These days I have been leaving the surgery to the surgeons and focusing on the post and crowns, the biting and esthetic part. I will tell you why in a minute. I did surgically place implants since the late 70s until the late 90s, but with all the new research coming out and all the new techniques being developed it was very hard to keep up, doing both the surgery and the implant restoration. Dentists call the implant crowns, bridges and implant supported dentures, the “restorative” part. In the early 2000’s I decided to leave the surgery to the surgeons and focus on the restorative phase of implant work.
So when new patients call me on the phone or visit my office on the Westside of Manhattan near Columbus Circle, some seem confused when I tell them yes I restore the implants but I do not place them surgically. I believe this is because there are some basic misunderstandings on the phases of implant restoration. At this point, it may help to understand some basics of implants.
An implant is not immediately put in together with the crown that you bite on, in the great majority of cases. Implants are actually just artificial roots that are surgically embedded in the jawbone and gum tissue of your mouth. These are most often made of “titanium” but some non-metal materials are starting to be used that do not have nearly the “track record” of the success of titanium. The implants should not be used for eating right away, a term dentists call “loading” because this would interfere with the biologic process of osseointegration, where the implant fuses with the bone. This rule is broken sometimes with immediate loading or early loading but this can carry substantial risk; more on that in another blog. For this reason, there is a certain timeline for replacing a tooth with an implant and crown.
First, the implant (also called a fixture) is surgically placed in the bone, covered over and then allowed to heal and integrate for a proper amount of time. In the second stage, the implant is uncovered and now connects with the outside via a healing cap which protects the implant and keeps the gum tissue in the ideal form to allow proper restorative work. In the third stage the work shifts to the restorative dentist who will take measurements and impressions with certain specific parts, depending on the different implant types, and will fabricate an implant post, called an abutment, and implant crown. Under certain conditions, like a very tight space between the upper and lower teeth, the post and crown are fused together. So an implant is really four steps: the surgical placement, the uncovering (sometimes called the “second stage”), the measurements and impressions and finally the placement of the post and crown, bridge or implant supported dentures.
The benefits of dental implants are many and varied, including for health, functional and cosmetic reasons. As far as the health reasons, if you are missing only one or two teeth in the same area the old way of placing something fixed, something that was not removable, was to grind down the teeth on either side, place crowns and attach false teeth between these crowns. The ground down teeth become more vulnerable to decay and nerve damage and there’s a better chance that root canal will be necessary for the future. Many times rough crown edges at the gum line can also lead to periodontal inflammation.
When a tooth root is lost, bone loss will eventually occur because the bone needs the root “in function”, that is, eating and biting, to stimulate and stabilize the bone. Also in this capacity, the implants function very much like natural tooth roots.
When you lose a back tooth and you are still able to eat and no one sees it and you have many other teeth, you don’t feel the necessity to replace that tooth. But again because of lack of stimulation the alveolar bone that formerly supported the tooth and in turn was supported by the tooth begins melting away. First, your jawbone changes and then your face will change; sometimes almost imperceptibly and other times dramatically. Losing teeth can also affect the rest of your teeth; teeth will move both sideways and down into spaces resulting in a “collapsed bite”. Teeth create a structure and framework for the outside the face and their loss can make the surrounding teeth shift and create aesthetic and bite problems. People get a caved-in look and also their facial height between the nose and chin get shorter because now the chin is closer to the tip of their nose and more wrinkles can occur. This is something dentists call shortening of the “lower facial height”, something you typically notice in older people who have lost a lot of teeth.
With tooth loss comes shifting teeth and a “shifting bite” which most times mean a bad bite. This results in tooth interferences when chewing or biting, a condition dentists call “traumatic occlusion”. This many times leads to muscle spasms in the jaw, head and neck area and even the development of TMJ/TMD problems. With enough tooth loss and/or pain with chewing it’s easy to see how one would stop eating more healthful foods like raw vegetables, or even a steak, resulting in a poor diet with less than optimal nutrition.