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Dental Implants

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Dental implants offer people who are missing one or more of their teeth the opportunity to restore full form and function to their mouths. Implant-supported crowns, bridges, and dentures are truly the next best thing to having a mouth full of strong, healthy natural teeth.

Also known as endosseous fixtures, dental implants are designed to replace the entire structure of missing teeth, from root to crown. The implants themselves are similar to small screws, usually made from titanium or a titanium alloy, which act as artificial tooth roots. Once they have been surgically embedded in the jaw, the implant posts fuse to the natural bone tissue through a process called osseointegration. They essentially become part of the patient's natural anatomy, providing security and stability comparable to healthy tooth roots. Custom-crafted replacement teeth are then attached to the implants via abutments.

Depending on the needs of the individual patient:

  • A single implant can be used to secure a dental crown
  • Multiple implants can be used to secure multiple crowns or a dental bridge
  • Several strategically placed implants can be used to secure dentures on the upper arch, lower arch, or both.

Many dentists also offer mini implants, particularly small implant posts that can be screwed directly into the jaw, through the gums, without the need for flap surgery. While mini implants are not right for every case, they do offer an implant-based solution to certain patients, including many whose jaw bones may not be sufficiently dense to support full-sized implants.

History

In 600 AD, Mayans replaced missing teeth by implanting stones, seashells, and jade into the jaw, and according to archaeologists, some of these primitive dental implants actually fused to the jaw. In more modern history, 1952, an orthopedic surgeon named Professor Per-Ingvar Branemark tried to remove a titanium fixture he had installed into a patient's jaw to study bone healing. The titanium had fused to the bone, and now we know this natural phenomenon as osseointegration. Branemark continued his work with osseointegration, implanting titanium implants into a patient who had severe jaw deformities and was, as a result, missing teeth. The patient, Gosta Larsson, was the first to receive titanium dental implants. In the 1970s, in only a few documented cases, implants were surgically placed in patients' jaws to secure full dentures. These early cases were performed out of desperation, when patients had problems with slipping, uncomfortable conventional dentures. In 1982, after Branemark presented research and data at the Toronto Conference on Osseointegration in Clinical Dentistry and the US FDA approved the use of titanium dental implants, we began to see dental implants used more widely. Throughout the 1990s to present time, dental implants and ceramics have undergone significant improvements.

Candidates

Ideally, a patient who is considering dental implant surgery will:

  • Have sufficiently dense bone tissue in the jaw
  • Be free from periodontal disease
  • Not smoke, or be willing to give up smoking, especially during the osseointegration period
  • Have good oral and overall health
  • Be willing to commit to healthy habits, a good oral hygiene regimen, and routine dental visits post-surgery

Potential Concerns

Implant posts rely on osseointegration for stability. When teeth are missing for an extended period of time, the body determines that the jawbone tissue is not required to secure teeth any longer. As a matter of efficiency, the human body directs calcium and phosphorous away from the jaw to other parts of the body that need these minerals. The jaw bone then degenerates because calcium and phosphorous are required to keep bone dense and healthy. Poor bone density can prevent osseointegration from occurring, thus it also poses concerns for dental implant success. A bone graft can improve bone density and one's candidacy for a successful dental implant procedure.

Gum disease is also a potential problem for implant candidates. One effect of chronic periodontitis (the advanced form of gum disease that causes tooth loss) is bone deterioration. Bacteria eat away at the connective tissues on teeth roots, and also destroy gums and bone. Gum disease should be addressed prior to implant placement.

Approximately 20 percent of dental implant patients need a sinus lift prior to implant surgery1. While shallower implant posts and new technology, such as the iRaise implant by Maxillent Ltd., may ultimately reduce this percentage, those who require a sinus lift face a rather invasive procedure with a three- to ten-day recovery period.

A patient who has trouble healing after surgery may also not be a suitable candidate for dental implants. In some cases, an implant dentist will agree to place implants in a slow healer, but the patient requires close monitoring throughout the recovery process. In addition, long-term use of biophosphates for osteoporosis may interfere with implant success, as may other medications. You must disclose all medications and medical history to your implant dentist during your initial consultation.

