Dental Implants

Dental implants are changing the way people live. They are designed to provide a foundation for replacement teeth which look, feel and function like natural teeth. The person who has lost teeth regains the ability to chew all food types using implant supported teeth that appear natural and preserve facial contours. Patients with dental implants can once again smile with confidence.

What are Dental Implants?

The implants themselves are small titanium screws, which are inserted into the jawbone in the area of a missing tooth or teeth. Dental Implants are root replacements, not whole teeth. They serve as anchors onto which your dentist can fabricate and attach new teeth. Dr. Rissolo will carefully place the implants beneath the gum into the jawbone by a minor, in office, surgical procedure. During a short and variable healing period, your bone should bond with the pure titanium surface of the implant creating a strong foundation for artificial teeth. Following proper bone healing, your dentist will place small posts or other precise attachments to connect a new tooth or teeth to your implant(s).

Dental implants are used to replace a single tooth, a segment of teeth, or an entire arch of missing teeth. Implants are also frequently used underneath full and partial dentures with special snap attachments to improve stability and function of these prostheses. Dental Implants can help preserve lip fullness and lower facial height and structure, slowing or preventing the bone deterioration that occurs when teeth are missing.

The Surgical Procedure

Dental Implant surgery is performed daily at Oral Surgeons Associates. These procedures are normally minor in nature requiring a short appointment with a local anesthetic. Sedation techniques are available on request but are often not necessary. Most of the implants placed at Oral Surgeons Associates involve only a one stage surgical process.

The implant is inserted through a small opening in the gum directly into bone like a small screw. Depending on the bone quality and placement technique, healing times are routinely between 6 weeks and 3 months. During this healing time the implant is expected to fuse to the bone forming a rigid bond called “ osseointegration”. After the bone to implant bonding is complete, the implant is evaluated for proper healing at a brief “final check” appointment. Once verified, your dentist is notified by letter that he/she may begin the process of fabricating a tooth or attaching your removable prosthesis.

The best determinant of implant success is adequate, healthy bone available in the area of implant treatment. To preserve bone when a tooth is extracted, Dr. Rissolo will often place a socket preservation graft in preparation for a future implant. This socket preservation technique simplifies the future implant surgery by preventing the collapse of a tooth socket and shrinkage of available bone for the future implant. This will often improve the short and long term success of future implant therapy.

Through out the healing process your dentist may have you wear a temporary dental appliance to replace the missing tooth or teeth. This appliance may be removable or sometimes fixed to adjacent teeth. These decisions are made following your surgical consultation in a coordinated discussion with your general dentist.

Surgical Advances: Immediate Implants/Immediate Restorations

Dr. Rissolo uses the most recent advances in dental implant technology to deliver treatment and have done so for over fifteen years. They routinely use single stage implants. These implants do not require a second surgical procedure to uncover them. Under ordinary circumstances, single stage implants require six weeks to three months of healing time before artificial teeth are placed. The latest innovation using “surface active” implants has increased the rate of healing requiring only half the usual time. There are often situations where the implants can be placed at the same time as a tooth extraction - further minimizing the number of surgical procedures and reducing treatment times. In select cases, technologic advances have also made it possible to extract teeth, place implants as well as place temporary crowns in the same day. You may ask our doctor if you are a candidate for these more advanced procedures.

Our office is highly dedicated to provide patients the most modern implant techniques and materials. Only the highest quality, scientifically documented, brand name materials are used on our patients.

Who actually performs the implant placement?

Implants treatment is a team effort between our oral and maxillofacial surgeon and a restorative dentist or prosthodontist.

Dr. Rissolo will start with a surgical consultation including necessary x-rays, study models, surgical guides and treatment planning recommendations from your dentist. As implant surgical specialists, it often best that Dr. Rissolo performs the initial tooth extraction when possible, socket bone preservation graft if necessary and final implant placement. This surgical plan is closely coordinated with your restorative dentist who will take pre-treatment study models, design a plan for implant positions, prepare you for a temporary appliance when necessary and fabricate the final tooth or dental appliance on top of the healed implant(s).

What types of prostheses are available?

Both fixed and removable prostheses can be anchored to dental implants. Each patient is evaluated on an individual basis to determine the type of restorative prosthesis, fixed or removable, and the number of implants recommended to achieve treatment goals.

A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. The single crown on an implant can often exactly mimic the missing tooth it replaces so that only a dental x-ray can recognize it is not your original tooth.

A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants.

A complete dental prosthesis (fixed bridge or fixed detachable bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended.

A removable prosthesis (over-denture) attaches with hidden clips to a small metal bar or precision snap on attachments underneath the denture. The removable prostheses often replace more teeth with fewer implants. They must be removed daily by the patient for cleaning.

The full arch fixed bridge prosthesis is anchored to the implants by miniature screws or cement and can only be removed by your dentist. Generally, more bone volume and a greater number of implants are required for full arch fixed prostheses.

Dr. Rissolo performs nearly all our implant and grafting surgery in our clean, modern, state of the art dental surgical operatories. Local anesthesia and intravenous sedation are available for maximum patient comfort.

Why dental implants?

Dental implants have become the “standard of care” for the fixed replacement of missing teeth, and for good reason.

They are strong, durable and feel like natural teeth, and have scientific documentation of over forty years clinical success in the jaws. Constant technologic improvements have positioned dental implant therapy at the forefront of dentistry for the replacement of severely damaged or missing teeth.

Why would you select dental implants over a fixed bridge?

