The Most Comprehensive Guide to Dental Implants
The 21st century has enabled people to live beautiful and healthy a large share of their lifetime. At one time, it was accepted in society that people would lose their teeth early in life, and just accept the loss of function as “just the way things are”. We now know that missing teeth and poor dental health affects many other aspects of our health. Studies show that oral health affects longevity with links to cardiovascular disease, diabetes, and neurological diseases.
Even though you may have good dental health, you can still experience tooth loss. Tooth loss can have negative effects later in life on the remaining teeth such as shifting, TMJ dysfunction, and periodontal conditions. With several options for replacing missing teeth, why gamble with not replacing missing teeth?
If you’re considering dental implant surgery, you likely have a lot of questions. You are probably weighing the pros and cons of dental implants against the alternatives, want to know the process and success rate, who is the best dentist in your area for dental implants, and are even wondering what is a reasonable cost for dental implants. This guide to dental implants is designed to help you sort through some of these questions to make an informed decision you feel comfortable with, and ideally answer the question, “Should I get dental implants?”
What Do Cosmetic Dental Implants Look Like?
A cosmetic dental implant is the closest structure to mimicking the structure of a natural tooth. An implant is a screw-like structure that resembles that shape of the root of a tooth.
How Dental Implants are like Legos
It may seem elementary to ask, What are dental implants? A cosmetic dental implant is just an implanted tooth, right? Actually, no. There’s much more to know than that. A dental implant refers to implanting the “root” of a tooth. Once the dental implant is placed, the platform of the implant opens up a host of different options for restoring the missing area. Think of cosmetic dental implants like the base of a Lego set. Numerous different configurations and designs can be developed from a Lego platform.
Now before you go thinking teeth are built with plastic, cosmetic dental implants are one of the most stable methods for replacing teeth. The implants themselves are typically constructed from medical grade titanium which is a highly biocompatible material. The jaw bone recognizes titanium similar to its own bone and goes through a process called integration where the implant stabilizes into the jaw bone to support the significant force of the bite. The cosmetic dental implants can then be used to create teeth that look, feel, and even enhance your natural teeth.
There has been a huge increase in the number of people that request cosmetic dental implants in the past 20 years. There are many reasons but most notably people are now better understanding the long term consequences of poor dental health, there’s an increase of public awareness of dental implants and the proven high success rate of dental implants.
Why Anyone with Proper Bone Should Get Cosmetic Dental Implants
The keyword in this section’s headline is “proper.” Here’s the deal with cosmetic dental implants. They are a great option to replace missing teeth, and probably the best option when a patient is a good candidate. The biggest disadvantage of cosmetic dental implants is that not everyone is a candidate.
So what makes a patient an ideal candidate for cosmetic dental implants? It comes down to the quantity and quality of bone of the site receiving an implant. Let’s first talk about the bone quantity, and then we will get into the more complex topic of bone quality.
Bone Sets the Tone
Bone quantity depends on two factors 1) How much bone was present when the tooth was lost (e.g. from effects of periodontal disease) and 2) How much time has progressed without bone grafting the site or without placing a dental implant. When a person first loses a tooth and the site is neither grafted or implanted, a long-term process begins during which the bone begins to decrease year by year. Therefore it is beneficial to plan for a replacement sooner than later. Significant bone grafting may be completed later on to place an implant, but with the compromise of decreased success rates. The image below details a site that had deficient bone and required significant grafting to be able to support an implant.
Bone quality is the second factor that predicts if a patient is a good candidate for cosmetic dental implants. Factors of bone quality are influenced by genetics, hygiene, and environment. Genetics generally don’t limit the placement of cosmetic dental implants other than for a small number of cases. Some factors that may be evaluated as contraindications are history of thin bone, autoimmune disease, poor diabetic control, treatment for severe osteoporosis, or other systemic factors that reduce the success rate of a dental implant. The patient’s oral hygiene is a factor that can be altered and improved to allow for the highest success rate of a dental implant. When the mouth has higher than ideal plaque and calculus, the gums become inflamed which lead to increased risk of bone loss around an implant. Environmental factors are the final criteria that must be evaluated prior to implant placement. The biggest environmental no-no for implant success is actively smoking. Non-smokers see significantly higher long term success rates for dental implants than smokers.
