implants are artificial teeth that are placed
permanently into bone to replace lost or missing
Although costly and involving surgery, dental
implants are considered the principal treatment
for lost or missing teeth. There are
disadvantages to receiving an implant, and not
everyone is a candidate.
Consequence of a missing tooth
many reasons why you might be missing teeth.
Perhaps a tooth was lost to injury or even
removed because of excessive decay - whatever
the reason; missing teeth are a common complaint
at the dental office.
implants prior to placement. They may
come in different shapes, sizes and
brands, but are all clinically the same
- even if the prices differ dramatically
you get the missing tooth or teeth replaced
though? The most popular reason is aesthetics. A
smile that shows a missing tooth often sends an
uncomplimentary message to others. From a
dentist's standpoint though, there are greater
concerns than just appearance.
tooth is missing, the above tooth might erupt
(coming out of its socket) into the empty space
across from it. A missing tooth can also result
in nearby teeth drifting, or tipping, into the
open space. Problems in occlusion (bite) can
arise, making it difficult to close the mouth.
It is important to note that teeth can move at
any age, so replacing missing teeth is not just
a childhood concern.
such consequences, not all teeth require
replacement. Dentists never recommend
replacing a wisdom tooth for example. Also, in
the case of older patients, most can lead
functional lives while missing their second and
third molars. Always question your dentist's
reasons for wanting to replace a missing tooth
that is not affecting your lifestyle.
Options For Replacing Teeth/Tooth
the natural appearance of dental
implants. For this patient, the two
lateral incisors were replaced with
have several options for replacing missing teeth
- not all options apply to every patient though.
The following are viable options for replacing
one or more teeth:
Partial or Full
various factors that dentists consider in
choosing the best option. Some include:
Cost: Dental implants
are very costly, and are not covered by most
dental insurance programs. Bridges are usually
second in cost, followed by partial or full
Time: Bridges are usually completed by
two appointments in the course of a week.
Dentures are made as quickly, but need
adjustments over a few weeks to fit the patient.
Implants involve surgery, and require several
months for healing. For all procedures though,
temporary teeth will be placed in the open space
while the final prosthesis is being
Number of teeth missing:
When only 1 or 2 teeth are missing, implants are
the best option. Bridges are usually placed when
no more than 2-3 teeth are missing since longer
spanning bridges are prone to collapsing.
Partial dentures are good for cases when more
than 3-4 teeth are missing, and complete
dentures are for when all teeth are missing.
Oral health: The
biggest dental concern is the condition within
the mouth. Few dentists will place implants in
patients who are avid smokers, as they are prone
to failure. Similarly, bridges need to be
supported by nearby teeth, so those teeth need
to be of sound health. Dentures have the highest
success rate in those with poor oral hygiene.
implants are the gold standard for replacing
missing teeth, and many patients can hardly tell
them apart from real teeth. Bridges are also
highly aesthetic and fixed in the mouth, but
keeping them clean can be difficult. Dentures
can appear natural, but can slip out while
eating certain foods, so most patients cannot
your dentist why they chose a particular
treatment in replacing missing teeth. They
should be more than willing to explain their
reasoning to you.
of a dental implant
A dental implant for replacing a
single tooth is composed of three parts. The
first part is the implant screw that is
surgically inserted into your jawbone. This
portion is made of titanium for strength and
biocompatibility – your body sees it as its
own and does not “react” to it. Although most
implants are in the form of screws, they are not
just held in by mechanical means.
