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Dental Implants: An Ideal Way to
Replace One, Many or All of your Teeth
By Dr. Jeff Shnall
Toronto, Canada
In this article we will discuss what a dental implant is and
some of the many ways implants can be invaluable in the replacement
of teeth.
I place dental implants in my practice, so I have first hand
knowledge of implant surgery. I also provide my patients with
the replacement teeth that are attached to the implants, so I am
also knowledgeable about the cosmetic aspect of implant
treatment.
Let’s first explain what a dental implant is. Note: All
photos in this article are implants placed by me personally.
A dental implant resembles a common screw that you would buy in
a hardware store (approximately 12 millimetres long x 4 mm in
diameter).
Implant
on x-ray view
Like a screw, the typical dental implant will have screw threads
running down most of their length.
As well, implants come in a variety lengths and widths.
There are implants with designs that do not look like threaded
screws at all, but the majority of implants used in North America
are threaded.
Let’s describe how an implant may be used in dentistry.
Picture a person missing a single tooth in the front of their
mouth. If an implant is to be placed, we first
anaesthetize or freeze the area.
We prepare a channel through the gums and into the bone in the
site where we want to place the implant. The implant is
threaded into this channel in much the same way a screw is placed
into wood. This step is painless and really only takes
minutes.
The implant is usually placed just below the level of your gums,
so when you smile you would not see it.
Tooth out of alignment and was extracted
Implant placed under gums
Our goal is to attach a crown to this newly placed implant, a
crown being a hat that sits on top of the implant. For
our convenience sake today, I will just call the crown a
porcelain crown.
In reality, I normally prefer to place what is called
porcelain bonded to metal crown, which has the beauty of porcelain
and the strength of metal. I discussed different types of
crowns in another article on this website called “Crowns:
Facts You Need to Know.” Just click here
to read it.
Porcelain crowns can be made to look exactly like a natural
tooth.
Now how do we attach a crown to an implant?
What I did not tell you before is that the standard
implant is not a solid piece of metal. It is actually
somewhat hollow,
Picture again that screw from the hardware store. At
the top or head of the screw you might find an “x” shaped
slot in which you would put your screw
driver.
Well, a dental implant does not have a slot at the
top. Instead, it is open and you can see into the
inside of the implant..
Looking into an implant bottom right of photo
In this way a dental implant is similar to a bottle of
wine. If you take the cork out of top of the bottle you can
look inside. You can look inside a dental implant as
well.
Getting back to our example, we have just placed an implant into
the bone of our patient where he once had a front tooth. The
top of the implant is a little below the gum line so when he smiles
we can’t see it.
The next step is for us to place a metal post inside the
open end of the implant, the same way we would place a cork
in the open bottle of wine.
So if the patient smiles we now would see a small metal post
protruding from the top of the implant.
This post would be thinner and shorter than a real
tooth.
We can now cement a porcelain crown onto the post.
The replacement tooth is really three separate pieces:
An implant in the bone, a post in the implant and a
crown onto the post.
Here are a few more pictures to
illustrate how I replaced this missing lower molar with an implant
for our patient.
 First, I placed an
implant into the space where the lower molar was missing.
The missing tooth was the lower right first molar. This
picture was taken with a large mirror over the tooth, so it is a
mirror image of the top of the implant, positioned slightly
below the gum line.
 Next, an impression was
taken of the implant and a stone model was made, showing us the
exact location of the implant in the mouth.
 On the stone model a
titanium post is screwed into the model. Our lab technician
shapes the post. This post will be screwed into the implant
at our patients next appointment. No freezing
required.
 The lab technician also
makes a porcelain bonded to metal crown, which fit exactly over the
post.
 The post is screwed into
the implant in the mouth. The crown is then cemented onto the
post.
Here is a picture of the post, screwed into
the implant. (mirror image).
The final crown is cemented onto the
post.
The field of dental implants is an exciting area of dentistry
and definitely has dramatically has improved the level of care we
can provide our patients.
