Dental Implants

Dental implants are designed to last for your entire life. That doesn’t mean they cannot fail, or won’t require any maintenance, but under ideal circumstances, implants are one of the most predictable procedures in dentistry. The long term (20 year) success rate for dental implants is above 90%, with 10 year success rates generally above 95%.  Although they are considered a last resort, implants are usually the most ideal option for replacing teeth.

You can think of dental implants as small screws that go into the jaw bones to replicate the function of tooth roots. Implants are generally made of titanium, although there are alternative materials like zirconia that can be used in rare circumstances. After an implant is placed, a prosthetic tooth called a crown will be attached to the implant with a connector called an abutment joining everything together.

Usually things go like this: Extraction and Bone Grafting > (3+ months of healing) > Implant placement > (3+ months of healing) > Abutment and crown fabrication. Individual circumstances may require more or fewer steps to get things just right for the crown, but these are the most common steps.

Before an implant is placed, the tooth or teeth that are going to be replaced need to be extracted. When the tooth is extracted, a procedure called bone grafting is usually done to fill in the defect left by the now missing tooth. Bone grafting material is most commonly a powdery substance that is placed in the tooth’s socket (where the tooth used to be), covered by a  resorbable barrier called a membrane, and then left to incorporate and become one with the bone for about 3 months.

If you have a space where a tooth has been missing for a long time, you may be able to have an implant placed right away.  If the bone has resorbed (shrunken) because the tooth is missing, additional grafting procedures may be necessary in order to create a solid foundation for your implant.

When the implant is placed, the titanium screw is placed in the bone, and then has to be allowed to heal into the bone (a process called osseointegration) for at least 3 months before it can have a crown placed on it. If too much force is put on the implant before it fully integrates into the bone, it will not heal properly.

Implants are a multi-step process with a lot of waiting in between. If you calculate all the healing time involved after the extraction, and then after the implant placement, it will take at least 6 to 8 months before a crown can be put on so you have a tooth in the space.

If you are having an implant placed in an area that is visible, a temporary appliance called a “flipper” can be made to fill the space while you wait for everything to heal. A flipper is essentially an acrylic retainer with a tooth attached. Although it is not a great long term solution, it is generally sufficient to get you through the implant process without others knowing you’re missing a tooth. If you are having a back tooth replaced with an implant, a flipper is probably not necessary during the implant process.

The process of getting a dental implant may sound intimidating, but the placement of the titanium screw into the bone is designed to be non-traumatic so the bone can heal properly. In general, it is a minor surgical procedure with only minimal soreness of the gums where the incision was made. Most patients find that the “worst” part of the implant process is having the tooth extracted, and each step from there gets easier.

Implants can fail soon after placement if they don’t integrate into the bone, or they can fail after having been in the mouth for years. Early implant failure happens in the first year, and is more common than failure later on. Although structural failures are possible, they are uncommon. Most failures happen when the implant loses its attachment to the surrounding bone. 

There are many elements that can affect the success of implants including:

• Oral hygiene habits
• Quality and quantity of bone
• Oral microbiome / bacterial makeup
• Patient health
• Medications
• Other habits (tobacco use, teeth grinding, clenching)

The quantity and quality of bone that is available in the placement site is a very important factor. For example, the bone in the upper jaw is generally less dense, so implants are slightly more likely to fail. If a tooth has been missing for years prior to implant placement, the bone may have shrunk and additional procedures like ridge augmentation or a sinus lift may be necessary to have sufficient bone to place an implant.

Before you have an implant, we will take a 3D x-ray called a CBCT to determine if there is sufficient bone to place an implant. For the placement of the implant, a precision surgical guide will be made to be sure the implant is put in at the most ideal area and at the proper angle. 

One of the most common causes of implant failure years after placement is peri-implantitis, which is a type of gum disease around the implant. If you have lost teeth due to gum disease, your risk of losing implants due to the same issue is significantly higher.

It is important to talk to us about all of your health conditions, but especially high risk conditions include:

Smoking: Due to decreased blood flow to the oral tissues, studies have shown significant increases in implant failure in smokers.

Diabetes: Patients with diabetes, especially if it is poorly controlled, have slower wound healing and are more likely to have implants fail. 

Although there are many medications that can affect the success of dental implants, some of the most common are:

Proton Pump Inhibitors: Used to treat acid reflux, proton pump inhibitors have recently been shown to lower the success rate of dental implants. 

SSRIs: Selective serotonin reuptake inhibitors are anti-depressants that can affect the integration of the implant into the bone.

Bisphosphonates: Bone building drugs called bisphosphonates change how the jaw bone remodels and can increase the risk of implant failure. Patients with a history of cancer that have had high dose IV bisphosphonates are at the most risk.

Brush and floss (or use a waterpik): Proper oral hygiene is critical to maintaining healthy teeth and implants. Although implants can’t get cavities, if you are not brushing and flossing daily, plaque buildup can lead to gum disease and bone loss around dental implants, which is known as peri-implantitis. 

Get a night guard: Clenching and grinding places abnormal forces on your teeth that can be very damaging, but it can especially be hazardous for implants because they are fused directly to the bone, and don’t have a periodontal ligament to act as a “shock absorber”. If you are aware of clenching or grinding, wearing a night guard to protect your implant is necessary to prevent issues.

See your dentist regularly to monitor the implant and identify issues early before they become problems.

If caught in early stages, failing implants usually don’t have any symptoms. Your dentist may observe bone loss on routine x-rays, or notice bleeding or pocketing during periodontal probing. This is why regular check-ups are so important.

In late stage implant failure, patients may notice the implant moves or “wiggles”. In most cases, it is only the crown that has come loose, which is usually an easy fix at your dental office, but if you notice your implant is not stable, contact your dentist immediately.

If you are concerned about your dental implants, see your dentist immediately. We may be able to place a localized antibiotic to reduce inflammation. Sometimes the implant can be saved with a surgical procedure to clean out infection and repair defects in the bone.

Some failing implants need to be removed, but even when dental implants fail, after the site has been allowed to heal, your doctor can many times re-attempt the implant placement. Current data shows success rates for replacing implants is about 71%.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327689/