A NewBeginningwithDentalImplants

A Guide toUnderstanding

Your TreatmentOptions

Why Should I ReplaceWhy Should I ReplaceWhy Should I ReplaceWhy Should I ReplaceWhy Should I ReplaceMy Missing Teeth?My Missing Teeth?My Missing Teeth?My Missing Teeth?My Missing Teeth?

Usually, when you lose a tooth, it is best for your oralhealth to have it replaced. Missing teeth can affectyour “bite” as well as your ability to speak and chew.Their loss can increase the burden on your remainingteeth and can cause muscle pain in your jaws andheadaches. And of course, losing a tooth can affectyour appearance.

The good news is that, most of the time, replacinga missing tooth is not an emergency. You have time toconsider what replacement option is best for you andto make an informed decision. This booklet discussesyour general treatment options.

Extraction site of upper front tooth.Extraction site of upper front tooth.Extraction site of upper front tooth.Extraction site of upper front tooth.Extraction site of upper front tooth.

What Are My ToothWhat Are My ToothWhat Are My ToothWhat Are My ToothWhat Are My ToothReplacement Options?Replacement Options?Replacement Options?Replacement Options?Replacement Options?

If you are missing one or more teeth and choose tohave it or them replaced, several treatment optionsare available.

A ‘flipper’ is a removable plastic tooth that isinexpensive but fragile and temporary.

A cast partial denture also is removable but isprecision cast in metal for longer service life. Wireclips help hold it in place.

A fixed bridge is cemented into place usingcrowns or “caps” on the teeth adjacent to the openspace for support. Crown placement usually requiresremoving or reducing the outer layer of the tooth.In some cases, a ‘Maryland’ bridge, a fixed bridge thatdoes not need crowns, is glued onto the back of theteeth adjacent to the space so that minimal toothstructure is removed.

Complete dentures or ‘plates’ are the traditionalsolution for people who have lost all their teeth in oneor both jaws. The success of a complete denture dependsupon the individual’s jaw size and shape, his or her oralhabits, and his or her adaptability. Some people adaptwell to dentures, while others are not able to adapt.

Dental implants can be used to provide supportfor the replacement of one tooth or all of an indivi-dual’s teeth. After years of research and clinical trials,we can now provide this option in addition to thetraditional treatments just described. Implant-sup-ported teeth can be cemented, screw-retained, orremovable and can be made attractive, stable, andcomfortable for almost any patient.

Missing front tooth.Missing front tooth.Missing front tooth.Missing front tooth.Missing front tooth.

Implant supported replacement tooth.Implant supported replacement tooth.Implant supported replacement tooth.Implant supported replacement tooth.Implant supported replacement tooth.

Flipper (removable).Flipper (removable).Flipper (removable).Flipper (removable).Flipper (removable).

Fixed Bridge (cemented in place).Fixed Bridge (cemented in place).Fixed Bridge (cemented in place).Fixed Bridge (cemented in place).Fixed Bridge (cemented in place).

Lower complete dentureLower complete dentureLower complete dentureLower complete dentureLower complete denture

Any other replacement options will be discussedAny other replacement options will be discussedAny other replacement options will be discussedAny other replacement options will be discussedAny other replacement options will be discussedwith you before treatment begins.with you before treatment begins.with you before treatment begins.with you before treatment begins.with you before treatment begins.

Implant supported replacement tooth.Implant supported replacement tooth.Implant supported replacement tooth.Implant supported replacement tooth.Implant supported replacement tooth.

Cast partial denture (removable).Cast partial denture (removable).Cast partial denture (removable).Cast partial denture (removable).Cast partial denture (removable).

Maryland Bridge (cemented in place).Maryland Bridge (cemented in place).Maryland Bridge (cemented in place).Maryland Bridge (cemented in place).Maryland Bridge (cemented in place).

Are Dental ImplantsAre Dental ImplantsAre Dental ImplantsAre Dental ImplantsAre Dental ImplantsAn Option For Me?An Option For Me?An Option For Me?An Option For Me?An Option For Me?

If you are considering dental implants, your mouthwill be examined thoroughly and your dental andmedical history will be reviewed to ensure that dentalimplants are appropriate for you. Dental x-rays and,frequently, panoramic (or complete) x-rays of yourjaws will be taken to evaluate your jawbone and todetermine if it will accommodate implants. Occasion-ally, more detailed information is required and can beprovided by special x-rays. They will help determineif additional tests or procedures are needed to placeyour implants properly.

