Megan M. Stock, DMD
So What Exactly is a Dental Implant?
When you think about someone losing a tooth, what are the replacement options that come to mind? Although my goal in dentistry is always to prevent tooth loss, sometimes things happen and a patient ends up with a missing tooth or teeth. So we need some options on what to do next. Without getting too in depth on the history of tooth replacement options, I'll briefly review some of the "older" options then spend some time talking about dental implants, which have truly become the gold standard for tooth replacement.
The oldest option when someone loses a tooth is to do nothing. This may seem less than ideal to some, but there are a number of reasons someone may choose to not replace a missing tooth or teeth. Financial hardship, lack of access to a dentist, or a feeling that the missing tooth isn't "important" are all common reasons I hear for choosing to not replace teeth. Aside from aesthetic problems, even a single missing tooth can have long term consequences. Surrounding teeth can begin to shift and create spaces, food traps, and bone loss where, previously, there were no issues. This is why, in most cases, your dental professional will likely suggest some form of replacement if you lose a tooth or teeth.
Another option that has been around for centuries is a removable denture. This picture shows one of the oldest dentures ever recovered by historians. Dentures may replace all of the teeth (a complete denture), or just some of the teeth if a person still has some of their natural teeth (a partial denture). Over the years, many different materials have been used to construct dentures including human or animal teeth, ivory, porcelain and, more recently, acrylics and other plastic based materials. Dentures are a relatively economical way to replace missing teeth, but have their drawbacks including the need to take them out regularly to clean and let the tissues "breathe". Even well fitted dentures have natural movement since they rest on mobile gum tissue. This can be difficult for some patients to get used to. Another common complaint is that sometimes taste can be altered in patients who wear a full upper denture. Lastly, bone continues to change over time in denture wearers and patients will often need adjustments or a new set of dentures after a while.
Another choice in tooth replacement is a permanently cemented bridge. A bridge uses at least two anchor teeth on either side of a missing space that are trimmed down and a solid bridge that looks like individual teeth is cemented onto those anchors, replacing the missing tooth/teeth in between. Floss can be passed underneath the bridge to keep the area clean. Some limitations to this traditional type of bridge include an inability to span a long distance without multiple anchor teeth, an inability to correct defects in the bone, and the need for strong enough support teeth.
This brings us to the latest and most predictable option for tooth replacement- dental implants. Technically speaking, dental implants have been around for centuries, as the Mayans used to hammer tooth-like pieces of shell into the jawbone- yikes! Modern implants, however, have been around since the 1950s. Most implants today are made from titanium because of its ability to fuse with bone, although some treated ceramics are showing promising results as well. The implant itself is the screw shaped piece that is placed into the jawbone. Single crowns, bridges, or dentures can all be placed on top of dental implants.
There are always variations for individual cases, but for the majority of single tooth replacements, the implant is placed in the bone and allowed to heal for a few months. During this time, the bone is actively fusing with the implant post, a process known as osseointegration. Once the implant is verified to be fully integrated, the dentist will take impressions or scans of the mouth and order a custom fitted connector, known as an abutment, and crown from the lab. The crown matches the natural teeth in shape and color and is often undetectable once it's in place. The abutment and crown are permanently placed onto the implant post with a tiny screw and/or dental cement. Once it is placed, the patient is able to floss and brush around the implant tooth just as if it were a natural tooth. Meticulous hygiene practices are necessary to ensure that the gums and bone around the implant do not get irritated or infected.
An implant supported bridge is similar in concept to the single tooth implant replacement except that it utilizes at least two anchor implants and spans a space with no natural tooth or implant. The picture below illustrates this concept. Just like the single tooth replacement, the implant bridge is put on permanently and requires proper brushing and flossing to keep it healthy.
Another way that implants can be utilized is for a patient who has lost all of their teeth. Special attachments can be placed on top of the implant posts that allow a patient to "snap" their denture in and out. This provides a much more stable fit than the traditional dentures, which mainly rely on suction to stay in place. The patient is still required to take these dentures out daily and clean them. This prosthetic is known as an overdenture.
Another implant option for someone who has lost all of their natural teeth is to have a full arch of teeth permanently screwed into multiple implants. This option is fixed in the patient's mouth, meaning that they can clean under and around the prosthetic, but they do not take it out like the overdenture. The picture below shows the difference between these last two options.
With any of the implant replacement options, one of the greatest benefits is that an implant actually preserves the bone. The ridges of bone that are meant to hold in our teeth play a very important role in face shape and fullness. When we lose teeth and do not replace them with implants, the bone begins to deteriorate. This deterioration can lead to a sunken in appearance to the cheeks or lips. By placing implants, bone is preserved and the mouth and face can maintain its more youthful appearance.
With over 50 years of case history and well designed studies to reference, dental implants are a safe and predictable way to replace missing teeth. In general, they are very well tolerated by the majority of patients who receive them. If you have lost or are at risk of losing a tooth, talk to your dental professional about whether implants may be an option for you.
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