Missing a tooth or wearing uncomfortable dentures can make a person self-conscious; so much so that they avoid smiling, or they cover their mouths when they speak. And while implants can remedy this problem cosmetically, there are even more important reasons why it makes sense to undergo this dental procedure.
“In dentistry, if a person is missing a tooth, you have to have a way to replace it so that they can have full function of their mouth,” explained Dr. John Pawlowicz of Pawlowicz Dentistry. “In addition to providing a better bite, because implants mimic the tooth root, they also prevent gradual bone loss and help to maintain gum tissue health.”
In the past, missing teeth were replaced with bridgework, which required dentists to file down the teeth around the empty space to create a crown to close the span. With the advent of implant dentistry, dentists can now just replace a single tooth. Implants can also last much longer than bridgework, which has an approximately 5- to 10-year lifespan.
“This is huge for a lot of people, especially those who don’t like going to the dentist in the first place,” said Dr. Pawlowicz, adding that implants also have a more lifelike feel and more closely resemble a natural tooth.
How It Works
According to the American Dental Association, there are generally three steps involved in the implant process.
First, the dentist surgically places the implant in the jaw, securing the gum over the implant. After it fuses to the bone, which can take a number of months, the implant is uncovered and the dentist attaches a post to the implant. After the gum tissue heals around the post, this serves as the foundation for the new tooth. Lastly, the dentist makes a crown to blend with the person’s other teeth, and this is attached to the implant post.
“At our practice, we use cone beam computerized tomography, or CBCT, to make a 3-D rendering of where the missing tooth is,” said Dr. Pawlowicz. “Using treatment planning software, I can virtually put a tooth in the space where it’s missing.
“By using this mock up, we can determine whether a patient is a good candidate for the procedure,” he adds. “We can tell if there’s not enough bone or if the space is not a good functional spot for a tooth.”
If a person is a good candidate, Dr. Pawlowicz makes a drill guide to help guide the implant through the bone to the most accurate position. “This steers us away from nerves in the jaw, or root tips of other adjacent teeth that couldn’t be seen with the naked eye or X-rays,” he said. “It also helps to speed up the process, so we can get the patient out of the chair a little bit faster.”
At the next appointment, impressions are taken, and a tooth is inserted in the space.
The length of time it takes to complete the entire procedure varies, depending on the patient.
“It gets tricky because people have different bone densities; if they have highly dense bone—rock hard like concrete—you may be able to start taking impressions more quickly,” said Dr. Pawlowicz. “With softer bone densities, you need to wait for the body to grow bone into the threads of the implant, and this osseointegration can take four to six months.”
While some dental practices can scan the implant and make the tooth in-house, others send the scans out to laboratories, which can add more time to the process.
Are You a Good Candidate?
As with any surgical procedure, there are good candidates and those who are at higher risk of developing problems.
“Smokers are typically not great candidates, and those with autoimmune diseases face a higher risk of implant failure or rejection,” said Dr. Pawlowicz. “People who suffer from pre-diabetes or diabetes, and those with bone disease are also at higher risk, as are those who take certain medicines, including bone rebuilding drugs like Fosamax.”
He adds that many people with these types of conditions have had successful implant surgery, but that the decision needs to be made on a patient-by-patient basis.
In the early days of implant dentistry, patients experienced a higher rejection rate, but with the advent of newer technologies, such as guided surgery and screening, many more patients are able to successfully undergo the procedure.
“Implant surgery is now one of the more predictable things in dentistry; while every so often, someone is not compatible, it’s still a good idea to explore this treatment because the rejection rate is so low,” Dr. Pawlowicz added.
He notes that patients who are thinking of getting an implant shouldn’t wait too long to learn about their options.
“The sooner you lose a tooth and get an implant, the better, especially for front teeth,” he said. “The bone melts away over time, which leaves patients with very limited options.”
A Natural Smile
In the past, dentists used metal connectors with metal substructures to replace teeth, which resulted in a less than perfect smile. Materials have since changed in that while they are still metal-like, they no longer have the metallic color.
“Especially in an aesthetic zone, like the front teeth, you don’t want the teeth to look dark; you want them to look as natural as possible,” said Dr. Pawlowicz. “While metal connectors blocked the light from going through, zirconia, which is what we use now, transmits light. Dental companies are now making more options in beige and white because patients want more lifelike materials.”
Costs can vary widely for this type of surgery, depending on which tooth or teeth need to be replaced; the amount of planning and preparation it requires; the knowledge and experience of the dental surgeon and more.
“For example, replacing a single front tooth is more expensive than having a back molar replaced; front teeth are trickier in that the bone is thinner, and it is a different type of gum tissue. To do it right and get the best aesthetic result requires a lot of prior planning,” said Dr. Pawlowicz.
He adds that patients should be wary of misleading advertisements.
“So many commercials say that they can give you teeth in a day, and that you can just walk in and get implants,” he said. “That can be true, but different people have different presentations, and you may not be a good candidate for that type of dentistry. Some people might have fantastic, dense bones and the implants can go right in; other people with softer bones will need to wait until the implants heal.”
He advises people to check out all of their options, especially if missing teeth are negatively affecting their lives.
“Implants are such a great part of dentistry; we’ve done single tooth, multiple teeth, dentures or full mouth implants, and it’s such a rewarding part of our practice,” he said. “It’s great to see patients laugh and smile again.”
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