And although it sounds very high tech and cutting edge,
believe it or not the modern day implant is very similar to the one
developed back in the 1960’s by Swedish orthopaedic surgeon
Dr. Per-Ingvar Brånemark, who is considered to be the
inventor of the first commercially available modern dental
implant.
He was the first researcher to develop a titanium dental
implant. This implant could be placed in the jaw
and be accepted by the human body as if it were self. That
is, our body will actually produce bone that attaches directly to
the surface of a titanium implant , which is why dental implants
have been such a remarkable success.
Very few other metals are accepted by the human body this
way. Dr. Branemark did years of
careful research that eventually led to the realization in
the dental community that titanium dental implants were a
reliable, long term way to replace missing teeth.
There is long term research data showing that
dental implants placed over thirty years ago in Dr.
Branemark’s first patients are still in function today.
Over the past twenty years the use of dental implants all over
the world has increased greatly, and each year, in the United
States alone, over half a million implants are placed.
So implants are not exactly new to dentistry.
However over the years that dental implants have been on the market
there have been improvements in their design, and refinements in
how they are placed and how they are used.
Here are just a few examples of
improvements:
● The surface of implants are now chemically
treated to increase their success in areas of the mouth with poorer
quality bone.
● It use to be thought that when an implant was placed it
had to be left alone to sit under the gums undisturbed for at least
three months before it could be used to anchor a temporary
crown or denture.
However, experience has shown
that here are situations where a single tooth or even many teeth
can be screwed or cemented onto one or implants the very day they
are placed.
● Patients, who in the past were told they did not have enough
bone for an implant, can have bone grafts to rebuild or restore the
amount of bone in the jaws, allowing implants to be placed.
Here are Some Situations in which the placement of one, a
few or many implants can be placed to benefit a
patient:
1. Implants can be used to replace one or more missing
teeth in almost all areas of the mouth.
2. Implants can be used to stabilize loose
dentures. A great many people are missing some or even
all of their teeth and wear a denture to replace them.
● Some patients do well with dentures
but some people hate wearing them , especially if they are missing
all their lower teeth .
●Full lower dentures can become very
loose, making it difficult for people to eat or speak with
confidence.
● For these patients, two or three
implants can be placed in the lower jaw and their denture can
be fitted with parts that attach to the implants.
●In this case, the patient can still take the
denture out of their mouth to clean it and to clean around the
implants. When the patient puts the denture in their mouth it
snaps firmly into place onto the implants the way that you may snap
shut a metal button on a jacket.
● The implants hold the denture tightly
in place so the patient can eat, talk and smile, not having to
worry about a denture falling out of their mouth.
3. For a patient missing all of their own
teeth either in their upper or lower jaw, a set of teeth can be
made that are screwed or cemented into implants, and the
patient never has to remove this set of teeth.
In the lower jaw usually 5 or 6 implants are recommended
to support a full set of permanent teeth.
In the upper jaw 6 to 8 implants are
recommended..
For patients with good amounts of bone and who meet other
criteria, it is possible to place implants and attach a full set of
teeth all in one appointment. A procedure like
this has to be planned carefully and for some patients it would be
wiser to place the implants and let them heal for 12 weeks, before
directly attaching any teeth to the implants.
A few more benefits of implant
dentistry:
● Implants never decay, so if a tooth is replaced with an
implant you don’t have to worry about the tooth developing a
cavity.
● After implants are placed, often there is not a
great deal of discomfort after the procedure. Any
discomfort can usually be managed with medications such as
Ibuprofen or Toradol.
If patients take one Toradol
tablet before the freezing wears off, I find that they may need to
take one or two more that day and usually by the next day they no
longer require any pain medication.
● Implants have a high long term success and survival
rate:
Under normal circumstances, a relatively
healthy patient receiving an implant in an area of the jaw with an
adequate amount of bone should have a 95% chance or
higher of the implant procedure being a success.
