You've Got Questions About Your Periodontal Health and We've Got The Answers

When teeth are lost or removed, the supporting bone begins to resorb, or deteriorate. This results in a defect, or indentation in the gums and bone, which causes the replacement tooth to appear too long compared to the adjacent teeth. This unnatural appearance can be corrected with ridge augmentation to fill in the defect to recapture the natural contour or the gums and jawbone.

Although gum recession can be caused by a variety of reasons, the most common cause is aggressive tooth brushing. Gum recession results in exposed tooth roots. Covering the roots that make the teeth look too long will improve the esthetic appearance of the smile. This will also solve the problem of root sensitivity to hot and cold and protect the roots from decay.

Soft tissue graft procedures involve taking tissue, usually from the palate (roof of the mouth) to cover and exposed roots and the defect caused by gum recession, or to reinforce thin tissue. This procedure will also help to prevent additional recession and bone loss.

If teeth are decayed or broken below the gum line, crown lengthening is often necessary in order to restore the teeth. Since the procedure adjusts the gum and bone levels to expose more of the tooth surface, it is easier to restore these teeth with cosmetic fillings and crowns.

Regenerative procedures are recommended when the bone supporting the teeth has been destroyed. These procedures can actually reverse some of the damage by regenerating lost bone and tissue. Typically the procedures involve folding the gum tissues and removing the bacteria that cause the disease. Then special membranes, or bone grafts can be used to encourage tissue and bone regeneration.

Guided Tissue Regeneration involves inserting membranes (filters) between the teeth and gums to allow the ligaments to regrow and bone to reform so that the teeth are better supported.

Bone Grafts involve placing tiny fragments of bone in areas of lost bone. These grafts stimulate new bone growth, or regeneration, and restore stability to the teeth by filling in the craters that resulted from periodontal disease.

A gingivectomy is necessary when the gums have pulled away from the teeth, creating deep pockets, and it is usually performed before gum disease has damaged the bone supporting the teeth. The procedure involves removing and reshaping loose, diseased gum tissue to eliminate the pockets between the teeth and gums. After removing the gum tissue, a puttylike substance is placed over your gum line to protect the gums while they heal.

As periodontal disease progresses, the pockets that form between the teeth and gums become deeper and the bacteria that develops around the teeth accumulates and advances under the gum tissue. The result is damage to the supporting tissues and loss of bone. Eventually, if too much bone is lost, the teeth will need to be extracted.

To prevent further damage to the bone and gum tissues caused by the progression of the disease and infection, it is necessary to reduce the pocket depth and eliminate the existing bacteria. This will also make it easier for you to keep the area clean.

The procedure to reduce the pockets involves folding back the gum tissue and removing the bacteria that causes the disease, then securing the gum tissue snugly around the teeth.

It may also be necessary to smooth irregular surfaces of the damaged bone and reshape it. This makes it more difficult for bacteria to accumulate and grow and increases the chance of saving teeth that otherwise would have been lost.

If periodontal disease is diagnosed early, nonsurgical therapy may be the only treatment necessary. This involves the removal of plaque and calculus, which controls the growth of bacteria and treating the conditions that encourage gum disease. Scaling is a type of cleaning that removes plaque and calculus from the teeth at and slightly below the gum line. Root planing is a procedure to smooth the surfaces of the tooth roots, so the gum tissue can heal and reattach to the tooth surface.

Initial Consultation

The first step is an examination and consultation with your dentist to determine whether or not you are a candidate for implant treatment. This usually involves x-rays and may include taking impressions for models of your teeth. During the examination, your dentist will be evaluating the area(s) of your mouth where teeth are missing and the type of replacement teeth that will best meet your needs. A review of your health history will indicate whether there are any medical conditions that could prevent you from being a candidate for implant treatment.

Surgical Evaluation

Following the initial consultation, you will be referred to either Dr. Miller or Dr. Bounds for a comprehensive surgical evaluation. This will typically be for the purpose of further evaluating the quality and quantity of available bone to determine the number of implants necessary, as well as whether additional procedures may be needed to obtain the desired functional and esthetic result. If you have already lost a significant amount of bone, the need for procedures to add (graft) bone, or create new bone will also be evaluated.

The doctors will often recommend 3D images of your teeth and jaws to provide more detailed information for developing the ideal treatment plan. The office is equipped with the latest 3D imaging equipment, making it convenient for our patients who need these additional images during their consultation. Once the surgical evaluation has been completed, a treatment plan will be developed with your general dentist to meet your individual functional and esthetic needs.

Implant Placement Procedure

The implants are placed in the bone using a gentle surgical technique. With the type of implant used by Dr. Miller and Dr. Bounds, in many cases, it will not be necessary to place the implant completely under the gum tissue, which eliminates a second surgical procedure.

Following the implant placement procedure, the implants are left undisturbed for a period of several weeks so that the bone can remodel around the implants to form a strong biological bond to them. During this bone-remodeling phase, you will have some type of temporary replacement teeth, so that you never have to be without teeth during treatment.

Abutment Attachment Procedure

Following the bone-remodeling period, which will be determined by quality and quantity of bone and whether a bone graft is necessary, a small connector post called an abutment is attached to each implant. The permanent replacement teeth will eventually be attached to the abutments.

Fabrication of Replacement Teeth

Your dentist will then take impressions of your teeth and the implant abutments; place temporary replacement teeth and select the appropriate shade for your replacement teeth. The laboratory technician will fabricate your replacement teeth and the underlying structures that will be attached to the implants. Then your dentist will try the replacement teeth for proper fit and attach them to the abutment.

Surgical Tooth Removal

Tooth loss can be a traumatic experience. Fortunately, if you do lose a tooth it can be replaced with an implant supported replacement tooth that will look, feel and function like your natural tooth. The dental implant functions like a natural tooth root and preserves the bone, preventing the deterioration of bone that would normally occur with tooth loss.

