Dental Implants

Implant Procedures– Steps by Steps Illustration

Implant is the modern advancement in Dentistry for replacement of missing teeth.  Implant consists of two parts: implant fixture and implant crown.  Implant fixture is a prosthetic anchor into a person’s own alveolar bone in the dental ridges and a prosthetic dental crown can be made on this implant fixture.  Let me illustrate the typical dental implant process with this recent case:

This patient walks in with a broken tooth.

Preop Implant Front Tooth

 

Xray image shows only a fraction of the root remains in the bone.

Preop Implant Xray

 

The remaining root is unrestorable.  Based on the patient’s medical history, he has no medical problems and is perfectly healthy.  And the bone level is adequate for implant.  Thus implant option is recommended to replace the tooth.

The typical implant process starts with initial consultation such as evaluation of patient’s pre-existing medical/health status, clinical and radiographic evaluation of dental condition and adequacy of bone in the implant site.  Implant process is to be discussed with the patient and informed consent obtained.

After the initial consultation, the patient agrees to proceed with the implant process.  The root is first to be extracted.  Because patient has adequate bone, implant fixture is to be inserted on the same day.  The tissue is to be sutured and the wound is closed.

MidTreatment Implant Xray Front Tooth

It would take 4 months for the implant to be integrated with the surround bone.  A temporary dental flipper (with the denture tooth) is made so patient can wear to cover the missing tooth.

After 4 months, patient comes back for evaluation and bone and tissue is healed completely.  The implant within the bone is uncovered.  Then implant crown is to be made and inserted.  This is how he looks like when the crown is put on.

Postop Implant Front Tooth   Postop Implant Xray Front Tooth

 

Written by Daniel Tee, DDS, MS

If you have any questions or want to schedule an appointment, Please call 480-820-6131

Genral Dental Office in Tempe AZ — Dental Implants, White Tooth-Colored Fillings, Porcelain Crowns, Veneers, Inlays, Onlays

Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona. Practicing Implant Dentist

Implant Restoration for Missing Front Tooth

I would like to demonstrate today how to restore the front tooth with the implant as the definitive treatment.  Of course, there are other alternatives to implant and the alternative options include bridge, partial denture, and flipper.  Each option has its own advanntages and disadvantages but implant is the standard treatment of choice if the medical and dental conditions of the patient fulfill the requirement for implant.

Missing Front ToothThis patient loses one of his front tooth because he has severe periodontal bone loss around that tooth and it becomes very loose.  The tooth was extracted and was allowed to heal for several months prior to implant is placed.  Meanwhile, the missing tooth gap is temporarily filled in with a dental flipper.  Dental flipper is essentially a plastic partial denture and its main function is a cosmetic one.

Once the bone is healed, dentist placed the implant into the bone.

 

 

 

Then the bone is allowed to undergo osteointegration with the implant.  Depending on the bone quality, upper front bone may take several month to fully heal around the implant.  The implant will become secure into the bone.  This is how the implant looks like within the bone:

Intraoral Implant Photo2

Xray Image showing Dental Implant in bone.

Xray Image showing Dental Implant in bone.

 

Once the bone is fully healed around the implant, the implant is ready to be restored.  The dentist with the help of dental laboratory will design the implant crown according to the patient’s dental condition.  Then the dental crown is fixated onto the implant.  This is how the final result looks like.

Front Tooth Restored with Dental Implant

 

Written by Daniel Tee, DDS, MS

General Dental Office in Tempe AZ — White Tooth-Colored Fillings, Porcelain Crowns, Veneers, Inlays, Onlays

Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona. Practicing General Dentist

 

Dental Implant Bridge to Restore Long Span of Missing Teeth

Dental Implants can have many applications.  Most of the time, it can restore one single missing tooth.  In some cases, it can be used to restore multiple missing teeth.  Depending on the patient’s bone structure and patient’s occlusion, multiple implants can be used to restore multiple teeth (one implant for each missing tooth) or an implant bridge can be used to restore multiple missing teeth.

Whenever it is possible, it is ideal to place multiple implants to restore each single missing teeth.  For example, if a patient has three missing teeth, it is ideal to use three implant to restore all three missing teeth.  This option depends on the patient’s bone morphology and also increase the complexity of the surgery because greater care has to be given during surgery to make sure each implant to be placed in perfect alignment to each other and also in compatible to the patient’s bone morphology.

Another method is to create an implant bridge.  After the implant is placed and has been integrated with the jaw bone for several months, we will take an impression and have the lab create the implant abutment for each implant.  Then we secure the implant abutment on top of the implant fixture within the jaw bone.  This is how the implant abutments are oriented in the mouth after it has been secured in the mouth:

Implant Bridge Lateral view pre-opNotice that the patient has three missing teeth and only two implant abutments.  The advantage of the implant bridge is that it allows restoration multiple teeth with less implants, thereby lessening the complexity of the implant surgery.  After the metal implant abutments are secured, we can then take another impression of the implant abutments and then an implant bridge can be made.