View Dental Implants Before & After Photos

Prerequisite Procedures

Bone Grafting: Also called bone augmentation, a bone graft is intended to build up bone tissue density and mass. Bone grafts can be harvested from your own body, and this type of graft yields optimal success potential. Grafts may also be harvested from a cadaver or cow, or be created from synthetic material. The dentist may want a cone-beam, 3D radiograph of your jaw prior to performing bone graft surgery. The image will help the dentist know exactly where to secure the graft for best results. Under local anesthesia, your jaw will be supplemented with the harvested or manmade bone material. Your own bone marrow and another substance that promotes bone growth will be added to the grafted bone, which will be secured in place with small screws. A membrane and sutures will close the surgical site, and the patient will be prescribed antibiotics and pain medication. A bone graft heals over the course of six to nine months. After this time, the dentist can determine whether an implant may be successfully secured into the reinvigorated jaw bone.

Periodontal Disease Treatment: In mild cases of gum disease, a deep cleaning and diligent daily homecare, along with special mouth rinse and toothpaste, may provide adequate treatment to restore oral health. If gum disease has advanced, however, surgery may be required. A periodontist can remove necrotic (dead) gum tissue to promote regrowth of healthy tissue. If bone tissue was damaged from the disease, a bone graft may be required, as well. Gum disease is a chronic, progressive condition. This means, once diagnosed, a patient will require regular-rechecks and must take special care to avoid recurrence.

Sinus Lift: For a sinus lift, space is made between the membrane tissues at the base of the maxillary sinus so that a bone graft may be inserted. The area of the graft is above the molars on the upper jaw, just behind the cheekbones. The procedure is necessary to create thick, dense bone tissue for implant post placement. The bone graft produces new bone tissue in six to nine months, and after this phase, an implant post may be secured. Various situations make sinus lifts for implant placement unsuccessful in half of all cases.

Costs

Implant costs range from a few thousand to several thousand dollars. Factors that contribute to cost include:

  • Region
  • Materials
  • Patient health
  • Whether prerequisite procedures are necessary
  • Number of implants being placed
  • The type of prosthetic the implant(s) will secure

In some cases, dental insurance will pay for all or part of the fee for the restoration of a dental implant. Rarely do insurance companies cover surgical placement of implant posts. However, financing may be available through third-party institutions such as CareCredit®, Springstone®, and private banks to help qualified patients break up the cost of dental implants into manageable .

Comparison to Other Prosthetics

Implants are superior to other dental prosthetics for many reasons. First, they're self-sufficient. Like a natural tooth, a dental implant is anchored into the jaw. Bridges, in contrast, require that healthy teeth be crowned and bear the burden of the replacement tooth or teeth. Upper dentures can rely on natural suction, and upper and lower dentures require denture adhesive. However, all dentures depend upon natural, bony ridges on gums to help keep them from sliding and moving. Wearing dentures for years wears down the natural, bony ridges, and as a result, dentures become more prone to slippage. Implants, whether retaining one tooth or a multiple-tooth prosthetic, do not rely on healthy teeth, adhesive, suction, or the bony ridges for support.

Unlike traditional dentures and bridges, dental implant posts can last for decades or even a lifetime, with proper care. Daily brushing, flossing, and regular dental exams and cleanings are all that's required in caring for implants. Over time, the prosthetic teeth that implants support may wear out or become damaged. Replacing the prosthetic teeth is quick and easy, and it does not require surgically altering the implant post.

Payment

Although dental implants come with a hefty initial price tag, their long-term value is unmatched. For patients requiring prerequisite bone grafting or a sinus lift, the cost is greater. While insurance won't necessarily pay for a complete implant procedure, a creative combination of insurance and financing can make dental implants an affordable option for most patients.

Financing

Patients can apply for dental implant financing with third party banks or their own private financial institutions. Those who are members of credit unions may qualify for a low-interest loan to pay for dental implants. In addition, most dentists accept major credit cards, and some will split payments made by credit card, over a period of three months or longer. Rarely, dentists offer in-office financing options to current patients in good financial standing with the practice.

Insurance

According to the National Association of Dental Plans, some dental insurance providers and discount plans now offer limited coverage for dental implants. Patients should check with their medical and dental insurance providers, as well as their dental discount plans, if applicable. In addition, funds from health savings accounts (HSAs) may be applied toward dental implant fees.

