Guide to teeth implants

You may remember my reviews of irrigator and electric toothbrush.

If not, watch them, they got some likes. In the comments I say that the only thing I regret is that I didn’t start to use those devices earlier. Actually, the reason I purchased the toothbrush was lower 7 tooth problem. Unfortunately, it was too late, the tooth crown broke below gum level and had to be removed. Extraction was a nightmare. Number 7 has very good roots, and in my case number 8 also had to be removed, as it was growing horizontally, applying constant pressure on 7, which may have led to the latter premature destruction in the first place. So they extracted two teeth at one 2 hour long session, by four hands of two doctors. 2 weeks of pain, blood and bandages followed. Obviously the best way to restore a lost tooth is to implant. Installing implant looks very similar to driving a screw into a drywall, that’s why I’ll use screws for visualization. Real implantation pictures are quite messy and disturbing, and people seldom like looking at other peoples rotten teeth, so use you imagination. So an implant is basically a metal dowel with inside threading, and the outer threading has a cutting tip. Don’t believe me? Well, see for yourself, these are pictures of real implants. Its worth mentioning only this inner part is called an implant. Normally you don’t see it, as it is secured inside your jaw bone. An abatement is screwed into it, which basically is the post on which the crown in pinned. The crown is the visible part of the tooth. This is just for you to understand the terms. Now let’s talk about implantation methods. There are two – classic and express. Tooth in an hour. You must chose longer method. Why not the quick one? Well imagine you come to the dentist, he pulls out your bad tooth. screws in implant, installs abatement, caps it with crown and lets you go home. Do you think the results will stand? Well, in some rare cases – may be, but generally – no. Of course this is an exaggeration, and real implantation takes a bit more steps and time. What you must understand is that there is no such thing as quick implant for a really simple reason – regeneration. Our body has only one mechanism to recover from damage – cell division and connective tissue. This connective tissue is everywhere – scars on your skin, gastric ulcer and even fibrosis areas in prostate are formed from connective tissue. Only one mechanism. Bones have a very similar way to restore. So when going the classic way, you wait 3 months after the tooth was removed. They offer special “safe extraction” option especially for future implanting, which aims at saving as much surrounding bone as possible. However, despite thrice the price, they often fail to deliver, and one of the bone walls cracks and goes out with the tooth. Don’t worry though, normally bone restores enough after any kind of extraction, leaving plenty of tissue to screw in the implant. Before that you normally go through a 3D X-ray. Put your head into a special device, and it scans you for about 20 seconds, producing a 3D image of required region saved to a file. Your dentist examines this area of the picture determining if there is enough bone to screw in the implant. 8 mm long implants are common, that means there must be at least 10 mm of bone before the nerve starts. This is crucial point! Any damage to this nerve results in facial paralysis, Silvester Stallone style, and may even turn you into a neurology patient. So the implant screw must never drill too close to the nerve. If there is not enough bone, they may choose to screw in a shorter implant, like 6mm. This normally goes well with the lower jaw. Upper jaw is a whole different story. The bone there is porous, much like that Whispa chocolate. Bone cavities are often above future implants, and you can’t screw in implants to an empty space. To solve the problem. the space is filled with bone. The extra bone comes from 3 main sources: donor bone, normally from dead people heels, and I’m not kidding; your own bone cells and artificial bone. Hopefully, we will be able to clone our own bone cells in the future, to reduce the risk of rejection. Meanwhile, rejection risk is reduced by mixing your own bone cells with artificial ones. A 50 / 50 mix has the least chance of rejection. Remember, rejection and immune reaction are the most common cause of dental bone enlargement failure, as with any other transplantation. You may wonder where do they get your bone cells from? Well, normally they make slices from chin and other jaw bones. Thin slices completely regenerate using the same restoration process I already mentioned, so you don’t lose bone tissue. Well I digress. Hopefully, everything is okay with the bone, and 3 months has passed since tooth removal. So classic implantation goes as follows. The dentist gently cuts soft tissues. Drills a hole in the bone deep enough, judging by that 3D x-ray. The drill has special measurements allowing precise drill out. As I already said, this is the most dangerous part because of the nerves proximity. After that the implant is screwed in. This is a very funny part, as a miniature version of the automobile ratchet wrench is used to do that, complete with cranking sound right in your mouth. After that a screw is inserted to cap the hollow part of the implant, and the tissues are sewn back