Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
When a natural tooth can’t be preserved, it is important to have it replaced as soon as possible. Presently, there are two excellent tooth-replacement systems in wide use: traditional bridgework and high-tech dental implants. What’s the difference between the two methods?
Essentially, it comes down to how the replacement tooth is secured in the mouth. In the dental implant system, a natural looking prosthetic tooth is solidly anchored in place by a screw-like titanium implant. This is inserted directly into the bone of the jaw in a minor surgical procedure, and over a short period of time (usually 6 – 12 weeks) its titanium metal structure will actually become fused with the living bone.
With bridgework, however, the support for the prosthetic tooth (or teeth) comes from the healthy teeth adjacent to it. These teeth must be prepared (shaped) by carefully removing some of the outer tooth material (enamel and some dentin), which enables them to be fitted with coverings called crowns or caps. Crowns are often used on their own, to restore teeth that are missing too much of their structure to be treated effectively with standard fillings. But the bridgework system goes one step further.
Instead of making individual crowns for each tooth, a dental lab will fabricate a bridge — a single unit consisting of crowns for the prepared teeth, plus complete prosthetics to replace the missing tooth (or teeth). A three-unit bridge, for example, consists of one complete prosthetic tooth to replace the one that’s missing, plus two crowns for the adjacent “abutment” teeth. It’s possible to have larger bridges as well: For example, a six-unit bridge might consist of two complete prosthetic teeth in the center, with two crowns for abutment teeth on each end, all linked together in one piece.
While bridgework has been used effectively for decades, it is now being gradually supplanted by dental implants. Implants don’t require the removal of healthy tooth material from abutment teeth, and they don’t place extra stress on those teeth; plus, they generally last much longer than natural tooth bridges. However, the dental bridge remains a viable alternative for tooth replacement in many circumstances.
If you’re missing a tooth, you’re not alone; in fact 35 million Americans are missing all of their teeth in at least one jaw! Whether it’s one tooth or many, it’s important to replace what’s missing. Depending on the number of teeth lost, the potential drawbacks to doing nothing may become hard to ignore: impediments to eating, interference with speech, and unaesthetic appearance, for example.
Traditional bridges and dentures are the most affordable options for replacing teeth. Tooth implants — tiny titanium, screw-like substitutes for a tooth’s natural root to which natural-looking dental crowns are attached — are pricier but offer an important extra benefit. In addition to addressing the common problems previously mentioned, by acting like the original tooth root, an implant can maintain or stimulate “remodeling,” of the jawbone below. Without a tooth root to provide stimulation, mature bone cells will continue to be removed, or resorbed, but no new bone cells will regenerate to replace them, leading to a progressive loss of bone width, height and density. The more teeth are lost, and with less bone structure to support it, the whole shape of the face can change.
Unfortunately, when greater numbers of teeth must be replaced, implants can become financially unrealistic for some people. But in appropriate cases there is a third option: a bridge or denture/implant hybrid. In the case of a bridge intended to fill a gap when multiple teeth are missing, an implant can be used on either side of the gap to support the bridge, leaving the natural teeth undisturbed. Strategically placed implants can be used to support a removable denture, too.
If you would like more information about dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants: Your Best Option For Replacing Teeth.”
Perhaps you've heard about dental implant surgery — or maybe you've been told you are a candidate for the procedure. You may already know that today, implants are the “gold standard” of tooth replacement options. It's no wonder why: They have a documented success rate of over 95%, and can last a lifetime. But if you're put off by the thought of implant surgery, then it may be reassuring to learn the following five facts.
1. The entire implant process is planned before surgery is done.
This usually involves taking radiographs (X-rays), and sometimes CT scans, as precision guides to implant placement. Before the minor surgical procedure begins, we have already examined the bite and the bone structure, and determined exactly where the implant will fit in. There should be no surprises during the surgery — which is only one phase of the implant process.
2. Implant surgery uses the highest-quality materials and state-of-the-art techniques.
The implant itself is fabricated of commercially pure titanium, or a titanium alloy. This metal has a unique property — it's capable of osseo-integration, which means it can actually fuse with bone. During the implant procedure, the bone is handled with utmost care: it's gently prepared to receive the implant, and cooled with water to prevent tissue damage. If you don't have enough of your own bone tissue to support an implant, it has even become routine to restore bone with grafting techniques.
3. The surgical procedure itself is generally painless.
Almost all implants are placed using local anesthesia — typically, a numbing shot. If you're especially anxious about the procedure, it's possible to be given sedatives or anti-anxiety medications beforehand. Of course, we will make sure you don't feel any pain before we begin! Some mild vibration is generally all that you may experience during the procedure, but it's very rarely a cause for concern.
4. There is little discomfort following the procedure.
On the day of surgery and perhaps the day after, a non-steroidal anti-inflammatory medication (NSAID) of the aspirin or ibuprofen family is usually all that's needed to control minor discomfort. You may also be given a prescription for antibiotics and/or a mouth rinse to aid healing.