Cosmetic Dental Implants Are the Superlative to the Alternative
So let’s talk about the options. If you are missing a tooth there are three tooth replacement options:
- Dental implant
- Fixed dental bridge
- Removable dental appliance, also called a partial or complete denture
Here’s the rundown of the three options. A removable denture is by far the most economical and affordable option. With a denture, a patient can replace one or numerous teeth for the least amount of money. And as more teeth are needed to be replaced a denture becomes even more cost-effective because it is approximately the same price for replacing one tooth with a denture as it is an entire arch of teeth. A denture allows a patient to remove infected teeth, regain health, and have a low maintenance solution. If cost and maintenance are your primary concern than a denture is your best option.
What are Dentures?
Dentures are a removable option to replace missing teeth. If all the teeth in one arch are replaced it is called a complete denture. If less than all the teeth are being replaced it is called a partial denture.
But are the disadvantages of a denture worth the price savings? Because the denture only rests on top of the bone, the area below a denture begins to lose bone over time. A patient that loses a tooth in early or mid-life will have a sunken facial appearance by late-life if enough teeth are missing. A denture often limits function. The most common complaints of denture wearers are a reduction in the ability to chew, reduction in taste, difficulty when annunciating speech. Studies show that patients with poor-fitting dentures are significantly more likely to complain of chronic stomach pain. The reduction in chewing force causes denture wears to swallow food more whole which eventually begins to tax the stomach leading to frequent gastrointestinal upset.
Dental bridges are an option to replace missing teeth when there are solid teeth remaining on either side of the space. The bridge is permanently fixed in place and isn’t removed. To the patient, the dental bridge will restore the tooth to near-natural function. The patient can chew, eat, and speak similar to natural teeth. The smile of the patient will appear naturally and it generally will appear seamless comparing the natural teeth to the dental bridge. A dental bridge is a good option when a patient is not an ideal candidate for a dental implant based on the bone remaining.
What are Dental Bridges?
Dental bridges are a fixed option to replace missing teeth that utilize the teeth on either side of the space to support a prosthetic tooth.
The primary disadvantage of dental bridges is that they require stable adjacent teeth that must be reshaped to support the missing tooth. This isn’t a concern if the adjacent teeth have old fillings that would require replacement anyway, but what if the adjacent teeth are in perfectly good condition? A compromise must be made to sacrifice some of the enamel of the adjacent teeth for the sake of the missing tooth. Because dental bridges connect 3 or more teeth together, it limits the ability of the patient to floss under the bridge. The patient must commit to using special floss such as Superfloss or floss threaders to access under the bridge to allow for proper hygiene and proper lifespan of the bridged teeth. The last disadvantage of a dental bridge is similar to a denture in that the bone under the bridge continues to slowly deplete over time.
What are the Benefits of Cosmetic Dental Implants
When people think of dental implants they immediately think, “Dental implants replace a tooth.” Although that is one benefit, the benefits of cosmetic dental implants don’t end there. There are many other implants that affect more than just the teeth of a patient. The benefits of cosmetic dental implants include:
- Prevent Shifting of Teeth: When a tooth is lost and not replaced, it begins a chain reaction that affects the entire mouth. The teeth adjacent to the missing tooth tilt and shift into space. The teeth above or below, no longer have a tooth to occlude with and begin to drift over time. These small changes accumulate to large changes of the mouth over time.
- Reduce incidence of TMJ disorder: As teeth move and shift from a missing tooth, the small changes add up to large changes in jaw position. The change in jaw position can stress the TMJ and muscles, leading to pain later in life. A dental implant securely maintains the position of the occlusion for the site to help avoid future TMJ dysfunction.
- Improved appearance: Implants feel and look just like your own natural teeth. Since they fuse with bone, they are permanently in place which contributes to a natural function.
- Decreased aging: When a dental implant is placed into the bone it helps to preserve the bone of the site. Bone loss of the face and mouth contributes to an appearance of aging because it contributes to a sunken or reduces the height of occlusion. By reducing the amount of bone loss of the mouth, cosmetic dental implants help to support a more youthful appearance.
- Ability to eat: Dentures help to restore many teeth easily but the primary difficulty is that they are prone to sliding and movement when chewing. Implants work the same as your own teeth and allow you to eat all types of food without pain and with confidence. Implants can also be incorporated into a denture plan to assist in stabilizing the denture by attaching to a dental implant.
- Natural speech: Dentures that don’t fit properly can cause slipping of your teeth inside your mouth, making you slur or mumble your words. Implants, however, are placed in a natural and stable position that allows you to speak confidently.
