DENTAL EVALUATION  

Before your dentist determines whether you are a candidate for dental implants, a comprehensive exam will be necessay and will include the following:   
 

Dental and Medical history: Not every one can have implants. Certain factors, such as diabetes, smoking, bleeding disorders, certain medications as well as compromised physical and mental integrity, may influence the procedure and outcome of the treatment.  

Dental Exam: The structures of your jaw, mouth, head and neck are examined. The dentist evaluates the bite and the existing jaw and teeth. Diagnostic models mounted on a dental articulator are essential. 

Diagnostic Tests: A Panographic x-ray provides a view of your entire mouth. X-ray tomography reveals whether the volume of the bone structure is sufficient to maintain an implant. 

Treatment Plan: If dental implants are likely to work for you the size, and any special surgical procedures (bone grafts, tissue regeneration, sinus lift) are outlined.  

Alternatives: If there are other options to restore your dentition, your dentist will discuss them with you. 

Although the first dental implant were attempted  over 2000 years old they still serve the same function: replacing missing teeth. Just like the root of a tooth they are placed in the bone structure of the upper or the lower jaw. The state-of-the-art implants used today are made of a Titanium alloy which may be threaded like a screw or may be cylindrical in shape with a slightly rough or textured surface. Implants often have holes at their lower ends. Implants are surgically placed in the jaw bone and over time bone grows into the surface irregularities allowing adhesion of the implant to the bone by a process known as osseointegration. The surface of the implant may be sprayed with a plasma coating or hydroxy appetite to increase the osseointegration process. 

As implants are used to replace missing teeth, the number of implants placed is dependent upon the span and the location of the missing teeth as well as the type of prosthesis required to restore the dentition.  
 

Single Tooth Implant: This is the case when a single tooth is missing. One implant is placed surgically. Once osseointegration is complete the implant is exposed and a crown is placed on the implant.  

Partial Prosthesis: This type of restoration can replace two or more missing teeth. Generally the implants are placed and used as abutments for a fixed bridge. 

Complete Denture: When the entire dentition from a jaw is missing, full dentures are the result. With time the jaw bone shrinks, the stability of the denture is impaired, and due to lack of retention the denture moves around causing sore spots in the mouth creating problems with eating and talking. To increase the retention of the denture, implants may be used. Either two or four implants are placed. The implants are then joined together by a bar and inside the denture a clip is placed which will hug the bar as positioned into the mouth. Even though this will increase the retention of the implants drastically, the dentures are still considered "removable". A "fixed prosthesis" may be fabricated using five or six implants, which are placed to follow the contour of the jaw. The artificial teeth are then fitted to a metal frame connecting the implant abutments together.

Modern Implants have over 90% surgical success rate. The surgery is generally done in two steps:  

The first surgery is to place the implant. The area is numbed using local anesthetics. The gum covering the sites lifted back. A  hole is drilled into the jaw bone for placement of the implant. The implant is transferred directly from its sterile housing to the recipient site and placed into position. To maintain bone integrity bone grafts or membranes may be used. The gum is then repositioned and sutured into its original position covering the implant completely. The time required for the implant to integrate with the bone is generally three to four  months for the lower jaw and six months for the upper jaw.   

The second surgery is minor. The implants are exposed by simply removing the overlying gum and healing caps are placed in the implants to allow the tissue around the implant to heal around the implant neck. Impressions are taken at a later appointment to build the desired restoration.  
 

Lack of optimal home care can result in plaque build-up and subsequent inflammation of the tissue surrounding the implant. Chronic tissue inflammation can result in peri-implantitis the same as periodontitis in natural teeth and eventual loss of the implant can occur. Foam coated-floss, interdental brush and rotary toothbrushes make cleaning easier.