Implants: Restoring a Solid Foundation

Tooth Root Substitutes

Sometimes people lose permanent teeth due to accident, injury, disease or extraction. In such cases, we find dental implants to be a secure, functional replacement option. A dental implant is simply an artificial tooth root replacement consisting of a tiny titanium post inserted surgically into the jawbone, covered by a customized restoration. After placement, under normal circumstances, the titanium post actually bonds chemically to the jawbone, thus serving as a secure, supportive structure for the chosen restoration. In addition to using implants to replace missing teeth, Dr. Goldberg may sometimes recommend implants as anchors for bridgework or fixed dentures as well.

Long Term Advantages

Since they are permanently, surgically anchored in the jawbone, implants offer impressive advantages over other tooth replacement options. Often, they can actually restore comfort and beauty, while providing long-term stability. Plus, they do not rely on neighboring teeth for support, and therefore are more conservative. And finally, this solid foundation means that once they're implanted, you'll never have to deal with the inconveniences and discomfort of ill-fitting prostheses again. In fact, you'll probably forget they're even there.

Unlocking the Secret of Successful Implant Restorations

Depending on how many teeth you're missing, we'll determine the best kind of restoration for your case. If you're missing one or two teeth, your restoration will most likely consist of implants with individual crowns. As the number of missing teeth increases, you'll probably require implant-supported fixed bridgework. And, if we're replacing a complete set of upper or lower teeth, we'll evaluate the advantages of removable vs. fixed prosthesis, which in turn determines how many implants per jaw are required.

What differentiates between our choice of doing fixed bridgework or what we call a combination "Fixed-Removable Prosthesis" to replace teeth in a fully edentulous arch is the relationship between the eventual tooth position and the supporting gum and bone.

If tooth loss is fairly recent and the jaw structure is relatively intact, there is generally enough bone to place implants at an ideal level and angulation to permit the fabrication of a fixed porcelain-fused-to-metal bridge.

Old bridgework on failing dentition
6 implants plus 4 natural teeth with gold telescopic crowns
Completed porcelain-fixed-to-gold bridge
Completed bridge showing screw retention
Implant bridge protected by upper nightguard

However, many people for whom implants are indicated are individuals who lost teeth from periodontal disease, trauma or have been missing their teeth for a long time. In most of these instances, enough time or infection has occurred to cause a significant amount of bone loss. What this in turn means is that the implants cannot be placed close enough to the proper tooth position to allow for the fabrication of an esthetic fixed bridge. Instead, some type of bar and overdenture combination is necessary because we need to simulate gums as well as replace teeth.

Implant overdentures have been done for a very long time, and they have always had one basic limitation…they have typically been built with some type of snap retentive device (ball and socket, bar and clip, etc) and the problem is that these attachments wear and/or break. Constant tightening or repair is costly and frustrating to patient and dentist alike. To get around this problem we are among the first in Dallas to use an alternative type of attachment, the MK1.

This attachment is unique in that it feature a slide type of interlock which, when activated, holds the overdenture rigidly in place with virtually no movement so that it acts and feels just like a fixed appliance. The overdenture can be released and removed for cleaning simply by using a small "pin" for deactivating a slide within the attachment. The design of the attachment features no wearing parts and so our past experience suggests that there is virtually no loosening and therefore no repair.

If you'd like to see an example of a patient treated with the MK1 appliance please click here.

Choices and Steps

The implant process generally requires three separate steps, "anchoring", "attachment", and "restoration". As the 'orchestrator' of a professional implant procedure team, Dr. Goldberg coordinates each step, the first two of which are completed by a surgical specialist. Once we've determined that implants are the best option for you, we work with you individually to evaluate the specific type of implants appropriate to resolve your particular concerns, carefully coordinating all steps of your treatment plan.

The next step includes doing a diagnostic evaluation, from which we'll create a surgical guide as to how many implants are needed, and their placement. We then provide this guide to the surgical specialist, who will then surgically anchor the implant into your jawbone below the gum tissue. The implant must form a solid, enduring base with sufficient stability to withstand the tremendous mechanical pressure involved in normal chewing, so we'll typically allow three to six months for the post to integrate into the bone. If indicated during this healing phase, you'll have a temporary bridge or dentures to maintain esthetics and function.

Once we're certain that your implant post has bonded with your jawbone, Dr. Goldberg will then take you through a series of appointments, including taking impressions, obtaining a bite registration, trial of the implant restoration, fit, and final delivery of your restoration.

Statistics and Commitment

Those unfamiliar with implant technology may question the success rate of such procedures. Surprisingly enough, the technology is well over 35 years old, and has proven successful in tooth replacement, depending primarily on the recipient's health, as well as the location and function of the teeth being replaced. Teeth placed in the lower front jaw may be up to 95% successful, while side or rear placements are up to 90% successful. It's also best if recipients are in good general health, with proper bone structure and healthy gums. Often, people unable to wear dentures are among those who benefit most from implants. On the other hand, chronic health problems such as clenching, bruxism, or systemic diseases may decrease the success rate of the procedure immensely. And it's also recognized that habits such as smoking may reduce their success as well.

In fact, this brings up a final, important point to consider. As an implant candidate, it's important to seriously consider your own commitment to future oral health. As you might imagine, poor oral hygiene itself is a common cause of implant failure. This means that you'll want to be sure and brush and floss around your implants at least twice a day, according to the specific instructions we give you. Further, you may need up to four annual professional cleanings to maintain healthy gums.

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