How to Choose an Implant Dentist

Placement of dental implants involves out-patient surgery, usually performed in the dentist's office. Training courses in which general dentists learn to place dental implants vary greatly. Some are weekend courses, while others require significant coursework and hands-on experience. While it's not required, to earn associate fellowship with the American Academy of Implant Dentistry (AAID), dentists must:

  • Undergo 300 hours postdoctoral training in dental implants
  • Have a year of experience as an implant dentist
  • Have experience in the surgical placement of implants and restorations
  • Successfully complete a written exam
  • Present five of his or her own successful implant cases of defined types
  • Attend at AAID annual scientific meetings

Full fellowship requires a greater commitment.

Prosthodontists, Oral Surgeons, and Periodontists

"Prosthodontists, oral surgeons, and periodontists have advanced training in oral surgery and are qualified to place dental implants."

Often, general dentists decide to refer patients out to specialists for more complex procedures, like impacted molar extraction, root canal therapy, and dental implant placement. Prosthodontists, oral surgeons, and periodontists have advanced training in oral surgery and are qualified to place dental implants. Prosthodontists focus on the area of dentistry having to do with replacement teeth, and implants certainly fall into this category. Oral surgeons handle all types of oral and maxillofacial surgery, so they are experienced at implant placement. Periodontists study and treat the supporting structures of teeth, which include gums and jawbone tissue. Implants are inserted beneath the gums, into the jawbone, so periodontists are well suited for this type of procedure.

Associations and Courses

In the United States, general dentists and specialists can join the American Academy of Implant Dentistry and the International Congress of Oral Implantologists. Each specialty recognized by the American Dental Association also has an association. Periodontists have the American Academy of Periodontology; oral surgeons have the American Academy of Oral and Maxillofacial Surgeons; and prosthodontists have the American Prosthodontic Society, as well as the American College of Prosthodontists and the Academy of Prosthodontists. Each of these specialties also has a governing board. For implant dentistry courses, implant associations, manufacturers, and some private educational institutions offer coursework and hands-on training.

The Initial Consultation

Many times, patients who currently wear traditional upper dentures, lower dentures, or both suffer from issues such as looseness, wobbling, slippage, a poor fit, and a cumbersome daily care routine. These issues can negatively impact one's lifestyle and be extremely inconvenient. If you're interested in becoming an implant patient, your dentist will evaluate the state of your oral health, including your:

  • Jaw bones
  • Temporomandibular joints (TMJs)
  • Occlusion (bite)
  • Overall oral health

He or she will also consider your overall physical health, as the healthier the patient, the better the chance of implant success. Your examination may include:

  • X-rays
  • Panoramic x-rays
  • 3-D imaging
  • Review of your dental and health records
  • Review of a list of medications you are currently taking
  • A thorough discussion about your case, concerns, and expectations

It is imperative that the dentist finds you to be a good candidate for dental implants, because the success of the procedure will be based in part on your cooperation and compliance.

Case Presentation

After the dentist has evaluated your records and spoken with you about having implants placed, he or she can formally present your case. At this time, he or she will explain any necessary prerequisite procedures, in addition to the state of your oral health. He or she will also talk with you about what to expect during dental implant placement, recovery (osseointegration), and placement of your final prosthetic. He or she will also answer your questions about ongoing care for dental implants. With proper care and maintenance, dental implant posts can last for decades or even a lifetime.

View Dental Implants Before & After Photos

Case Acceptance

After talking with the dentist about your case, if you determine that implants are right for you, you will formally accept the case. This means that you will agree to undergo dental implant surgery and restoration. A treatment coordinator will explain payment options, as well as costs and scheduling your appointments. If you have questions about any part of your case, whether clinical, regarding your comfort, or about finances and scheduling, do not hesitate to ask. Your peace of mind will come from understanding what to expect from the dentist and what is expected from you, as the patient.

