Dental Implants – What are those?If you've never been a dental implant patient before, the concept and process can be confusing and foreign as implants are not what most people think of as day-to-day dentistry. However, implants quickly became the gold standard for tooth replacement after being introduced to dentistry in the early 1980s due to how versatile and predictable they are. Dental implants are made of titanium, one of the most bio-compatible materials on the market, which means even if you have a metal allergy you are still likely to be an excellent candidate for implants. The implant is designed to function as the root of a tooth, meaning it is placed entirely in the jaw bone, as a tooth root is. The top portion of the implant can be a single tooth, a part of a bridge helping to replace multiple teeth, or a component designed to improve a denture or partial denture.
As previously mentioned, implants are now the gold standard in tooth replacement, and for a variety of good reasons:
- No detriment to neighboring teeth: Traditionally, if missing a tooth the dentist would make a bridge. To fabricate a bridge, the neighboring tooth on either side of the space needs to be ground down to allow for a 3-unit bridge (3 crowns fused together that rest on the two teeth) to fit. If those teeth did not need crowns, then they have had a major portion of healthy tooth removed unnecessarily. Bridges set those teeth up for difficulties in the future, such as need for a root canal, cavities in hard to fix areas (you can't floss between the teeth when fused together), and fracture (we're asking two teeth to do the work of three, and the supporting teeth have been whittled down).
- Can look and function like natural teeth: Individual implants mimic a natural tooth better than any other option in dentistry. And unlike bridges, partials, or dentures, the strength of implant biting is often stronger than a natural tooth.
- Designed to be a long-term fix: Although bridges have been successfully used in dentistry for hundreds of years, they generally shorten the lifespan of the teeth that support them and often need to be replaced multiple times over the years. Implants as we know them were introduced in the early 1980s, which means that our current research is only about 35 years old at this point. Over the last three decades implants have changed some and improved greatly to be very predictable restorations. Because they are attached to a human body, nothing can be guaranteed, but we anticipate implants that are well maintained by the patient to last many decades and hopefully for life.
- Prevent bone loss and tooth movement: Without stimulation, our bone atrophies and shrinks away. When a tooth is removed, the bone that used to support that tooth will resorb over time creating defects or dents, changes in face shape, and collapse of the cheeks and lips to make the patient appear older than they are.
When implants are placed, the forces from chewing are transmitted through the restoration (crown, bridge, or implant-denture) into the bone. These forces stimulate the bone so that it maintains density and volume to support the implant, just as the bone surrounding natural teeth does. Also, our teeth prefer to have partners: if a tooth is removed, the opposing tooth will often grow out of the bone because there is no contact. Teeth will also tip or move forward into areas were teeth are missing which can alter and disrupt proper biting.
- Versatility: The most common image of a dental implant is one supporting a single crown, but they can be used in a variety of indications. Implants placed in multiples are able to support bridges to maximize the number of teeth replaced with a smaller number of implants. When a patient has lost bone, four or more implants can be placed to support up to a full arch prosthesis that replaces teeth and the bone that used to support them. Partial and complete denture patients benefit greatly from implants, as "snaps" can be placed on top of the implants instead of crowns and bridges. These snaps help the denture fasten in place and provide a major improvement in stability, comfort, chewing forces, and phonetics. A set of complete dentures can only provide about 25% of the chewing forces that a mouth of healthy teeth can. By adding in just two implants at the lower canine positions, the patient improves to about 60% of their previous chewing ability. With every additional implant those forces increase, and the dentures can be designed to be smaller and less cumbersome which also improves taste, comfort, and esthetics.
- Can be changed or updated: The top portion of the implant can be changed or updated throughout the patient's life. If an implant was first placed to replace a single missing tooth, it can be swapped out to help support a bridge if nearby teeth are later extracted. If many or all of a patient's teeth end up being removed, the crown or bridge can be changed to a snap to help support a partial or complete denture. This ability to modify an implant helps the patient to continue to benefit from the implant as they age and indications change.
- "The entire process under one roof” In many offices, if you need an implant you will be required to travel to outside offices for special x-rays, additional evaluations, the actual implant placement surgery, and multiple post-operative check-ups before you're able to receive your restoration. Here at Atlanta Dental Spa, we understand that our patients greatly prefer not having to go through that ordeal, and we've designed our practice so that we can provide every step of the implant process in our office. All of our doctors are very comfortable restoring implants, and Dr. Andrew Currie is our implant surgeon who will walk you through every step of the way during your consultation. Depending on your scenario, Dr. Currie may also be your restoring dentist as well.