● Implants can be placed in patients who smoke, however
smoking does decrease the success rate of implants in
some cases to about 80%.
● Patients with osteoporosis can have dental
implants placed, however if they are on bisposponate medication to
control their osteoporosis, careful consultation with their
physician will be necessary before going ahead with any dental
surgery involving bone.
● Implants have the potential to last a lifetime.
An implant may be expected to outlast many other types of
restorations we provide patients.
Let’s use a Canadian example to illustrate how replacing a
single tooth with an implant and crown compares with other
traditional methods of replacing a single tooth.
Here’s a real scenario that I have seen in my own office
many times over the years:
An adult male patient arrives at my office Monday morning.
He had an accident while playing ice hockey the previous evening
with his friends. He was hit in the mouth with a hockey
stick and his upper front central tooth broke off at
the gum line. So now when he smiles it looks like he is
missing a tooth.
This patient has the following options:
1. We could remove the root that is still in the
bone, after all, only the top half of the tooth broke off, not the
root.
He could decide to leave the gap and never replace the
tooth. He wouldn’t be the first hockey player to do
so. This option would not be realistic for most patients.
2. We could remove the root and replace the front tooth
with a removable denture.
Again, not the way many people wish to
replace a single tooth as a long term option.
3. We could leave the root of the broken tooth in
place. No extraction of the root. We then could
cement a metal post (titanium or stainless steel) into
the root of the broken tooth, and cement a crown on top of that
post.
Sometimes saving a broken tooth by
cementing a post into the root that is still in the gums with a
post is a good option.
However if the tooth is broken far
under the gum line, placing a post in the tooth and placing a
porcelain crown on top of the post may not be a permanent fix.
Roots with a post cemented down
their length can break, or develop root
fractures. As well, cavities or gum disease can form in
the remaining root, which could result in loss of the tooth.
4. We could place a bridge to replace the missing
tooth. What is a bridge? Let me explain it this
way:
● When we provide a bridge for a patient , first we freeze
or anaesthetize the area.
● Next, I reduce the size of the tooth on the
left side and right side of the one that is missing..
Before view – upper front bridge
● Next., we cement the bridge over the two teeth we have
prepared.
● In the porcelain bridge method of tooth replacement,
teeth that have been reduced in size may eventually require root
canal treatment.
● Once root canal treatment is done, a post will
likely need to be cemented into each of the teeth that support the
bridge. And this leads us back to the problem of teeth with
posts: they are more prone to breakage.
● Cavities and/or gum disease can develop in the teeth that
support the bridge.
Dental research has shown that bridges, on
average, may only last about 10 years before they fail.
Having said that, to be fair, I have seen bridges that look great
after 50 years of service in patient’s mouths.
● For patient’s not wishing an implant or who are
not good candidates for an implant, a bridge can be a suitable
option.
5. We could place an implant and a crown.
Research and clinical experience has shown that an implant
will normally outlast the other options that I described for
replacement off one or more teeth.
So, there are definite advantages for the implant option to
replace one or more teeth. A dental implant with a crown
won’t decay, will rarely break, and can be, in some cases, more
resistant to gum disease than a natural tooth.
And for your interest, in my office it costs approximately the
same to replace one tooth with an implant and crown as it does with
a bridge.
So implants help preserve the health of neighbouring
teeth. Patients who wish to replace their missing teeth
with something other than a removable denture, no longer have
to cut down natural teeth to support bridgework, which, about
twenty or so years ago would have been your only other
option.
Wrapping things up, dental implants can provide many years of
service and are an excellent way to replace missing teeth.
If you should like more information on implants you can do the
following:
2. Call us or e-mail us to set up your free initial
implant consultation.
Office telephone; 416-691-2886
E-mail: BeachDentistry@gmail.com
(reception e-mail)
Dr.Shnall@gmail.com
(My personal e-mail)
We welcome your questions or feedback on this article.
Sincerely,
Dr. Jeff Shnall
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