10: Implant Dentistry: Substitutes for Tooth Roots Placed into Your Jaw

CHAPTER 10 Implant Dentistry

Substitutes for Tooth Roots Placed into Your Jaw

Dental practitioners have tried to develop artificial teeth to be placed in the jawbones since the origin of dentistry, but in recent years activity has increased in the area of implant dentistry. Initiated by Swedish research in the 1960s, the placement of small titanium cylinders or screws into the jawbone has progressed from an experimental (and highly criticized) procedure to common usage by many dentists (Fig. 10.1). The titanium-screw concept popularized implant use, but other types of implants were available much earlier. Examples are blades placed into the jawbone, with heads protruding above the gums (Fig. 10.2), and subperiosteal implants placed on top of the bone, between the bone and gums (Fig. 10.3). These types of implants are still used, but the screws or cylinders are more popular.

Do these tooth substitutes (dental implants) work? Yes, in the mouths of healthy people, without abusive oral habits or excessive smoking. Their ability to function rivals that of natural teeth. In severe cases they have allowed persons unable to wear conventional artificial dentures to chew well and appear normal. The most popular current concept (cylinders and screws) requires one or two clinical sessions.

1. The gum tissue is opened, and the screwlike titanium implant is placed into the bone (Fig. 10.4). This implant combines with the bone as the bone cells grow into its surface. This process, which has been called osseointegration, takes several months. During this time, the implant is usually sealed below the gum, away from mouth fluids and debris, while it heals into place.
2. On the second appointment, a small hole is made in the gum tissue, and the implant is exposed. A healing cap is placed on the implant for a short time, and a head is placed onto the implant body (Fig. 10.5). The gum tissue heals for a short time, and the dentist places some artificial teeth (prosthesis) onto the implant(s) (Fig. 10.6). These artificial teeth can be made to appear and function as well as or better than natural teeth.

On occasion, only one appointment is required. The implant is placed and allowed to protrude into the mouth. It may be restored on that appointment or at a later time.

Not all dentists provide implants. There are two distinct divisions in the implant procedure described. The placement of the implant into bone is a surgical procedure performed by oral and maxillofacial surgeons, periodontists, prosthodontists, and some general dentists. If your general dentist does not provide this service, he or she will refer you to a practitioner who performs the surgical portion of the procedure. Both portions of the implant procedure are exacting techniques requiring high skill, and experienced practitioners must be found for an optimal result. Prosthodontists or general dentists usually accomplish the second portion, or attachment of the artificial teeth (prosthesis) onto the implant(s).

If implants are so good, why doesn’t everybody have them instead of natural teeth? Numerous aspects of the implant concept are complicated and difficult for dentists placing them, making the procedure less predictable than desired. Implants are expensive, and, as with natural teeth, require upkeep by patients and dentists. When implants are really needed, they do not have satisfactory substitutes. The task for you and your dentist is to determine whether your oral needs would be served best by using dental implants to replace the root structure of the natural teeth, followed by some form of prosthesis (artificial replacement) for the missing tooth structures. The following pages will help you make that decision with the help of your dentist.

WHAT YOU SEE OR FEEL

Conditions, Signs, Symptoms Related to Implant Dentistry

1. All of Your Natural Teeth Have Been Removed

(Fig. 10.7). This type of condition is called edentulous. Loss of all teeth is decreasing in frequency because of the use of fluoride, better diet, and improved oral hygiene. However, millions of people around the world have lost all their teeth. Unfortunately, much of this tooth loss is among those persons who are least able to afford having implants placed.

Persons without any natural teeth have several classic signs and symptoms, some of which can be helped significantly by the use of implants and tooth replacements.

A. Collapse of Facial Form: Edentulous persons have reduced underlying support for the muscles of the face below the nose. These muscles collapse into the void space of the mouth, giving the person an aged appearance (Fig. 10.8). In edentulous persons the lower jaw can close much farther than normal before it stops and hits any structures. Some edentulous persons cannot touch their upper and lower jaws together after the teeth have been removed. Few people want to have a collapsed facial appearance.
B. Bone Shrinkage: When teeth are removed, the bone previously holding the teeth shrinks at a fast rate, leaving only a small percentage of the supporting bone present after many years of having no teeth (Fig. 10.9). In the later years of life, the amount of bone remaining in the jaws may be only one third or less than that of normal bone structure. The jawbones are weak and cannot support artificial dentures well.

If you are an edentulous person, you have the following alternatives:

(1) Reline or Rebase Your Old Dentures (p. 161). If your dentures are satisfactory except for fit, relining or rebasing your old dentures may be accomplished.
(3) Change Soft Tissues in Mouth Surgically. You may have the soft tissues in your mouth changed surgically (p. 97), providing more bone support for a new denture; then obtain new conventional dentures.

Jan 3, 2015 | Posted by in General Dentistry | Comments Off on 10: Implant Dentistry: Substitutes for Tooth Roots Placed into Your Jaw
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