Dental Implant Options

One tooth can be replaced with an implant-supported crown instead of a traditional fixed bridge. A traditional dental bridge features one or more solid, manmade teeth attached in a bridge formation to crowns at either end of the prosthetic. The crowns are secured permanently to natural, healthy teeth on either side of the space where one or more teeth are missing. A traditional bridge requires that strong, healthy teeth be altered to hold dental crowns. In the past, crowns were the only way a dental bridge could remain secure. Dental implants offer a conservative alternative to crown-secured bridges.
Implant-supported restorations are independently anchored into the jaw on a titanium post. Their structure mimics that of a natural tooth, because it features a root and a crown. The root portion is the titanium post. Replacing one tooth with an implant simply means securing a single implant post into the jaw, and topping it with an abutment and a dental crown. In contrast, a bridge requires crowning to healthy teeth to secure the prosthetic teeth in place. In some cases, one or two implants can hold a bridge that replaces multiple teeth.

"A diverse selection of manufacturers have dental implants on the market today. The most well-known are Branemark, Nobel Biocare, and Zimmer."

Denture-Retaining Implants

Dental implants can also anchor a full denture or a partial denture. In most cases, four to six implant posts are secured into strategic locations in the jaw, where bone is most dense and the implants can endure the most pressure. Implants can secure upper or lower dentures, or partials on either arch. Implant - retained dentures may be fixed, meaning permanent, or removable. For the denture patient, implant - retained dentures can greatly improve quality of life. Implant - retained dentures do not slip, loosen, or wobble, so they offer optimal stability and security. With implants, denture wearers can dine out and speak confidently in public, which ultimately improves mental outlook and quality of life.

All-on-4®

As mentioned above, dental implants may be secured to four or six implant posts. Nobel Biocare, a respected implant manufacturer, markets a product called All-on-4®. The All-on-4® procedure involves placing an implant on four titanium posts. What makes this Nobel Biocare All-on-4® technique unique is that a metal guide is fabricated to use during surgery. The surgical guide allows for extreme precision with implant post placement, and temporary implant restorations can be secured the day of surgery. Some call this procedure implants in a day, same-day implant dentures, or implants in an hour. However, one does not need Nobel Biocare All-on-4® in order to enjoy implant - retained dentures. An implant dentist can secure four to six individual implant posts strategically into the jaw, without a surgical guide, to retain a denture. In most cases, implant-retained dentures are fixed, or non-removable, but they may be made removable if the patient and doctor prefer.

Mini Dental Implant

As a patient ages, his or her body's tolerance for surgery and ability to recover quickly declines. In addition, jaw bone deterioration, a type of osteoporosis, may increase with age. When a patient has insufficient jaw bone density to anchor a dental implant, and age or health prohibits him or her from undergoing a bone grafting procedure, mini dental implants may be a good choice. Mini dental implants feature a screw instead of a post. This screw can be inserted directly through the gums into the jaw. No flap surgery or sutures are required. No bone grafting is required, either. In some cases, miniature dental implants are the best solution for a patient. However, mini implants do not offer the level of stability, and thus the potential longevity, of traditional dental implants placed in dense bone tissue in a healthy mouth.

Major Brands & Suppliers

A diverse selection of manufacturers have dental implants on the market today. The most well-known are Branemark, Nobel Biocare, and Zimmer. As the number of aging baby boomers increases, the amount of people who will need dental implants will also increase. Although access to dental care is greater now than it has ever been, many Americans live life with ill-fitting dentures or without teeth. For such people, implants offer an amazing opportunity for improved quality of life and self-confidence. As technology in the dental field increases and dental materials are developed, more and more implant suppliers will arise in the market, with better, less invasive products.

Before the Procedure

Candidacy for dental implant greatly depends upon the oral health and overall health of the patient. Considerations include:

  • Current medications
  • Autoimmune diseases and other medical conditions
  • Health and density of the jawbone where the implants are to be placed
  • Periodontal, or gum, health
  • Age

After a thorough evaluation, your dentist can determine whether dental implants are the best option to replace your missing teeth. In some cases in which job bone density is poor, a bone graft can improve candidacy for dental implant placement. Likewise if a patient suffers from gum disease, periodontal therapy may improve the patient's candidacy for implants.

The Procedure

If you and the dentist deemed that you are healthy and prepared for dental implant placement surgery, the dentist will discuss sedation options prior to the day of surgery. Your dentist will also explain what you can expect during the implant surgery and throughout recovery. If your dentist has prescribed oral sedation for your surgery, you will take the sedative pill about an hour before your procedure. You will need a ride to and from your appointment, so be sure to arrange this beforehand. If you will have nitrous oxide, you will still be able to drive for and after your procedure. It is a good idea, however, to have someone escort you after your surgery.

