Treatment options for missing teeth
Dr Weiner is here to, in partnership with your restorative dentist, help provide you with options to replace your missing teeth, restoring your aesthetics and function. There are several options to replace missing teeth, and your periodontist and dentist will work together to explain to you the pros and cons of each of these options.
There are many reasons why a person may lose one or more teeth. However, there are several options if you do. You can review these options with your dentist to find the best one for you. These include by are not limited to: a bridge, a partial denture, or an implant.
What are dental implants and how do they work?
A dental implant is a titanium-based fixture used in dentistry to restore a site previously occupied by a tooth. Today, dental implants are considered the standard of care to replace missing teeth, with success rates in healthy patients of over 98%. Dental implants function just like natural teeth, making them a terrific option to replace one or more missing teeth. From the day a tooth is lost, the surrounding gums and bone begin to shrink. Thus, the longer you wait to have your dental implant placed, the more tissue is lost and the greater the chance that the implant site may need to be rebuilt prior to implant placement. We are here to guide you through options to replace your missing tooth (or teeth). Every individual, and every tooth, is different, so at your initial consultation appointment with Dr Weiner, she will provide you with a personalized treatment plan catered to your address each of your concerns and aimed to help you improve your aesthetics and chewing function for a lifetime.
This video provides a good overview of the basics of dental implant therapy.
Bone and Gum Grafting
If you do not have enough bone or gum tissue to support a dental implant, don’t worry. Today there are many different techniques to regrow your lost gum and bone tissue, all of which will be discussed at your initial consultation visit.
The Implant Process
Step-by-step appointment outline for dental implant therapy
Replacing a single missing tooth with a dental implant typically requires only 4-5 appointments*
1. The consultation appointment: Step one is a comprehensive consultation with Dr Weiner. Required diagnostic radiographs (“x-rays”) will be taken and before you leave the office our team will provide you with a detailed treatment plan including timing and cost of procedures.
2. Stage I surgery: implant placement: At this appointment, your implant will be placed by Dr Weiner. Dental implants require a healing period before the final crown can be delivered. Everyone heals at different speeds and depending on the quality and quantity of the bone your dental implant was placed in, this period can range from two to six months.
3. Stage II surgery: healing abutment placement: If necessary, at this brief appointment, a small incision is made to expose the top of your implant, allowing Dr Weiner to place a healing abutment, which allows your gums to heal and prepare for placement of your new crown. (In certain cases stage II surgery can be avoided – this will be discussed at your initial consultation appointment)
After placement, the implant was covered to heal underneath the gums. At stage II surgery, a small incision was made and a healing cap was placed to allow the gum tissue to be molded in preparation for the new crown.
4. Impressions (with your referring dentist): To make your new crown, impressions (“molds”) of your implant and surrounding gums are necessary after the implant is fully healed. Typically these can be taken 2-3 weeks after the healing abutment is placed.
5. Delivery of implant-supported crown (with your referring dentist): Your implant supported crown is placed at your dentists office.
Therefore, you can see that typically, it takes 4-6 months from initiation of treatment to the day your implant-supported crown is delivered.
*In more complex cases, more appointments will likely be needed but this will all be discussed at your initial consultation with our implant team
Replacing One Tooth
Replacing a single tooth with a dental implant allows for desirable long-term functional and aesthetic results.
Additionally, by electing to replace your missing tooth with an implant vs. a bridge or partial denture, you have chosen to help preserve the condition of healthy adjacent teeth by eliminating the need to grind down healthy adjacent teeth or use clasps for support.
Additionally, your dental implant will continue to stimulate bone and gum tissue while in function, which helps prevent future bone loss over time.
To understand dental implants, it is first important to understand the anatomy of a natural tooth. Every tooth is made up of a crown and a root, or several roots. The crown of the tooth is the part that is visible in the mouth.
The tooth root, or roots, anchor the tooth into the jawbone. In health, this root is visible only on dental radiographs (“x-rays”). When a tooth is lost, it is necessary to replace both the tooth crown and root.
A dental implant is a replacement for the root component of a tooth.
For implant placement, it is essential that you work with a highly trained surgeon who can manage placing your implant in an ideal position. In some cases, it may be necessary to “grow back” missing bone or gum tissue prior to placement of your dental implant to obtain both an ideal aesthetic and functional result. Even the best general dentists cannot achieve an ideal final result if an implant is placed in a poor position. This highlights the importance of recruiting an dental implant expert, like Dr Weiner, to work with your restorative dentist to replace your missing tooth.
