What are implants?

They are titanium “screws” that are placed in the jaw bone via a surgery to function as roots. Crowns or bridges are connected over the implants to replace missing teeth.

Due to rapid technological advancement in the field of implants, implants now
provide an improved alternative to replacing teeth with a reasonable to good long term success rate.

Are all implants created equal?
No. There are many different brands in the market with different designs and texture of the implants. There are also some brands of implants that have a different technique of insertion of the implant during surgery.

An important question to ask the dental surgeon when deciding on implant therapy is find out the amount of research and technical support the implant brand/company has. You can also go on the internet to check this information.Generally the cost of most implants are about the same and corresponds to the amount of R and D the implant company has done and success rates recorded in scientific journals. It is definitely not wise to choose to do an implant with a certain clinic just because it is the cheapest in the market.
The total cost of the implant therapy will take into account the brand of implant used, how thorough and comprehensive the planning of the implant positions are, the type of X rays needed (2 D or 3D) and of course, the skill of the surgeon (specialist or general practitioner).

What are mini – implants?
These are implants that have a much smaller diameter than the conventional implants. They are also much cheaper than the regular implants. In general, these should only be used to replace a narrow tooth like the lower front teeth. They are too narrow to support replacing multiple teeth or bridges. Also, as they are very thin, they can break if the load on the teeth is too heavy and are difficult to clean.

Do implants last forever?
This depends on many factors. Implants definitely cannot get decay. However, they are susceptible to gum disease just like a natural tooth. Hence, if the oral hygiene of the patient is poor or he smokes or has gum disease on his other teeth that is not controlled, then there is a high risk he may lose his implant sometime in the future. The patient’s medical condition and type of medication he is on also play a part at the time of implant placement as well as in the future.

Implants also have different parts to it i.e. the titanium screw and the crown that goes onto it. If the planning of the implant position is not done well and there is excessive load on the implant, it may give way as well.

Also, due to wear and tear, it may also be necessary to replace the crown over the implant. That is another reason to chose an implant that will probably be in the market for years to come. Otherwise the replacement components for the crown may not be available.

What are some of the factors that the dental professional will look at when planning for implants?

(1)    Function
The positioning of the implant is important and should be planned carefully via the use of 2D or 3D x-rays and models (mould)  of the patient’s teeth. It is of no use to insert an implant if at the end of the day it cannot enhance the patient’s ability to chew or last a reasonable length of time.

(2)    Aesthetics.
The smile line of the patient is important as with the thickness of gum tissue and the level of the gum line in deciding the position of the implant to be placed. Other considerations include the diameter of implant used as well to decide if any additional procedures such as grafting of extra gum or bone is needed.

A certain amount of bone and gum level and thickness are needed to provide an implant that looks like a natural tooth and not many patients have the ideal amount. Hence, additional surgeries such as bone and gum grafting may have to be done prior to or at the same time of implant placement to achieve the ideal amount. Please see below.

In fact, implant therapy should be decided on and planned even before the loss of a diseased tooth. Once the tooth is extracted, gum and bone starts to shrink away and implant placement should be timed appropriately to minimize this shrinkage. There are also other methods to minimize shrinkage if implants cannot be placed soon after the extraction of teeth. This procedure is known as socket preservation and is usually used if the diseased tooth has had a long history of infection and bone is already lost around the tooth or if the patient has to delay implant placement due to finance or is too young for it.

Are implants the best choice to replace a missing tooth or teeth?
Not necessarily. All types of teeth replacement should be discussed with the patient as well as the pros and cons of each treatment modality before deciding on implants. Implants certainly provide a good option to replacing teeth but sometimes the circumstances or oral environment may not permit its use or they  cannot provide for a better aesthetic and functional result compared to the other options.

What type of after care has to be provided after the placement of implants?
The patient should be taught proper oral hygiene techniques including the Bass technique of brushing and flossing or the use of other interdental aids. They also have to regularly get their teeth, gums and implants checked and cleaned. Special instruments are used to scale around implants and x rays are periodically taken to ensure no gum disease has occurred.  A gum check and occlusion or load check is also done periodically on the implant.
Smoking affect the success rate of implants as do patients with chronic disease such as diabetes or osteoporosis. These patients have to be followed up more closely.