Surgery

At your appointment, after the sedative is administered, you will relax in the operatory chair and a surgical suite. The dentist will create an opening in your gum and a space in your jaw for each implant post, then secure the posts and with an additive that promotes bone growth. Over the course of three to six months, osseointegration will occur. During this time, the titanium post will fuse with the jawbone tissue to create a strong, solid foundation for an implant restoration.

Temporary Placement

You may wear a temporary flipper or crown during the osseointegration process, particularly if you're implant is being placed in the front of your mouth, in the area that shows when you smile. The flipper or crown is only temporary; it must be replaced with the permanent crown after your jaw has completely healed. Space some dentists prefer not to place a crown, because it can disturb the surgical site. Another deterrent is the $300 to $400 average cost of the temporary crown.

Recovery

For most patients, caring for dental implants is similar to caring for healthy, natural teeth. Twice-daily brushing and once daily flossing will remove plaque, food debris, and bacteria. The dentist will advise you on how often to attend checkups and professional cleanings. If you wear a removable implant retained denture, there will be special care instructions for your denture.

Restoration Replacement

Dental restorations of any type do not last forever. At some point, your implant-retained crown, bridge, or denture may need to be replaced. Generally, dentists can replace implant-retained prosthetics without performing surgery.

Results

With proper daily oral care and professional dental visits, and in the absence of disease or injury, dental implant posts can remain strong for decades. When the implant-retained prosthetic (crown, bridge, partial, or denture) wears down, or if it breaks, it can be easily replaced. No additional surgery is required, unless the implant posts become loose.

Benefits

In a two-month follow-up study on dental implant patients, a study published in Evidence-Based Dentistry1 in 2002 revealed that dental implant-retained dentures offered improved oral health and quality of life over conventional mandibular (lower) dentures. More recently, in 2013, Straumann, an international dental implant manufacturer, published a review2 of 14 previous studies. The Straumann report found that implants are cost-effective for single and multiple tooth replacement, and furthermore, implants to replace multiple teeth led to improved oral health and quality of life. These findings are logical, when one considers the many benefits of implants.

Comfort

Implants essentially become part of the body. The posts literally fuse with jawbone tissue. Implant patients no longer have to remove their dentures, because implant-retained dentures can be permanently fixed. Because of this, the patient no longer has to hassle with removing, soaking, and re-affixing their prosthetic. Instead, the prosthetic feels like a natural part of the body.

Confidence in Function and Appearance

Like natural, healthy teeth, dental implants anchor into the jaw by way of a titanium post that fuses with bone tissue. As an anchor that replaces teeth roots, an implant post creates a firm foundation for single replacement teeth or a bridge, partial, or denture. This solidity ensures that the patient's teeth will not loosen, wobble, slip, or slide out of place during biting, chewing, speaking, or performing other oral functions. When fabricated from high-quality dental materials that imitate natural gum tissue and tooth enamel, implant-retained prostheses can look natural and attractive, even more attractive than one's original teeth.

Bone Retention and Oral Health

Natural tooth roots move when we bite and chew. This motion stimulates the jawbone, telling the brain that the jaw needs to support the teeth, so calcium and phosphorus are delivered to the jawbone as nourishment to keep bone strong. This phenomenon is called the piezoelectric effect. The only prosthetic that offers the piezoelectric effect are implants, because implant posts replace teeth roots. Conventional crowns, bridges, partials, and dentures only replace the crowns of lost teeth. Therefore, the brain is not alerted to direct the body to continue delivery of essential nutrients to the jawbone. Over time, bone density decreases due to a lack of calcium and phosphorous in the jaw. The jawbone deteriorates and shrinks in size, and this can cause a sunken facial appearance known as facial collapse.
A significant oral health benefit of an implant-retained bridge is that natural, healthy teeth do not have to be reduced and crowned to bear the weight of the bridge. With implants, natural teeth are left undisturbed.

Risks

All surgeries pose some degree of risk, but over 10 years, implants have a 95 percent success rate.