If you are facing impending tooth loss, Dr. Miller and Dr. Bounds are able to surgically remove the tooth using a special technique that minimizes discomfort and promotes rapid healing. This technique also preserves as much of the bone surrounding the tooth as possible, which is important for implant placement.

Sometimes a dental implant can be placed at the time the tooth is removed. However, when this is not possible, a graft using bone from another area of the mouth, or synthetic bone, can be placed to preserve the tooth socket for future implant placement. This graft will also facilitate healing and preserve a significant amount of the gum tissue that would normally shrink during healing if the socket was allowed to collapse.

Bone Grafting

Many times due to progressive disease, infection or trauma, bone and soft tissue are lost in areas around the teeth. Bone resorption, or deterioration, occurs naturally when teeth are lost or removed unless dental implants are placed to preserve the bone.

Fortunately for those patients who have lost bone, it is possible to augment or replace the bone with grafting techniques and successfully place implants. And any defects in the bone in the front of the mouth can be corrected to create the proper facial contours and tissue support necessary to achieve optimal esthetic results.

If small defects are present in the desired implant location, a bone graft with either real or synthetic bone is used to fill in the defects. Since gum tissue grows faster than bone and will in essence invade the bone graft, causing it to shrink, a thin collagen membrane is used to cover the graft to prevent the gum tissue from growing into the area. Sometimes the bone graft can be accomplished at the same time as implant placement. This type of graft takes the same time to heal as it takes for the bone to remodel after the implants have been placed.

If there is a substantial amount of bone loss, which prevents the placement of dental implants, an actual block of bone can be removed from the chin or behind the lower back teeth and transplanted to the area in need. These "blocks" of bone are held in place using small titanium screws to allow for healing. They will often be covered with a thin collagen membrane to aid the healing process. These grafts typically require four to six months to heal and form new bone identical to the shape of the transplanted block. Implants can then be placed securely in this bone. It will usually take another three to four months for the bone to remodel around the implants.

Overall quality of life is enhanced with replacement teeth that look, feel and function like natural teeth.

With implant-supported replacement teeth, the appearance of the smile is more natural and the teeth function more like natural teeth. The result is increased comfort and confidence when smiling, speaking, and eating. If dentures and partials are replaced with implant-supported teeth, the overall enhancement in quality of life is even more significant, with an ability to eat all types of foods, elimination of messy adhesives, and improved speech, comfort and appearance.

Implants preserve the integrity of facial structures.

By preventing the bone resorption (deterioration) that would normally occur with the loss of teeth, the facial structures remain intact. This is particularly important when all of the teeth are missing, as the lower one-third of the face collapses if implants are not placed to preserve the bone.

The mouth is restored as closely as possible to its natural state.

By replacing the entire tooth, including the root, it is possible to replicate the function of natural teeth, with a strong, stable foundation that allows comfortable biting and chewing. In addition, nothing in the mouth looks, or feels artificial.

Your smile is improved when replacement teeth look more like natural teeth.

Even when only one tooth is missing, long-term esthetics are usually much better with an implant-supported replacement tooth than with a traditional tooth- supported bridge. This is particularly important in the front of your mouth, where preventing a visible bone defect is critical for a natural appearance.

Adjacent teeth are not compromised to replace missing teeth.

Tooth replacement with traditional tooth-supported bridges requires grinding down the teeth adjacent to the missing tooth/teeth, so that the bridge can be cemented onto them. This tooth structure can never be replaced and the long-term health of these teeth is compromised. Partial dentures have clasps that hook onto adjacent teeth, putting pressure on them as the partial rocks back and forth. Eventually these teeth can loosen and come out as a result of this pressure. Replacing missing teeth with implant-supported crowns/bridges does not involve the adjacent natural teeth, so they are not compromised, or damaged.

Convenient oral hygiene.

It is much easier to care for an implant-supported crown, which can be cleaned like a natural tooth. In comparison, a tooth-supported bridge requires the use of a floss threader for proper cleaning. It is also more convenient to clean implant supported replacement teeth than a denture, which often needs to soak in cleaning solution overnight.

Improved appearance.

Since dental implants preserve bone, preventing deterioration of the facial structures, appearance is improved. Collapse of the lower one-third of the face caused by complete tooth loss can be visually corrected and the remaining bone preserved. The appearance of wrinkles around the mouth caused by posterior bite collapse, or complete facial structure collapse is virtually eliminated.

Restored self-esteem and renewed self-confidence.

Many people who now enjoy the benefits of implant supported replacement teeth state that their self esteem and self confidence have been restored as a result of improved appearance, function, comfort, and health.

Dental implants have enhanced the quality of life for thousands of people throughout the world, improving overall health and well being and restoring the confidence that comes from a natural smile and appearance. This "state-of-the-art" dental technology makes it possible to restore the mouth as closely as possible to its natural state and eliminate the need to cut down adjacent teeth for bridgework.

Dental implants are basically substitute tooth roots, used to replace natural tooth roots in areas of the mouth where teeth are missing.

The reason it is so important to replace the tooth root and not just the visible part of the tooth (crown) is that natural tooth roots, which are embedded in the bone, preserve the bone. When teeth are missing, the bone that previously supported those teeth melts away, or deteriorates. This process is called bone resorption.

However, the bone can be preserved by replacing missing tooth roots with dental implants. Since the bone actually forms a strong bond to the implants, they can serve virtually the same functions as natural tooth roots: a strong foundation for biting and chewing, and stimulation for the bone to preserve facial structures.

Our website provides the answers to questions that our patients typically ask about dental implant treatment. For more comprehensive information please visit www.MissingTeeth.org.