What Are Dental Implants?

Dr Advocate Avatar IconUpdated: September 1, 2022
By: Dr. Advocate

Replacing a permanent tooth is not a new concept; our ancestors had to contend with it for generations, with some creative solutions. Replacement teeth, or dental implants, were found in 2000 BC in China. Back then, they used carved bamboo pegs to replace missing teeth! Today, dental implants consist of titanium hardware surgically inserted into the jaw bone to replace missing teeth.

Implant technology has dramatically advanced over the past 50 years and has shown great promise for predictable longevity. There are multiple implant companies today, and the majority use bioactive titanium-coated implants that assimilate with the jaw bone. Oral surgeons and periodontists place most implants; however, many general dentists have completed advanced training and are also competent.

There are two types of implant techniques: immediate and delayed implants. Immediate implants occur immediately after the extraction and require adequate bone for retention and engagement of the implant. Premolars and anterior teeth are the most common sites for immediate implants. On the other hand, delayed implants occur four months after extraction and are considered less risky for implant failure.

Recommended Reading: Top 5 Brushing Habits to Break in 2022


What’s involved?

Implants have become the “gold standard” for replacing teeth. It’s a permanent solution that responds most similar to a natural tooth. Before implant technology, partials and bridges were the most common tooth replacement options. Partials are a great option if multiple teeth need to be replaced; unfortunately, they’re removable.

On the other hand, bridges are permanent; however, fabrication requires tooth surface removal of adjacent teeth. Both options are still available today, and it’s essential to understand the pros and cons of each option before moving forward with your treatment.

Bone graft material is often placed after the tooth is extracted, either with or without the implant, depending on if an immediate or delayed implant is planned. Bone graft material consists of cadaver bone, bovine bone or a combination of the two. This material along with a resorbable or non-resorbable membrane, will be placed to encourage integration between the bone and dental implant.

Immediate implants

Pros

  • Implant placed same day as extraction
  • Final crown is placed four months sooner than delayed implant (4-6 months total)
  • Only one surgery is necessary
  • Gum tissue can be shaped and contoured for better esthetics

Cons

  • Higher risk for implant failure
  • More technique sensitive
  • More prone to postoperative pain and swelling

Delayed implants

Pros

  • Less risk for implant failure
  • Less prone to postoperative pain and swelling
  • Allows bone graft to fully integrate prior to implant placement

Cons

  • Final crown takes four months longer than immediate implant (8-10 months total)
  • Requires two surgical procedures
  • More challenging to contour gum tissue around final crown

Why do implants fail?

Dental implantation concept | Why do dental implants fail | My dental advocateAccording to multiple retrospective studies, dental implants have a 98% success rate. Although rare, implants can fail, and the most common reasons are poor oral hygiene, medical issues with delayed healing (diabetes), smoking, and poor surgical technique.

After the implant is placed, the gum tissue is sutured closed, and the healing process begins. If the surgical site is not cared for or cleaned properly, bacteria can congregate and penetrate the vulnerable tissues, impeding the healing process. Like smoking, failure will occur if contaminants interfere with the healing process. If a failure occurs, it often occurs soon after the implant is placed.

If the patient has diabetes or other medical conditions that inhibit healing, it may affect the success rate of dental implants. It’s essential to have your primary care physician verify that your physical health is stable and under control for a predictable outcome. Lastly, the surgical technique can affect the success rate of dental implants.

If contamination occurs during the placement process or the implant is torqued too quickly, the bone tissue may be altered, leading to poor osseointegration and implant failure. Therefore, it’s paramount that the clinician is well trained and competent in the placement of dental implants.


Implant occlusion

After the final crown is secured to the implant, ideal occlusion is required for the implant’s long-term success. Preserving the bone structure that houses the implant is done by limiting excess occlusal forces, limiting excursive chewing forces, and limiting bacteria buildup around the implant. Natural teeth have a ligament around the tooth, known as the periodontal ligament (PDL), which acts as a shock absorber when chewing.

Unfortunately, dental implants lack this, and therefore the occlusal contacts should compensate for this. This means that the impact with the opposing tooth should be light when your teeth come together and are non-existent in an excursive or side-to-side movement. If contacts are present when you chew side to side, the forces will negatively affect the bone integration and may lead to implant failure. If you grind your teeth, a nightguard is highly recommended to prevent unnecessary forces.

