Dental implants are a great treatment option for many patients to replace a missing tooth. A dental implant is an artificial titanium tooth root that is placed and the bone and either holds in a prosthesis which can be a natural looking tooth, a bridge, or even dentures. As often times teeth are lost due to cavities, implants have the added advantage of not getting cavities. Implants have become much more common place in the past ten years as technology has made them more predictable. The biggest issue though with all implants is that they need to be placed in healthy bone so that they heal well and function properly. The problem is though that when a tooth is removed, the bone tends to dissolve and go away. If too much of the bone is gone or is in a poor place, then changes need to be made to surgery. The three ways I try to get good bone is through sinus lifts, bone grafts, and guided placement.
In many people, the lower part of the sinus is very near the upper back teeth. It is even common to see an upper molar that is in the sinus. This rarely causes an issue if the tooth is healthy. However, if the tooth needs to be removed and an implant placed in the future, the sinus might make it difficult if not impossible to place the implant. I fix this by doing a sinus lift in the area which helps grow back the bone that was lost. Usually for most implants only a few millimeters of bone is needed and it is a straightforward procedure. The sinus membrane is gently pushed up by the same type of instruments that brain surgeons use and bone is placed in the area. An x-ray of the area is taken to make sure the graft took properly. If it did not, the surgical area is closed, and I’ll come back three months to do it again. If it does take properly, then the implant is gently placed in the proper position, and a stitch is placed over the gums to allow for it to heal. If the sinus is lifted in this manner, then the implant is generally given between 6 to 9 months to heal depending on how many millimeters it needed to be pushed up.
The second way to get more bone is to do typical bone grafting. Bone grafting comes in many different shapes and forms. The most common type of graft is routine socket preservation. After a tooth is removed, bone graft material is placed into the socket either the same day if there is no infection in the bone or six weeks later if the bone was infected and needs to heal. The body absorbs the graft and places its own bone in that area. This is the best way to approach grafting because it is the most routine and least expensive. If the bone has already been lost, then a graft is placed and needs to be protected so that the bone can heal into it properly. This can either be done a few months before placing the implant or at the time of implant placement depending on what is needed. The more bone though that has to be replaced, the harder it is do as the body needs a way of getting adequate blood supply to it and allowing itself to heal.
The third way of dealing with missing bone is to plan the surgery fully guided. Sometimes it is not feasible to add bone. Either it is too much bone to add or it costs too much for too little benefit. In these cases, doing the surgery guided is the best option. While I like to guide the vast majority of my surgeries because it makes the implant placement easier, when bone is limited, the guide really shines well. I can precisely place the implant in the proper spot each time within half a millimeter accuracy. By directly visualizing the bone as well as planning it out ahead of time, no surprises occur and my patients have the opportunity to heal well. Surgeries that used to take four hours 20 years ago, can now be done in as little as one hour for lower cost.
Bone is the foundation of the mouth and is needed to hold in the teeth and implants. By using modern surgical techniques, I am able to place implants better and help them heal more predictably. If you have any questions about implants or if you know that you’ll need bone grafting or a sinus lift and want a second opinion, call us at 504-392-5104.