 

Implant bridge is to be cemented on top of the implant abutments.  This is how it looks like in the mouth:

Implant Bridge Lateral view

Then this is the Xray image taken after the bridge is cemented:

Implant Bridge Xray Image

 

The comments that I get from my patient is that the implant bridge feels and functions just like her natural teeth.  She comes in for routine hygiene visit and she is doing just fine.

 

Dental Implant Crown Restoration — A Real World Example Part 2

Dental Implant: For Part 1 of the same topic, click here.

This is the continuation of the real world case of restoring dental implant discussed in the previous article.  In the last article, we have taken impression of the dental implant.  From the impression model, the lab made a stone model of the patient’s dentition and the implant.  A custom-made dental crown is made based on the stone model.

Dental Implant Crown Stone ModelThe stone model consists of the patient’s upper and lower teeth.  Upper and lower teeth are arranged accordingly to the correctly articulated patient’s bite.

Commonly the implant crown is either cement-retained or screw-retained.  In this case, given the short space between the lower ridge bone and the upper teeth, I decided that only custom-made screw-retained crown can be used in this situation.  The type of implant crown is a custom-made screw-retained crown.  The implant crown is made in one piece.  No cement is needed to secure the crown with the implant fixture within the jaw bone.  The implant crown is fixated using a screw.

So the patient comes back in for crown-insertion appointment.  I first remove the cover screw.  Then I try in the crown and taken the xray images to check for correct fitment.   From the xray image, I can see that there is no space between the crown and the implant fixture.  This means that the implant crown is fully seated into the dental implant fixture.

Dental Implant Crown Xray ImageAfter the confirmation from the xray image, I then tighten the screw and use the torque wrench to measure the final torque strength to make sure the screw is secured.  A cover material is inserted into the screw access hole.  Finally I will adjust the biting surface of the implant crown so to make sure there is at least 30 micron of space between the implant crown and upper teeth.  This space is important because when patient’s bites down, the implant does not have the natural ligament around it to absorb the biting forces.

 

 

Here is the final image of the implant crowns seated properly in patient’s mouth.  It looks and feels like natural tooth.

Dental Implant Crown Intraoral Photo

Implant Restoration of Missing Teeth — The real world example

Today, I am going to share one of my implant restoration case.  Patient has tooth #31 extracted in many years ago.  It was recommended to him that implant would be the only good option to restore the tooth.  In his case, a bridge cannot be made because he does not have another posterior tooth behind the missing tooth for the bridge.

The patient had the implant placed more than six months ago for the tooth #31 location.  Today we took an xray to review the implant and its adjacent bone.

Implant Restoration, Implant Fixture, Implant Xray, Nobel Biocare Replus Implant, Tempe DentistFrom the Xray radiograph image, I can inspect the condition of the gum and the position of the implant.  The condition of bone around the implant seems to be in excellent condition.  The bone height around the implant is exactly where it should be.  There is no bone recession noted on the xray radiograph.  Ideally, the bone height should be at the level of the first screw thread of the implant fixture.  Also, the implant is upright and is within good distance from the adjacent tooth.  Theoretically, there should be a minimum of 1.5mm of space between the implant and adjacent tooth.  Clearly, from the xray, it shows there is a least 2 mm of space in this implant case.

Next, I would review the implant inside patient’s mouth.  Currently, the patient has a healing cap placed on top of the implant.  This is how it looks like in the mouth.

Implant Restoration of Missing Teeth, Implant Healing Cap, Dental Intraoral Photograph, Tempe DentistThe tissue around the implant healing cap seems to be normal in appearance.  The color and texture of the tissue is normal.  The patent confirms feeling fine.  No pain or swelling complaint.

With the examination complete, I would proceed to the clinical procedure of taking impression of the impant so that I can use the impression to make the implant crown for the patient.  In the current state, the implant still sits with the bone.  It serves as the anchor for the implant crown.  I would need to find a way to record the position of the implant so that I can make the implant crown correctly to fit on top of the implant fixture.  This is how I would begin.

I would take off the implant healing cap.  After the cap is removed, this is how the implant fixture sits within the jaw bone.

Implant Top View, Implant Fixture, Implant Xray, Nobel Biocare Replus Implant, Tempe Dentist

Implant Bitewing Xray, Dental Implant, Tempe DentistThen I would insert an impression device called the implant impression coping into the female portion of the implant fixture and tighten it lightly so that it does not move or come off.  The height and orientation of the impression coping accurately reflects the position of the implant fixture in the bone.  Then I would take a putty impression of the patient”s lower right arch.  The impression coping would leave an indentation mark within the impression putty in the impression tray.

I would take this impression to my favorite dental laboratory and the implant crown will be fabricated.  When the laboratory finished the implant crown, I would schedule the patient to come for another appointment to have the implant crown  inserted.  At that time, then I will post a follow up article about how I go about inserting the implant crown.  Stay tuned!

 For Part 2 of the same topic, Click here.

Written by Daniel Tee, DDS, MS

Practicing General Dentist in Tempe Arizona