The titanium screw is usually
etched with acid, or sandblasted, to create a
rough surface that allows for
osteointegration – your body develops bone
on, and around, the screw to lock it in. For
this reason, implants need 3-6 months to
osteointegrate, but after, are held in the jaw
like regular bone.
abutment is the second portion of the dental
implant. Also composed of titanium, it latches
onto the implant screw and provides a surface
for the artificial tooth to be placed on. The
abutment and artificial tooth are placed only
after the implant screw has had months to fully
portion is the visible crown or
artificial tooth. Made of porcelain, the tooth
appears natural and functions like a normal
tooth. It is attached to the abutment, and
unlike the implant screw, can be removed or
involved in implant placement -
altogether taking roughly 6 months.
implant procedure involves two phases;
surgical and restorative. During the
surgical phase, the screw is
placed into the bone. Several months later, the
restorative phase begins when the
visible porcelain crown is inserted onto the
screw. During those healing months in between, a
temporary crown is in place.
surgeon, prosthodontist or even a well-trained
general dentist, usually does the surgical
placement of the screw. Your general dentist
almost always does the restorative phase though.
Therefore, you may have two different dentists
working together to place and restore the dental
dentist should have done conclusive testing to
make sure you are a good candidate. This
involves a general checkup, various x-rays and
dental impressions. If your dentist has found
you do not have enough jawbone to support a
dental implant, you may receive bone-grafting
surgery first. This usually involves taking
regenerative bone from the hip and placing it in
the jawbone. While more costly and time
consuming, it is required for patients who lack
the bone structure required for supporting an
implant (usually the very elderly).
dentistry is an outpatient procedure (you go
home the same day) and performed under general
anesthesia (you are asleep) or local anesthesia
(you are awake, but sensation to the mouth is
blocked). The entire procedure should run an
hour or two in length if only one implant is
being placed, and begins
(2) with the surgeon incising and
raising the gum tissue to expose the bone
slow-speed surgical “drill” is used to place a
hole into your jawbone that enters your cortical
bone. The dentist is careful to avoid nerves
that run along the region. Following this, the
implant screw is hand-inserted into the hole by
a surgical “wrench” and a cover is placed over
the implant screw. (3)
The gums are then drawn over the
screw and stitched together so that the implant
screw is hidden underneath.
You will be
sent home, and roughly 3 to 6 months are
required for the screw to osteointegrate into
your bone and become firmly set in place. After
roughly a month though, you will return to your
dentist for the temporary abutment to be placed.
Your dentist will provide local anesthetic and
then cut your gum tissue and reveal the implant
underneath. A healing abutment will be placed,
along with a temporary tooth. This is not the
final product – it simply directs your gums so
that they can heal around the artificial tooth
and look like a normal gum line. During this
phase, you need to be careful about the amount
of force or pressure you apply since the implant
screw has not fully integrated into bone.
months have passed by, you will return to your
dentist where the temporary healing abutment and
tooth will be removed. (4)
In their place, you will receive the
final abutment and tooth. Your dental implant
surgery is essentially complete. You should have
several appointments after to ensure everything
is progressing normally and that there are no
increasingly common strategy to preserve bone
and reduce treatment times includes the
placement of a dental implant into a recent
extraction site. In addition, immediate loading
is becoming more common as success rates for
this procedure are now acceptable. This can cut
months off the treatment time and in some cases
a prosthetic tooth can be attached to the
implants at the same time as the surgery to
place the dental implants.
Success rates & possible complications
dentistry has a considerably high success rate –
96% and 91% for the upper and lower jaw,
respectively. Anatomically, the upper jaw has
less bone density than its lower counterpart,
accounting for the differing success rates. For
the same reason, implants placed in the back of
the mouth (molars) have a higher success rate
than those in placed in the front.
reason for implant failure is the lack of
osteointegration. As earlier stated, implant
screws are held in place because the body
develops bone on, and around, the implant. When
this process fails to develop, the implant is
mobile and ineffective. Your dentist may
consider bone-grafting, reinserting the implant
at another site, or remove it altogether and
choose another treatment option.
implants are not susceptible to traditional
dental decay since they are fully artificial,
but problems can develop in the bone that
surrounds and supports the implant. A condition
that mirrors periodontitis, termed
peri-implantitis, can develop. The cause may
be infection that was introduced during surgery;
or failure by the patient to follow correct oral
hygiene routines. In either case, inflammation
in the bone surrounding the implant causes bone
loss and ultimately failure. Peri-implantitis
is often dealt with before it develops by being
prescribed antibiotics in the days prior to
Risk of failure is greatly increased in smokers.
