What are dental implants?

A dental implant is a small man-made screw or cylinder that serves as a replacement for the root portion of a missing natural tooth. Today, most dental implants are made of titanium which is well tolerated by the human body. Gently placed into the upper or lower jawbone, a dental implant will bond securely to the bone. A crown, bridge or denture is attached to the implant, restoring the part that is visible above the gum line. Dental implants are used to support the replacement of a single tooth, multiple teeth or a full row of upper or lower teeth.

Components of a dental implant

A dental implant functions as an artificial substitute for a natural tooth root. The implant is hidden below the gum line and supports the coronal portion of the tooth that is visible. A complete dental implant has three components:

Implant —

A small screw-like metal post implanted into the jawbone

Abutment —

A small metal extension that is placed on top of the implant

Crown —

A prosthetic tooth that is secured to the abutment

A solution for the replacement of missing teeth

Dental implants offer a proven, long-lasting and attractive solution for replacing missing teeth. Millions of people have regained healthy, beautiful smiles with dental implants. Because a dental implant mimics the structure of a natural tooth root, it provides a secure and comfortable anchor. Prosthetic teeth (crowns, bridges and dentures) stay firmly in place. Most patients say their dental implants are virtually indistinguishable from natural teeth.

An ideal alternative to removable dentures and bridges

The stability, durability and longevity of dental implants make them an ideal alternative to removable dentures and bridges. With dental implants, you can eat any type of food without worrying about your teeth coming out. No messy adhesives, no denture slippage or worrying about your smile. With implants, you won’t need to remove your false teeth to clean them. Dental implants can change your life!

Dental implants can replace one or more teeth

Depending on whether a single tooth, multiple teeth or a complete row of upper or lower teeth are missing, one or more dental implants may be required.

• Replace a Single Tooth: An individual implant placed in the jawbone secures a custom-made replacement tooth. Even one missing tooth can ruin your smile and jeopardize oral health. A dental implant restores an attractive appearance and renews healthy, comfortable function.
• Replace Multiple Teeth: Dental implants can replace multiple missing teeth, no matter where they occur in the mouth. A single dental implant can be used to replace each missing tooth. But an implant-supported partial denture or bridge is more often used to replace multiple missing teeth. Secured in place by only a few dental implants, a partial denture or bridge eliminates gaps spread throughout a smile. Unlike a traditional fixed bridge, implant-supported bridges don’t require any alteration of healthy tooth structure to stay in place.
• Replace a Complete Row of Upper or Lower Teeth: A full denture secured to four or more dental implants can replace an entire row of upper or lower teeth. Implant-supported dentures provide extraordinary stability and convenience. You won’t need to use adhesives to hold them in place, and you’ll never again worry about slippage. Plus, you won’t have to remove your dentures to clean them.

Can any dentist place dental implants?

As dental implants continue to gain popularity, the number of dentists performing implant procedures is increasing. The American Dental Association (ADA) does not yet recognize implantology as a dental specialty. Therefore, any dentist with a degree and a license to practice dentistry is allowed to perform dental implant procedures. This can be unfortunate for patients, because dental implants are one of the most complex and demanding treatment procedures performed in dentistry. Both the placement and restoration of dental implants require extensive knowledge that can only be obtained by special training and experience.

Prosthodontists are uniquely qualified

Prosthodontists are uniquely qualified to perform dental implant procedures. In fact, prosthodontic training focuses heavily on dental implants. A prosthodontist is a specialist with a high level of skill in the restoration and replacement of teeth. Prosthodontists are frequently included as part of interdisciplinary teams involved in the surgical placement of dental implants. Their ability to carefully plan and successfully place dental implants is a major clinical asset. An experienced prosthodontist can calculate the best position for dental implants, loading forces, the biomechanics of the jaw, occlusal harmony and esthetic factors that affect the outcome of dental implant procedures.

The next article in this 4-part series will discuss the history of dental implants.

A number of scientific studies have been done to evaluate the possibility that oral bacteria and inflammation specific to gum disease may influence the initiation or progression of other diseases. Many of these studies found a link between gum disease and heart disease. Studies published in The Journal of Periodontology reported a suspected link between gum disease and respiratory infections, kidney disease and stroke. A recent study published in the Journal of the American Dental Association found that people who lost teeth before the age of 35 due to gum disease had an increased risk of dementia. Gum disease has been linked to everything from heart disease to Type 2 diabetes to pancreatic cancer.

