Frequently asked questions about dental implants and bone grafting

questions about dental implants

Dental implants are prostheses used to replace missing teeth and are the best tooth replacement option available. They are made of pure titanium or titanium alloy and closely resembles your natural teeth. Implants are superior to other alternatives and doesn’t harm the neigbouring teeth.

Frequently asked questions about dental implants and bone grafting

In this blog, I will answer the most frequently asked questions about dental implants and bone grafting. So, let’s get started.

Who can get a dental implant?

A tooth extracted due to cavity, trauma, or fracture can be replaced with a dental implant. However, a tooth lost secondary to periodontitis (advanced gum disease with bone loss) might not be replaced with an implant due to insufficient bone to support an implant. Bone augmentation might not last long if you have active periodontitis and is more likely to fail.

If you have several teeth missing from the mouth, you may get an implant supported denture.

If you have lost all teeth in the jaw, you can get all-on-4 denture, where four implants are placed in the jaw and a denture is placed on the top of it. All-on-4 dentures are fixed and you don’t have to remove them every night. However, regular dental check-ups are required for their maintenance and cleaning. 

who can’t get a dental implant?

The following patients are often not the best candidates for implant placement and are evaluated to see if they deem fit for the dental implant placement:

  • Pregnancy – implant placement is delayed until delivery.
  • Mentally unstable patients
  • Chronic alcoholics – have problems with blood clotting.
  • Heavy smokers (>20 cigarettes/day) – experience more bone loss and delayed wound healing.
  • Patients with atypical facial pain (chronic unexplained pain on the face)
  • Growing individuals – implant placement is delayed until growth is complete.
  • Mental retardated individuals
  • Uncontrolled Diabetes – the rate of implant failure is 20% in first 5 years.
  • Bone disorders such as osteoporosis or osteomalacia
  • Heart attack – The surgery is delayed up to 12 months after a heart attack.
  • Patient who underwent head and neck radiation therapy – the success rate is 26% in first 5 years.

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What are the benefits of dental implants?

A dental implant is the best tooth replacement treatment available so far. Structurally and functionally, it resembles with your natural tooth.

It has a body or an abutment that is surgically placed inside the jawbone. The implant abutment acts like the root of a natural tooth; absorbs all the masticatory forces and transfers it to the surrounding bone. Also, the epithelium (gums) attaches to the implant in the much similar way as your natural teeth. Moreover, the crown placed on the implant body closely resembles the shape and color of the missing tooth.

An implant maintains your chewing efficacy because the heavy forces of mastication are transferred to the bone through implant abutment in a similar way as your natural tooth. However, the chewing efficacy is reduced to 30% after denture placement and is recognised in people with multiple missing teeth.

It matches with natural teeth and improves your smile and esthetics. It is hard for a layman to differentiate between an implant and a natural tooth.

The dental implants are fixed to the jaws and require similar oral hygiene maintenance as your natural teeth. The longevity and success rate of an implant is directly related to plaque control. Inadequate plaque removal around the implant leads to inflammation in the implant soft tissues, known as peri-implantitis. Long-standing inflammation destroys the bone supporting the implant resulting in implant failure.

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How long does a dental implant procedure take?

On average, the dental implant procedure takes 4-7months to complete. An implant abutment is placed in the prepared bony socket and is left for 3-6 months to fuse (osseointegrate) with the bone, a process known as osseointegration.

The sterile titanium surface allows bone to form around the implants. The quality of bone formed around the implant and the close contact between the bone and implant holds it firmly in place.

After implant osseointegration, the gums are opened, and a healing cap is screwed to the implant abutment. The healing cap promotes the healing of the gums around the implant. The soft tissues take 4-6 weeks to heal, followed by crown placement. 

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How painful is the dental implant procedure?

Dental implant placement is a painless surgical procedure because the whole surgical site is anesthetized before the surgery. It is normal to feel pressure during the procedure and shouldn’t be confused with the pain. You will be prescribed pain medication at the end of the procedure to avoid post-operative pain.

The effect of anesthesia lasts for 2-3 hours. After the anesthetic wears off, you will experience mild to moderate pain if you don’t take pain medication.

Slight discomfort may be felt during the healing period (for 7-10 after the surgery). Severe pain indicates an infection, so report to the dental clinic if you experience severe pain in the wound. 