- Maintenance of oral health: With implants, the dentist doesn’t need to reduce other teeth as they would with a tooth-supported bridge. If the adjacent teeth next to the missing tooth are in excellent condition, this is a significant drawback of dental bridges. Since implants don’t require the dentist to alter nearby teeth, it leaves more of your natural teeth intact and improves your long-term oral health. Furthermore, because a bridge links three or more teeth together, it makes food accumulation more likely. Cosmetic dental implants improve oral hygiene because they are easier to access between the teeth for oral hygiene.
- Improved self-esteem: Surveys have shown that 48% of young adults have untagged themselves from a photo on Facebook because of their smile. Implants help bring your smile back and improve your self-esteem, making you feel better about yourself. Whether you desire a complete Hollywood smile makeover or a simple restoration for a missing tooth, implants have a large effect on how you feel about your health and self-being.
- Longevity: Because implants are made of durable materials and cannot decay, they’ll last many years. Many implants may last for life making cosmetic dental implants a solid long term investment.
- Peace of mind: You remove dentures, which can cause inconvenience and embarrassment. Implants take the embarrassing inconvenience away. Dental implants do not require as many adjunctive tools such as denture adhesive as is the case for dentures or floss threaders as is the case for dental bridges.
The Different Types of Cosmetic Dental Implants
Let’s go over your dental implant options. There are several types of dental implants. Three common ones are tooth cosmetic dental implants, all-on-four dental implants, and implant-retained dentures.
1. Tooth Dental Implants
This is probably what you think of when you think of cosmetic dental implants—a tooth is lost and it is replaced with another tooth via a dental implant. Depending on the patient’s circumstance, a dental implant can be used to replace one tooth, or a combination of several teeth via several individual implants or implant-supported bridges.
2. All-On-Four Dental Implants
If any of your teeth require reconstruction or you are already missing most or all of your natural teeth, you may opt for a specific type of dental implants known as all-on-four implants. The treatment of all-on-four implants allows a patient to restore an entire arch of teeth by placing only four implants that support an entire arch of teeth. The all-on-four option is good for two reasons: It helps to limit cost compared to placing single tooth implants for each tooth missing, and it allows for a full mouth implant option when there is too little bone in the back of the mouth.
All-on-four implants are an innovative procedure that even helps those with extensive bone loss to totally restore missing teeth. The way all-on-four implants allow for restoration in areas of bone loss is because the implants can be angled to avoid areas of bone loss and allow osteointegration into areas that have sufficient bone.
While there are numerous benefits to the all-on-four implant procedure, not all individuals are good candidates for this treatment. You may be a good candidate for all-on-four dental implants if you:
- Require an entire set of teeth or full arch replacement
- Currently wear dentures and are not happy with the fit or upkeep required
- Lack of the bone density needed to support a large number of regular implants
All-on-four implants are an alternative solution for patients who may not want to or can’t undergo lengthy implant procedures where bone augmentation, multiple implants or soft tissue regeneration are needed.
3. Implant Retained Dentures
An implant-supported denture is an option for patients who do not have remaining teeth in the jaw but have enough bone in some areas of the jaw to support implants. An implant-retained denture is a type of overdenture that is more secure than a traditional denture because it is attached to implants. A regular denture rests on the gums via a suction method without the support of dentures. The implants essentially have buttons on top of them similar to the snaps on a jacket. The denture has reciprocating snaps on the underside of it that snap into the implants and allow it to remain more stable in place.
How Cosmetic Dental Implants Work
Let’s talk about how the process for completing dental implants works. The dental implant process is generally considered in two stages: the placement of the implant followed by the restoration of the implant. The process generally involves the following steps:
- Preparing the Site for the Dental Implant
Depending on the clinical situation the jaw is made ready for an implant. If there is a damaged tooth in the site, it must be removed and free of infection. If the site has insufficient height or thickness of bone it will be grafted with bone minerals to increase the bone volume. A bone graft helps create a stronger base for your implant.
- Placing the Dental Implant
During the procedure to place the implant, your dentist will make an incision to open your gum to expose the bone. The incision can be done with a scalpel or a laser, either way, has similar result and healing. The dentist will create a small pilot hole in the bone and place the dental implant in the same pilot hole. Most often the procedure is sutured closed at this point and allowed to heal prior to attaching a tooth to the implant. If the area is in the front of the mouth your dentist can make you a temporary tooth to wear which is commonly called an Essix retainer, a flipper, or a Maryland bridge.
You may be wondering how large a dental implant is. Cosmetic dental implants on average are between 8mm to 12mm in length which mimics the natural length of the roots of most teeth.