After your implant is placed and allowed to heal, we will contact your general dentist and let him/her know it is time to see you to take impressions for your implant supported crown.
You can see how working together, Dr Weiner serves to replace the “root” portion of your tooth with a dental implant and your restorative dentist will replace the “crown” portion, giving you an aesthetic and functional replacement for your lost tooth. We look forward to being a part of your team to replace your missing tooth and get you smiling and chewing well again.
The standard of care for replacing missing single anterior (“front”) teeth is a dental implant. The placement of this fixture involves the reflection of gum tissue to gain access to the underlying bone. Sequentially larger holes are created to the appropriate diameter and depth to receive the implant. The next step involves placing the threaded implant into the drill site and a closure screw is placed on top. Implant-bone integration typically requires a minimum of 8-12 weeks after which time and abutment (“healing cap”) is placed and impressions are taken to fabricate your implant-supported crown. Your dentist may or may not elect to place a temporary crown during this transitional period.
The standard of care for replacing single or multiple missing teeth is a dental implant. The placement of this fixture involves the reflection of gum tissue to gain access to the underlying bone. Sequentially larger holes are created to the appropriate diameter and depth to receive the implant. The next step involves placing the threaded implant into the drill site and a closure screw is placed on top. Implant-bone integration typically requires a minimum of 8-12 weeks after which time and abutment (“healing cap”) is placed and impressions are taken to fabricate your implant-supported crown. Your dentist may or may not elect to place a temporary crown during this transitional period.
Case Study 1
Patient presented with hopeless tooth root present next to an area where a tooth was previously lost due to deep decay. At the same appointment, the patient’s remaining tooth root was extracted and two adjacent implants were placed.
Implants placed immediately following extraction
Progression of radiographs (“x-rays”) taken throughout implant surgery. At this time, the patient is are waiting for the implants to heal. After this 3 month healing period the patient will return to his general dentist to take impressions for his implant supported crowns.
Replacing Several Teeth
When several adjacent teeth are missing, an implant supported bridge is an excellent way to replace them. This type of restoration is similar to a regular dental bridge, but instead of being supported by your natural teeth the bridge is supported by implants placed in key positions to allow for equal stress distribution during chewing. A bridge is attached to two or more implants. The number of implants required to replace several missing teeth depends on many factors, including the quantity and quality of existing bone, your bite, and other anatomical factors. There are several reasons your periodontist and general dentist may recommend this type of restoration, all of which will be discussed with you at the initial consultation appointment.
Case Study 1
Deep decay beneath existing bridge in the upper left quadrant requires removal of the first and second molars
The upper left first molar was extracted and a socket graft was completed. The upper second molar was temporarily kept to allow the patient to wear a temporary bridge during the healing period following implant placement to maintain her chewing function on the left site. Below is an image from the CBCT that was taken 2 months post extraction.
Two implants were placed to restore this area with a 3-unit, implant-supported bridge. The photo below shows the implant preparation using a surgical guide provided by the restorative dentist.
3 months following implant placement, the implants were uncovered and healing abutments were placed
Final restorations were fabricated and delivered by the restorative dentist. Note the beautiful restorations and healthy gum and bone tissue surrounding the implants.
Case Study 2
69 year-old male presented to a local prosthodontist with a failing dentition. Patient’s chief concern was, “I know I need a lot of work. I don’t like my smile but more importantly I feel like my teeth are falling apart and am looking for a longterm solution to improve both my looks and function.”
A comprehensive treatment plan developed by referring prosthodontist for replacement of failing/hopeless teeth with dental implants. A total of 9 dental implants were placed by Dr Weiner.
4 implants were placed in the maxilla (upper jaw) to be restored as single unit implant crowns: upper right first and second premolar…
… and upper left first and second premolar positions
5 implants were placed in the mandible (lower jaw) – note the surgical guide verifying implants were placed in the correct position for restorations
Patient was seen 2 weeks following surgery and all sutures were removed. Patient noted minimal post-operative discomfort and healed uneventfully.
After 3 months of healing, all 9 implants were uncovered by Dr Weiner to allow for soft tissue development prior to being restored by Dr Mordis (prosthodontist)
3 weeks following uncovery, the patient was placed in implant supported acrylic temporary restorations. Note the dark spaces (“black triangles”) between his front teeth. Dr Mordis worked on recontouring these temporaries until she was able to train the gingiva (gums) to fill in these voids for a much more aesthetic final outcome.
