Implant dentistry is a 2-step procedure in which the implant is placed at surgery and the replacement tooth connected 4-6 months later after the bone healed. The term prosthodontics refers to tooth replacement and can be either a single crown connected directly to the implant, an implant bridge to replace 2 or more missing teeth, or even an implant denture to replace the full set of teeth when mounted on 4 or more implants.
After the implant is surgically placed in the jawbone and allowed to heal, it usually takes 3 to 4 months for the bone to strengthen around the implant and anchor it firmly. The implant is then uncovered to make a mould for the final restoration. Where possible, this second surgery can be avoided by placing an attachment which passes through the gums at the point of surgery. In some patients, the bone is much firmer and it may be possible to load the implants earlier. Conversely, patients with porous bone at surgery may require a longer period for the bone to heal. After the implant has completely healed, a mould is made of the implant to record the exact position and angulation of the implant to be transferred to the laboratory for processing of the final tooth. The relationship between upper and lower teeth will also be captured. The final crown is then attached to the implant either directly using a special screw or be cemented on a post which is screwed into position. The replacement teeth are made of porcelain on a base of metal, completely of porcelain or with zirconia.
Loosening rarely happens as the final crown or bridge is usually attached firmly by a special device to tighten the connecting screw or by utilising a strong cement. If it does dislodge, keep the crown and bring it along with you to the clinic. The dentist will clean the crown and cement it back if possible. If it happens again, there is a need to review the design to check if the forces in the implant are excessive or if the post which joins it needs to be changed. An X-ray is advised to check if the loosening has caused any problems to the underlying implant fixture within bone.
Different brands may offer different implant properties, your dentist will generally advise you on which brand may be more suitable for your bone type. However, if you are traveling overseas, using a well-known, international brand may be more convenient, should you require any replacement of parts or the crown / bridge by another dentist.
A person who does not have any teeth in the jaw but have sufficient bone to support implants can consider using 4 or more implants to support their dentures. The dentures essentially secure onto special attachments on the implants, making the dentures more stable and allowing patients to feel as if the dentures are fixed in their mouth.
While some patients may choose to replace every missing tooth individually, dental implants are made from titanium, a very strong and lightweight material and 4 to 8 implants in each jaw may be sufficient to carry the load of the removable denture or fixed bridge, even when all your teeth have been lost. Your improved appearance and the ability to once again chew your food well will help you regain confidence and resume an active social life. Even if teeth have been lost for many years, it is still usually possible to rebuild the jawbone to place implants.
The implant bridge or implant denture is more comfortable than wearing a conventional full set of dentures as implants allow better support and thus only a smaller denture base is required. If less than 4 implants are placed, additional support will be needed from the tissues and greater coverage of the gums is required. This will however still be less than if no implants were used. It has also been shown that biting force is many times stronger with implants than with dentures and that implants are more suitable support for dental bridges when many teeth have been lost.
A dental bridge is a long-term replacement for spaces between teeth as the result of tooth loss. The teeth on both sides of the gap are prepared to support a framework on which new teeth are mounted. This is then fixed in position using a special cement and does not need to be removed at night, unlike removable dentures.
Dental bridges are also more stable, comfortable, and aesthetically pleasing than dentures. Bridges can be used on natural teeth or dental implants. Bridges last on an average between 7-10 years, though some may last for up to 15 years or more.
Dentures or “false teeth” are a simple and low-cost method of replacing missing teeth. They are classified into partial and complete dentures based on whether any teeth remain in the mouth to support and retain them while in use. Prefabricated teeth are attached to a plastic base which may be strengthened by a metal mesh or base and are held in place by wires which grip lightly to the sides of remaining teeth. If all teeth have been lost, the denture will have to rely on a close fit with the gums and soft tissue of the mouth to produce a “suction” effect to keep it in position.
It usually takes more than 4 visits to make a denture for the most precise and comfortable fit. A mould is taken of the patient’s remaining teeth and/or gums. As fit is critical to obtain an effective suction, a second, more accurate mould is often required. The dentist will then need to ensure that the dentures made (the two separate upper and lower moulds) will match each other for proper biting ability. The teeth will also have to be checked for alignment as the position will affect the lip posture and support as well as the number of teeth shown. Once these have been verified, the denture can then be fabricated in about a week.
Complete dentures are made when all teeth are lost. It depends on saliva and natural forces known as “surface tension” to provide the stability. Over time, due to the direct pressure of the denture on the underlying soft tissue and bone, the tissues become thinner and the denture becomes loose. In general, lower dentures tend to be less well tolerated by patients as they are usually less stable when compared to upper dentures which have a broader base for support. If patients are suitable for implants, your dentist may discuss the option of implant-retained or implant-supported dentures as a much more comfortable alternative to conventional dentures.
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