Avoid eating hard, crunchy food after the surgery, as it can injure the healing gums around the implant and cause pain. 

Read more: 10 Signs of healthy gums

What is the best brand of dental implants?

The following are the reliable dental implant brands that provide sterile, durable, and variable implant designs:

  • Nobel Biocare 
  • Straumann
  • Zimmer Biomet
  • Dentsply Sirona 
  • BioHorizons 
  • DIO implant 
  • Neodent 
  • Southern implants 
  • Astra Tech implant system
  • Osstem implant 

Are dental implants safe?

Yes, dental implants are safe. They are made of pure titanium, titanium alloy or zirconia, which are safe and biocompatible materials. Implants require a highly sophisticated material that the human body can tolerate as we want healthy bone to build around the implant. The human body rejects any material that is considered foreign (such as stainless steel) and titanium is considered safe to be placed inside the bone.

Titanium toxicity is rare. However, release of titanium particles in the surrounding area may trigger an inflammatory response and an extreme reaction may loosen your implant. People with allergy to metal or autoimmune disease are more likely to develop titanium toxicity.

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When do you need bone grafting for dental implants? 

There are certain cases when you need bone augmentation before an implant placement. After a tooth extraction, you are expected to lose 40-60% of socket bone because the tooth’s root maintains the width and height of the bone; the most significant loss is expected in the first two years. The longer the teeth are missing, the more significant bone loss is seen. A significant bony atropy is seen people after age 60 particularly in lower jaws.

The following conditions indicate that you need a bone graft (bone augmentation) before an implant placement.

  • Horizontal or vertical bone loss leaving not enough bone in width and height to place an implant abutment.
  • A bony defect due to infection or trauma.
  • Sometimes prophylactic socket filling is done soon after the tooth extraction to preserve the ridge, prevent future bone loss, and stimulate new bone formation. Some bone loss is expected even after bone grafting, however, it prevents future surgical bone augmentation.
  • Bone defect due to peri-implantitis.

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How do I know if my bone graft have become successful?

The following conditions are required for a successful bone graft: 

Bone-forming cells

Bone grafts provide or stimulate bone-forming cells, which are prerequisite for new bone formation. 

Good blood supply

Sufficient blood supply is required for clot formation and the recruitment of regenerative cells at the graft site. A blood clot is a foundation where regenerative bone cells anchor themselves and laydown new bone.  

No mechanical stress on the implant

Mechanical stress on the bone graft should be avoided during implant osteointegration. Implant movement inside the bone leads to fibrous tissue formation, a consequence of tissue repair. At the graft site, we need bone regeneration, that can accomplished when there is zero stress on the implant.

You will be given a tooth supported prosthesis after the soft tissue closure. You must not wear a tissue-supported partial denture for at least two weeks following an implant surgery to avoid any stress.

The implant is left in the bone for 6 months for the upper jaw and 3 months for the lower implants replacing molars and premolars. The lower jaw bone is dense and has thick cortical plate that allows quicker osseointegration. The upper jawbone, on the other hand, is spongy with thin cortical plate and, therefore, requires longer period for successful osseointegration.

No tension in the soft tissues over the dental implant

There should be no pressure from the overlying soft tissues on the soft collagen secreted by bone cells. The soft tissues (dividing epithelium) go through the process of contraction when the wound edges meet and close the gap.

The contracting soft tissues may collapse the underlying collagen framework, and disrupt the new bone being laid down. Bone formation is a slow process and takes 6 -8 months to fill the socket. However, the soft tissues divide faster and fill the bridge the gap in 2-3 weeks. A bone graft or tissue-guided regeneration matrix separates the new bone from the soft tissues and prevents its collapse. 

Avoid smoking or irradiation

Heavy smoking or irradiation during osteointegration diminishes the blood supply of the bone and delays the healing process. 

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How does the bone grafting procedure work for dental implants?

Bone grafting is done where there isn’t enough bone to support an implant. An artificial bone graft is placed to fill the bony defect or augment the bone, horizontally or/and vertically. The soft tissues are closed and left in situ for 1-3 months. The bone graft is either placed at the time of tooth extraction or at a missing tooth site before implant placement.