What Is A Dental Implant?What Is A Dental Implant?What Is A Dental Implant?What Is A Dental Implant?What Is A Dental Implant?

The best way to describe a dental im-plant is to compare it to a real tooth.A natural tooth consists of a root anda crown. The part of the tooth thatyou see and eat with is called thecrown. Beneath the crown is the root,which anchors the tooth through thegum tissue to the jawbone. When youlose a tooth, you lose both the rootand the crown. To replace a tooth,we first have to replace the root.Essentially, a dental implant is anew root. This titanium root is fittedinto a socket that we create in yourjaw, replacing the lost root of yournatural tooth.

Dental implants come in variousshapes and sizes and have different

types of surfaces. The actual implant selection willdepend on a variety of factors related to your specifictreatment needs and the most appropriate one(s) willbe used. Once an implant has been placed in the jaw,the bone around the implant will need to heal forup to six months, depending upon how hard the boneis. When this initial phase of healing is completed, a sup-port post called an abutment will be placed on the im-plant itself and then a new crown will be placed on top.If all of your teeth are missing, a variety of treatmentoptions are available to support the replacement teeth.

A thorough examination of your mouth is required.A thorough examination of your mouth is required.A thorough examination of your mouth is required.A thorough examination of your mouth is required.A thorough examination of your mouth is required.

Frequently panoramic x-rays of your jaw are takenFrequently panoramic x-rays of your jaw are takenFrequently panoramic x-rays of your jaw are takenFrequently panoramic x-rays of your jaw are takenFrequently panoramic x-rays of your jaw are taken.....

After you lose a tooth, we generally allow theAfter you lose a tooth, we generally allow theAfter you lose a tooth, we generally allow theAfter you lose a tooth, we generally allow theAfter you lose a tooth, we generally allow theextraction site to heal. The implant is then placedextraction site to heal. The implant is then placedextraction site to heal. The implant is then placedextraction site to heal. The implant is then placedextraction site to heal. The implant is then placedinto the mature site.into the mature site.into the mature site.into the mature site.into the mature site.

How Are DentalHow Are DentalHow Are DentalHow Are DentalHow Are DentalImplants Placed?Implants Placed?Implants Placed?Implants Placed?Implants Placed?

Usually, the office procedure to place a dental implanttakes about an hour for one implant and no morethan two or three hours for multiple implants. Theplacement process consists of the following steps:• If indicated, you will be given medication suchas antibiotics prior to the surgery. You may be offeredsedation with nitrous oxide (“laughing gas”) or intra-venous medications. Then, a local anesthetic will beadministered to numb the areas where the implant(s)will be placed.• After you are comfortable, a small incision ismade into the gum tissue, revealing the bone intowhich the implant will be placed.• Using special instruments, a socket is createdcarefully, avoiding damage to the bone.• The titanium implant is then inserted intothe socket.• Finally, if necessary, sutures will be used.

Once the implant is inserted, it is completed inone of two ways: First, the gum tissue will be closed(or sutured) over the implant, allowing the implantto heal for up to six months. Then a second procedure,called “uncovering surgery,” will be performed aftera local anesthetic has been used to numb the gumtissue. Next, the gum is moved out of the way, theimplant located, and a healing cap placed into it. Thegum tissue is then sutured around the healing cap.Generally, after two to four weeks, you will return tohave the healing cap removed, the abutment (or sup-port post) placed, and impressions made in order forthe final crown (replacement tooth) to be fabricated.This is called a “two-stage” or “two-step” approachto implant placement and is the more traditionalapproach. For more aesthetically important areas,we may ask that you wait up to 12 weeks to begin thefinal restorative process. During this time, you will befitted with temporary teeth. Occasionally, impressionsare made at the time the implant is placed in order tohave a crown ready when the implants have healed.

After the implant is placed, the area will need toheal for as long as six months. How long your mouthwill need to heal will be determined by a variety offactors. Follow-up care (one to four appointments)is usually needed to ensure that your mouth is healingwell and to determine when you are ready for the re-storative phase of your treatment.

