IMPLANT SUPPORTED TEETH

What are dental implants and why might they be right for you?

Implants are cylindrical titanium posts that are surgically placed into the jaw where the tooth root used to be. This post sits below the gum, but provides the foundation for artifical teeth above, in the form of crowns, a bridge or a denture. There is absolutely no pain or movement of the implant supported teeth when eating or talking. In most cases, an extremely natural appearance is achieved. Most people describe implant supported teeth as being “part of themselves,” with a return of self confidence, particularly when eating out socially.

Advantages

The appearance is very good and the teeth feel natural.
They are very useful in cases where a person naturally has slight spaces between their teeth. With a single tooth implant these spaces can be reproduced.
They are permanently fixed and not removable, which means there is no movement during eating and speaking.
They are looked after just like natural teeth, there is no need to take them out for cleaning.
Implants and their supported teeth do not get decay.
The metal used in implants is titanium. This is a safe, biocompatible metal to put in your body.
The remaining teeth are left intact and carry no extra load as the implant teeth support themselves.
An implant can be used in cases where teeth on either side of the gap may not be strong enough or suitable to support bridgework.
They help to maintain and support the surrounding gum.
By replacing missing teeth, they stop adjacent and opposing natural teeth from shifting.
Where we can, the artificial teeth are screwed onto the implant fixture. This means if there are any problems, the teeth can be removed, adjusted, and even repaired.
If the implant ever does need to be removed, any of the other options could still be used to fill the gap.
Implants are very common now, 1 in every 100 adults has one.

Disadvantages

Because the implant is rigidly fixed in the bone, the patient needs to have stopped growing. Otherwise the adjacent teeth will grow down below the implant, and make it appear to 'submerge'.
The procedure is technically demanding, especially when replacing multiple teeth.
Treatment involves surgery to place the implant fixtures in the jaw.
There must be enough bone in the jaw to support the implant fixtures, a problem if teeth have been missing for a long time, the jaw is thin, or the sinus is close.
The crown/bridge or denture may chip, wear or break and need replacement during it’s life
Implants have a higher failure rate in people that grind their teeth, smokers, diabetics, patients with a history of periodontal (gum) disease, patients with a genetic predisposition, and patients with poor oral hygiene.
While treatable, all implants still have a risk of developing peri-implantitis (5% of patients after 5 years). Follow this link for more information.
The implant process takes a minimum of three months. Complex cases may take to a year or longer and involve multiple dental visits.
Implant treatment is more expensive than other options.

Longevity & Cost

The implant fixtures will last a long time, possibly the rest of your life. Scientific studies of all implants show success rates of 96.5% at 11 years.

It is important to understand that the artificial teeth (crown, bridge or denture) require regular maintenance and that they will wear with use. Porcelain crowns are very colour stable and after many years the colour of the crown may not match the colour of the adjacent teeth. While the implant fixtures remain in place, the worn, damaged or mismatched teeth they support may need removal for repair or replacement. We would expect the teeth to last at least 10-15 years before this was required.

Cost varies greatly depending on the treatment plan, prosthesis design and choice of material. As a guide, total cost, including the surgeon’s fees are:

$6,500 - $7,000 for a single tooth
$7,500 for two teeth supported on one implant
$13,000 for two single teeth on two implants
$13,000 - $14,000 for a 3-tooth bridge on two implants
$13,000 for an implant supported lower denture
$24,000 - $36,000 for a full implant supported bridge

What does implant treatment involve?

There are four basic stages of implant treatment.

1. Diagnosis & Treatment Planning

After we have confirmed that implant treatment is a suitable option, we confer with the oral surgeon and dental technician. We determine the best position of the implant and the anticipated position of the artificial teeth. Usually this involves taking moulds of your existing teeth, x-rays and a consultation with the oral surgeon to determine if there is enough bony support for the implant.

Options to build up bone

For some patients, when a tooth is lost, there is loss of bone and gum as well. For these patients, augmentation (or building-up) of the tissue must be performed prior to implant placement. The oral surgeon will advise us if this is necessary after his assessment.

2. Implant placement

(A) The first piece of the implant is known as the fixture. Treatment starts with the removal of any unrestorable teeth and placement of the implant fixture in the site of the missing tooth. Often this is done in a single visit. Patients hardly feel anything as treatment is always carried out using local anaesthetic with the option of intravenous (IV) sedation.

(B) A ‘healing abutment’ is attached to the top of the fixture, protruding just through the gum.