During bone grafting, an incision (a cut) is made on the gums to expose the bony defect. The chosen bone graft material is placed in the defect or over the desired bone, and the soft tissues are closed without tension. 

There are four different types of graft materials available:

  • Autograft – derived from the roof of the mouth or hip bone of the patient.
  • Allograft – derived from a different individual (a cadaver or living person).
  • Xenograft – derived from animals such as bovine or porcine.
  • Alloplast – inorganic, synthetic or inert material placed at the surgical site.

Bone grafting stimulates new bone formation and not repair. The bone graft provides bone-forming cells or stimulates bone to make new bone-forming cells. The tension-free soft tissue closure prevents disruptive pressure from the contractile forces of the rapidly dividing soft tissues (epithelium) on the newly developed collagen in the bone. 

In tissue-guided regeneration, a lattice or a framework is placed under the soft tissue that not only stimulates bone regeneration but also separates the new bone from the pressure of rapidly dividing epithelium. 

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Do implants need to be checked and maintained? 

No, they don’t require regular check-ups. However, you have to control plaque build-up to prevent any inflammation around them. Annual check-ups, scaling, and root planning may prolong the life of an implant. 

Why don’t implantologists do implants for wisdom teeth?

Wisdom teeth are additional teeth in the mouth, and our masticatory apparatus performs best with two premolars and two molars on each side of the jaw. If you have healthy premolars and molars, you don’t need wisdom teeth replacement.

Implant placement is an expensive, invasive procedure with a lot of patient discomfort, tissue damage and long healing time to restore bite and esthetics and wisdom tooth replacement is considered an unnecessary procedure and is, therefore, avoided.

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How long does a dental implant last?

Dental implants can last 15-20 years if good oral hygiene is maintained. According to a study, 95% success rate was seen in implants placed in the lower jaw and 85-90% for the upper jaw after 5 years. Factors like bad oral hygiene, smoking, osteoporosis, and the habit of clenching and grinding can reduce their lifespan. 

What are the risks associated with dental implants?

There are a few risks associated with dental implants.

Damage to sinus wall

The implants placed near the sinus may damage the sinus wall leading to maxillary sinusitis or displacement of implant into the sinus cavity. This problem is often seen in patients with short roots, molar encroaching the sinus wall or patients who lost their tooth a long time ago. The dental implants require 2mm clearance from the sinus cavity to preserve their integrity. A sinus lift procedure is recommended in patients with large sinus cavity and less bone available for the implant.

Inferior alveolar nerve damage

Lower implants in the premolar region are close to the mental nerve and molars to the inferior alveolar nerve (IAN). IAN damage is the most common injury following implant placement, followed by lingual nerve. Injury inflicted due to traumatic local anesthetic injection or implant surgery and placement can lead to temporary or permanent nerve damage.

A 2mm clearance is given between the implant and vital structures such as nerves and blood vessels. A dental implant placed close to these vital structures can cause tissue compression, leading to altered sensation (paresthesia) or numbness in the areas innervated (supplied) by these nerves.

Implants are placed after growth cessation

Implants can’t be placed in children or teenagers, and you have to wait till the growth of the jaw is completed. The bone growth can submerge the implant and can lead to esthetic (spacing) and periodontal problems.

Allergy

Allergy to titanium is rare and accounts for 0.6% in the United States (US). An antigen-antibody test is done before implant placement to see if you’re hypersensitive to titanium. Most people tolerate it with no side effects.

Metallic discolration

The metallic gray color of implants may be visible in people with thin gums. 

Are dentures better or worse than dental implants?

Dental implants are better than dentures. Dentures significantly reduce your chewing efficacy, and it will be challenging to eat hard and crunchy foods with dentures and you will take time to adapt to it. 

You must remove dentures before bed and soak them in water until you’re ready to wear them the next day. 

Some dentures have clasps – anchoring wires encircling one or more neighboring natural teeth, that may increase the stress/load on these teeth, leading to loss of bone and periodontal support in the long run. 

Upper partial dentures often get support from the palatal bone (roof of the mouth). The area covered by dentures creates speech difficulties; however, patients get used to it with time. More missing teeth require greater palatal coverage, leading to difficulty in pronouncing certain syllables. 

Implants, on the other hand, cost you an arm and a leg, but they are worth getting, and you won’t have to face the problems associated with dentures. 

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