- Waiting on Bone Growth
Once the dentist places the implant post in your jawbone, the body begins a process called osseointegration. During osseointegration, your body essentially accepts the dental implant and attaches bone to it. The process takes a minimum of 8-12 weeks and creates a solid foundation for your future teeth.
- Placing the Abutment
Sometimes when a dentist places an implant, they cover the implant with the gums during osseointegration and sometimes they are able to leave an abutment exposed at the same time of placement. If your bone required your implant to be covered during osseointegration you will require a small secondary surgery where the dentist makes a small incision and attaches an abutment to the implant to allow the gums to shape around the abutment. The second procedure is a minor surgery performed in an outpatient setting, requiring only local anesthesia, and it can often be avoided in many cases.
During the process of placing the abutment:
– The dentist will reopen your gum, exposing the implant.
– They’ll attach the abutment to the implant.
– They’ll close the gum tissue around the abutment, but not over it.
- Attaching the Artificial Tooth
After they place the abutment, you’ll have to wait a couple of weeks for your gums to heal before the dentist can attach the artificial tooth.
How All-On-Four Dental Implants Work
The all-on-four implant procedure is quite a bit more specialized than traditional dental implants, and it is recommended to see a specialist in your area who has expertise with all-on-four cases. A typical all-on-four implant procedure will involve three general phases:
- Removal of the broken, decaying or otherwise compromised tooth or teeth of the arch to be treated.
- Two dental implants are placed in the front of your jaw and two additional implants are placed at an angle in the back of the jaw so that they engage the stronger bone of the front of the mouth but also are far back enough to support molars.
- A full arch of teeth that resemble a long dental bridge are attached to the implants. Over a series of follows the fit is adjusted for comfort.
How Sedation Dentistry for Dental Implant Surgery Works
Although oftentimes dental implant surgery can comfortably be performed with only local anesthetic, it is understandable if you are anxious about the procedure. Sedation dentistry is an option for dental implant surgery that can help make the process less anxiety-ridden.
In addition to local anesthesia, often patients may elect for a form of sedation dentistry to aid their comfort. There are three main options of sedation dentistry that we will discuss below:
- Inhalational: Inhalational dental sedation in the office setting is typically done with laughing gas. The patient wears a small mask on their nose and breathes the gas during the procedure. During the procedure, the patient breathes in a gas that reduces their anxiety. The patient will be fully conscious and in full control of their actions, but the gas helps to reduce mild to moderate anxiety to a more comfortable level.
- Dental Oral Sedation: For dental oral sedation the patient is given a medication to place under their tongue before beginning the procedure. The medication is typically a type of medication in the benzodiazepine family such as triazolam or lorazepam . The medication takes about 30-60 minutes to take effect and allows the patient to feel more relaxed and sleepy than can be achieved with inhalation sedation. The medications used also have an amnesia effect that makes the patient feel like they were sleeping during the entire procedure.
- Dental IV Sedation: IV sedation has the greatest amount of control over a patient’s anxiety during dental procedures. The sedation is performed by providing medication intravenously. is administered intravenously, or directly into a vein. The medications can easily be titrated during the entire procedure to keep the patient at the optimum level of sedation comfort and sleep. During both oral sedation and IV sedation, the dentist and team will meticulously monitor the patient’s vital signs during the procedure. The medications can be completely reversed if needed, making dental IV sedation very safe when performed by an experienced board-certified sedation dentist.
What is the Healing Process of Dental Implants Like?
When planning for dental implant surgery, you can expect most of the healing to occur in the first 3-5 days. During the first 3-5 days after dental implant placement, you will have mild to moderate pain and swelling which is typically manageable with pain medication and anti-inflammatory medications. Your surgeon may prescribe antibiotics to prevent infection during healing, and you will be taking antibiotics for 5 to 7 days to help heal successfully. Most swelling and pain will subside in the first week, but the implant area will be tender to touch or chew near for about 2 weeks postoperatively.
Complications of Cosmetic Dental Implants
Having cosmetic dental implants placed is usually a very safe and routine procedure that many patients find great benefit in. However, as with any surgery, you could experience complications. Some of the most common complications that occur with cosmetic dental implants are:
- Failure to osseointegrate
- Nerve paresthesia
- Sinus, nerve or nasal cavity injuries
The good news is many of these complications can usually be avoided by proper planning. Infections can occur in the mouth due to natural bacteria that exists in all our mouths.