together. The implant must be tightly sealed by tissue to prevent inflammation, which is a common cause of implant rejection. If you’re implanting a visible area, a plastic temporary tooth will be installed to conceal the missing one. No one could tell. Is it painful to undergo implantation? Compared to that 2 hour long tooth extraction – it’s a breeze. And even without that, it’s a completely painless process. After local wears out, it dully aches for a couple days, but bearable I didn’t even take painkillers. You have those seams for about 10 days. Then you show up at the dentist for inspection, he normally removes the threads and leaves you be for the next 3 to 4 months. That’s the minimal time for the implant to settle. New bone cells grow around it, securing the implant in place. A lot of people ask – is it true implant life cycle is only 10 years? Do you have to remove the implant after 10 years? And what to do next? Well, this is not exactly true. Most implant manufactures provide lifetime warranty on their products. If the procedure was done correctly and the implant was chosen wisely, and you take good care of it preventing inflammation – the implant will last you 15, 20 years and even till the end of your life. 10 years is the longest warranty the dental clinic can offer. Even if you will have to remove the implant – for instance if it got loose or there was an infection, the next steps will be exactly the same. You wait 3 to 4 months until the bone regrows, and attempt another implantation. So, after three months you get back to your dentist. He cuts the soft tissues again, makes sure the implant stands securely in place, and screws in gum former. This is little round-shaped metal object that does what it is called – forms a round hole in the gum to wrap it around future abatement and tooth crown. In some cases gum plastic surgery may be required: when you don’t have enough soft tissue to hide the abatement, they use skin flaps to cover it. That is called gingivoplasty. Here is a good time to tell about… well these are not exactly scams, but they are aimed to siphon money out of your pockets anyway. Normally, standard abatements are used which come with the implants as part of the system. These are mass produced. However, recently a new trend appeared for individual abatements. Zirconium dioxide is used to create custom abatements, tailored exactly for your jaw. They are usually wider and gum embraces it better. The tooth crown is also made of zirconium dioxide. This material has a very important feature: it is slightly transparent for light, just like real bone. Common metal ceramic crowns lack this feature: they are not transparent to light. You may have seen some older celebrities with white, but very unnatural looking teeth. You can’t tell what’s exactly wrong, but the teeth look artificial. Light transparency is the answer. Younger celebs have newer crowns and veneers which are transparent, and look like real teeth. Real and beautiful. So if you have the money, go for it, especially when implanting the front 8 teeth in the aesthetically important area. But there is no other benefit except better looks, so if your implant is in a not visible area, metal ceramic crown will work just as good. Perhaps the more popular those made to measure abatements become, the cheaper they will be. So the dentist installed the gum former, which you must wear for a couple more weeks. Then you come to the dentist again, he removes the former, takes measurements for the future crown, and lets you go for another couple weeks. Then you come again, the dentist screws in the abatement and caps it with the crown. Two methods exist to hold the crown in place – cemented from top and cemented from bottom. In the first case, the crown has a hole at the top to hold the screw, which is later covered with cement. Bottom method is better, because it leaves crown intact. However, there is a risk of cement getting between the crown and the gum, which may cause inflammation and even lead to loss of the implant. So the dentist must be very careful here. After the cement solidifies, you can finally eat with your new tooth. So in classic implantation, it takes 3 months to recover from tooth removal, 3 to 4 months for the implant to settle in and even more, if you had to enlarge the bone area, 2 weeks to wear gum former and 2 more to get the crown. So on average, it takes 4 months to get an implant, which in practice means 7 months as you have to recover after tooth removal. 7 months is nothing but express. Gimmick like lasers and ultrasound cannot shorten this period. There is no such thing as laser implanting. In surgery, laser and ultrasound replace the main surgeon’s tool – scalpel and do exactly the same job – cut flesh. Well they have benefits of course, like ultrasound knife being able to vaporize bad tissue, which is especially useful when removing ingrown nails, and laser seals the cut right afterwards, corking blood vessels and minimizing infections and often eliminating the need for seams. But in essence, they are just cutters, and surgery itself takes only a fraction of those 7 months. You spend the majority of time regenerating bone tissue, which is a slow process like in any bone fracture. So don’t believe false advertising, look for a decent dentist and don’t rush.

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