Manufacturer

Short on time? Get whiter teeth with just 5 minutes once a day. Crest Whitestrips Daily Whitening Multicare gradually whitens your teeth, and is ideal for teeth sensitive to whitening. Apply strips for 5 minutes once a day, and gradually whiten your teeth for a brighter, more beautiful smile. Whiten with 5 minutes, once a day; Ideal for teeth sensitive to whitening. How it Works The thin, easy-to-wear strips offer (more…)

Smile BrightTM professional home whitening kit gives you a fresh, white smile at the speed of light. All kits include 1 PRE-FILLED MOUTH TRAY with pharmaceutical grade whitening gel that is activated by a portable LED light. Our patented mouth tray is an industry leader! Spill guards ensure all the gel will stay in place throughout the whitening to maximize results. Our unique prism design allows for easy handling. As a special offer for trying our product we’ll include our refi (more…)

Most dental diseases are silent till at an advanced stage yet most people only visit the dentist when there is a problem. Examples of dental diseases are gum disease, early decay, erosion, excessive attrition and early oral cancer.

So why is it important to make sure that our mouth is in a healthy state all times of our lives especially when we are medically healthy? This can be achieved with thorough check ups and Xrays as well as regular maintenance visits to the dentist. The reason is that when we are diagnosed with a chronic or terminal disease , there is often not enough time to make sure that our mouth is healthy before starting the treatment of our medical illness. If we have gum disease or decay in the mouth and should need dental care after the aggressive medical treatment has started, it is often very difficult to get an ideal result dentally. Also, there are some medical conditions that affect our oral condition and vice versa.Some examples are given below:

Diabetes

Diabetes and periodontal (gum) disease have one thing in common. Both are chronic (long-term) diseases that can never be truly cured but can definitely be well controlled

People with diabetes are more likely to have periodontal disease than people without diabetes. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don’t have their diabetes under control are especially at risk. They also heal slower with periodontal (gum) treatment.

Diabetics, who are under optimal control, have HbA1c readings which are consistently less than 7 %. Well-controlled diabetics respond better to periodontal treatment and are less likely to lose teeth compared to poorly-controlled diabetics.

There is also some research to suggest that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
Heart Conditions and High Blood Pressure

There has been some research to show an association between gum disease and heart  attacks. Apparently, people with advanced gum disease run a higher risk of getting a heart attack. This is however, an association and a direct link has yet to be proven. A particular medication for high blood pressure, nifedipine,  has also a side effect of producing gum hypertrophy (enlargement) usually in patients who already have gum disease. There are many other medications that have an impact on the gums as well.

Medications and the oral condition

Hyperplastic (overgrowth) gums.
Medication such as Nifedipine, Cyclosporin, which is used in transplant cases eg kidney transplant patients and an epilepsy drug can cause overgrowth of the gums. This is turn makes it difficult for the patient to keep his gums and teeth clean and increases his risk of periodontal (gum ) disease.

This condition can be treated successfully by the Periodontist to give a normal looking appearance again. Good follow ups and maintenance on a regular basis can keep this condition under control.

Bisphosphonates eg Forsamax
Forsamax is a commonly used medication to treat osteoporosis especially in the post-menopausal woman. Other bisphosphonates such as Zometa are used to treat certain cancers and other bone diseases. Unfortunately, in those patients on bisphosphonates such as Forsamax, there is a small risk  to contract osteonecrosis (bone death and possible infection) of the jaw bone whenever an extraction needs to be done, oral  surgery or implant surgery. Those on intravenous bisphosphonates such as Zometa have a much higher risk of contracting osteonecrosis even when none of these surgeries are done.

Hence, those patients on these drugs should ensure they have good dental health and regular follow ups. Should osteonecrosis happen, it responds very poorly to treatment.

Radiotherapy in the head and neck region
Those patients who have gone through radiotherapy for cancers in the head and neck region, the most common being nasopharyngeal cancer, suffer from lack of saliva flow after the therapy. This leads to a dry mouth, ulcers, burning gums and an increased risk to decay and gum disease.

Various prescription and over the counter creams, mouthwashes and ointments can help alleviate all these conditions. Such patients should seek dental clearance and treatment before and after radiotherapy to avoid long term dental problems which become major.

Conclusion
Don’t wait till the symptoms arise to seek dental treatment, it may cost you more than just money or time to rectify the problem. Often, an ideal result cannot be obtained even with both. A healthy mouth will mean a healthy body at all times.