Dental Implants in Toronto

More than 42% of people above the age of 65 are missing all of their teeth in one or both jaws. Most of these teeth were lost to gum disease. Research shows that 85% of the estimated 32 million people with dentures in the US and Canada experience pain, embarrassment and difficulty with their false teeth. Now patients who have lost more than one tooth in a row may have a better choice than a fixed bridge, removable partial or full denture.

All About Implants

Dental implants are artificial tooth roots that are used to replace missing teeth. They can solve many problems that often come with removable plates and dentures. Although implantation of artificial or replacement roots has been attempted for hundreds of years, only recently have techniques been worked out that makes them predictably successful.

Modern dental implants techniques and technologies originated in Sweden in the early 1960's. After scientifically proving that these new bone-integrating titanium implants were successful, Swedish researchers brought their methods to a few select centres in North America in 1981.

Toronto was one of these original, chosen study centres. I was fortunate to be one of the few dentists selected to work with patients in the early 1980's giving me a longer history than most in this field and an opportunity to see and experience many changes and advancement in the field of implant dentistry.

Dental implants are best for patients who don't have enough or suitably strong roots to support replacement teeth when original teeth have been lost. Implants are reliable and predictable treatment to restore healthy appearance, chewing effectiveness, digestion, comfort, and facial support.

What Is A Dental Implant?

Dental implants are metal cylinders - usually titanium- roughly the size and form of one root of a tooth. They're placed into the jawbone and act as supports for replacement teeth above the gum. The procedure usually is done in three stages once treatment is fully planned.

  1. Titanium implants are first placed into the jawbone with a surgery that's similar to tooth extraction but in reverse. A healing cap is placed on top of the implant that is visable in the mouth allowing the gum tissues to heal and form a natural gingival contour. The implant is allowed to remain undisturbed for three to six months. This period of time is required to have bone integrate to the implant surface making it a part of the body, not just a foreign object.
  2. The next stage is a torque test procedure to assess implant healing and stability.
  3. The third stage is impression taking for the fabrication of the replacement tooth or teeth.
  4. The final phase is attachment of the new tooth (crown) or teeth to the implant.

Titanium has a long history being well accepted by the body in such things as artificial hip and knee replacements. When used for dental implant-roots bone becomes firmly attached to the titanium implant surface, making the implant a strong anchor and support root.

Even if you've been told in the past that you don't have enough jawbone, there are now advanced techniques in bone grafting to increase bone width or height to allow placement support implants. Today, most obstacles that previously prevented implants from being used can be overcome.

In order to properly assess your needs I'll usually need special CAT scan type X-ray images of your jawbone to determine it's size and shape. Accurate models of your mouth and photographs are also needed to plan this type of complex treatment.

Common Sequence of Dental Implant Treatment

A. TREATMENT PLANNING PHASE

  1. Models of your mouth mounted to a device that mimics biting jaw movements?
  2. Mock-up treatment on these models of your mouth?
  3. Specialized x-ray films - usually computerized tomography (CAT)?
  4. Fabrication of a surgical template?
  5.  Selection of specific implant hardware and techniques

B. STAGE I SURGERY PHASE

  1. Placement of implant root-forms and possible bone grafting or sinus modification surgery to alter bone to accommodate implants.
  2. Placement of healing caps to guide healing of gum tissue.
  3. Post-operative healing assessment at one week?
  4. Post-operative healing assessment at two weeks.

C. HEALING PHASE

  1. Bone heals into the implant - minimum of 3-6 months - lasts occasionally as long as one year

D. FABRICATION OF FINAL TEETH PHASE

  1. Final impression of healed implants and gum tissues.?
  2. Try-in of metal portion of teeth approximately 1 to 2 weeks later?
  3.  Insertion of final teeth approximately 1-2 weeks later?
  4.  Post-operative verification of fit and bite

E. MAINTENANCE PHASE

  1. Home care for dental implants and artificial teeth is similar as that of natural teeth

Phase I Surgery

Implants are still best placed into the jawbone after hopeless teeth have been removed and the extraction site has healed for 12 weeks.

The surgical appointment for placing implants into the jawbone and under the gum usually takes between 1 to 3 hours depending on the number of implants and their location in the mouth. Many people choose to be asleep for this appointment.