Dental Implant Consultation and EvaluationAt the beginning of your dental implant journey you will complete an oral evaluation and consultation with Dr. Currie where, using a state-of-the-art Cone Beam CT 3D scan, he will evaluate your bone to make sure you are a good candidate for dental implants. A virtual surgery can be done on a computer to plan exactly what size, position, depth, and angulation your implant should be which helps determine if you would require or benefit from any bone or gum grafting before or during implant placement. At this point we're able to discuss all of your treatment options and indications as well as answer any and all questions you may have. Step by Step of Process
- Consultation with Dr. Currie
- CT scan
- Surgical guide
- Sedation and surgery
- Tissue and bone development (with a temporary restoration)
- Final restoration
Safety First! CT Scans, every timeHere at Atlanta Dental Spa, we are always planning for your safety and comfort which comes in many forms during the implant process. We mentioned the 3-D planning process using CT scans, which is critical. You are a three-dimensional thing, and so any implant surgery should be planned in a 3-D manner to help safely avoid important anatomical structures like your sinuses and nerves. Proper planning = Predictability
I.V. SedationDespite all of these safety features, we understand that the idea of implant placement can give patients some anxiety which is why we encourage our patients to take advantage of the I.V. Sedation we offer to make the surgery a comfortable (and forgettable) experience. I.V. Sedation is a very safe method of anesthesia, where the medications are short-acting (you feel like yourself shortly after the procedure) and reversible (in case of emergency we can wake you up immediately, which is not the case in many general anesthesia procedures). Something many patients don't realize is that sedation was brought into dentistry to make treating patients with any type of cardiac condition or history (high blood pressure, heart surgery, heart attack, or stroke) much safer, as pain, anxiety, and blood pressure are all much easier to control when relaxed and sedated. Most patients report only remembering the beginning of the appointment and being helped into their car for their designated driver to take them home.
Growth FactorsAnother state-of-the-art approach Atlanta Dental Spa uses is implementing autologous growth factors into many of our procedures. What that means is while you snooze through your surgery, we draw up a few vials of blood (just like giving a sample at the physician's office) and place them in a centrifuge while we work. The blood is separated into two parts: the portion that doesn't aid in healing, and the portion that is critical to healing. This concentrated clot of plasma is rich in your growth factors, platelets, fibrin, hormones, and proteins that encourage rapid bone and soft tissue healing. There is no way to reject or be allergic to this, as it is the refined, best version of your very own blood. This jump-start to healing helps minimize discomfort and swelling and accelerates the healing process.
Thinking about your final tooth at every stepOne of the most common complaints from dentists who do not place implants in their office is that when a patient is referred out, they return with an implant in a different place than they were envisioning which creates difficulties when making the final prosthesis. From the surgeon's standpoint, they're always trying to do their best with the given scenario of where the patient's bone is located. Sometimes the surgeon has to make a judgment call on changing the position of the implant, and they do not have the luxury of asking the restoring dentist's opinion during the surgery. At Atlanta Dental Spa, Dr. Currie consults with the restoring dentist throughout the process for initial treatment planning, during the surgical procedure if needed (as the restoring dentist is right down the hall), during tissue development and staging of other restorations if there are multiple teeth being treated, and during the final restoration fabrication when choosing design, materials, etc. Also, Dr. Currie is a restorative dentist as well, so although his main focus and additional training has been primarily about surgery, implants, and I.V. sedation, he is always evaluating the patient with the final restoration in mind. Having a restorative mindset is critical so that our goal and your goal align to give you the smile you desire.
Pop Quiz: Which of the following patient(s) have an implant as one of their front teeth?
Background on Dr. Currie:Dr. Currie was hired by Atlanta Dental Spa to function as the surgeon for our practice where the vast majority of the procedures he offers are with implants in mind: careful extractions to preserve healthy bone, bone grafting to augment the volume and quality of bone at implant sites, sedation to make surgeries relaxing and easy on the patient, 3D planning and guide fabrication for safe and predictable surgeries, implant placement and fabrication of same-day temporary teeth (when indicated), tissue development during the healing process to create the most natural, life-like result possible, and often delivery of the final prosthesis with special consideration to the nuances of proper biting on implants. Dr. Currie spent two years in a post-doctoral residency that he sought out specifically, as it's one of the best implant-focused residencies in the nation where he was Chief Resident. He was one of the youngest recipients ever of the highest award (Diplomate) offered by the International Congress of Oral Implantologists, and he has been a lecturer and instructor in numerous hands-on implant placement courses. On his days off, Dr. Currie often volunteers as part-time faculty at The Dental College of Georgia at Augusta University's General Practice Residency where he helps teach young dentists surgical techniques and implant placement. Recently, a number of Dr. Currie's implant cases were added to the curriculum for the American Academy of Implant Dentistry's Georgia Maxi Course to help teach dentists about immediate implant placement (when an implant is placed moments after extracting a tooth) and a technique on fabricating a temporary tooth to be delivered at the same time.
Who is a candidate?We frequently hear patients report that they'd been told previously that they are not candidates for dental implants. These days, it’s fairly rare to be a patient that cannot have implants. That being said, as time passes with teeth missing the bone that used to support the teeth will shrink and therefore bone grafting may be required, but that has become a routine aspect of tooth replacement.
Who is a candidate?
- Almost everyone!
- Denture patients
- Patients with missing or failing teeth
The main demographics and reasons for not placing implants:
- Smokers/Tobacco users (lowers success rates, but implants are often still a good option)
- Poorly controlled diabetics
- Very young patients (Implants should only be placed after puberty is finished)
- Immuno-compromised patients
- Long-term steroid users
- Kidney Disease
- Bisphosphonate users