Table of contents:
Overview
A dental implant is a surgical procedure which places a metallic prosthesis into your jaw to replace a missing tooth or teeth. They may be used for the front or back teeth. The purpose of the implant is to restore form, function, and aesthetics. That way you can smile, chew, speak, and eat properly.
Important Note: Patients often think that the implant includes the screw in the jaw bone as well as the final crown which is incorrect.
The implant ONLY refers to prosthetic screw that gets osseointegrated into the bone.
The implant crown is a separate restorative procedure that places a crown on top of the implant. It either gets screwed in or it gets cemented into place.
The abutment is often included as part of the implant crown procedure.
This distinction is important because a lot of advertisements state that the implant costs X amount of money. Patients come in thinking that is the total cost but it's not because the implant crown cost is separate from the "implant".
Screw retained vs Cement retained
The implant crown restoration comes in two different types, screw retained and cement retained.
The screw retained implant crown has the abutment and crown pre-cemented together. Your dentist has to screw the entire crown fixture into the implant. Afterwards the hole on the chewing surface will be covered up with a composite resin.
The cement retained implant crown has the abutment and crown separate. Your dentist will screw in the abutment first and then cement the crown over the abutment.
Which one is better?
Each type has its uses and the choice will depend upon clinician preference. For our office, we prefer to use the screw retained crowns whenever possible for retrievability. It also eliminates the possibility of residual cement failures.
However, sometimes you may not have a choice and are forced to use cement implant crowns for the anterior teeth. Reasons are due to angulation and placement of the screw access hole.
Implant material
The body of the implant fixtures are commonly made of either titanium or zirconia. Titanium is the most commonly used and has been around the longest. All of the photos which we've provided above are all made of titanium.
Zirconia on the other hand has been a recent entrant into the industry. They look very different from a titanium fixture since they're white in color.
The downside to using zirconia is the potential for fractures since it isn't as forgiving as the metal titanium. However some patients seem to prefer them because they want their mouth "metal-less" which is understandable.
We personally do not use them nor do our surgeons place them unless requested. Our first choice is titanium since it has been around longer and has a longer proven record for success.
Types of implants
There are three different types of dental implants with the most common being endosteal. The differences among them are based on how they are placed into the jaw. The entirety of our article will be mostly focused on endosteal implants. The other two types are reserved for special situations thus we'll give them their own time and place to shine elsewhere.
Endosteal
What is most commonly used and what you've probably heard of the most are endosteal implants. All of the photos above and what we've been talking about so far are this type.
Essentially it is a prosthetic screw that gets drilled into your jaw bone. Then a crown is fixed on top of that screw. It's really that simple.
Zygomatic
Zygomatic implants are similar to endosteal ones except they are much longer and are placed not in the jaw but the zygomatic bone. We believe it is easier for you to see drawings and x-rays rather than us describing it to you in words.
The photos below are by Aegis Dental Network on what they look like:
We can picture the thoughts running through your head... Yes, it is much more involved than the endosteal implants. However if you no longer have enough bone in the upper jaw, you may need to use your cheek bones (zygoma) to anchor the implants. That is when they would be used and needed.
Subperiosteal
Subperiosteal implants look different from the other two types because it is similar to a metal framework that gets placed on your jaw. They were more common and in use prior to the development of endosteal implants. However once endosseous ones became common place, subperiosteal implants gradually fell out of favor and are no longer used as often.
Yes, it is also much more involved to place these as well. One of the reasons as to why endosteal won over is due to its simplicity of placement and decrease in surgical complications. For zygomatic and subperiosteal, the surgical procedure is much more involved.
When it's necessary
The purpose of a dental implant is to replace a missing tooth or a tooth that is about to be extracted. If you don't need a tooth replaced, an implant would be unnecessary because there would be no place to put it. Therefore this procedure is only meant for teeth that are already missing or are so badly damaged that they need to be removed.
Alternatives
They aren't the only option available for missing teeth because prior to them, dental bridges and partial dentures have been in use for a long time.
Dental bridge. This is a fixed prosthetic option that replaces the missing tooth by using a bridge. It requires the adjacent two teeth to be prepared for a crown and shaved down.
Partial denture. This is a removable prosthetic option that replaces the missing tooth. You can remove this appliance from your mouth at will. Patients often don't like having to take it in and out which has made this option fallen out of favor.
The bridges which is a minimum of three crowns connected together used to be the preferred option prior to implants. With the advent of implants, which does not require shaving down adjacent teeth, most patients have switched over. It is preferred since it is much more conservative.
What to expect
The implant is a surgical dental procedure which requires a lot of planning prior to starting it. You can't just waltz into your dentist office and leave with an implant the same day, that's not how it works.
Pre-operative
The first thing your dentist needs to do is review your medical history to make sure that you're an able candidate for an implant. Allergies to metal or bleeding disorders may complicate the procedure and require extra preparation.
The second thing they need to do is to determine whether you need a bone graft or not. If you don't have enough bone to support the body fixture, you will need to get a bone graft prior to even doing the procedure. The implant is planted into your jaw bone and if there isn't enough bone, you can't do it.