Discomfort and swelling are common afterwards and controlled best with cold packs held on your face next to the surgical site for two days along with taking medications I'll prescribe for you. It's best to have no temporary replacement teeth rest on top of the implant surgical site for at least three days and six weeks or longer is highly recommended.

Advanced Treatment Considerations

Strict procedures and techniques have contributed greatly to the success of bone integrating implants. But in recent years, a growing body of preliminary research has led many dentists to believe that variations to classical procedures are possible. The classical approach involves the following principles that many patients find inconvenient:

  • Removal of any teeth to be replaced with implants 6 weeks to 6 months prior to implant surgery Wearing no teeth over new implant sites for a minimum of 6 weeks and up to 3 months.
  • Placing the implant in two surgical stages

Other areas of controversy involve:

  • Using materials other than proven titanium
  • Smooth, machined titanium versus rough or microscopically rough surfaces
  • Placing permanent teeth with full biting forces versus staging the amount of biting force applied to the artificial roots by using temporary teeth prior to making permanent teeth
  • Method of interface between dental root-form implant and tooth. There are well over 30 different types of implants and many manufacturers. There is considerable controversy regarding the best way to attach artificial teeth to the top of the dental root-form implant.

The industry is in a time of tremendous growth and change. A prudent choice for implant type and manufacturer must not only consider biological factors specific for you, the patient, but also issues of hardware costs, reliability and stability of the manufacturing company.

Implant Treatment Difficulties and Complications

There are various problems that can arise during and after this type of extensive dental treatment. Here's a list in order of likelihood:

Discomfort, Bleeding, Infection, Swelling & Bruising

These are the most difficulties arising after implant surgery. The severity and duration of these expected difficulties are about the same as other oral surgeries such as tooth extraction.

Screw Loosening

Very small screws are used to hold some part of the implant and tooth assemblies together. These screws may loosen or even break. As implants have been used with increasing frequency for replacing one or more teeth surrounded by other natural teeth as opposed to patients with no teeth at all, this has become the number one problem with implants. While this is an annoying problem, it's not a 'catastrophic', irreversible problem.

Screw loosening appears to be related to biting forces, metal creep and embedment relaxation involved from clamping two machined components together and precision of fit of the various implant-tooth assembly parts. It currently appears that by using precision machined, high quality parts, high-gold content screws stretched to a specific torque force and designing the teeth to fit accurately into your bite that the incidence of loose or fractured screws can be minimized.

Imperfect Appearances of Artificial Teeth

Implants aren't the same shape or colour as natural, healthy tooth roots. They were initially designed to support full dentures for people without lower teeth and the basic design hasn't yet significantly changed from an appearance standpoint. These facts combined with difficulties positioning an implant at time of surgery can lead to appearance compromises. When implants are part of a plan to replace upper front teeth, careful consideration needs to be made about the final appearance especially for those who when they smile show gum tissue above the upper front teeth.

Bone Loss Similar to Periodontal Disease

Over time a small percentage of patients experience bone loss around implants. If this loss continues, just like a natural tooth, the implant may become loose and be lost. While this is very uncommon, it would mean further treatment and additional cost.

Approximately 3 to 5% of implants fail due to the bone not healing into the implant. A success rate of 95-97% is truly remarkable. If there is a failure it most often occurs within the first 6 months.

The loose and often sore implant is easily removed and a new implant can be placed after a few months of healing. The loss of an implant does not seem to lead to a reduced rate of success of future implants into the same site.

Infection & Overt Failure of Dental Implant

Contributing factors to the success of dental implant placement, as with most surgical procedures, include the patient's overall general health and compliance with post-surgical care.

Failure is more common in smokers, diabetics and patients who clench and grind excessively during sleep.

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At Dentistry Asleep®,Dr. Kevin Dann offers dental hygiene services, routine dental care for adults and children, periodontal and endodontic therapy,  cosmetic dental procedures and dental implants. Dr. Dann is one of the few Certified Specialists in Dental Anaesthesia, giving complete, comfortable care to all his valued patients. Enjoy experienced, anxiety-free dental healthcare!  Make your appointment now!