***Note this patient wanted a “Hollywood smile” with teeth in a bleach white shade – he was THRILLED with the final outcome.
After nearly a year of treatment, the full mouth rehabilitation was complete and the patient could not have been happier! This case illustrates how ANYONE is a candidate for implant therapy and shows how dramatically interdisciplinary dental treatment can change esthetics, function, and overall quality of life.
Case Study 3
67 year-old male presented with a failing tooth-supported bridge due to deep decay on lower right first premolar, necessitating extraction
The existing tooth-supported bridge was sectioned, the lower right first premolar was extracted, and a socket graft was completed
Three months later, adequate bone volume was achieved and two implants were placed for an implant-supported bridge. (Note that in this case, the healing abutments (“healing caps”) were placed on top of the implants the day of surgery, as the implants were very stable within the bone.)
Three months following implant placement the patient’s tissues appear healthy and the implants had healed. At this point, the patient was sent back to his referring dentist to fabricate an implant-supported bridge.
The patient returned to see Dr Weiner for a routine recall appointment 6 months after his bridge was cemented by his restorative dentist. At this stage, the patient’s bone and gums were healthy and he was thrilled with his improved aesthetic, oral health, and chewing ability!
Replacing All Teeth With A Fixed Prosthesis
Sometimes described as the “Ferrari of dental implant rehabilitation,” full arch implant supported restorations allow you to eat and function like having natural teeth. These restorations are stable, strong, and do not need to be removed. They preserve your facial appearance and stabilize bone levels.
The number of implants needed per arch to complete this rehabilitation is different for each patient, but traditionally 4-8 implants are needed in the upper jaw (as bone is less dense) and 4-6 in the lower jaw to support this type of restoration. We will work with you and your restorative dentist to rebuild your new smile from the foundation up.
Replacing All Teeth With A Removable Prosthesis
If all of your upper or lower teeth are missing, the use of dental implants to stabilise your upper or lower denture will help improve your chewing ability and quite honestly, your quality of life. Traditionally, the maximum force that can be generated with an upper and lower denture is only roughly 20% that of natural teeth. However, when supported by implants, your chewing ability will improve exponentially. Complete lower dentures are typically fabricated for aesthetics more than function, but the addition of implants will help support and stabilize your denture, dramatically improving your chewing ability and comfort. Additionally, dental implants will prevent your bone from continuing to shrink, extending the lifetime of your denture.
When teeth are replaced with conventional dentures rather than dental implants, a natural attrition of the jawbone occurs. This ongoing deterioration of the ridge can lead to ill-fitting dentures and sores over time. When this occurs, options to restore the denture fit are denture relines, denture rebase, or construction of a new denture. Additionally, placement of dental implants to facilitate an overdenture restoration will aid in minimizing future ridge resorption and improve denture stability.
To facilitate better retention (“less rocking and moving”) of your lower denture, your dentist may recommend placing 2-4 implants to anchor your denture to. Once the implants have healed within your bone, they are uncovered to allow for the placement of retentive abutments. The retentive abutments are designed to fit into the precision attachment within the denture, creating a secure fit. This will help stabilize your denture and will allow you to chew and speak with far less movement of your lower denture.
Fully edentulous patients (“patients without any teeth”) can benefit from the placement of multiple implants connected to each other with a retentive bar. The implants are placed at appropriate distances from each other and the retentive bar is secured to the restoration (“the fixed denture”). The denture is designed with retentive clips that securely hold your denture in place. This will help stabilize your denture and will allow you to chew and speak with far less movement of your lower denture.
Implant Care and Maintenance
Maintenance is the period after your implant is restored. Our emphasis on maintenance means that we will continue to work with you to ensure that your implant and surrounding gums and bone stay healthy. Typically, this means coming to our office for a follow-up appointment 6 months and 1 year following restoration of your dental implant. During this time you will continue to see your general dentist, but we want to ensure that before fully returning you to your dentists care your implant is healthy and has good long-term stability. Just like natural teeth, proper care and maintenance of your implant and implant-supported crown is the key to preserving an ideal outcome over time. Be sure to make routine follow-up appointments and keep your implant-supported tooth clean by brushing and flossing as instructed by your oral health professional.