Frequently Asked Questions
1. What is a dental implant?
2. What are the advantages of dental implants?
* Dental implants can replace a single missing tooth. In this case, using an implant would avoid drilling the adjacent teeth needed to support a permanently cemented bridge. This is often desirable when the abutment teeth do not have any fillings. A single dental implant reduces the need for extra crowns and future dental work.
* Dental implants can replace a removable partial denture. Removable bridges are not always as firm and kind to the tissues as we would like. When they’re not, they tend to move around a bit, sometimes wiggling or loosening the teeth they rest on, which are called abutments. In time, abutment teeth can become loose and sometimes need to be removed. When this happens, a new, larger removable denture is needed. Removable dentures collect a lot of plaque, and make cleaning around some teeth quite difficult. And there’s always the chance that decay will form at the spot where tooth meets the gums in the remaining teeth. With implants, these problems tend to be avoided or, at least, minimized.
* Dental implants can replace a full upper or lower denture. Most people have enough bone remaining to have implants placed in their jaws. In the off-chance that there’s not enough bone, new techniques exist to regenerate the amount needed to successfully have implants.
* Dental implants can provide more retention for full or partial dentures. Instead of placing five, six, or more implants, two-four implants can be inserted for increased stability. When this happens, the final prosthesis will be more stable, giving a greater sense of security. Also, the prosthesis is often smaller than the one being replaced.
* Dental implants avoid removable bridges. Often, the loss of a critical tooth eliminates a fixed bridge as an option. Either there are not enough teeth to support a fixed bridge, or the span will be too long, or a critical abutment has been removed. Regardless of the cause, a fixed (cemented) bridge cannot be employed to replace the missing teeth, so a removable bridge is suggested. Is a removable bridge the only option to replace missing teeth when there are not enough suitable abutments? This is the time to consider dental implants.
* Dental implants can be used in complex cases in order to avoid a denture while the patient still has some teeth left. These patients usually have existing bridges, and they are certainly not strangers to the dental chair. What usually happens is that a root canal has failed, or a key abutment tooth has cracked, or their periodontal condition has worsened. Any of these conditions could force a dentist to suggest that unless dental implants are placed in strategic areas, complete (removable) dentures will be needed. For most people, this step is too horrific to contemplate, let alone experience. But with the success of dental implants, complete (removable) dentures can be avoided with proper planning.
* Dental implants are also being used these days to help fix eye and year prosthesis. The implants placed inside the bony sockets housing the artificial eye or ear help in retaining the prostheses in position.
3. Is there discomfort involved?
4. How much rest is needed after implant procedures? How long could one expect to miss work?
5. What will happen without treatment?
6. Who is a candidate for implants?
7. How costly are dental implants?
8. What are the different types of dental implants available and how is a particular implant design chosen for a particular treatment?
There is yet another important classification of dental implants based on the number of components in dental implants:
Three Piece implants – The conventional implants are all three piece – with the implant, the abutment and the fixing screw forming the three components of the implants. They are mostly used as delayed loading implants
Two Piece implants – has the dental implant and the abutment separate. Both are cold-welded into place using morse-taper technology without the use of a screw to connect the two. They are mostly used as delayed loading implants.
Single Piece implants – both the implant and abutment are fused into a single piece. These implants are mostly used as immediate loading implants.
9. What will be the time duration required for dental implant treatment?
The duration of treatment will be based on multiple factors. The bone availability for implant placement, the dental implant design chosen and the general medical status of the patient are the primary factors. Broadly, based on treatment duration, implants are classified into delayed loading and immediate loading.
Delayed loading - all conventional dental implants (the three piece and the two piece varieties) are mostly delayed loading. The implants are placed via surgery procedures in the jaw bone and sutured. They are left undisturbed in order to osseointegrate (this means that the bone is allowed to integrate with the implant so that there is a firm and healthy attachment of the implant inside bone). After three to six months, the implant is re-exposed and then, the abutment (the attachment fixed onto the implant on which the artificial tooth crown is fixed) is placed. The crown is then fixed onto the abutment.
Immediate loading - the latest implant designs such as the single piece crestal implants and the single piece basal / lateral implants are all immediate loading dental implant designs. Rarely three/two piece implants may also be taken up for immediate loading, however, based on certain important bone quality parameters. The dental implants are loaded immediately… within two to three days such that the patient is able to start chewing from the second or third day of the dental implant procedure.