Gingivitis is the most common form of gum disease affecting over 50% of adults in the United States. It causes gums to become red, swollen and bleed easily. Untreated gingivitis can progress to a more serious form of gum disease known as periodontitis. As oral bacteria spread and grow below the gum line, chemicals produced by the bacteria irritate the gums. These bacterial chemicals stimulate an inflammatory response in which the body in essence turns on itself. The chronic (long-term) inflammation associated with gum disease along with the body’s own natural chemical defense reactions may influence other disease pathways.

Plaque and the development of gum disease

Teeth and the surrounding gum tissues are constantly exposed to oral bacteria commonly called dental plaque. Within a few hours of brushing and flossing, these bacteria re-colonize tooth surfaces and the spaces between the gums and teeth. Some dental plaque is normally present and does not cause a health problem. However, in people with poor oral hygiene, dental plaque is not regularly removed. An accumulation of dental plaque leads to the development of gum disease. Pristine gum tissue (Figure 1) is devoid of inflammation and has only some plaque formation.

Early stage gum disease

Early stage gum disease is often undetectable. In this mild form of gingivitis, an accumulation of oral bacteria releases fatty acids and other biologically active substances including lipopolysaccharides (LPS) and chemotactic peptides such as f-MLP. These chemicals are soluble and quickly penetrate the outer layers of the gum tissue entering the epithelium. Chemotactic peptides signal neutrophils (white blood cells) to enter the epithelium and produce pro-inflammatory agents known as cytokines. Salivary glands also begin to produce anti-bacterial agents. See Figure 2.

Established gum disease (Gingivitis)

Established gum disease (Gingivitis) is characterized by widespread dental plaque and inflammation of the gum tissues with symptoms of redness, swelling and bleeding. Increased numbers and increasing diversity of oral bacteria continue releasing biologically active chemicals. More white cells enter the epithelium to release more diverse cytokines and prostaglandins. Lymphocytes (B-cells) also infiltrate the gum tissues releasing antibodies against the spreading oral bacteria. Chronic inflammation triggers the gum tissue and the liver to produce C-reactive protein. See Figure 3.

Advanced gum disease (Periodontitis)

Advanced gum disease (Periodontitis) is associated with extensive dental plaque formation dominated by anaerobic, gram-negative bacteria. Chronic inflammation results in the ulceration of the epithelium which allows bacteria to enter the gum tissue and the bloodstream. Inflamed gum tissue separates from teeth creating deep gum pockets in which the bacteria thrive. The body responds with even more chemical defenses. Aggressive synthesis of cytokines, C-reactive protein, lymphocytes and antibodies leads to the breakdown of collagen, the loss of supporting bone tissue and the subsequent loss of teeth. See Figure 4.

Does gum disease influence heart disease?

Several case-control studies published in the early 1990s found that patients with a history of heart disease had worse oral health than control subjects. This led to a flurry of research to verify these observations. While most of the follow-up studies did support an association between gum disease and the outcomes of heart disease (i.e. myocardial infarction, angina or stroke), several did not. Certain mechanisms are common to both gum disease and heart disease that were not considered in the studies. For example, both diseases share common risk factors including lifestyle habits such as cigarette smoking. Ignorance of such factors, along with the absence of a standard measure for gum diseases, rendered several of these studies inconclusive in terms of linking gum disease to heart disease.

Gum disease and heart disease may be linked because they are both signs of poor circulation, or there could be common bacteria that are involved in both gum disease and plaque build-up inside coronary arteries. The link may also have something to do with the body’s response to prolonged inflammation. Gum disease researchers have long suspected the production of C-reactive protein by the local gingival cells and the liver has an influence on other diseases including atherosclerosis. More scientific research is needed to prove or disprove that gum disease has an influence on heart disease.

Elevated C-Reactive Protein (CRP)

Clinical studies have shown that patients with gum diseases demonstrate elevated blood levels of C-reactive protein and fibrinogen as well as peripheral white blood cells. The body’s production of inflammatory cytokines may also elevate cytokines in the blood. In turn, this may cause the liver to produce acute-phase proteins including C-reactive protein. Elevated blood levels of C-reactive protein (CRP) have been associated with several health problems including vascular injury, adverse pregnancy outcomes, cardiovascular disease and stroke.