After implant surgery, your dentist may prescribe an antibiotic to prevent bacteria from accumulating and infecting the healing site. Bleeding normally will occur for up to a day after surgery. If bleeding continues more than a day it is considered a complication which usually is related to medications the patient is taking, failure to keep the site clean, or preexisting issue with the liver—all of which can usually be coordinated prior to treatment. Injury to the nerve or sinus is a complication that rarely occurs with a dentist thoroughly experienced with dental implant surgery, and modern technology allows for 2D and even 3D visualization of the sinus and nerves prior to and during the procedure which minimizes the risk. Failure to osseointegrate is a complication that occasionally happens which usually means the procedure can be redone to achieve success. The most common causes of a dental implant failing to osseointegrate is due to infection, lack of bone, lack of oral hygiene, smoking, autoimmune disease, and idiopathic response of the body.
Despite these drawbacks, cosmetic dental implants are a reliable and safe option with a high success rate which averages above 97% for all cases, and can improve your quality of life significantly.
Are Cosmetic Dental Implants Right for Me?
Not everyone is a candidate for cosmetic dental implants but usually, with proper planning, most people can become candidates. The best candidates for dental implants:
- Have abundant bone in the area receiving the implants
- Do not active dental decay or periodontal disease
- Have a good commitment to oral hygiene
- Are non-smokers
- Have not taken bisphosphonate medication for an extended period
- Do not have an uncontrolled systemic disease or autoimmune disease
But, because implants aren’t the right option for all people, as we discussed there are other options that may be more successful for you. Some alternative options available are:
- Removable Denture
A removable denture is a prosthetic replacement of the teeth that are supported by your gums or the remaining teeth. A removable denture is a non-invasive and low-cost alternative to implants, but the tradeoff is they are more unstable, uncomfortable, and function less naturally.
- Tooth-Supported Fixed Bridge
A fixed dental bridge functions like natural teeth because it is not removable, however, it uses the teeth on either side of a space to support the missing tooth. The adjacent teeth are essentially prepared for crowns and the crowns are linked together which are then cemented permanently in the mouth. Dental bridges are commonly an alternative to implants, especially if the tooth has been missing significant time and bone is limited.
- Do Nothing
If you decide to delay tooth replacement treatment or do nothing at all, you should first consider the consequences. The consequences generally occur slowly, but over the long term can create severe issues later on in life. Most importantly, bone loss occurs when a tooth is not restored with an implant, and the surrounding teeth begin to slowly shift which can result in temporomandibular dysfunction and TMJ pain later in life.
How Much Are Cosmetic Dental Implants?
There are several factors that could influence the cost of a dental implant, but the average cost that you could expect to pay for a qualified implant dentist in the Boston Metropolitan area ranges from $1,500 to $3,000 for just one implant. That cost will represent the first phase of treatment to place the implant which opens up the many options for which it can be restored. To add in the abutment and crown, and those could cost from $500 to $3,500 additionally.
Why does getting a dental implant have to be so expensive? Well, you need to keep in mind that this is a surgical procedure, so it’s best to see a dentist who has received the proper training. The higher upfront cost of a highly skilled implant dentist will cost less than complications of the alternative.
You may be relieved to learn that sometimes dental insurance and potentially medical insurance may help with the cost of cosmetic dental implants or bone grafting. Dental insurance provides insurance benefits for procedures that are dentally necessary and medical insurance provides benefits for procedures considered to be medically necessary. Because dental implants replace missing teeth, a portion of the treatment is often considered dentally necessary. In addition, because dental implants reconstruct the bone loss of the mandible or maxilla some medical insurances may consider a portion of treatment medically necessary. Dental implants may also be needed as a result of trauma or an accident which also renders them medically necessary. It is important to note that not all cosmetic dentists, periodontists, or oral surgeons accept all insurances, and not all are able to bill medical insurance. Research the top implant dentists in your area, and contact them to discuss your dental and medical insurance. That will help to give you a sense of your treatment will be partially covered by some of your dental or medical insurance.
Contact The Best Dental Implant Dentist in Metro Boston, MA
For more information on cosmetic dental implants visit a top implant dentist in your region. In the metro Boston area, Dr. Charles Sutera has established himself as an authority in implant dentistry due to his comprehensive expertise. His national media attention for renowned expertise in TMJ, sedation dentistry, and high-profile celebrity smile makeovers has earned him the title of “The Best Outside the West”. Contact Aesthetic Smile Reconstruction for further information.
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