Feb. 10, 2022

This paid piece is sponsored by Siouxland Oral & Maxillofacial Surgery.

When you need a tooth replaced, there’s a lot to consider.

There are multiple patient problems that could lead you to the point of replacement, multiple surgical solutions and different capabilities depending on your provider.

For the next few months, we will go through different elements of tooth replacement, starting with a brief overview of what your “major choices are.”

For instance, most dental implants are made of a titanium alloy, but there are other materials utilized for uncommon situations.

Lets begin with “mini implants.” As the name implies, these are very small in diameter, actually under 3 mm. They resemble little toothpicks and generally come in sizes of 1.8 and 2.4 mm. They can be fitted with a traditional crown or a compression snap-on attachment to assist in holding in a denture. Mini implants are a good choice for selected situations where there is very little bone and when we are seeking a truly temporary solution.

The next choice would be a small-diameter traditional implant of 3 mm. It is also utilized for small spaces and little bone volume, but the implant has the required size and strength to have much better long-term survival rates. These 3-mm implants are are not meant to be subjected to a great deal of biting forces, so they generally are used to replace front teeth or premolars. If a patient doesn’t have quite enough bone to have one of these implants placed, then there are several bone-grafting solutions to help make this possible.

The standard set of implants – 3.5 mm to 6 mm in diameter – are what most people receive to replace missing teeth, stabilize dentures and give patients “teeth in a day.” The survival rates are about 80 percent to 90 percent over 10 to 15 years versus crowns and bridges that have survival rates of 60 percent to 70 percent over the same time frame. There are wider and bigger implants that serve different purposes for patients with different needs.

Recently, ceramic implants have come to the market and are used for people with certain metal allergies and for the aesthetics of replacing front teeth. Since the bone itself is a dynamic structure, it can change shape over time as different forces are applied to it. That process certainly happens when the bone receives forces applied to it by a natural tooth versus a dental implant. Especially for the upper front teeth, the buccal bone, or bone on the lip side of the implant, tends to slowly dissolve over time. If this bone gets thin enough, as the light reflects through the gingival tissue and through this bone, the grayish color of the titanium implant will show through significantly. This is observed in approximately 20 percent of people, and in 5 percent of people it will be very noticeable and bothersome.

Since ceramic implants are all white, this aesthetic problem is less of a concern. Despite their better soft tissue response, however, the connectors for the tooth/crown – the portion that is actually seen in the mouth – are weaker, and you don’t have many choices for the connectors. This can result in compromises on the angles at which the implants can be placed and compromises in the actual tooth shape that would have to be made.

For patients who are missing most or all of their teeth, there is a way of placing implants so that the denture can be snapped onto the implants or screwed onto the implants themselves. This is known as removable or fixed appliances. Here is where the actual implant choices become extremely important. The more implants you have and the wider and longer the implants are, the more stable the appliances will be.

In most cases, some form of bone grafting will be needed to accomplish these goals, and the most common type is bone grafting into the maxillary sinus.

The most recent entry into the field of dental implants is the resurrection of an old idea called a sub periosteal implant. Fused with modern computer modeling and 3D printing, it currently is undergoing FDA review and hopefully will be available in a year or so. This is the IPS, or individual patient solution, Preprosthetic implant system that has been used to treat cancer patients who have lost large portions of their dentition, bone and ability to chew. The system uses plates that actually fuse to the facial skeleton to stabilize the dental implants and potentially remove the need for any bone grafting.

Lastly, there is an engineering component to the treatment plan, and it’s not always one implant for one tooth or one implant to replace one posterior tooth. Implants do not tolerate lateral forces very well, so a lot of dental prosthetics that work well when placed on natural teeth will not work as well on dental implants. When not adhering to certain implant placement protocols or not implementing a sound restorative decision, the risk of overloading the implants will go up as well as the possible failure rate. Conversely, at times it is better to use one implant instead of two to replace two small teeth – such is the situation when replacing two lower central incisor teeth.

This is a very basic overview of the range of dental implant choices that are available. Thus it is important that if you are interested in having dental implants placed that you go to an oral and maxillofacial surgeon to have the surgery completed. Only oral and maxillofacial surgeons have the education and training to place all these different styles of implants and manage the different types of accompanying bone and soft tissue grafting. You would want to visit an office facility where the surgeon has all the tools in the kit, rather than just “the hammer” where everything in the treatment world becomes a nail.

Siouxland Oral & Maxillofacial Surgery: It’s where you go for oral surgery by real oral surgeons.