The third but probably the most important step is to figure out the size of the implant to use. Ideally, your dentist would like to put in the widest and longest implant that they can because it is more stable. A skinny and short implant is not as stable.
There are various softwares which help your dentist plan the placement of the implant. It'll tell you the exact size, diameter, and length of implant that the jaw bone can support. Oftentimes you will need a CBCT x-ray in order to determine the amount of jaw bone available.
Intra-operative
This is the day for the surgical placement of the implant fixture into your jaw bone.
Administer local anesthesia to numb the gums and the bone.
Make an incision and raise a gum flap to reveal the bone.
Pilot drill hole to check angulation of placement.
Subsequently drill wider and wider holes until one size before the implant size.
Ensure adequate irrigation and cooling while drilling in the dental implant.
Place implant cover screw.
Close up surgical site with stitches.
That's the entire procedure and it can be explained in just seven steps.
Does it hurt?
A lot of patients are worried about the procedure being painful but that is simply untrue. You will be adequately anesthetized for it. If you wanted additional reassurance, most of our patients tell us that the tooth extraction is often much more unpleasant than putting the implant in.
There is truth to that because when you're removing the tooth there is a lot of pushing and pulling to get it out. However for the implant portion, it is a smooth process because you just have to drill the screw into the bone. There is no tugging or pulling for this step.
Post-operative
Typically after the implant placement, there aren't as many restrictions like in aftercare for a tooth extraction. The reason is because for this procedure your dentist is able to fully close the surgical site. You won't even be able to see the implant at all, only the stitches that are sticking out.
Common sense dos and don'ts:
Keep the area clean by brushing and flossing like you usually do.
Rinse with salt water after each meal so that food doesn't get stuck in the stitches.
Stick to soft foods for first few days until the area heals.
Avoid chewing on that side if it is tender.
Take your antibiotics and pain medication if prescribed.
Second stage surgery
After the implant gets put in, you have to wait for it to osseointegrate which takes about 3-4 months of healing. Essentially you are waiting for the bone to grow around the fixture and lock it in tightly.
Once it has successfully osseointegrated, your dentist will perform second stage surgery which is the uncovering of the dental implant. They will surgically open up the site to reveal it and then replace the cover screw with a healing abutment.
Cover screw vs healing abutment
The difference between them are very easy to spot.
Cover screw. You cannot see this because it is usually submerged underneath the gums on purpose by your dentist. This is to allow the implant to heal undisturbed.
Healing abutment. A tell-tale sign that you have this is if you see a metal piece sticking out of your gums.
Once you have the healing abutment put in, you can see your general dentist in about 2 weeks to get the impressions taken for the implant crown. Essentially it means you are now ready to get your tooth! You also choose the dental implant color at that time for the crown.
Risks and Complications
All surgical procedures comes with risks and potential complications. Getting implants put in are no exception to the rule.
Implant failure. The success rate for this procedure is over 96% and hopefully that includes you. However that means about 4% of all cases do fail.
Peri-implantitis. Sometimes the gums around the implant can get infected with an abscess and become swollen. Pus oozing out of the area is a tell-tale sign.
Infection. The titanium screw may not get cavities but the bone and gums around it can always get infected if you don't keep it clean.
Bleeding. Potential bleeding after the surgery especially if you have a bleeding disorder or are taking blood thinners.
Loose healing cap. The dental healing cap can get loose and wobble side to side in your mouth. This will need to be re-tightened immediately.
Fallen off healing abutment. If you wait too long to tighten it, the abutment can fall off.
Sutures coming out. The dental implant stitches can come out prematurely.
Screw showing. If the implant screw threads are visible, it could be an indication you're losing bone around it or that the gums are receding.
How long does it last?
Longevity of dental implants are very good, they've been around long enough where there are 10 year survival studies on it. The study followed 89 patients with a total of 179 implants.
112 hollow screws
49 hollow cylinders
18 angulated hollow cylinders
Implant Type | 10 year survival rate |
|---|---|
Hollow screws | 95.4% |
Hollow cylinders | 85.7% |
Angulated hollow cylinders | 91.7% |
In summary based on the survival rates over a period of 10 years, we can say that implants fair pretty well. Shoes and car tires don't even last that long! Just so that you know, these implants can go on to last even longer but no one has done studies beyond that.
Cost
The average cost of a dental implant is $2141.41 without insurance. It may range from $1620-2772 depending on the cost of living in your neighborhood. That is of course, according to the ADA survey of fees.
However if you do have insurance, you can expect it to cover about half of the procedure. The most common coverage that we see for it is about 50% in total.
Note: You should be aware that some insurances do have a missing tooth clause. What that means is you'll get denied implant coverage if you lost that tooth before getting the insurance.
FAQ
Does an implant include the crown?
The implant procedure does NOT include the crown that is fitted on top of it. Those are two separate procedures. Typically the placement of the screw fixture is done by the oral surgeon or periodontist. The crown on the other hand is done by your general/restorative dentist.
Consequently, the "price" for the two procedures are also separate. Be sure to ask your dentist exactly how much each procedure costs!