Related: Learn more about Crowns


Implant care and maintenance

The “waist” of an implant is more narrow than a natural tooth, so it’s essential to floss well below the gum line to remove plaque located on the metal abutment. The abutment connects the crown to the implant post, inserted into the bone. Also, because the “waist” is more narrow, food impaction around the implant is possible, as the gum tissue cannot fill the space between the implant and adjacent natural tooth.

As a result, over time, the bone around the implant may slowly resorb away from the top of the implant, causing the gum tissue to recede and expose a gap between the teeth, known as a “black triangle.” This can be unsightly, especially between your front teeth, so it’s essential to limit plaque build-up that could accelerate the formation of “black triangles.”

When your implants are being cleaned, your hygienist will use a rubber-tipped ultrasonic scaler or a titanium hand scaler to carefully clean away plaque and tartar without damaging the implant surface. Like natural teeth, the gum tissue will attach to the abutment to seal and prevent bacteria from penetrating the bone. If bacteria begins to formulate along the gum line, it can damage this attachment and potentially lead to bone loss and implant failure.

Related: Best MDA Recommended Products


Final thoughts


Dental implants are expensive and require months of healing. Therefore, it’s essential to understand the pros and cons of your dental implant options and how to maintain them for long term success properly. Have you recently been diagnosed with needing an implant? Do you understand your alternative options? My Dental Advocate’s team of board-certified dentists can provide a second opinion on your planned treatment. We look forward to bringing you peace of mind by verifying your treatment plan, suggesting an alternative, or answering your questions.


Dr Advocate Avatar IconAbout the Author

Dr. Advocate is an actual board-certified dentist with clinical practice experience and a mission to provide accurate dental patient education. He believes everyone should access easy-to-read dental resources presented in layman’s terms with relevant, up-to-date dental research and insight to improve their oral health.




Dental Implants. 3D illustration concept | What are dental implants | My Dental Advocate

What Are Dental Implants?

Dr Advocate Avatar IconUpdated: September 1, 2022
By: Dr. Advocate

Replacing a permanent tooth is not a new concept; our ancestors had to contend with it for generations, with some creative solutions. Replacement teeth, or dental implants, were found in 2000 BC in China. Back then, they used carved bamboo pegs to replace missing teeth! Today, dental implants consist of titanium hardware surgically inserted into the jaw bone to replace missing teeth.

Implant technology has dramatically advanced over the past 50 years and has shown great promise for predictable longevity. There are multiple implant companies today, and the majority use bioactive titanium-coated implants that assimilate with the jaw bone. Oral surgeons and periodontists place most implants; however, many general dentists have completed advanced training and are also competent.

There are two types of implant techniques: immediate and delayed implants. Immediate implants occur immediately after the extraction and require adequate bone for retention and engagement of the implant. Premolars and anterior teeth are the most common sites for immediate implants. On the other hand, delayed implants occur four months after extraction and are considered less risky for implant failure.

Recommended Reading:
Top 5 Brushing Habits to Break in 2022

What’s involved?

Implants have become the “gold standard” for replacing teeth. It’s a permanent solution that responds most similar to a natural tooth. Before implant technology, partials and bridges were the most common tooth replacement options. Partials are a great option if multiple teeth need to be replaced; unfortunately, they’re removable. On the other hand, bridges are permanent; however, fabrication requires tooth surface removal of adjacent teeth. Both options are still available today, and it’s essential to understand the pros and cons of each option before moving forward with your treatment.

Bone graft material is often placed after the tooth is extracted, either with or without the implant, depending on if an immediate or delayed implant is planned. Bone graft material consists of cadaver bone, bovine bone or a combination of the two. This material along with a resorbable or non-resorbable membrane, will be placed to encourage integration between the bone and dental implant.

Immediate implants

Pros

  • Implant placed same day as extraction
  • Final crown is placed four months sooner than delayed implant (4-6 months total)
  • Only one surgery is necessary
  • Gum tissue can be shaped and contoured for better esthetics

Cons

  • Higher risk for implant failure
  • More technique sensitive
  • More prone to postoperative pain and swelling

Delayed implants

Pros

  • Less risk for implant failure
  • Less prone to postoperative pain and swelling
  • Allows bone graft to fully integrate prior to implant placement

Cons

  • Final crown takes four months longer than immediate implant (8-10 months total)
  • Requires two surgical procedures
  • More challenging to contour gum tissue around final crown

Why do implants fail?