An alternative approach is called the “single-stage” or “one-step approach,” in which a healing capis added at the same time as the implant is placedand the gum tissue is sutured around it. If the entireprocess occurs during one step, a second surgery toplace the healing cap is unnecessary. Because only onesurgical appointment usually is all that is needed,both patients and doctors often prefer this approach.However, it is not always the best method for placingimplants. We will use the most appropriate approachto meet your particular needs.

On occasion, it may be necessary to perform a“soft tissue graft” to obtain stronger, more easilycleaned and natural appearing “gum” tissue in thearea around the implant. This process involves mov-ing a small amount of gum tissue from one part ofyour mouth to the area around the implant. Most of-ten, it is a brief and relatively comfortable procedure.

When Are TheWhen Are TheWhen Are TheWhen Are TheWhen Are TheImplants Placed?Implants Placed?Implants Placed?Implants Placed?Implants Placed?

Approximately three months after the tooth is re-moved, the implant is placed where the missing toothwas located. Once a tooth is removed, if your socketwalls of bone are intact and fairly thick, your bodywill grow new bone to replace or refill the emptysocket. Your socket will usually be completelyfilled in with bone by the time you are ready forplacement of your implant (about three monthslater). Occasionally, it is possible to take out the toothand place the implant at the same time. This may in-volve a little more risk, but it simplifies the process—you won’t have to wait three months for the bone torefill the socket. Again, there are times when this isappropriate and other times (when infection or otherproblems with the bone are present) when immediateimplant placement is not the best treatment.

If your tooth has been missing for some time, theadjacent bone is likely to grow thinner because theroot of the tooth itself has stimulated the bone. Oncethe tooth root is removed, the bone loses this stimula-tion and starts to disappear. As much as one third ofyour jaw’s thickness can be lost in the year followingtooth extraction. If you are missing quite a bit of bone,you may need to have additional bone grafted into thearea so that the implant will be supported adequatelywhen it is placed.

Bone loss occurs over time.Bone loss occurs over time.Bone loss occurs over time.Bone loss occurs over time.Bone loss occurs over time.

Healing cap in place.Healing cap in place.Healing cap in place.Healing cap in place.Healing cap in place.

Original bone and tooth relationship.Original bone and tooth relationship.Original bone and tooth relationship.Original bone and tooth relationship.Original bone and tooth relationship.

Do I Have Enough Bone?Do I Have Enough Bone?Do I Have Enough Bone?Do I Have Enough Bone?Do I Have Enough Bone?

Again, if after tooth extraction the walls of the socketare very thick, they will usually fill with bone in threemonths. However, if the walls of your socket are verythin (such as in your upper and lower front teeth),then this type of healing will not be as predictable. Af-ter waiting three months for the bone to fill in, youmay have only a very thin ridge of bone. Sometimes, abone graft is placed at the time of tooth extraction tohelp your body fill in the socket with bone. This stepwill maintain the width or volume of bone you willneed for implant placement. It is most commonly per-formed on thin-walled extraction sockets, especiallyin such visible areas as the front of the mouth.

If your tooth was removed many years ago, thenyour bony ridge may be extremely thin and you maynot have enough bone left for implant placement. Inthis case, a bone graft can be placed next to the thinbone and allowed to heal for three to nine months.After the graft has fused to your pre-existing bone,the ridge will be re-entered and the implant placed.Usually bone grafting is a relatively comfortableprocedure. Many different bone-grafting materialsare available, including your own bone.

You also may need bone grafting if the sinuscavities in your upper jaw are very large or very lowand extend into the tooth-bearing areas. This oftenoccurs when teeth in the back of a person’s upper jawhave been removed many years before, and theamount of bone available for implant placement isthus limited. This condition requires what is called a“sinus grafting procedure.” Most often, it is performedin the office with local anesthesia and perhaps seda-

tion. During this procedure, the membrane that linesthe sinus will be located and elevated. Bone will beadded to restore the bone height and ensure that den-tal implants of an adequate length can be placed. Thisprocedure often can be performed at the time of im-plant placement.

Bone width restored with bone grafting.Bone width restored with bone grafting.Bone width restored with bone grafting.Bone width restored with bone grafting.Bone width restored with bone grafting. Implant and replacement tooth in place.Implant and replacement tooth in place.Implant and replacement tooth in place.Implant and replacement tooth in place.Implant and replacement tooth in place.

