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Why Should I Replace My Missing Teeth?
When you lose a tooth it usually is best for your oral health to have it replaced. Missing teeth compromise your "bite" and ability to chew and they increase the burden on your remaining teeth. Additionally, when you lose a tooth it can have a serious impact on your appearance. Fortunately, replacement of a missing tooth is not usually an emergency. You have time to consider what replacement option is best for you and make an informed decision. This section of our site discusses your general treatment options.
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 What is a Dental lmplant?
The best way to explain this is to compare a dental implant to a real tooth. A natural tooth consists of a root and a crown. The part of the tooth you see and eat with is called the crown. Beneath the crown is the root, which anchors the tooth through the gum tissue to the jawbone. When you lose a tooth, you lose both the root and the crown. To replace a tooth, we first have to replace the root. A dental implant is essentially a new root. This titanium metal "root" is fitted into a socket that we create in your jaw, replacing the lost root of your natural tooth. Once an implant has been placed in the jaw, the bone around the implant will need to heal anywhere from three to six months depending on how hard the bone is. When this initial phase of healing is completed, your dentist will place a support post, also called an abutment, into the implant itself and then will place a new crown on top of the implant. If all of your teeth are missing, a variety of treatment options are available to support the replacement teeth.
 Your restorative dentist will work with us as part of a team to establish a comprehensive treatment plan. Occasionally, additional specialists’ help may be required to achieve the best result. Your dentist will be responsible for planning your treatment and placing the temporary and final restorations, whether they are individual crowns, bridges, or specialized dentures. We will work closely with your dentist to plan the details of your implant-supported restoration.
How Are Dental Implants Placed?
This office procedure usually takes about an hour for one implant and typically no more than two or three hours for multiple implant cases, and is as follows:
 We will give you preoperative medications, if indicated, before surgery and then administer a local anesthetic to numb the areas being treated. You may also prefer to be sedated using intravenous medications.
After you are comfortable, we will make a small incision into the gum tissue, revealing the bone into which the implant is placed.
Using specialized instruments, we will then very carefully create a socket avoiding damage to the bone.
We will then insert the titanium implant into the socket.
Sutures (or stitches) will then be used to close up the gum tissue.
After the implant is placed, the area will need to heal for three to six months. We will provide follow-up care, usually three to five office appointments, to ensure that the implants have healed appropriately and are ready for the restorative phase of your treatment.
Dental implants come in various shapes and sizes with different types of surfaces. We will use the one(s) most appropriate for your particular situation. Once the implant is inserted, we complete it in one of two ways: First, we will close (or suture) the gum tissue over the implant to allow the implant to heal for three to six months. Then we will perform a second procedure called "uncovering surgery" where we use local anesthetic to numb the gum tissue. Next we will move the gum out of the way, locate the implant, and place a healing cap into the implant. We will then suture the gum tissue around the healing cap. After two to four weeks, you will return to your restorative dentist who will then remove the healing cap, place the abutment (or support post), take impressions, and make the crown to complete the process. This is called a "two-stage" or "two-step" approach to implant placement and is the more traditional approach.
An alternative approach is called the "single-stage" or "one-step approach." In this approach we will place the implant, then add a healing cap at the same time onto the implant and suture the gum tissue around it. With this approach, a second surgery to place the healing cap is not needed and the entire surgical procedure will essentially be done in one step. Because only one surgical appointment is needed, both patients and doctors often prefer this approach. However, it is not always the best method for placing implants. We will use the most appropriate approach to meet your particular needs.
When Will You Place The Implants?
Although there are many different thoughts on this subject, usually we will remove the tooth and, after waiting approximately three months, will place the implant where the missing tooth was located. Once a tooth is removed, if your walls of bone are intact and fairly thick, your body will replace or refill the empty socket with new bone. In three months your socket will usually be completely filled in with bone when we re-enter it for implant placement. We will then place the implant, allow it to heal for four to six months, and complete the procedure as we discussed. Some surgeons prefer to take out the tooth and place the implant at the same time. This may involve a little more risk, but it simplifies the process—you won’t have to wait three months for the bone to refill the socket. Again, there are times when this is appropriate and other times (when infection or other problems with the bone are present) when we would prefer not to do immediate implant placement.
