Losing your teeth in an accident or losing them to tooth decay is no laughing matter. Many people with missing teeth areDental Implants Smile too embarrassed even to smile. But a relatively new procedure called dental implants can permanently repair your smile. Below, two clinical professors will discuss the options.

What is a dental implant?

It is basically a titanium screw placed into the jaw bone with a tooth anchored to it.

First, we make an osteotomy, which is a hole in the bone, and then it’s screwed in. After a certain amount of healing, we place a tooth on top of it.

How far into the bone does the implant go?

It depends on the areas in the mouth, but there are some vital structures that we can’t invade, such as the sinus or the mandibular nerve, since there are nerves inside the bone. We just have to avoid those. Sometimes a patient has to have bone replaced or augmented there prior to placing the implant.

What is that tooth made out of?

It could be made out of ceramic material which is aesthetic, or it could be made out of a metal with a ceramic on top of it.

When does a patient need this procedure?

Of course, an implant can be used in any situation where a patient is missing teeth. Implants were first developed for people who lost most or all of their teeth and until recently these people were condemned to wearing removal dentures, what people call “plates” for the rest of their lives. They go to bed at night and put the plates in a glass by the bed.

But we can also use implants where patients have lost only one tooth or just a group of teeth, due to either dental decay or periodontal disease. Frequently these days they are for people who’ve lost a single tooth due to trauma, an accident or sports injury.

What’s good about that is that you’re not touching the adjacent teeth. Adjacent teeth remain untouched. You’re not drilling into them to put some type of anchor on there to anchor the pontic, which is the fake tooth. Before, we would file down those teeth and make a bridge or use something removable. That’s why it’s much better to have an implant available to us in these instances.

The miracle is that we are literally replacing people’s teeth — this is something that science has been trying to do for thousands of years. There are records among the Egyptians and archeological finds where they have tried to put teeth back in the mouth.

How long does the process take?

The patient comes in if the bone is healed and there is an incision made over the crest of the ridge where the tooth is missing. The area is opened up, dissected and an osteotomy is made — a hole is made into the bone and a titanium screw is placed there. Then it’s usually covered. This may take a half hour, 45 minutes and we do it under local anesthesia so you’re awake but don’t feel it.

The healing is actually very short. It may be a couple of days at the most, and without a great deal of discomfort in most cases. But what we are concerned about in terms of healing is what we call the integration of the bone with the implant itself. This is a biologic process and that takes time, anywhere from three to six months depending on the part of the jaws the implant is in.

How is the pain after the anesthesia wears off?

It’s actually less painful than having periodontal disease and having periodontal surgery. That’s what most patients will tell you who have gone through both. So it’s not a very painful procedure. The patient most of the time — if it’s only one tooth — can go back to work that day, as long as they can take some medication for it. We usually give Motrin, Advil, Nuprin or a stronger version of that.

Right after the surgery, the area is usually covered with some type of provisional prosthesis. The implant is now submerged in the bone and the gum is sutured over it. So the patient really doesn’t even know what happened there after a few days and it heals and you have the sutures removed.

What is the success rate for this procedure?

The success rate is very high. For the lower jaw, we generally consider the success rate to be about 95% and for the upper jaw, it’s a little bit lower. It’s probably about 89-90% because the bone in the lower jaw is more dense than the bone in the upper jaw.