Sinus grafting to replace bone height.Sinus grafting to replace bone height.Sinus grafting to replace bone height.Sinus grafting to replace bone height.Sinus grafting to replace bone height.

How Many ImplantsHow Many ImplantsHow Many ImplantsHow Many ImplantsHow Many ImplantsDo I Need?Do I Need?Do I Need?Do I Need?Do I Need?

Most frequently, one implant per missing tooth isplaced. Because many of the larger teeth in the backof your jaws have two or three roots, the most com-mon approach is to replace missing back teeth withlarger implants or more than one implant per tooth,especially if there has been moderate bone loss or ifthere is evidence of excessive biting force.

A second option involves placing four to six im-plants, depending on your jaw size or shape, into yourlower jaw. After healing is complete, the implants areconnected with a custom-made support bar. Yourdenture will be made with special retention clips in-side that attach onto the support bar, allowing thedenture to snap firmly into place. This is called an“overdenture.” The advantage of this option is that itis much more stable than the first option, allowingvery little denture movement. Your denture still willbe removable for easy cleaning and maintenance.

A third option involves placing five or more im-plants in your jaw and attaching a permanent denture.Your denture is held in place by screws or clasps thatsecure it to the support posts or bar. It doesn’t touchthe gum tissue, which allows you to clean under thedenture without removing it. This denture will replaceall your missing lower teeth and will not be removedexcept at maintenance visits. Although cleaning underyour denture without removing it is more time con-suming and requires more dexterity, many patientswho want a permanent denture prefer this option.

The final option is to have all your teeth individu-ally replaced so that they will appear to be growingout of your gum tissue and will most closely resemble

What If I’m Missing All OfWhat If I’m Missing All OfWhat If I’m Missing All OfWhat If I’m Missing All OfWhat If I’m Missing All OfThe Teeth In My Lower Jaw?The Teeth In My Lower Jaw?The Teeth In My Lower Jaw?The Teeth In My Lower Jaw?The Teeth In My Lower Jaw?

If you are missing all of the teeth in your lower jaw,you may consider a number of treatment options.Although many patients have no problem wearingan upper denture, some find it difficult to wear lowerdentures.

The first option is to have two implants placedin your lower jaw and a denture made that snaps ontothese implants. This option allows your lower dentureto be more stable while chewing than without implants.This is a viable option if your jaw’s support ridge is bigenough. There will still be movement of your lowerdenture, however, and you can still get sore spots ifany food particles, especially seeds, are caught under it.As with all removable replacement teeth, you still willneed periodic appointments for denture adjustment.

3 Implants Replace 2 Lower Molars.3 Implants Replace 2 Lower Molars.3 Implants Replace 2 Lower Molars.3 Implants Replace 2 Lower Molars.3 Implants Replace 2 Lower Molars.

Custon made support bar and specialized lowerCuston made support bar and specialized lowerCuston made support bar and specialized lowerCuston made support bar and specialized lowerCuston made support bar and specialized lowerdenture with retention clips.denture with retention clips.denture with retention clips.denture with retention clips.denture with retention clips.

the appearance of your natural teeth. This optionusually requires eight or more implants. Separateabutments or support posts for each one of theseimplants will be made and crowns for each missingtooth will be placed. The teeth are then frequentlyjoined together for strength and support. Overall,this is the most costly option, because (among otherreasons) it requires the most implants. In addition,your options may be limited by the current size andshape of your jawbone

What If I’m MissingWhat If I’m MissingWhat If I’m MissingWhat If I’m MissingWhat If I’m MissingAll Of My Upper Teeth?All Of My Upper Teeth?All Of My Upper Teeth?All Of My Upper Teeth?All Of My Upper Teeth?

A similar range of treatment options is also availablefor your upper jaw. However, because the bone is notas hard as that in the lower jaw, people often needmore implants to support their replacement teeth.

What Can I Use For Teeth WhileWhat Can I Use For Teeth WhileWhat Can I Use For Teeth WhileWhat Can I Use For Teeth WhileWhat Can I Use For Teeth WhileThe Implants Are Healing?The Implants Are Healing?The Implants Are Healing?The Implants Are Healing?The Implants Are Healing?

