Dental Implant Dentistry

Dental Implant Dentistry

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. M Mostafa 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.

This folder has been credited by:
Dr. M Alhaj Mostafa