Susceptibility and immune response to gum disease

While an accumulation of oral bacteria (dental plaque) is the cause of gum disease, it is the innate susceptibility and immune response of the host that determines the outcome. In some people with poor oral hygiene, the disease never progresses beyond mild gingivitis. In others, due to a weak immune response or environmental factors, or both, the disease progresses to periodontitis. Those with an overabundance of dental plaque will certainly develop gingivitis, but not all those with untreated gingivitis will progress to periodontitis. Individual differences in susceptibility and immune response to oral bacteria must be considered when evaluating gum disease and its possible connection to other health problems.

Treatment for Gum Disease

Depending on the stage of gum disease, treatment may range from nonsurgical procedures that control bacterial growth to surgery that restores damaged tissue. Most general dentists can evaluate the extent of gum disease and recommend a treatment plan.

Established gum disease or gingivitis can usually be reversed with good oral hygiene and regular, professional cleanings. A nonsurgical procedure called scaling and root planing can be performed to immediately halt the progression of the disease. Scaling removes plaque above and below the gum line. Root planing smooths out the surface of tooth roots to remove bacteria and encourage the gums to regenerate. All gum disease patients should follow a diligent regimen of daily brushing, flossing and routine dental cleanings.

In patients with advanced gum disease or periodontitis, surgery may be part of the treatment plan to prevent further infection and restore damaged tissue. Curettage is a surgical procedure in which diseased gum tissue is scraped away, allowing the infected area to heal. Periodontal flap surgery may be performed to reduce gaps or “pockets” between the teeth and gums. Soft tissue grafts may be done to replace tissue where the gums have receded. Guided tissue regeneration may be performed to stimulate bone and gum tissue growth. Surgical treatments such as these help control the spread of bacteria and prevent the loss of teeth.

Conclusion

Gum disease is a serious health problem, and the trouble doesn’t stop at the gum line. Scientists know that gum disease contributes to pathological inflammatory processes throughout the body. Chronic inflammation has been linked to a host of health problems including cardiovascular disease, stroke and cancer. While not everyone with gingivitis will get cancer or heart disease, averting gum disease is crucial for anyone who wants to live a long and healthy life.

One Lost Tooth Causes a Chain Reaction

The loss of a single tooth starts a chain reaction. After a back molar tooth is lost, a series of destructive events occurs including the eruption of other teeth, decay, tilt, drift and gum pocket formation. Eventually, bone loss and periodontal disease will cause further destruction. If you fail to replace a lost back tooth, you could eventually lose all your teeth. This article explains how.

Losing Teeth = Two for One

The extraction of a lower back tooth has created a space. See Figure 1. The tooth directly above the lost tooth is now useless, because it no longer has a lower tooth to chew against. Losing one tooth can result in the loss of the use of two teeth. The missing lower back tooth is obviously useless, and the tooth directly above it has become useless. In terms of losing teeth, this is what I call “two for one.”

Tooth Eruption = Exposed Roots

Back teeth have a lifetime tendency to erupt (move farther into the mouth). Only the presence of a tooth to chew against keeps a back tooth from erupting. This patient had a tooth extracted from space X. The tooth immediately above the missing tooth has over-erupted. See Figure 2. This eruption has caused some of its roots to be exposed. Exposed root decays much faster than the crown of a tooth.

Uneven Teeth = Trapped Food Debris

The resulting unevenness among the upper back teeth has created areas between these teeth that trap food debris. See Figure 3. It is very difficult to keep spaces between uneven teeth clean, despite your best efforts at brushing and flossing. The accumulation of food debris and the resulting bacteria cause inflammation of the surrounding gum tissue. The inability to easily remove the trapped food debris accelerates tooth decay.

Tilt & Drift

When teeth are lost, the remaining adjacent teeth have a tendency to tilt (lean over) into the space the missing tooth once occupied. They also have the potential to drift or move. Now that a tooth has been extracted from position X, a space is left. This allows lower molar #7 to tilt and drift forward. Lower #7 will tilt farther and farther over time. Upper molar #7 no longer makes proper contact with the adjacent, erupted molar #6 or with tilted lower molar #7. This has caused upper molar #7 to tilt and drift backward. See Figure 4.

Gum Pocket Formation

A tooth tilted over will develop a gum pocket along its forward root, as shown in Figure 5. Gum pockets are narrow, abnormal spaces or clefts that develop between the gums and the tooth root. These pockets trap food debris and bacteria. A gum pocket is a problem, because you can almost never keep it clean. The debris and bacteria that collect in a gum pocket lead to ever-worsening inflammation of the gums and the bone adjacent to the gum pocket.