Many options are available, and they are tailored toyour specific needs. If you need a replacement toothwhile the implants are healing, temporary removableteeth or a temporary bridge can be made. If all yourteeth are missing, we can usually modify your presentcomplete denture or make you new temporary den-ture. If you would prefer nonremovable teeth duringthe healing phase, temporary transitional implantsusually can be placed along with the permanent im-plants, and temporary teeth may be made and in-serted the same day.

What Are TheWhat Are TheWhat Are TheWhat Are TheWhat Are ThePotential Problems?Potential Problems?Potential Problems?Potential Problems?Potential Problems?

Although it is natural to be concerned about thepain that may be caused by these procedures, mostpatients do not experience severe or significantpostoperative pain. Pain medication and antibioticswill be prescribed for you to make your recovery aseasy as possible. Occasionally, some people developpostoperative infections that require additional anti-biotic treatment. In addition, there is a chance thatthe nerve in the lower jaw, which provides sensationto your lower lip and chin, may be affected. If you aremissing quite a lot of bone, it might be difficult toplace an implant without infringing on the nervespace. Although we take great care to avoid this nerve,occasionally it is irritated during the procedureresulting in numbness or tingling in your lip, chin,or tongue. And although this numbness will usuallyresolve, it can be permanent. If you notify us of post-operative numbness as soon as possible, it will allowus to manage your care in the most appropriate way.

Depending upon the number of implants to beplaced, it may be possible to eliminate the need forcovering the roof of your mouth with the denture.This option will allow you to better taste your foodand to better sense food temperature, and it will makeyour denture feel more natural. You will still have a re-movable denture, which makes cleaning the supportbar and denture much easier. If you want a restorationthat is similar to your natural teeth and therefore notremovable, you probably will need eight to ten im-plants placed. This is followed after healing by theplacement of the abutments and crowns.

Relationship of nerve to lower teeth.Relationship of nerve to lower teeth.Relationship of nerve to lower teeth.Relationship of nerve to lower teeth.Relationship of nerve to lower teeth.

Implant Supported Upper Denture.Implant Supported Upper Denture.Implant Supported Upper Denture.Implant Supported Upper Denture.Implant Supported Upper Denture.

How Long WillHow Long WillHow Long WillHow Long WillHow Long WillThe Implants Last?The Implants Last?The Implants Last?The Implants Last?The Implants Last?

Implants last a long time. Of patients who were miss-ing all of their teeth, long-term studies (more than 30years) show an 80 to 90 percent success rate. For pa-tients missing one or several teeth, six-year studiesshow a success rate of greater than 90 percent, whichcompares favorably with other areas in the body thatreceive implant replacement (such as hips or knees).However, if one of your dental implants either doesn’theal properly or loosens after a period of time, youmay need to have it removed. After the site heals (oron occasion at the time of removal), another implantusually can be placed.

What Happens After TheWhat Happens After TheWhat Happens After TheWhat Happens After TheWhat Happens After TheImplants Have Healed?Implants Have Healed?Implants Have Healed?Implants Have Healed?Implants Have Healed?

In most cases, after four to six months of healing, yourjawbone is firmly fused to the implants. The restorativephase of your treatment, when your missing teeth areactually replaced, is now ready to begin. Dependingon a variety of factors, it may be possible to begin therestorative phase of your treatment earlier in certaincases immediately after implant placement. We willreview the most appropriate treatment sequence andtiming for your particular situation.

In some cases, depending on the density or hard-ness of your bone, it is helpful to increase graduallythe work on your implants. Various types of tempo-

rary replacement teeth are used during this phase.Information we obtain at the time of implant place-ment will help us to determine what is the most ap-propriate approach for you.

The dental work required to complete your treat-ment is complex. It is, however, considered more com-fortable and more pleasant than conventional dentalcare. Frequently, most of the work can be done with-out using even local anesthesia.

Your restorative treatment begins with special-ized impressions that allow us to produce a replica ofyour mouth and implants. We will also make “bite”records so that we see the relationship of your upperand lower jaws. With this information, we will makethe abutments (support posts) that attach your re-placement teeth to your implants. Various types ofabutments exist. Frequently, we can use “off the shelf ”abutments. Other times, custom abutments must bemade of gold or a tooth-colored ceramic material. Asyou can imagine, these custom-made abutments addto the cost and treatment time involved. Which abut-ment to use is a decision that often cannot be madeuntil after healing is complete and impressions havebeen made.

