Dental Implants (Frequently Asked Questions)

What if I don’t have dental implants?

If you delay replacement of a tooth the following are a list of potential consequences:

Research shows that bone needs to be stimulated on a daily basis to be maintained in its current form. Just as a healthy tooth maintains the jaw bone around it, an implant does the same. If you delay placement of an implant, the jaw bone may disappear requiring additional procedures to rebuild it before the implant can be placed. Once in place and with proper care, an implant can maintain the jaw bone in that tooth’s position for a lifetime if properly maintained.

Clinical experience shows that when a tooth is lost and not replaced, the adjacent teeth very often drift into the space within the first year. This reduced space can often prevent proper placement of an implant and necessitate additional treatment including braces, to re-open the space. The health and bite of the teeth that drift can also be adversely affected.

To the right is an x-ray of a site where a tooth was extracted and not replaced with an implant. The adjacent molar tooth drifted forward into the space and has created a bad bite situation which will result in wear and possible fracture of the tooth. To permit placement of an implant, this patient will need braces to move the drifted tooth back.

Additionally, the opposing natural tooth, which used to bite against the lost tooth, can shift in position. Not only does this prevent proper implant placement, but may result in excessive tooth wear and/or fractured teeth due to an altered bite.

Below are photographs of a patients right and left sides. On the patient's right (left picture) the missing teeth were never replaced with dental implants and the opposing teeth (see arrows) continued to erupt towards the gum tissue. The molar tooth actually bites against the gum on the top. On the patient's left (right picture) the positions of the teeth are maintained because the patient did not lose any teeth.

TEETH DRIFTING TOWARDS OPPOSING GUM	TOOTH POSITIONS MAINTAINED

Experience also shows that when upper back teeth are lost and not replaced with implants, the sinus enlarges and reduces available bone. Although simple procedures do exist that allow us to re-grow this lost bone (see sinus lift procedure) this may result in additional procedures before implants can be placed.

X-ray showing the loss of sinus bone due to the loss of this patient's back teeth ( the dashed, blue line shows the current level of the sinus bone and the dashed black line shows where the bone was before the back teeth were lost).

X-ray showing the normal position of the sinus (dashed, blue line) when the teeth are present.

Loss of an upper front tooth and delaying replacement can result in less esthetic outcomes, sometimes severe. The peaks of gum tissue in between teeth are lost following extraction which results in unsightly black triangles if the extraction is not managed properly or the tooth not replaced in a timely manner.

NOTE LOSS OF THE PEAK OF GUM TISSUE NORMALLY PRESENT BETWEEN THE FRONT TEETH.

What if I have a bridge instead of an implant?

Bridges have long been the first option for replacing a missing tooth in dentistry, but times have changed.

The following are a list of pros and cons for replacing teeth with bridges vs. implants to help you make the right choice:

To replace a tooth with a bridge, the adjacent natural teeth have to be ground down to allow the bridge to fit passively. This results in removal of natural tooth enamel and dentin (the living part) that can never be replaced.

Below is a series of drawings which shows the process of replacing a tooth using a traditional bridge. The adjacent healthy teeth are ground down to allow cementations of the bridge. As you can see flossing and brushing under the bridge is difficult due to limited access. The bone in the area where the tooth was extracted will be lost with time.

Below is a series of pictures showing replacement of a missing tooth with a dental implant. The adjacent healthy teeth are not affected and flossing and brushing techniques are much easier. The implant will strengthen and maintain the bone in the site where it is placed.

Research shows that a high (67%) percentage of teeth prepared for bridges ultimately require root canals, have recurrent decay, and may fracture due to lack of strength and higher chewing demands placed on bridges.

Implants, on the other hand, require no grinding of adjacent teeth so they can remain strong and healthy.

Bridges are difficult to clean around and often result in decay due to inaccessibility for flossing and brushing. Implants can be brushed and flossed exactly like your natural teeth and they never decay!

Bridges also result in loss of jaw bone in the site where the tooth is lost. Implants will maintain the jaw bone in the tooth’s position for a lifetime. (Click here to learn more about maintenance of jaw bone with dental implants.)

Why should a periodontist extract my tooth before an implant is placed?

As a surgical specialty, periodontists are trained to gently manipulate both soft (gums) and hard (bone) tissue to specifically achieve desired results while minimizing trauma (damage) to the selected tissues. This type of atraumatic (gentle) approach is precisely what is needed to prevent damage to the soft (gums) and hard (bone) tissues when a tooth is planned for extraction. If traumatized during the extraction process, the bone and gum tissue may not fill the extraction socket completely and result in a defect in the jaw bone.