5. The result: Natural-looking teeth that can last a lifetime.
Implants have become dentistry's premier option for replacing missing teeth. Their placement involves minimally-invasive techniques, and has a success rate higher than any other tooth replacement system. And, given proper care, they can last for the rest of your life. Could you ask for more?
If you have questions about dental implant surgery, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Dental Implants.”
How can sinus surgery contribute to the replacement of missing back teeth with dental implants?
Dental implants must be anchored the in bone to be successful. Maxillary sinus surgery can help regenerate bone that has been lost and is critically needed to anchor dental implants.
What are the maxillary air sinuses?
Inside the upper jaw, or “maxilla,” are structures known as the maxillary air sinuses, one on either side of the upper jaw. Each sinus is an air-filled space lined by a membrane. Upper back teeth are normally encased in the bone of the maxilla, below the sinuses.
Why is it important to replace missing back teeth?
Replacing back teeth restores the ability to eat, chew, and talk properly. The back teeth also provide facial and cheek support.
Why use dental implants?
Dental implants are the state-of-the-art method for replacing missing teeth.
Why does bone loss occur?
Unless special precautions are taken to prevent it, when teeth are lost, the bone supporting them is also lost.
If there is insufficient bone to anchor dental implants, what are the alternatives?
If all the back teeth are lost and dental implants cannot be placed, removable upper dentures may be the only alternative.
How do you determine whether a sinus surgical procedure is necessary?
The size, shape, and remaining bone of the maxillary sinuses influence whether you can have dental implants with or without a sinus surgical procedure.
How does surgery grow bone?
A small window is created in the sinus wall above where implants need to be placed. The sinus membrane is lifted and the space thus created filled with bone grafting and biologically active bone generating materials. The window is then closed and simply heals.
How is the surgery done?
The surgical procedures are performed from inside the mouth in the area just above the missing back teeth. They are generally carried out under local anesthesia (small shots, just like for a filling), sometimes with the addition of sedation or anti-anxiety medication.
How do bone grafts work?
Bone grafts act as scaffolds that the body replaces with its own bone. The most well researched bone substitute grafting material is currently bovine (cow) bone. All grafting materials are approved by the Food and Drug Administration. They are specially treated to render them completely sterile, non-contagious, and free of rejection factors.
What can I expect after surgery?
Moderate swelling and discomfort after surgery generally lasts for a few days to a week, about the same as having an upper impacted wisdom tooth removed. Supportive treatment usually includes a course of antibiotics to prevent infection and prescription strength medication of the aspirin or ibuprofen type. A decongestant may also be prescribed, if necessary. Healing is generally uneventful.
Who performs this surgery?
Maxillary sinus augmentations are usually carried out by oral surgeons, periodontists, or appropriately trained general dentists. Proper assessment of your situation and diagnosis are critical pre-requisites to the right procedure.
If you are missing upper back teeth, contact us today to schedule an appointment and discuss maxillary sinus augmentation. You can also learn more about this procedure by reading the Dear Doctor magazine article “Sinus Surgery: Creating Bone for Dental Implants out of Thin Air.”
Why is it important to replace missing teeth with restorations such as dental implants? You might be surprised to find that the damage caused by missing teeth is much greater than the simple gaps left in your smile.
As the years go by, teeth lost early in adulthood cause structural changes in a person's face. By age 45 changes in facial structure are already visible in the form of sunken cheeks. By 60, cheeks and lips lose their support, resulting in an aging look. This process continues and if the teeth are not replaced, much of the structural support of the person's face is lost.
These changes are caused by loss of bone. Although it may seem static, bone is actually living tissue that needs constant stimulation to maintain its form and density. With normal stimulation it is in a constant state of resorption (breaking down) and deposition (building up). Teeth provide the needed stimulation for the bone that surrounds them (called alveolar bone) as they meet each other during biting, chewing, and speech. When the stimulation continues, the bone continues to rebuild itself. Without this stimulation, the bone resorbs, does not build up again, and loses substance.
Without stimulation, alveolar bone loses width, height, and volume. Since your teeth and their surrounding bone support your chin, cheeks, and lips, this has a powerful effect on your appearance. It may also affect your ability to chew and to speak.
As alveolar bone diminishes, the next layer of bone also begins to resorb. This is the bone of the jaw itself. The lower part of the face begins to collapse, and the cheeks become hollow. This effect is especially noticeable for people with no teeth (edentulous).
Usually the first tooth to be lost, due to infection and decay, is a molar (back tooth). In the past, a missing single back tooth was frequently replaced by a fixed partial denture (FPD). A crown is provided for each of the two teeth on the sides of the gap, called abutment teeth, to support a false tooth in the middle. However, if they are not well cared for, the abutment teeth may be the next to succumb to decay.