If your tooth has been missing for some time, your adjacent bone will tend to grow thinner because the root of the tooth itself stimulated the bone. Once the tooth root is removed, the bone loses this stimulation and starts to disappear. If you are missing quite a bit of bone, you may need to have additional bone grafted into the area so that the implant will be totally supported by bone when we place it.
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Late Bone Loss |
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Bone Graft Restores Height and Width | Do I Have Enough Bone?
As stated earlier, after tooth extraction, if the walls of your socket are very thick, they will usually fill with bone in three months. However, if the walls of your socket are very thin (such as in your upper and lower front teeth), then this type of healing will not be as predictable. After waiting three months for the bone to fill in, you may have only a very thin ridge of bone. Sometimes, we place a bone graft at the time of tooth extraction to best aid in your body’s attempt to fill in the socket with bone. This step will maintain the width or volume of bone you’ll need for implant placement and is commonly performed on very thin-walled extraction sockets, especially in such visible areas as the front of the mouth. If your tooth was removed many years ago, then your bony ridge may be extremely thin and you may not have enough bone left for implant placement. In this case, we will place a bone graft next to the thin bone and allow it to healfor three to nine months. After the graft has fused to your pre-existing bone, we will re-enter the ridge and place the implant. Bone grafting is usually a relatively comfortable procedure. We can use many different bone grafting materials, such as man-made bone which we will supply, or we can use your own bone which we can obtain from different areas in your mouth or other donor sites.
Another reason why you may need bone grafting is if the sinus cavities in your upper jaw are very large or very low and extend into the tooth-bearing areas. This often occurs when teeth in the back of a person’s upper jaw have been removed many years ago and the amount of bone available for implant placement is decreased. This condition requires what we call a "sinus grafting procedure." Most often we will perform this procedure in our office with local anesthesia and sedation if you desire.
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Implant in Place After Sinus Grafting | During this procedure we will locate and elevate the membrane that lines the sinus and will add bone to restore the bone height to ensure that dental implants of an adequate length can be placed at the same time or in the future.
How Many Implants Do I Need?
Usually, we place one implant per missing tooth except in the back of the mouth. Because of the great chewing forces involved, most back teeth have more than one root. Again, an implant is just a new tooth root. Since many of the larger teeth in the back of your jaws have two or three roots, we tend to replace missing back teeth with more than one implant per tooth, especially if there has been moderate bone loss or there is evidence of excessive biting force.
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Implant Supported Lower Denture |
What If I’m Missing All Of The Teeth In My Lower Jaw?
If you are missing all of the teeth in your lower jaw, you may consider a number of treatment options.
While many patients have no problem wearing an upper full denture, some find it difficult to wear lower dentures.
The first option is for us to place two implants in your lower jaw and have your dentist make a denture that snaps onto these implants. This option allows your lower denture to be more stable than without implants if your jaw’s support ridge is big enough. There will still be movement of your lower denture, however, and you can still get sore spots if any food particles, especially seeds, are caught under your denture. As with all removable replacement teeth, you will still need periodic adjustments by your dentist.
A second option would involve our placing four to six implants, depending on your jaw size or shape, into your lower jaw. After healing is complete, your dentist will connect the implants with a custom-made support bar. Your denture will be made with retention clips inside that attach onto the support bar. The advantage of this option is that it is much more stable than the first option, allowing very little denture movement. Your denture will still be removable and will come in and out for easy cleaning and maintenance.
A third option involves our placing five or more implants in your jaw and attaching a non-removable denture. Your denture is held in place by screws or clasps which secure it to the support posts or bar. It doesn’t touch the gum tissue, which allows you to clean under the denture without removing it. This option will replace all your missing lower teeth and will not be removed except by your dentist for maintenance. Although cleaning under your denture without removing it is more time consuming, many patients who want a non-removable denture prefer this option.