We go to great lengths to perform the most non-traumatic extraction possible for every tooth to ensure complete regeneration of bone needed to place an implant in the future. Using microsurgical instruments and recently developed tooth extraction devices, each tooth is removed as gently and as non-traumatically as possible. This is very different from the way teeth were removed just a few years ago. The result is complete regeneration of the bone to fill the tooth socket and less post-extraction discomfort. (Please click here to see the article by Dr. Jeff Thomas in the Journal of Esthetic and Restorative Dentistry)

Below is a photograph where a tooth requiring extraction was removed by the gentle (atraumatic) approach described above and a bone replacement graft was placed to ensure complete regeneration and preservation of the gum and bone tissue (an implant can now easily be placed in this site).

The photograph below illustrates what may happen when teeth are extracted and not replaced with dental implants. The bone is no longer "stimulated" and very often will deteriorate. The dashed, blue line indicates the current bone dimensions, and the dashed, black line indicates the volume of bone which has been lost.

After removing the tooth, the periodontist delicately cleans the socket to remove all infected tissue and determine the need for bone grafting. If some of the bone walls are anatomically thin or possibly missing due to an infection, the site is filled with selected bone grafting materials which are very specific to the individual tooth and site deficiency. Your periodontist may also elect to use barrier membranes to guide the direction of future bone growth when necessary. This is all done to ensure that only a few months later, the site is ready for a dental implant, thus preventing the loss of jaw bone and the need for complex grafting before implant placement.

Most importantly, in many cases your periodontist may elect to extract your tooth and place the implant at the same time. (Click here to read about the advantages of immediate dental implant placement at the time of tooth extraction.)

Below is a photograph of a patient requiring removal of his front right tooth due to a traumatic accident (note the black color of the tooth and irritated appearing gum tissue).

The tooth was extracted, an immediate implant placed, and a temporary tooth placed on the implant all in the same appointment. The photograph shows temporary tooth on the implant one week after extraction and placement. The x-ray on the right shows the implant with the temporary tooth.

Looking at the x-ray you can see that the front left tooth is the implant!

Why should a periodontist place my dental implant?

As stated earlier, periodontists are very adept at gently manipulating soft (gums) and hard (bone) tissues while minimizing trauma to the selected surgical site. As bone is inherently slow to heal very special and delicate care must be taken to ensure rapid integration with the dental implant. In addition, circumstances may arise that require simultaneous grafting or augmentation of gum or bone tissues at the time of implant placement. Periodontists are also trained and experienced to place implants at the time of extraction (Click here to read about the advantages of immediate dental implant placement at the time of tooth extraction). Whether you are having a front tooth replaced with an implant or plan to use an implant to help secure a denture, the importance of achieving the desired result from both the hard (bone) and soft (gum) tissue types cannot be over stated when considering the long term stability of a dental implant. Specific surgical scenarios call for application of a multitude of surgical techniques, all of which result in more precise and more predictable implant placement.

What are the advantages of immediate dental implant placement?

In many cases, your periodontist may elect to extract your tooth and place an implant at the same time. This procedure is called immediate implant placement. Immediate implant placement has the advantage of reducing the number of your surgical appointments to a single visit, reducing the amount of waiting time to get your tooth (cap), minimizing possibly the impact on your busy daily schedule. However, not all teeth are candidates for immediate implant placement and there is a slightly elevated risk involved with this procedure. Please ask your periodontist if this is an appropriate treatment option for you.

In some cases, not only can an implant be placed at the time of extraction, but a temporary tooth can be secured onto the implant on the same day. This is a procedure called immediate implant placement with immediate temporization or immediate loading. In specific situations, your periodontist will work with your dentist to place a temporary tooth onto the implant at the time of implant placement (immediate provisionalization). This procedure has the distinct advantage of helping to preserve the contours of the gum tissue around your extracted tooth and can result in excellent cosmetic results. This procedure is typically used when a front tooth must be lost, but can be used in situations where multiple implants are placed. Please ask your periodontist if immediate implant placement with immediate provisionalization is right for you.

Below is a photograph of a patient who fractured her tooth to the gumline one week before an important social event. The tooth was extracted, an immediate implant placed, and a temporary replacement tooth was custom fit to the implant all the same appointment.

TOOTH FRACTURED TO GUMLINE	TEMPORARY REPLACEMENT TOOTH ON IMPLANT the same day the tooth was removed
	X-RAY OF IMPLANT AND TEMPORARY TOOTH

A number of factors are involved in choosing the most appropriate time to place and restore your dental implant.  We encourage you to ask us or your general dentist about these options.  In the end, the most successful and predictable approach will be used to help meet your dental implant needs.

If I have an implant, will I have to go without my tooth/teeth?

No.  Your appearance and confidence is very important to us.  If you must lose a front tooth, or if you desire temporary replacement of any tooth (or teeth) during the course of implant treatment, we can work with your dentist to provide you with good looking and functional temporary replacement teeth.