The number of appointments and the amountof time required for each appointment is different foreach patient. No two cases are exactly the same andregardless of the number of teeth replaced, thework must be completed with great precision andattention to detail. If you are having only a few teethreplaced, there as few as three short appointmentsmay be required. Between appointments, we will needtime to complete the necessary lab work to make yourreplacement teeth.

If your final restoration is a removable denture,you will need to come to as many as five office ap-pointments (although it may be fewer) over the fol-lowing several months. During these appointments,we will perform a series of impressions, bites andadjustments in order to make your new teeth as wellas the custom support bars, snaps, magnets, or clipsthat will secure your teeth to the implants. During thisperiod we will make every effort to make certain youhave comfortable temporary replacement teeth.

In general, once your implants are placed, youcan expect your treatment to be completed anywherefrom two to 12 months. For these reasons, it is diffi-cult for us to tell you exactly how much the restorativephase of your treatment will cost, although you shouldreceive a reasonable estimate of costs . It also is diffi-cult to give you a specific timeframe for completion ofyour treatment until after the implants are ready forrestoration.

A number of short appointments are needed toA number of short appointments are needed toA number of short appointments are needed toA number of short appointments are needed toA number of short appointments are needed tocomplete your treatment after the implants havecomplete your treatment after the implants havecomplete your treatment after the implants havecomplete your treatment after the implants havecomplete your treatment after the implants havehealed.healed.healed.healed.healed.

How Do I Clean My Implants?How Do I Clean My Implants?How Do I Clean My Implants?How Do I Clean My Implants?How Do I Clean My Implants?

As with natural teeth, it is important that you clean im-plant-supported restorations regularly with tooth-brushes, floss and any other recommended aids. Youalso should visit your dentist several times each yearfor hygiene and maintenance. As with regular denturesand other tooth replacements, your implants and theirassociated components are subject to wear and tear andeventually will need repair, including clip replacement,relines, screw tightening, and other adjustments.

another dentist provides the temporary teeth and re-stores the dental implants after healing is complete. Inthis case, both doctors are involved in planning yourdental treatment. Also, depending upon a variety offactors, different dental specialists will help with yourdental care.

What Do TheseWhat Do TheseWhat Do TheseWhat Do TheseWhat Do TheseServices Cost?Services Cost?Services Cost?Services Cost?Services Cost?

Before treatment begins, every effort will be made togive you an accurate estimate of all the expenses in-volved in placing and restoring your dental implants.This includes the implant placement itself plus anybone and soft tissue grafting procedures that areneeded. In many cases, there is an initial charge forthe diagnostic work-up, including study models,x-rays, and the fabrication of a surgical template toensure the best possible result. You also will be chargedfor the abutment or support post(s), plus the crown,dentures, or anything else that will be placed over theimplants, including temporary restorations, as well asfor periodic maintenance such as hygiene visits, tissueconditioners, denture relines and other repairs.

We will try to assist you in estimating what youractual payments will be after we evaluate your insur-ance coverage or other third party payments, if any.Your ultimate restorative choice should be guided byyour sense of what is best for you based on the infor-mation we have provided you. You also should con-sider the financial impact of each treatment optionas some insurance companies provide no or limitedcoverage. If different doctors are involved, they willcharge you separately for their services.

Will One DoctorWill One DoctorWill One DoctorWill One DoctorWill One DoctorDo Everything?Do Everything?Do Everything?Do Everything?Do Everything?

In some situations, your dental implants can beplaced and restored in the same office. At other times,one dentist places the implant(s) and performs anyother necessary additional surgical procedures while

A variety of toothbrushes and floss are availableA variety of toothbrushes and floss are availableA variety of toothbrushes and floss are availableA variety of toothbrushes and floss are availableA variety of toothbrushes and floss are availableto help you clean your implants.to help you clean your implants.to help you clean your implants.to help you clean your implants.to help you clean your implants.

Each patient is unique, and it is not possible for us to discuss every option and everycontingency for treatment outcome. This booklet is intended to help you understandthe general treatment options available to you. If your specific treatment options are

not clear, please contact us.

We will be happy to answer any questions you have about your dental care.

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