success rate, however over the decades this rate has drastically improved and the dental profession can proudly report a 90% success rate in the osseointergration and long term usage – some reports are brave enough to claim as high as a 98% success rate. Unfortunately, even though its a small percentage, there is still a chance that the implants may be rejected by your body and thus do not successfully fuse to the bone. This could be due to numerous factors. If this happens, the implants have to be removed and the bone left to heal and you may require bone augmentation (grafting) before you can re-visit this particular treatment plan.
To find a dentist in your area that comes highly recommended – who work with a Dental Laboratory, where quality is their pride, and for some examples of veneers before and after pictures – or if you would just like to read more about dental work/dental procedures or dentistry, click on the relevant tabs on our website (we work closely with Cape Town dentists in Sea point, Durbanville, Rondebosch, Tamboerskloof, Newlands and Cape Town CBD) – or visit your chosen dentists website.