Dental Implants

Dental Implants

Houston Dental Implant Overview

What is a dental implant?

A dental implant is a screw that is surgically inserted in the jaw bone to replace lost tooth roots.  After a period of time, the bone and gums will fuse around the screws, thereby creating a stable base for implant restorations.  Osseointegration refers to the process through which implant screw is intimately integrated to the jaw bone.

A dental implant is made of 3 parts:

  • implant screw – made of titanium or zirconia and is placed into the jaw bone
  • implant abutment – connects implant screw to implant crown
  • implant crown – mimics the natural tooth’s crown

What are the different types of dental implants?

Dental implants are made of titanium or zirconia that is very well-tolerated and highly bio-compatible with the human body.  It is extremely seldom for an individual to develop rejection to titanium or zirconia dental implants.  The main advantage of zirconia implants is its white color which may be important in implant esthetics.  Dr. Daniel Ho and Dr. Mack Coker place dental implants developed by the most reputable companies in the world to provide patients with excellent quality care.

There are mainly two types of dental implants when categorized by their diameter:

  • Conventional Dental Implant: These implants have diameters ranging from 3mm to 7mm.
  • Mini-Dental Implant: These implants have diameters ranging from 1.5mm to 2.8mm.  Mini-implants are particularly useful in situations when there is very limited amount of space available to place a conventional dental implant.  Most common sites for mini-implants are upper lateral incisors and lower central and lateral incisors.  In addition, in patients with severely atrophic jaw bone requiring implant overdentures, mini-implants can be placed at those sites to support the dentures.

What are different ways of placing a dental implant?

There are two ways by which a dental implant (implant screw) can be inserted into the jaw bone – flap or flapless approach.  In flap approach, implant is placed after the gums are peeled away from the jaw bone.  In flapless approach, gums are not peeled away when implant is placed.  The advantage of the flap approach is that clinicians will have better understanding of what the actual bony architecture looks like.  The advantage of a flapless procedure is that it is less invasive and sometimes soft tissue contour can be better optimized at the time of implant placement.  Surgical placement of dental implant into the jaw bone can be done under local anesthesia.

What are implant cover screws and implant healing abutments?

Following the placement of dental implant screw, either a cover screw or a healing abutment will be placed on top of the implant screw.  When a cover screw is placed, patient will need to come in for an extra visit about 3 months later to have the cover screw changed to a healing abutment before the start of implant restoration.  Sometimes cover screw is placed because a simultaneous bone grafting and/or gum grafting procedure is/are done, or if the implant screw stability at the time of placement is sub-optimal.  Healing abutment helps to contour the gums around the future implant crown.  Note that because healing abutment is hand-tightened to the implant screw, it is likely that sometimes the healing abutment may come loose.  If so, do not worry, just bring back the healing abutment and have your periodontist tighten it back to the implant screw.

How long does it take to complete dental implant therapy from start to finish?

Usually 3 months is required to allow an implant screw to fully integrate with the jaw bone.  When a bone grafting procedure is done at the time of implant placement due to deficiency of jaw bone, it is recommended that the patient waits for at least 4 months to allow grafted bone to grow and implant to integrate with grafted bone.  While the patient is waiting for the implant screw to integrate with jaw bone, the dentist may provide patient with a temporary prosthesis (e.g. interim denture, retainer, temporary bridge) to replace the missing teeth.

Timeline – Scenario A

  • tooth extraction + bone graft (preserve jaw bone for future implant)
  • 3 months later, place implant screw into jaw bone
  • 3 months later, start making implant crown (2-week period)

Timeline – Scenario B

  • extraction + bone graft + place implant screw into jaw bone
  • 4 months later, start making implant crown (2-week period)

Am I a good candidate for dental implant?

Typically, candidates for dental implants have one or more missing teeth.  If you have been missing teeth for quite a number of years and have been told that you have jaw bone deficiency, your periodontist may need to perform a bone grafting procedure prior to or at the same time of implant placement to ensure good bone quality around the implant screw.  Ideally, individuals who are in good health and do not smoke are great candidates for dental implant therapy.  Individuals who are not in good health (diabetes) or are smokers can still receive dental implants; however, further discussion of health issues and tobacco use should take place to ensure your safety and success of implant therapy.

How long do dental implants last?

The conventional dental implants have been utilized in dentistry for about 20 years.  Numerous studies have shown that with proper implant care and maintenance program and regular dental visits, the survival rate of dental implants ranges from 90-98% at 20 years.  This means that out of 100 dental implants, 90 to 98 of these implants are still in function 20 years later.  This is not to say that implants will only last for 20 years.  Scientists can only make statement up to 20 years because this type of dental implant has only been around for about 20 years.  It is very likely that the conventional dental implants can last much longer than 20 years and still be in function.

Who provides dental implant therapy?

Dental implant therapy is provided to the patients by a team of dentists including a periodontist and a restorative dentist.  A periodontist is a dentist who has at least 3 years of advanced training in implant dentistry and is responsible for the surgical aspect of dental implant therapy (i.e. surgical placement of dental implant into the jaw bone).  A restorative dentist is a dentist who is responsible for the making of implant crown.  Effective communication between both periodontist and restorative dentist is critical to the success of implant therapy.

Why see a periodontist for the surgical placement of dental implants?

There is a great number of dental implants that are functional but not esthetic.  Making a dental implant to look as natural as possible can be very challenging.  The esthetics of a dental implant depends on two elements:  A) implant crown, B) gums around implant crown.  An implant crown can be made esthetic so long good quality work is done by the restorative dentist and the dental lab.  The implant crown can be remade if patient is not satisfied with the esthetics.  However, if the gums around the implant crown do not look natural or symmetrical to adjacent teeth, no matter how esthetic the implant crown is the overall implant esthetics will be jeopardized.  Unlike implant crowns, gums around implant crowns cannot be “re-made” in a dental lab.

Periodontists have extensive trainings in the management of the gums around dental implants.  As such, if you see a periodontist to have implant surgically placed, your chance of getting better quality dental implant therapy will be higher.