Tooth Destruction Spreads

Lower molar #7 has drifted and tilted so far forward that upper molar #7 no longer bites on it. This allows upper molar #7 to over-erupt. The adjacent upper molar #6 has already erupted. Decay has begun on upper teeth #6 and #7, particularly on the exposed portions of their roots. See Figure 6. The advancing gum pocket along the forward root of lower molar #7 causes chronic gum inflammation and eventual bone loss. Gum pockets also begin to form around the exposed roots of upper teeth #6 and #7 causing inflammation.

Eventual Bone Loss & Periodontal Disease

When an area of the gums is constantly inflamed, as happens in a gum pocket, the bone immediately adjacent to the gum pocket also becomes inflamed. Inflamed bone softens, and slowly begins to resorb (disappear). See Fig. 7. Chronic gum inflammation and the eventual loss of underlying bone are symptoms of advanced periodontal disease. When left untreated, this condition will negatively affect your facial appearance and damage your remaining teeth.

Replacing Lost Teeth

There are a number of treatment options for replacing lost teeth:

• Dentures – These are removable prostheses also known as false teeth.
• Bridges – These are a series of crowns fixed onto adjacent natural teeth.
• Implants – These are metal posts placed in the jawbone. A single crown, a full denture or a bridge is permanently screwed (fixed) on top of dental implants.

The most appropriate treatment will depend on the number of teeth you are missing, where they are in your mouth and the condition of your remaining teeth. A qualified dentist or dental specialist can help you decide which option is best for you.

Conclusion

If missing teeth are not replaced, a chain of damaging events may occur. Over time, one missing tooth can lead to bone loss, periodontal disease and the eventual loss of remaining teeth. Replacing a lost tooth today will avoid grief and greater expense tomorrow.

I’m a Prosthodontist — a specialist in dentures. After graduating from dental school, I had 4 years of advanced training in dentures and dental prostheses. In practice since 1985, I do most of the denture work myself. The average denture procedure takes me from 5 to 10 visits to complete. This includes follow-up visits or adjustments. I spend quite a bit of time with my denture patients, because I want them to be happy. The cost of dentures will vary, depending on the patient’s condition and the type of denture needed. If teeth need to be extracted first, this will add to the total cost of dentures. That being said, each patient’s experience with dentures will be different, and dentures are among the most difficult of all dental procedures for patients to adapt to.

Historically, women do worse with dentures than do men. This is particularly true with post menopausal women. Older women experience twice the rate of bone loss when compared to men of the same age, and this affects the jawbone that supports a denture. Additionally, women have more sores and sensitivity than men do. So, a poor fitting denture can be extremely uncomfortable for women. My practice has almost 90% women to men for dentures. They often come to me after they have had problems with dentures made by other dentists.

Many people complain about their dentures. They say, “The dentures don’t fit.” “The dentures hurt my mouth”, or “I can’t eat what I want while wearing my dentures.” If a patient is uncomfortable with dentures, he or she should return to their dentist for an adjustment. Unfortunately, many people will not return for an adjustment. They simply won’t wear their dentures, or worse, settle for gluing them in. I hate to see people suffer with dentures that don’t fit properly. There are solutions.

I recommend dental implants for edentulous patients or for those who have extensive tooth loss. Dental implants have many advantages over traditional removable dentures. Dental implant patients experience less pain and discomfort than they do with conventional dentures. For example, an implant supported denture is a hundred times more retentive than a traditional denture. Dental implants let you eat foods that you can’t eat with even the best dentures. Moreover, dental implants help prevent bone loss that most denture wearers will experience over time. In short, dental implants are superior to traditional dentures. Still, there are people who are adverse to the idea of dental implants, for whatever reason, and they want a full or partial denture.

There are a number of dentists in Tucson that do dentures. Some are very good at denture procedures and others are not. You should ask each of them: What is their experience with denture procedures? Do they do the dentures themselves, including checking and setting the teeth in office, or do they have a dental lab do everything? There are many types of dentures available today, and some look and function better than others. A good dentist will discuss all of the various types of dentures and the alternatives with you, and he or she may refer you to a specialist for dentures.

Dentures are a complicated dental procedure that involves proficiency. Therefore, you should choose a dentist with experience making, placing and adjusting dentures. Selecting a qualified dentist or a dental specialist, trained and experienced in denture procedures, will help ensure that your dentures look good, fit comfortably and function properly.