For this reason implants are frequently placed
only after a patient has stopped smoking.
If smoking cannot be stopped, clinicians
often advise patients that a bridge or partial
denture, rather than an implant, may be a better
solution. Even those options have higher
failure rates among smokers though.
implants have been used for over 30 years to
replace missing teeth and they can last a
lifetime depending upon how you look after them.
Like any other restoration your
implant-supported teeth can still be damaged by
trauma and affected by gum disease and poor oral
Advantages of implants
over bridges or dentures
several important advantages that dental
implants hold over other therapeutic options.
Prevention of bone loss and gum recession
that often accompanies bridges or dentures.
Bone, much like muscle, shrinks in size when
it is not regularly used. Since bridges and
dentures do not place force on the jaw at
the site of the missing tooth, that location
often loses bone with time. Implants are
bound in bone, and conduct chewing forces
down towards it – preventing bone loss in
Preservation of adjacent natural teeth.
Bridges require that adjacent teeth be
trimmed and crowns be placed on top to
support the artificial tooth. Dentures also
require alteration of natural teeth.
Implants rely on bone support instead and
the natural teeth are never touched.
Stability. Dentures are fairly mobile when
eating sticky foods or other circumstances.
Bridges are considerably more fixed in
place, but nothing rivals the stability
found with dental implants. Once
osteointegrated, they provide the same
support and stability as your natural teeth.
Reliably successful. Implant dentistry is
roughly 95% successful and tops the success
rates of both bridges and dentures.
implants over bridges or dentures
dental implants have left a lasting mark on the
field of dentistry, there are some setbacks.
Implants take nearly half a year to be
implemented from start to finish. In
contrast, a dental bridges and dentures can
be completed in a few weeks.
Implants are costlier than dental bridges,
and far more than dentures.
Surgery. Implants require surgery, and
therefore, not everyone is a candidate.
Bridge and denture work require teeth to be
modified, but no tissue surgery.
support required. Because implants are bone
supported, you need a certain level of bone
to be present before surgery can be
performed. Teeth-supported bridges and
dentures are not as dependent on bone level
Are you a
dentist is in the best position to tell you of
your cadency for dental implants. By reviewing
your x-rays, dental impressions and oral health,
your dentist has knowledge about your particular
situation. Whether you are a young, middle-aged
or older adult; whether you need to replace one
tooth, several teeth, or all your teeth, there
is a dental implant solution for you.
Nonetheless, here are some of the things that
may exclude you from dental implants:
Existing medical conditions. While
precautions are advisable for certain
conditions, patients with such chronic
diseases as high blood pressure and diabetes
are usually successful candidates for dental
implant treatment as long as their symptoms
are controlled and stable.
disease. If you suffer from periodontal
disease, your dentist should first get it
under control before considering dental
Currently wearing partials or dentures.
Patients who have worn dentures for long
periods of time may suffer from bone loss in
the jaw. Bone grafting may have to be done
Smokers. Smoking doesn’t eliminate the
possibility of getting implants, but it
lowers the success rate to a point that many
dentists refuse to implement them.
children. Dental implants should only be
placed in fully developed adults.
Relative to other
dental treatments, implants are still in their
infancy. As a result, the cost is rather high,
but gradually following as its popularity grows.
phases of treatment, surgical and restorative,
have separate costs and are often even performed
by two different dentists. The surgical fee is
the cost of the implant screw and the surgery
required to place it in the jawbone. This
usually falls within $1500 to $2500 per implant
for the dental specialist.
fee goes towards the restorative phase. This
involves the placement of the artificial
porcelain tooth into the implant screw. Your
general dentist is likely to do this for a cost
that has a greater range; anywhere from $1000 to
you should expect to pay roughly $5000 from
start to finish for a single dental implant.
Having a full mouth reconstructed can cost
anywhere from $25000 to $100,000, but opting for
dental-supported dentures may be the
better/cheaper solution for someone who is
missing all of their teeth.