Dental implants are artificial teeth that are placed permanently into bone to replace lost or missing natural teeth.

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

There are 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.

Standard dental 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 between them.

Why should 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.

When a 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.

Even with 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.

Available Options For Replacing Teeth/Tooth

Photos demonstrating the natural appearance of dental implants. For this patient, the two lateral incisors were replaced with implants.

Dentists 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:
 

· Dental Implants

· Partial or Full Dentures

· Bridges

There are 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 dentures.

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 manufactured.

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.

Comfort: Dental 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 function normally.

Always ask your dentist why they chose a particular treatment in replacing missing teeth. They should be more than willing to explain their reasoning to you. 

Anatomy 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.

The 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 osteointegrate.

The final 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 replaced.

Dental implant procedure

Different steps involved in implant placement - altogether taking roughly 6 months.

The dental 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.

An oral 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 implant.

Your 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).

Implant 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 underneath.

A 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.

Once the 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 complications.

An 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

Implant 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.

The major 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.

Dental 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 surgery.

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.

Longevity

Dental 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 hygiene.

Advantages of implants over bridges or dentures

There are several important advantages that dental implants hold over other therapeutic options. They are:

• 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 the jaw.
   

• 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.

Disadvantages of implants over bridges or dentures

Even though dental implants have left a lasting mark on the field of dentistry, there are some setbacks. They include:

• Time. 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.
   

• Cost. 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.
   

• Bone 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 density.

Are you a candidate?

Your 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.
   

• Gum disease. If you suffer from periodontal disease, your dentist should first get it under control before considering dental implants.
   

• 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 first.
   

• 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.
   

• Growing children. Dental implants should only be placed in fully developed adults.

Cost

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.

The two 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.

The second 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 $3000.

On average, 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.