Dental implantation concept | Why do dental implants fail | My dental advocate

According to multiple retrospective studies, dental implants have a 98% success rate. Although rare, implants can fail, and the most common reasons are poor oral hygiene, medical issues with delayed healing (diabetes), smoking, and poor surgical technique.

After the implant is placed, the gum tissue is sutured closed, and the healing process begins. If the surgical site is not cared for or cleaned properly, bacteria can congregate and penetrate the vulnerable tissues, impeding the healing process. Like smoking, failure will occur if contaminants interfere with the healing process. If a failure occurs, it often occurs soon after the implant is placed.

If the patient has diabetes or other medical conditions that inhibit healing, it may affect the success rate of dental implants. It’s essential to have your primary care physician verify that your physical health is stable and under control for a predictable outcome. Lastly, the surgical technique can affect the success rate of dental implants. If contamination occurs during the placement process or the implant is torqued too quickly, the bone tissue may be altered, leading to poor osseointegration and implant failure. Therefore, it’s paramount that the clinician is well trained and competent in the placement of dental implants.


Implant occlusion

After the final crown is secured to the implant, ideal occlusion is required for the implant’s long-term success. Preserving the bone structure that houses the implant is done by limiting excess occlusal forces, limiting excursive chewing forces, and limiting bacteria buildup around the implant. Natural teeth have a ligament around the tooth, known as the periodontal ligament (PDL), which acts as a shock absorber when chewing.

Unfortunately, dental implants lack this, and therefore the occlusal contacts should compensate for this. This means that the impact with the opposing tooth should be light when your teeth come together and are non-existent in an excursive or side-to-side movement. If contacts are present when you chew side to side, the forces will negatively affect the bone integration and may lead to implant failure. If you grind your teeth, a nightguard is highly recommended to prevent unnecessary forces.

Related: Learn more about Crowns


Implant care and maintenance

The “waist” of an implant is more narrow than a natural tooth, so it’s essential to floss well below the gum line to remove plaque located on the metal abutment. The abutment connects the crown to the implant post, inserted into the bone. Also, because the “waist” is more narrow, food impaction around the implant is possible, as the gum tissue cannot fill the space between the implant and adjacent natural tooth. As a result, over time, the bone around the implant may slowly resorb away from the top of the implant, causing the gum tissue to recede and expose a gap between the teeth, known as a “black triangle.” This can be unsightly, especially between your front teeth, so it’s essential to limit plaque build-up that could accelerate the formation of “black triangles.”

When your implants are being cleaned, your hygienist will use a rubber-tipped ultrasonic scaler or a titanium hand scaler to carefully clean away plaque and tartar without damaging the implant surface. Like natural teeth, the gum tissue will attach to the abutment to seal and prevent bacteria from penetrating the bone. If bacteria begins to formulate along the gum line, it can damage this attachment and potentially lead to bone loss and implant failure.

Related: Best MDA Recommended Products


Frequently asked questions (FAQ)


loader-image

No, implants are fabricated from titanium, and cavities cannot penetrate and damage this material. Instead, bone loss is the greatest threat to implants, and this can occur when bacteria advance below the gingival attachment and causes inflammation near the bone.

Yes, implants are safe and biocompatible. However, there have been a few cases where patients have been allergic to the titanium implant. Zirconia implants would be a great alternative.

The abutment that connects the implant post to the implant crown is metal, and because it’s metal, it may show through the crown giving off a gray hue. The good news is that a white zirconia abutment can be requested to minimize the altered shade.


Final thoughts


Dental implants are expensive and require months of healing. Therefore, it’s essential to understand the pros and cons of your dental implant options and how to maintain them for long term success properly. Have you recently been diagnosed with needing an implant? Do you understand your alternative options? My Dental Advocate’s team of board-certified dentists can provide a second opinion on your planned treatment. We look forward to bringing you peace of mind by verifying your treatment plan, suggesting an alternative, or answering your questions.


Dr Advocate Avatar Icon
About the Author

Dr. Advocate is an actual board-certified dentist with clinical practice experience and a mission to provide accurate dental patient education. He believes everyone should access easy-to-read dental resources presented in layman’s terms with relevant, up-to-date dental research and insight to improve their oral health.



Related Topics


Dentures

• Oral Appliances

Partials


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