Today the treatment of choice is an implant. A dental implant is a tooth-root replacement made of titanium, which fuses with the bone — making it very stable. Above the gums it is covered by a crown that looks like a natural tooth. The benefit of the implant is that it continues to provide stimulation to the alveolar bone, preventing bone loss.
Implants are also a good choice in the case of multiple missing teeth. They can be used to support bridges or false teeth (dentures). The results are an improved, younger appearance and better functionality.
Contact us today to schedule an appointment to discuss your questions about missing teeth. You can also learn more by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”
When a device meant to make your life easier doesn't function properly, it can be extremely frustrating. This is sometimes the case for people who wear lower dentures, which loosen over time. These removable replacement teeth can become less reliable and more uncomfortable. Why does this happen?
The answer is bone loss. When a tooth is lost, the bone surrounding it deteriorates and this will change the shape of the jawbone in your mouth. You may find that a lower denture that once had a snug fit on your lower jaw is now sliding around. This happens more often on the bottom because your muscular tongue pushes against the denture. Also, a top denture has more surface area due to an artificial palate to help create suction to the roof of the mouth and keep it in place.
Dental implants, which permanently replace the roots of teeth, do not loosen and they also prevent bone loss. But replacing a whole set of bottom teeth with dental implants and crowns is expensive. What to do?
There's a relatively new solution that combines the security of implants with the affordability of a removable denture. It's called an overdenture, and it may be something you want to consider. An overdenture is a lot like the removable lower denture you already have, only it fits over two implants strategically placed in your lower jaw. While the lower denture is still removable, its stability is greatly improved.
Studies have shown that people with two-implant overdentures have a higher quality of life, and receive better nutrition, than those wearing conventional dentures. It's not hard to figure out why: A more stable denture makes it easier to eat healthy foods such as vegetables — or, really, any foods — and prevents embarrassing slippage of false teeth.
You can read more about this topic in the Dear Doctor magazine article “Implant Overdentures for the Lower Jaw.”
Thanks to technological advances, today there are more than 40 types of traditional or standard implants. A traditional dental implant actually replaces the root of a tooth, upon which a crown is built — the part you see in the mouth. There are 2 others types that are quite similar to standard implants. Mini implants are most like traditional implants except they are smaller in diameter. Micro-mini implants are an even smaller variation with an even narrower, more screw-like appearance. Micro-mini implants are also designed to be used on a temporary basis, thus can easily be removed. Together all of these types of implants provide us with a wide variety of options for permanently replacing missing teeth.
The following list details the types of implant restorations:
What does the term “two-implant overdentures” mean?
For more than a century, complete dentures were the only care option for edentulous (toothless) people. As a solution, these left a lot to be desired, particularly for the lower jaw. Now dental technology has developed a better alternative that combines two strategically placed dental implants and a traditional lower denture that has been modified to fit over the two implants — thus the term.
What are the problems with traditional dentures?
The problem is that when you lose teeth, the bone that supported the missing teeth begins to shrink away. This is known as resorption, and it is the reason that dentures fitted too soon after teeth are lost quickly become loose. Bone loss happens most rapidly during the first year and is four times greater in the lower jaw than in the upper.
Why not just use dental adhesives to hold dentures tightly to the lower jaw?
Zinc, a major ingredient in most dental adhesives, has been associated with neurological disorders and may be unsafe. In addition, dental adhesives are expensive and the cost of frequent usage adds up.
Besides dental adhesives, are other health problems associated with dentures?
Yes, edentulism has been related to poor nutrition. Many edentulous people switch to soft foods with high fat content because they find healthier foods like vegetables and proteins difficult to chew.
What are dental implants?
Dental implants are replacements for the roots of teeth, the parts that are below the gumline and anchored in bone. They are usually covered with a crown that shows above the line of the gums.
What are the benefits of implants?
Most importantly, implants reduce the amount of bone resorption. Studies have shown about 75% less resorption in parts of the jaw with implants compared to areas without them. Since most of the bone loss occurs within the first year after tooth loss, it is important to place implants within this time period.
Is a complete set of dental implants a good solution for edentulism?
Yes, it can be a good solution, but it is not for everyone. Some patients, who have lost a great deal of bone support, need another solution for cosmetic reasons that offer more facial support like an implant overdenture. In addition, depending on their resources and insurance, some people require a less expensive solution.
Why does the two-implant overdenture work better for the lower jaw?
Based on differences in bone volume, density and other factors, we think that four to six implants are needed to retain an upper implant overdenture. Thus a two-implant overdenture is a good solution to consider for a lower jaw, but other options might be preferred for an upper jaw.
Contact us today to schedule an appointment to discuss your questions about dentures and implants. You can also learn more by reading the Dear Doctor magazine article “Implant Overdentures for the Lower Jaw.”