Our bodies are covered by protective skin. The jaws are covered with gum tissue. Ideally, gums keep underlying oral structures safe from damage and bacteria. However, when surgery is required, as is the case when placing dental implants, a number of issues may arise. Injury and damage to other teeth, blood vessels, and surrounding tissues may occur. Should a nerve be accidentally damaged, the patient may experience lingering pain, tingling, and numbness for an undetermined time. Implant posts improperly placed in the top jaw may puncture the sinus cavity. Of course, infection from bacteria, during surgery and healing, is a risk, as well. While these potential problems can arise, patients who select a reputable, experienced implant dentist are less likely to suffer negative side effects of implant surgery. Check your doctor's references and interview him or her thoroughly before deciding whether he or she is the right implant dentist for you.

Implant Failure

Smoking, uncontrolled diabetes, untreated osteoporosis, high alcohol consumption, and significant radiation exposure on the head and neck increase the risk for implant failure. For postmenopausal women, implant failure is more of a risk in the absence of hormone replacement therapy3. Persistent infection at the surgical site, loosening implant posts, nerve impingement, and implant puncture of a sinus cavity, nose, or lingual space, are causes for implants to be removed. If the underlying problem can be corrected, the patient may become a candidate for implants after the oral cavity is healthy.

Reduce Risk for Failure

Many factors increase the risk for dental implant failure. Patient and doctor should work together to reduce risk by being thorough before and during the implant procedure. The patient should disclose all medical history, including medications, to the doctor. The doctor and patient must commit to a thorough diagnostic and case planning phase. Precise placement of the implants is imperative, and to accurately define the ideal location in the jaw for implant posts, x-rays and, in some cases, 3D images, are a wise investment. These images eliminate much of the educated guesswork and allow an implant case to be planned, based on facts. The patient and doctor must also commit to using quality materials for the implant post, abutment, and crown. Sub-par materials are a financial shortcut that can result in implant failure. By spending the proper amount of time and money on implant placement and restoration, patient and doctor will reduce the potential for failure and become part of the 95 to 98 percent success rate of dental implants.

Temporary Side Effects

Discomfort after dental implant placement surgery is usually brief and can last as long as two weeks. Bleeding subsides about 24 hours after surgery. Biting on a wet teabag or gauze pad, remaining in an upright, seated position, and limiting activity will reduce bleeding. Swelling should be expected for 48 hours after surgery, followed by bruising of a black, green, yellow, or blue color. Moist heat and reduced activity can soothe bruises and swelling. Pain may linger, particularly in the cheeks, chin, nose, and eyes, but will subside some each day. Over-the-counter or dentist-prescribed pain relievers will help minimize or eliminate pain. If you are prescribed antibiotics, take all of the pills as prescribed; finish the medication to reduce risk of infection.

Eating and Drinking After Surgery

Continually drink water after implant surgery. This will keep the body hydrated, which promotes prompt recovery. Do not drink through a straw or consume hot foods and beverages. For 12 to 24 hours following your procedure, eat soft foods. After this period, return to your normal diet, unless the dentist advises differently.

Oral Hygiene after Surgery

You may be given a special oral rinse to use twice a day after your procedure. Rinse your mouth for 30 seconds or longer with each use. Warm salt water should be swished around the surgical site, gently, approximately five times a day, and certainly after eating a meal. Brush your teeth normally, taking special care to be very gentle at the surgical site for the first few days. A clean mouth will heal faster than a mouth that's riddled with bacteria and food debris.

Speech Issues

Expect an adjustment period as your tongue and mouth become accustomed to speaking with your implants in place. Over time, your speech will become normal and natural. Many patients speak more clearly with dental implants.

FAQs

How much do dental implants cost? The price of dental implants varies significantly, based on a number of factors. The patient's health, and whether prerequisite procedures are necessary, certainly affect price. The number of implants required, as well as the type and quality of the prosthetic, also influence cost. Location, and local economy, are often factors in implant pricing, as is the doctor's training and expertise. The most important consideration for the potential implant patient should be peace of mind. You need to feel confident in your implant dentist and comfortable in his or her office. Ultimately, because dental implants greatly enhance quality of life and confidence, and because they can last a lifetime with proper care and good oral health, dental implants are a cost-effective, logical solution to replace missing teeth.

