Dental Implants

The technological advancements related to dental implants have significantly improved the treatment options available for patients missing one or more teeth. A dental implant can be compared to a tooth root which anchors the visible portion of the tooth in the mouth. Current research has demonstrated successful healing and function of dental implants to be 90% after 15 to 20 years of service.

A dental treatment plan involving dental implants will depend on the area within the mouth and the number of missing teeth. For example, a space with one missing tooth and natural teeth on either side can be treated with a dental implant supported restoration to provide a long-term , low-maintenance treatment result while maintaining the integrity of the adjacent teeth.  In a situation where all of the lower teeth are missing, four dental implants can be strategically positioned to support a restoration with 10-12 teeth providing function similar to a full complement of natural teeth.

The significant advancements in technology have influenced dental implant supported restorations through:

0. The use of 3-dimensional images to improve the planning process.
0. The modification of the surface of the dental implant to decrease the healing time.
0. The refinement of the techniques used to place and restore the dental implants.

The most critical factor in the success of dental implant supported restorations relates to the healing potential of the natural structures following the procedure. Uncontrolled diabetes, history of radiation of the head and neck area, and hypothyroidism will act to limit the healing potential and therefore alter the anticipated success of dental implant therapy.  Success rates for patients who smoke have been shown to be 10% lower than healthy non-smokers due to a diminished healing capacity. When a concern arises regarding the healing potential, the time between the placement of the dental implant and the placement of the definitive restoration may be extended in order to provide the greatest opportunity for success.

The advantages of using dental implants to replace missing teeth include the following:

• Dental implants help to maintain and retain the supporting jaw bone that would otherwise shrink away, thus maintaining the facial structure and preventing a sunken-in appearance to the face.
• Placing dental implants rather than placing a traditional bridge prevents having to remove healthy tooth structure on adjacent teeth used to support the bridge.
• Replacing missing teeth with dental implants helps to distribute the forces of chewing so that the remaining teeth are not taking the brunt of the chewing load.
• Using dental implants to support a denture prevents the denture from moving on the gum tissues and provides an extremely stable anchor for dentures allowing for improved chewing capacity and function. 

The circumstances that surround a situation where a patient is missing one or more teeth can be different for everyone.  It is certainly a powerful experience to help someone through the process and watch the reaction in the patient’s eyes after the definitive restoration is placed. Patients report an improved level of confidence in daily interactions as well as improved chewing function as a result of a successful dental implant supported restoration.

Dental Implant Supported Restorations for Missing Teeth

A dental implant can be described as a titanium tooth root that becomes attached to the supporting structures of the jaw.  The visible portion is the crown or cap that is attached to the dental implant (A). Dental implant supported restorations can be made in areas of one missing tooth or areas of several missing teeth. The first patient is missing three consecutive teeth in the upper right area of the mouth. The space is too long for a conventional cemented bridge, and the patient is not interested in a removable partial denture prosthesis.

Due to the history of significant chewing forces, three dental implants were placed (B), and a custom designed prosthesis was made with the abutment to attach to the dental implants, and the visible portion of the teeth to cement onto the abutments (C). The view inside the mouth shows the abutment in position attached to the dental implants, and the crowns in position cemented to the abutment (D, E, F, G).









The next patient presents missing three consecutive teeth on both the upper right and upper left areas of the mouth.  Two dental implants were placed on each side to support a custom designed restoration with the appearance of 3 individual teeth. Due to the limited space available, the restorations were attached directly to the dental implants (H). The three teeth on the right side of the photo (I) are supported by two dental implants, and the three teeth on the right side of the photo are crowns or caps cemented onto the natural teeth. The patient was happy with the final result (J).





This patient presents for restoration in the upper front area of the mouth. Two of the teeth are prepared for traditional crowns or caps, and the middle of the three is an abutment that is attached directly to the implant (K, L). The definitive restorations are cemented individually.

Implant-Supported Dentures vs. Traditional Dentures

One of the best ways to utilize dental implants is to support a denture. Traditional dentures rely on the support of the underlying gum tissues, which are movable and thus cause the denture to shift with eating and speaking. This instability can be uncomfortable and can cause anxiety when in a public setting. The stability of the denture is vastly improved with dental implants, which provide a solid anchor for the denture to attach. The number of implants used may vary depending on each individual case and weather the denture is for the upper or lower arch, however the stability of the over-denture increases as does the number of dental implants used for support. Implant supported dentures provide better support allowing for increased chewing function. They also decrease shrinking of the jawbone as typically seen in long-term denture wearers and thus help retain facial contours and reduce tissue irritation that commonly occurs with traditional dentures.

Fixed Restorations

The options available for patients missing all of their upper or lower teeth have improved significantly due to advances in dental implant treatments. The restorations shown here are fixed in position and can only be removed by a dental professional.

When all of the lower teeth are missing, as few as four dental implants can be placed strategically to provide support for 10 to 12 teeth fixed to a milled titanium substructure. The position of the teeth is first determined and approved by the patient. A customized impression is made and the information is transferred for computer aided design and manufacture (CAD/CAM) of the substructure (A, B, C). Teeth are added to the substructure for verification of tooth position (D). The prosthesis is processed and inserted (E). The earliest and most studied version of this design was first published in the 1960’s by a Swedish orthopedic surgeon.







Certainly, it is possible to design dental implant supported restorations with the appearance and contours similar to natural teeth for patients missing all of their natural teeth. A dental treatment plan such as this requires careful planning during all stages of treatment in order to achieve the desired outcome. Three-dimensional Cone-Beam images are critical to identify key features such as the position of the nerves and sinus cavities while planning for the position and inclination of the dental implant to match with the planned position of the teeth (F, G). Upper and lower teeth can be custom designed based on the position of the dental implants to provide overall comfort and function similar to natural teeth (H, I, J).

As we go through the restorative process and begin to make recognizable progress, the excitement is obvious in our patient’s eyes. Very often we see their personalities blossom as they grow far more comfortable and confident with themselves.

The most common feedback from dental patients who have implant supported restorations is that they experience increased confidence, especially in social situations. They describe the ability to speak freely without concern that their teeth may come loose and the comfort of making choices from the entire restaurant menu rather than the necessity to exclude certain foods.