Implants-The Dental Consumer

The Dental Consumer

IMPLANTS: They can replace one tooth or several teeth in an arch

Written by Dr. Ed Prus Wednesday, 04 August 2010 00:39 Southern Dutchess News, Beacon Free Press, Northern Dutchess News:   Healthy Lifestyles Section, "The Dental Consumer" column.

This column is all about becoming a better dental consumer through knowledge. In most cases, knowledge is power: power to make wise choices and guide oneself in the direction you want to go with your dental health.

This month I will go into greater detail on how implants are used so as to help you better understand this unique area of dentistry. Implants are used to replace a single missing tooth, several missing teeth in an arch or the complete arch (upper or lower).

Missing One Tooth

Implants are preferable over standard crown and bridge dentistry under the following conditions:

BONE: The single “edentulous” area has sufficient bone (volume and density) to support an implant. If there is a large, broad amount of bone the implant (as long and broad as possible) can be placed precisely as it should to mimic a natural tooth when crowned.

HEALTHY TEETH: The immediately adjacent teeth are totally healthy: no decay; no fillings, no periodontal disease, no fractures, and they are esthetically pleasing.

ESTHETICS and CLEANSABILITY: The missing tooth area can be esthetically restored with an implant to mimic a natural tooth. This becomes an issue if the smile line is high and shows the point where the implant comes out of the gums. The implant has to be ‘submerged’ far enough under the gum line to prevent the metal of the implant from showing as well as allow the attached crown to develop full tooth-like shape before it emerges from under the gums. It can then be cared for just like a natural tooth.

ADDED STRENGTH: When adding an additional man-made root (the implant) will noticeably contribute to the strength of that area of the mouth (e.g.: the other teeth have bone loss). Remember, when a bridge is placed over a missing tooth, the two adjacent teeth to the space are then absorbing the chewing forces of three tooth surfaces. If those teeth are not strong, this may overload them, accelerating additional bone loss.

Missing Several Teeth in an Arch

Many times several adjacent teeth are lost in an arch, with one or no teeth behind the space. Replacing the missing teeth with a

  • fixed bridge ( adjacent supporting abutment teeth have crowns placed on them; pontics to replace the missing teeth; all these joined together) will put significant added chewing forces on the supporting teeth. A single molar abutment in the back may be very vulnerable to bone loss, putting the fixed bridge at risk and compounding costs.
  • Removable bridges often have movement during chewing which also damages the bone of supporting teeth. Multiple missing teeth can be restored by several implants and strengthen the remaining teeth in the mouth at the same time. 
  • Because multiple implants in an area can be a more expensive alternative to regular crown and bridge work, a good, less expensive solution may be to have one or more implants support a removable denture (partial = some teeth remain; full = no teeth remain in the arch). This eliminates the cost of making crowns on multiple implants, and still stabilizes and supports the chewing function of the removable prosthesis and takes pressure off the remaining teeth.
  • This implant supported, removable denture can be a good economical solution.

Fully Edentulous Arch

A full, removable denture has been the treatment of choice for restoring a full arch of missing teeth for years.  Implants can improve a full denture.

  • Implant supported removable denture: A good alternative is to place a sufficient number (normally 3-6) of implants in the arch and use snap on attachments to affix the denture to them. There are several ways to do this but they all to the same essential thing. My own mother had a loose lower denture which was totally stabilized by placing three implants, connected by a bar, and snapping the denture onto it. It was placed 15 years ago and it is still working well.
  • Implant supported dentures gain stability from the implants allowing them to be slimmer, more comfortable and more enjoyable.
  • Denture type teeth are still used (saves money over implant supported crowns) and tissue colored acrylic can be used to create lip support if needed. This is a frequently used approach in implant supported full denture treatment.
  • Implant supported fixed crown and  bridge. Full arch bridgework can also be fixed (only the dentist can remove them).

Implants and Crown and Bridge Dentistry

  • Implants can almost always be used to support crown and bridge dentistry. 
  • Implant supported crowns can be beautiful and can mimic the natural condition completely. While each case has its pros and cons, this approach tends to be the most esthetic.
  • It also tends to be more expensive than the other approaches. In the end implants can be a great tool in improving one’s quality of life: functionally, socially and emotionally.

Dr. Edward Prus has had a Manhattan practice in cosmetic and rehabilitative dentistry for over 25 years and is now working in Hopewell Junction. His treatment strongly focuses on preventive therapies to maximize dental health, the cornerstone of cosmetic dentistry. This Dental Health column explores a wide range of topics of consumer interest to help you make positive dental choices.



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