Procedures

• Dental Implants
• Bone Grafting
• Wisdom Teeth
• Jaw Surgery
• TMJ Disorders
• Pain & Anxiety Control
• Infection Control

Dental Implants

As long as tooth loss has been a problem for patients, dentists have tried to provide replacement teeth for both functional and esthetic purposes. For small areas where teeth have been lost, "fixed bridges" provided an easy and predictable result (Fig. 1). When the toothless areas became larger or the area was not bounded on both sides by natural teeth, fixed bridges were not feasible and teeth could only be replaced with removable partial dentures (Fig. 2). When all of the teeth were lost full dentures were the only answer (Fig. 3).

Fig. 1

Fig. 2

Fig. 3

Although these various types of prostheses generally functioned well, patient complaints included the need to cut down adjacent teeth for fixed bridges, unsightly clasps with partial dentures, and slippage and poor retention with both partial and full dentures.

Extensive basic science, animal, and human clinical research has developed a system of dental implants which, when placed in the jaw, can serve as "anchors" for tooth replacement. This two stage surgical procedure known as "osseointegration" may eliminate the need for conventional fixed bridges and removable partial and full dentures. Although most patients are candidates for these highly successful procedures, individual variations in potential implant sites as well as certain systemic medical conditions may preclude implant placement or change the overall success rate. These factors are all evaluated and discussed in an in-depth consultation with our surgeons and your dentist.

The cases which follow are representative of the most common dental implant procedures which can be performed as an alternative to fixed bridges and removable full and partial dentures.

 

Fig. 4

Fig. 5

Single implants can be used to replace individual teeth without the need to use adjacent teeth for support as in fixed bridges (Fig. 4, 5).

Surgical Advances

Using the most recent advances in dental implant technology, Drs. Schabes, Sacks, and Amrani are often able to place single stage implants. These implants do not require a second procedure to uncover them, but do require a similar healing time before artificial teeth are placed. There are even situations where the implants can be placed at the same time as a tooth extraction – further minimizing the number of surgical procedures.

Dental Implant placement is a team effort between an oral and maxillofacial surgeon and a restorative dentist. While Drs. Schabes, Sacks, and Amrani perform the actual implant surgery, initial tooth extractions, and bone grafting if necessary, the restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.

What Types Of Prosthesis Are Available?

A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed or removable bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis is planned or recommended. A removable prosthesis (overdenture) attaches to a bar or snap attachments, whereas a fixed prosthesis is screwed down or cemented and removable only by the dentist.

Drs. Schabes, Sacks, and Amrani perform in-office implant surgery in a hospital-style operating suite, thus optimizing the level of sterility. Inpatient hospital implant surgery is for patients who have special medical or anesthetic needs or for those who need extensive bone grafting from the jaw, hip or tibia.

Fig. 6

Fig. 7

Freestanding dental implant supported bridges allow "fixed" restorations to be placed in areas not bounded by natural teeth, where only removable partial dentures were available prior to the era of "osseointegration". In areas of cosmetic concern, no unsightly clasps are needed (Fig. 6, 7).

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Overdentures are prostheses which utilize clips and bars attached to implants to assist in holding in the dentures. They improve the ability to chew by reducing undesirable movement while still allowing easy cleansability as a result of their removable nature. Overdentures may be indicated in those patients who have insufficient bone height and width to support a fixed implant borne prosthesis, are limited by the number of dental implants that can be placed, or who lack the manual dexterity to adequately maintain a fixed prosthesis (Fig. 8, 9).

Fig. 8

Fig. 9

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Fig. 10

Fig. 11

Fixed-detachable or "hybrid" prostheses are denture-like replacements, however, they cannot be removed by the patient. Teeth are held in place by screws placed into receptors in the implants and can only be removed by the dentist. This is done periodically for cleanings (Fig. 10, 11).

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Fixed bridges are similar to bridgework on natural teeth where individual "caps" are made on each of the dental implants. The caps are usually made of porcelain and are extremely esthetic. A larger number of implants are required for a restoration of this type and meticulous hygiene is needed to maintain the health of the dental implants and of the gum tissues (Fig. 12, 13).

Fig. 12

Fig. 13

Why Dental Implants?

Once you learn about dental implants, you finally realize there is a way to improve you life. When you lose several teeth – whether it's a new situation or something you have lived with for years – chances are you have never become fully accustomed to losing such a vital part of yourself.

Dental implants can be your doorway to renewed self-confidence and peace of mind.

A Swedish scientist and orthopedic surgeon, Dr. Per-Ingvar Branemark, developed this concept for oral rehabilitation more than 35 years ago. With his pioneering research, Dr. Branemark opened the door to a lifetime of renewed comfort and self-confidence for millions of individuals facing the frustration and embarrassment of tooth loss.

Why Select Dental Implants Over More Traditional Types Of Restorations?

There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a “partial” at night may be inconvenient, not to mention that dentures that slip can be uncomfortable and rather embarrassing.

Are You A Candidate For Implants?

If you are considering implants, your mouth must be examined thoroughly and your medical and dental history reviewed. If you mouth is not ideal for implants, ways of improving outcome, such as bone grafting, may be recommended.

What Type Of Anesthesia Is Used?

The majority of dental implants and bone graft can be performed in the office under local anesthesia, with or without general anesthesia.

Do Implants Need Special Care?

Once the implants are in place, they will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.

 

Bone Grafting

One of the more common questions asked is: “Do I have enough bone for implants?” In some cases, there is insufficient bone to place an implant. This happens most often because of the shrinkage and bone loss that occurs after a tooth is extracted. The bony support for the tooth is no longer needed and it begins to decrease, most significantly in the first three to six months after an extraction. To minimize this bone loss and to quicken the healing time, bone graft substitutes are sometimes placed into the socket when a tooth is removed.

In some instances, however, a more formal bone grafting procedure may be needed to create the necessary support for the implant. Common areas in need of such a procedure are the front of the upper jaw and the back of the lower jaw. In this illustration , bone (usually taken from within the mouth, either from the area behind the lower wisdom tooth or from the chin) is secured onto the bone that is still present and allowed to heal before the implant goes in. Another site often in need of grafting is the back of the upper jaw. Here there may be too little bone below the sinuses (the large air-filled cavities in the middle of the upper jaw). Several procedures are available to help increase the bone volume by raising the bottom of the sinus lining and placing bone and bone substitutes to allow new hard tissue to form. In addition to the graft material used, growth factors concentrated in the blood cells called platelets are prepared and added to the graft for better healing.

The team approach to implant-based dental reconstruction includes you, your dentist, and a qualified, experienced surgeon. Only after a complete clinical and x-ray examination and a detailed consultation can team members develop a treatment plan with the best chances for reaching an optimal esthetic and functional result.