The final option is to have all your teeth individually replaced so they will appear to be growing right out of your gum tissue and will most closely resemble the appearance of your natural teeth. This option usually requires eight or more implants. Your dentist will make separate abutments or support posts for each one of these implants and crowns for each missing tooth. They are frequently joined together for strength and support. Overall, it is the most costly option, requires the most implants, and may be limited by the current size and shape of your jawbone.
What If I’m Missing All Of My Upper Teeth?
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Implant Supported Upper Denture |
A similar range of treatment options are also available for your upper jaw. However, because the bone is not as hard as that in the lower jaw, people frequently need more implants to support their replacement teeth. Depending on the number of implants we place, your dentist may be able to eliminate the need for covering the roof of your mouth with the denture. This option will allow you to better taste your food and to better sense food temperature, and it will make your denture feel more natural. You will still have a removable denture, which makes cleaning the support bar and denture much easier. If you want a restoration that is similar to your natural teeth and therefore not removable, you will probably need eight to ten implants placed. This is followed by the placement of the abutments and crowns by your dentist.
What Can I Use For Teeth While The Implants Are Healing?
There are many options available depending on your needs. Temporary removable teeth or a temporary bridge can be worn while the implants are healing. If all your teeth are missing, your dentist usually can modify your present complete denture or make you a new temporary denture. If you would prefer non-removable teeth during the three to six months of healing, we can usually place temporary transitional implants along with the permanent implants and insert temporary teeth the same day.
What Are the Potential Problems?
Although you may be concerned about pain caused by these procedures, most patients do not experience severe or significant post-operative pain. We will prescribe pain medication and antibiotics for you to make your post-operative course as easy as possible. Occasionally some people develop post-operative infections that require additional antibiotic treatment. Additionally, there is a chance that the nerve in the lower jaw, which provides sensation to your lower lip and chin may be affected. If you are missing quite a lot of bone, it might be difficult for us to place an implant and not infringe on the nerve space. Although we take great care to avoid this nerve, occasionally it is irritated during the procedure resulting in numbness or tingling in your lip, chin, or tongue. Although this numbness will usually resolve, it can be permanent. If you notify us of post-operative numbness as soon as possible, it will allow us to manage your care in the most appropriate manner.
How Long Will The Implants Last?
Implants usually last a long time. Of patients who were missing all of their teeth, long-term studies (more than thirty years) show an 80 to 90% success rate. For patients missing one or several teeth, six-year studies show a success rate of greater than 90%, which compares quite favorably with other areas in the body that receive implant replacement (such as hips or knees). If one of your dental implants either doesn’t heal properly or loosens after a period of time, you will usually need to have it removed. After the site heals, we can usually place another implant.
How Do I Clean My Implants?
As with natural teeth, it is important that you clean implant-supported restorations at home regularly with toothbrushes, floss, and any other recommended aids. You will also need several visits to your dentist per year for professional hygiene and maintenance. As with regular dentures and other tooth replacements, your implants and their associated components are subject to wear and tear and as such will eventually need repair, including clip replacement, relines, screw tightening, and other adjustments.
What Do These Services Cost?
We will charge you for the implant placement plus any bone grafting procedures that are done. Your restorative dentist will charge you for the abutment or support post, plus the crown, dentures, or anything else that they will place over the implants, including temporary restorations. You will need to understand that there are two different doctors working with you most of the time and, as such, you will have two separate doctor’s bills for your dental treatment.
Your restorative choice should be guided by your sense of what is best for you, with input from the restorative dentist and implant surgeon. You should also consider the financial impact of each—some insurance companies offer adequate coverage while others may only cover specific types of dental restorative procedures. Each patient is unique and it is not possible for us to discuss every option and every contingency for treatment outcome. This pamphlet serves to help you understand the general treatment options available to you. If your specific treatment options are not clear, please call us. We will be happy to answer any questions you have about your dental care.
CASE # 1
65 yo F with mandibular atrophy, unable to wear conventional denture
Patient had four osseointegrated implants placed and susequent bar attached to secure the denture.
Final Result
CASE # 2
Tooth #30 replaced with osseointegrated implant
Final restoration of # 30 implant
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