There are several reasons:

Conventional bridgework fills an empty tooth space by grinding away natural tooth structure on the teeth adjacent to an empty space. Then a rigidly connected series of crowns is then fitted over the top of these prepared tooth stumps. The preparation of teeth for crowns is often necessary when a tooth is fractured or damaged by decay, however this always causes an inflammation of the nerve inside a tooth. Crown or bridge preparation may traumatize the nerve inside these teeth enough to result in the need for a root canal procedure. Root canal treated teeth become dry and more brittle and over time they will loose strength and are more likely to fracture.

Once a bridge is cemented into place the supporting teeth are all connected together. This makes them more difficult to clean around and under where food and plaque reside. A small gap or seam between the natural tooth and crown may also collect plaque bacteria. Teeth that are not properly cleaned on a daily basis are more likely to get tooth decay and gum disease. The fixed bridge restoration for years provided dentists with a tool for fixed replacement of missing teeth, but not with out permanent compromise to additional healthy teeth.

Why sacrifice the structure of surrounding good teeth to bridge a space? Why put additional teeth at risk of future breakdown and failure? The American Dental Association supports dental implant therapy as the best treatment option for a patient missing a tooth. Using Dental Implants to replace missing teeth always treats the problem in a localized fashion. Long term, the dental implant restoration only treats a local part of the dentition, because it does not attach to adjacent teeth. In the event the implant should develop a future problem it remains a local problem since nearby teeth were not involved. This is not the case when a dental bridge fails, the area of the original problem often becomes larger and more complex to restore.

We recommend you have this discussion with your restorative dentist before selecting the treatment which is personally best for you.

Are you a candidate for implants?

If you are considering implants, your mouth must be examined thoroughly, radiographs are taken and your medical and dental history reviewed during a detailed oral evaluation.

Health: Dental Implant treatment is highly predictable for nearly all patients. If you are healthy enough to heal a tooth extraction and mechanically remove plaque from your teeth with a toothbrush, it is likely you are healthy enough for an implant. Some alterations in treatment are made for various medical conditions. No patient is “too old” for a dental implant. This becomes a matter of treatment preference.

Implants are delayed in the growing patient until the mid to late teen years when facial growth is complete.

Tooth loss is most often due to tooth decay, periodontal disease or tooth fracture. Dental Implants seldom fracture, are not susceptible to decay but can get peri-implantitis (a disease very much like periodontal disease).

Diabetics and patients with Periodontal Disease must be watched carefully after treatment by their dentist. Good daily oral hygiene is important to all implant therapy but especially important to this subgroup of patients.

Smokers are advised to quit before the placement of dental implants. Although implant treatments are often successful in many smokers, there is an increased risk failure with loss of implant stability in bone. Peri-implantitis is almost impossible to stop in patients who smoke. Dental implant treatment is expensive and involves considerable time and effort on behalf of the doctor and patient. Smokers are advised to quit to reduce this additional risk.

Patients on Oral Bisphosphonate therapy ( Fosamax, Actonel, Boniva etc. ) are advised to consult with their medical physician. There is no present solid evidence that implant treatment increases risk of bone exposure or implant failure in these patients. We do elect to proceed with caution and often may advise a patient to discontinue oral bisphosphonates for a period prior to and following implant placement. There is no scientific evidence to support any standard treatment protocol at the time of this writing. Please consult with our doctor for the most recent updates and recommendations concerning this emerging clinical situation.

Bone: Do I have enough bone?

This is a question frequently asked by patients referred for treatment.

Healthy bone that is wide enough and tall enough is one of the most important determinants essential to implant success. Bone of adequate volume influences the ease to properly position the implant during surgery. The long term health of an implant is also improved when larger implants are placed into an adequate bone volume. The position of near bye structures, such as nerves, tooth roots and the maxillary sinus, need be identified and measured.

Bone volume is often a limiting factor to treatment. The most predictable way to protect bone volume is to try and prevent post extraction bone loss. Often, patients who anticipate implant treatment following extraction are treated with a socket preservation graft. Socket preservation grafts help preserve the existing bone shape and volume for the future implant placement.

Patients who present for consultation that have less than ideal bone volume have several choices. A compromise in implant size and position, using smaller or thinner implants, however more often Dr. Rissolo will suggest a bone graft technique to replace the missing bone. The best long- term health and success with implants is achieved when the implant restoration most closely mimics the shape and size of the tooth it replaces. It is easier to make a tooth of proper dimension when the bone foundation is adequate. Various Bone Grafting techniques are available to correct the underlying bone deficit and provide implant support similar to the shape and position of the original missing roots. These are best discussed at consultation following a thorough exam and review of options.

What type of anesthesia is used?

The majority of dental implants and bone grafts can be performed in the office under local anesthesia. We are fortunate in oral and maxillofacial regions to obtain profound local anesthesia (numbness) for surgery with simple local injection techniques. Patients with anxiety may choose inhalation or intravenous sedation to supplement the local anesthetic. Sedation provides freedom from anxiety, muscle relaxation, sleepiness and some amnesia. Please ask your doctor if you are interested in these supplemental techniques.

Do Implants need special care?

Once the implants are in place, they should serve you for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dentist. Properly cared for, a well healed, well restored implant has the potential to last the rest of your life. Smoking, Periodontal Disease and Poor Oral Hygiene are leading causes of implant failure. Consultation with your dentist and surgeon is recommended to teach you the best techniques for continual health and success of your implants. Your dental hygienist may teach you new and special techniques for the daily removal of plaque on your dental implants.