Normal temporary teeth

Immediate loading & temporary teeth

(D) If there is sufficient healthy bone, a temporary crown or bridge can be placed on to the implant fixture at the time of surgery. This is called immediate loading. It is very useful for visible missing teeth. Patients can have the implant and temporary crown placed on the same day. However, this technique puts extra force on the healing implant. Immediate loading does have an increased risk of failure, but the success rates for immediate loaded implants and conventional implants are still both high. The oral surgeon will advise us if this immediate loading is possible.

3. The Healing Period

As the fixture heals, bone grows around the implant and binds to it, a process known as osseointegration. The oral surgeon will advise us when the healing is complete, and the fixture has ‘integrated’ with the bone. This usually takes three months but may take longer if there are any complications

4. The Final Crown, Bridge or Denture

Once integrated, we can take an impression of the tops of the implants. We work with the dental technician to design and make the crown, bridge or denture to replace the missing teeth. The finished prosthesis is either screwed or glued onto the implant supports.

Replacing two missing front teeth with implant crowns

BEFORE: This patient was missing two upper teeth.

AFTER: One implant was placed for each of the missing teeth and two seperate, free standing crowns attached. Just like natural teeth.

Replacing two missing premolar teeth with an implant bridge

BEFORE: This patient was missing two upper premolar teeth on the left.

AFTER: One implant was placed and a single cantilever bridge used to replace the missing two missing teeth.

Replacing a fractured incisor tooth using the natural tooth as a veneer

1. This poor patient had an accident, needed root canal treatment and eventually split his upper incisor in half. This was unsaveable.

2. The tooth was extracted and an implant placed in the site. The implant abutment and crown was made by our dental technician.

3. The front face of the natural tooth was then bonded to the artificial foundation (abutment), and the chips in the edge filled with composite.

4. The fitted implant supported crown looked amazing. Nothing will ever beat the aesthetics of mother nature.

5 and 6. Before and after photos, the only difference you can see is the correction of the chipped edge of the tooth. Perfect.

Replacing a single incisor with an implant crown

1. This patient lost his upper lateral incisor after it fractured. He has mild tetracycline staining in his teeth causing the brown banding.

2. The tooth was removed and an implant placed. Here you can see the top of the implant fixture.

3. The patient was not concerned about the discolouration of his teeth, so the challenge for the technician was to characterise the new tooth to match.

4. The result was a perfect match. It is very difficult to tell which tooth is the artificial one.

Replacing a narrow lower incisor with an implant crown

BEFORE: Here there was only a narrow space for the surgeon to place the implant, but he cleverly managed just to fit it in.

AFTER: The implant crown in place. Note how healthy and well supported the gum around it looks. Implant teeth are very good at helping preserve gum.

Combining crown and implant treatment to replace four front crowns

1. This poor patient lost her upper right incisor. Fortunately we could replace it with an implant supported crown. To get the best aesthetics, she decided to replace the four front crowns in one treatment.

2. The crowns were removed and an impression of the teeth and the implant taken at the same time. The blue metal piece is a coping we use to get an accurate copy of the implant.

3. Matteo Moro, our talented Wellington technician, made four beautiful new front crowns.

4. The crowns are bonded onto the natural teeth and screwed onto the implant. The missing tooth is replaced, the old crowns improved and the smile looks fantastic.

Replacing implant crowns from the 1980's

BEFORE: These crowns were placed in the 1980's, the early days of implant treatment. Unfortunately the system used was no longer available, so we had to completely remove the old implants.

AFTER: The new implants were inserted in the ideal position. A small composite veneer was added to widen the natural tooth and a new bridge made to match. A great example of how far technology has improved!

Replacing four front teeth with an implant bridge

1. This patient had an accident, losing one tooth and damaging three others. The three remaining teeth develped root resporption and needed to be extracted.

2. After removal of the teeth, two implants were placed and the patient wore a temproary denture during the healing period.

3. Here you can see the implant fixtures with their cover screws.

4. In this case the abutments were made of titanium. The problem was the patient had lost a lot of gum.

5. The gum was replicated using pink composite. This photo shows us selecting the gum shade with three blobs of composite.

4. The final teeth were porcelain, with gum coloured composite inbetween. Everyone was very happy with the result.

Replacing a failed tooth supported bridge with an implant supported one

1. Here we have a three tooth front bridge supported by two natural teeth. Unfortnately, the supporting teeth fractured and the whole bridge had to be removed.

2. Two implant fixtures were placed to support the new three teeth bridge.

3. Moulds were taken of the implant. The technician constructed the entire prosthesis from tooth coloured ceramic for optimal aesthetics.

4. The bridge was screwed on to the tops of the implant fixtures. Here you can see the screw holes in the back of the bridge.

5. The holes are plugged up with composite so they can't be seen. As they are on the back of the teeth, they are well hidden.

6. The final bridge, looks great, feels like natural teeth and no longer relies on other teeth to carry any extra load.