10. What sort of information is needed by the Dental Implantologist to make a preliminary assessment concerning of patients needing dental implants?
The following are necessary to make a proper assessment. You may forward these details by email to Dr@TheSmileCentre.in .
1. A digital OPG Xray (Panoramic Dental Xray) image – gives a clear idea of the present condition of the upper and lower jaws along with the teeth
2. A short note on the general medical status of the implant patient. Blood sugar and Blood pressure are to be assessed before the patient is taken up for implant surgery. A thorough medical history along with details of relevant medicines the patient has had previously or is on at present is also essential.
3. A physician’s clearance may be needed for patients with relevant medical history or who are on medications for medical conditions
4. Photographs of the patient’s face with lips in rest position & smiling – frontal and side views
5. Photographs of the smile of the patient – in all its fullness
6. Photographs of dental problem areas – eg. the area of missing teeth where the patient intends to have implants placed.
11. How many implants are needed to situations where the patient has no teeth at all or if he or she needs to undergo extractions of all the teeth and get fixed replacements?
Certain techniques such as “all on 4″ and “all on 6″ dental implants techniques are being propagated by various implant companies. However, the fact remains that with lesser number of implants, failure rates turn higher as the chewing forces get distributed on the lesser number of implants. Often in these techniques, immediate loading is difficult or nearly impossible. In these techniques, very often the first molars do not get replaced and the replacement occurs only up to the level of the second premolar. Moreoever, there is no functional stimulus in the areas where there are no implants. Functional stimulus (stimulation of bone during chewing) helps in maintaining & even building up bone in areas where the implants are present.
At our center, we generally place minimum of 6 to 8 implants in the lower jaw and 8 to 10 implants in the upper jaw. We use a combination of compression screw implants, basal bicortical screw implants, basal osseointegration (BOI) implants and tubero-pterygoid implants. With these advanced single piece, immediate loading, basal implant techniques, we are easily able to deliver a full set of permanent teeth within 3 days of implantation. The most important factor here is that that all this is done without any kind of bone augmentation / grafting such as “ridge split”, “sinus-lifts”, “GTR techniques” etc. in addition to the benefits of nearly 98% success rate coupled with minimal post implant-surgery difficulties.
12. What are the possibilities of rejection of dental implants?
13. When do dental implants fail?
14. What are the techniques adopted to prevent or reduce the instances of dental implant failures?
15. What is peri-implantitis?
However, in our practice, we use varied implant designs which help prevent this condition which is the most important cause for failure of dental implants. The unique designs of offered by the Bicortical Screw (BCS), the KOS-T and the BOI implants, help prevent peri implantitis.
16. What are the options available in cases of failed implants?
17. How long do dental implants last?
Regarding the longevity of dental implants, at the present time we cannot answer this question. All we can say at this point is that the first patient who had dental implants placed in 1965 still has his original implants in function today.
The simply answer to the long-term success rate of dental implants are that dental implants can fail, but fortunately very infrequently. Failure rates vary depending on the site in the mouth, whether they are placed into natural or grafted bone and whether the patient smokes. The overall success rates in natural bone is 95%, though this falls to between 85 and 90% in grafted bone. If a patient smokes it has been shown that they are statistically two and a half times more likely to have an implant fail than a non-smoker. Basal implants, with their unique design and smooth machined surface generally tend to be less prone to peri-implantitis, owing to the smooth, machined surfaces they have. Peri-implantitis is detrimental to implants and contributes to their failure. Basal implants are also found to work well in smokers and diabetics.
However, it is always better to take adequate precautions to prevent failure of dental implants, They are to maintain meticulous oral hygiene, and evaluate the dental implant both clinically and radiographically at frequent recall visits with your dentist.