What is an implant dentist or implantologist? Implant dentist and implantologist are synonymous. Any general dentist can be an implant dentist and perform both surgery and placement of dental implant restorations. However, most general practitioners place implant restorations, meaning the crown, bridge, partial, or denture that fits on implant posts. A good number of general dentists prefer to refer the surgical phase of an implant case to an oral surgeon or periodontist.

Do I need an implant to replace each of my missing teeth? No. One implant post can hold one implant restoration, or crown. Two implants may secure a bridge or partial. Four to six implants are often sufficient to stabilize an upper or lower denture.

Does implant surgery hurt? Like all oral surgeries, implant placement is performed with anesthesia. Some dentists use nitrous oxide and local anesthetic, while others prefer to deliver oral sedation, conscious sedation (oral and nitrous oxide), or IV sedation when placing implants. Most patients report post-procedure pain, and dentists commonly prescribe over-the-counter or prescription pain relievers and a special diet during the first few days after surgery. The diet should include a good amount of water, no use of a straw, and soft, cool foods that don't need to be chewed. Soups, yogurt, hummus, and guacamole are good examples of tolerable foods after implant surgery. Do not chew on the implant or implant restoration until the dentist tells you to do so. If your implant abutment or restoration dislodges, contact your implant dentist immediately so that it can be reattached.

A bit of bleeding or oozing is normal, and the patient can bite on gauze or a moist teabag for about a half hour to reduce bleeding or oozing. After implant surgery, smoking is strictly prohibited during healing. Stitches will naturally dissolve in about a week, but if they come loose before this time, the patient should not worry unless excessive bleeding occurs. Swelling will subside in approximately 24 to 48 hours following surgery and can be minimized by applying an ice pack to the outside of the cheek, over the area where the implant was placed. To aid healing, elevate the head at a 45-degree angle when lying down.

An implant patient should rinse the mouth with room-temperature salt water three times per day for about a week, and brushing can resume the day following surgery. Be cautious not to scratch or irritate the implant surgery site while the mouth heals. Dentures and partials should not be replaced without the consent of your dentist. Implant patients should attend all follow-up appointments on time, as directed by the dentist, to ensure optimal results from implant placement surgery.

Will implants make dentures more comfortable? With traditional dentures, the underlining rests on the gums, on natural ridges. For upper dentures, natural suction or adhesive creates stability; for lower dentures, adhesive is required. Over time, friction between the denture underlining and gums causes natural bony ridges to flatten. When this occurs, dentures must be relined for a more accurate fit. Ultimately, the gum ridges completely wear down, and the gums become smooth and flat, and dentures, even with adhesive, become chronically loose or wobbly. The potential for slippage increases. In other cases, patients never find a comfortable fit with a denture. Because implant-retained dentures snap or are affixed to posts anchored in the jaw, they will not loosen, wobble, or come loose. They usually fit comfortably, from day one. Furthermore, because of their stability, implant dentures make the patient feel more confident and comfortable in public, particularly when dining out.

Are implant dentures removable or fixed? Either. Your implantologist will discuss your preference and explain the pros and cons of fixed and removable dentures. You can then decide which option will work best with your lifestyle.

When are mini dental implants a good choice? Miniature dental implants are best reserved for older patients who have poor jawbone density, but cannot endure bone grafting surgery.

Will insurance pay for dental implants? Dental and medical insurance policies can be extremely diverse in their coverage. In some cases, dental insurance will cover all or part of the cost of prosthetics, and medical insurance will cover all or part of implant placement surgery. However, not all insurances cover dental implants. Most dentist offices accept credit cards and offer payment options through third-party banks or in-house financing.

1http://www.dentistryiq.com/articles/2013/02/making-painful-sinus-lift-dental-implants-a-thing-of-the-past.html

2 Evidence-Based Dentistry (2002) 3, 73-74; doi:10.1038/sj.ebd.6400115

3 http://www.straumann.com/en/home/media/media-releases/2013/tag_xml_newsbox_ch2013-07-04149789digest.html

4 http://www.researchgate.net/publication/11146395_A_meta-analysis_evaluating_the_risk_for_implant_failure_in_patients_who_smoke/file/72e7e51f94d10ea464.pdf

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