When a patient is faced with the decision of replacing a missing tooth there is always a discussion about implants. Implants are essentially a modern day dental miracle. If successfully performed it replaces your missing tooth with an aesthetically pleasing and extremely functional replacement. In spite of the benefits of an implant it isn’t always an easy decision. The cost and suitability of the candidate are important factors to consider.
Determining if a patient is a suitable candidate for implants begins with their health. A candidate must have a healthy body and a healthy mouth. Medical conditions involving immune suppression, bleeding, osteoporosis, or psychiatric illness are typically contraindicated. Smoking or drug abuse are also contraindications. In an initial consult, the oral surgeon or periodontist, will thoroughly review the medical history with the patient. Additionally, the health of the bone, the occlusion, and the movement of the jaw are also important factors. To assess the suitability of these factors the doctor will rely on collecting data by visually and digitally inspecting the area, periodontal probing, measuring with bone calipers, radiographs, computerized tomography, and cone beam computerized tomography. This will reveal the thickness and height of the bone in the area under consideration for implant placement. The health of the teeth surrounding the site is also critical to consider. Any necessary restorative or periodontal therapy will need to be performed prior to implant placement.
The ideal time to prepare a site for implant placement is at the time of the extraction of the natural tooth. This allows for bone preservation to begin immediately. A socket can be grafted, and a guided tissue membrane placed at the time of extraction. This will aid in bone growth in the case of loss from trauma or infection. The doctor will also debride and stimulate the bone in the socket to promote integration of the implant. The extraction should be done with the doctor placing the implant to help facilitate this process.
The day of surgical placement of the implant the doctor may prescribe an antibiotic. Studies have revealed that a 2g or 3g dose of amoxicillin one hour prior to surgery significantly increases implant success. This won’t be necessary for patients who already require antibiotic premedication for all dental procedures. A post surgery antibacterial rinse will also be recommended.
The implant is screwed into the bone, and a final image will be taken to ensure proper placement. A cover screw, healing cap, or provisional restoration will be placed at this point. A provisional restoration will give the best soft tissue growth which will be the most aesthetic. This option is more costly and does increase the time involved in the implant process. After a period of 7-10 days the area will be reevaluated to determine successful healing.
Once healing has occurred, usually 3 months or more, and the implant is determined to be successfully integrated and the gingival growth accomplished it will be time to place the final prosthesis. This part will be done at the patient’s general dentist. An impression will be taken, and a crown will be fabricated. Final placement of the restoration will usually be 2 weeks later.
Because of the tremendous amount of consultation, diagnostic work, and treatment an implant is not an inexpensive option. However, a well placed implant will have a longer life span than a fixed bridge or a partial and will not involve treatment of any healthy teeth surrounding the missing tooth.