18. How successful is basal implantology? Why isn’t it being propagated?
a) Immediate loading of implants with fixed teeth is truly possible only with the use of basal implants as these are the implants which have been uniquely designed for immediate functional loading. We generally fix teeth within 72 hours of basal implantation at our centre. In situations where bone grafting is necessary, loading of conventional implants with fixed teeth will need a waiting period of minimum 6 months.
b) Basal implants offer excellent designs which help in securing them to bone… even in situations where only limited bone is available, by avoiding complex bone augmentation and sinus lift procedures.
c) The patients tolerate basal implantology procedures very well and the post operative recovery is also quite fast.
d) Total costs with respect to Basal implantology work out to be a lot more economical than conventional implants.
e) The unique single piece designs of basal implants are less prone to interface problems, unlike the conventional implants which are either two or three piece in design. Moreover, incidence of peri-implantitis, the commonest cause for implant failures, is also considerably lower with basal implants.
Though there are numerous publications concerning basal implantology, I have have clearly noticed felt that the propagators of conventional implants have always turned a blind eye to basal implants, just because the treatment philosophy with basal implants is completely different from that of conventional implants and at times even contradictory. Moreover, dental implantology training to dentists in most parts of the world is generally performed by conventional implant manufacturers who wish to recover their investments in their respective businesses. Many of the implantology departments and programs in dental colleges are funded by such companies. When they have invested a lot of money into research on bone graft procedures, sinus lifts, implant interface issues etc., it is difficult for them to accept the claim by basal implantologists that such procedures are not needed any more.
However, at the end of the day, dental implant patients will opt for procedures which are faster, advanced in design and without the involvement of tedious and unpredictable procedures. In this era of fast computers, fast planes & trains and super-fast communication services, we cannot remain in the olden era of delayed loading implantology any more.
Now, Basal implantology is increasingly being accepted by implantologists in different parts of the world. The fact that implantologists who have failed in some of their cases with their conventional implants have started prescribing use of basal implants for these patients, points to the reality of affairs.
19. Who are the doctors involved in your centre in dental implant treatment?
20. What are the qualifications & work experience of the dental implant centre team?
21. I have reached a dental crisis and have received recommendations from 3 dentists here in South Lake Tahoe, CA USA, where I live. There are 4 plans recommended to me, which all include some combination of root canals, crowns, partial dentures, full dentures, bridges and implants I have endured 40 years of extensive dental work already and spent tens of thousands of dollars just the past ten years. I question the advisability of continuing to sink more money and hours of procedures over the next 20 years of my life (I am 69 years old). I seek a more permanent solution, like the permanent teeth in 3 days I have read about and think might work for me. Will you advise full mouth rehabilitation with implants in cases like mine? If so can you give me a brief idea about full mouth rehabilitation with implants?
Generally we perform full mouth rehab. in patients in a single stage
Stage 1: Extraction of teeth with poor prognosis and immediate replacement with implants + implants facilitating fixation of prosthesis in areas where there are no teeth. Generally we recommend 8 – 10 implants per jaw in situations where the patient is completely edentulous (without teeth). We generally extract teeth and place immediate loading basal implants in the same sitting. We load these implants within 72 hours… ie the patient gets fixed teeth within 72 hrs. Generally we request full mouth rehab. patients to be available for a period of 3 – 4 weeks so that we are able to complete the adjustments and evaluation after fixation of the interim prosthesis.
Stage 2: After 6 months. This stage is necessary only for patients who have had extractions and implantation and / or open surgical placement of implants during the first phase. The second prosthesis is necessary as there will be a certain amount of gum and bone healing taking place around the implants and the first stage prosthesis. In such situations, there will be gaps developing between the prostheses and the gums once healing has taken place. This can lead to food impaction and such other problems. Therefore, we give the final prosthesis in the second stage. The final prosthesis is generally done with laser sintered porcelain fused to metal (PFM) crowns or Zirconia or noble metal – ceramic crowns. Sometimes, laser procedures may be employed during the second stage to improve the gum contours around the implants and also eliminate the unhealthy granulation tissues in the implanted sites.
Now, if on clinical examination we feel that patients have healthy teeth which can be retained, we will certainly retain them and that will bring down your costs proportionately.
We have been able to help many patients like you with the help of full mouth rehab. with implant supported prosthesis. Kindly visit our websites:
These websites will give you a clear idea of the various treatment options.
You can also visit the testimonials page on www.TheSmileCentre.in to have an idea of the experiences of our patients.
- Dr. Prasanth Pillai MDS (OMFS), FICD
Oro-Maxillofacial Surgeon & Implantologist