How many teeth can a dental implant support?

Traditionally, an implant placed into your bone supports a single crown and this is know as a “single tooth implant”. However, if you have several missing teeth, you do not necessarily need an implant for every missing tooth: one implant can support several teeth via a bridge or denture. The number of implants required depends on the volume and density of bone tissue available at each implant site. Often, smaller-sized “mini implants” are used to secure dentures in place.

In the case of full-mouth reconstructions, where an arch of several teeth (10+) needs to be supported in either the upper or lower jaw, a minimum of five to six implants in each jaw would be required. The exact number of implants needed would depend on the individual case and your implant surgeon would be able to advise you on the best solution after a thorough examination and assessment.

Where can bone be taken from for the graft?

The best source of bone for your graft is your own bone tissue from elsewhere in your body. Bone can be grafted from the chin, the back of the lower jaw, the hip and the tibia. Bone taken from your own body is the most viable and has faster healing times when compared to alternatives. In many cases, a combination of artificial bone substitutes and your natural bone is used. In any bone grafting procedure, the grafted bone provides an anchor and stimulus for the existing bone to grow onto, eventually providing an environment suitable for the placement of implants.

What Dental Implants Can Do?

• 
  Replace one or more teeth without affecting bordering teeth.
• Support a bridge and eliminate the need for a removable partial denture.
• Provide support for a denture, making it more secure and comfortable.

Types of Implants in Use Today

• Endosteal (in the bone): This is the most commonly used type of implant. The various types include screws, cylinders or blades surgically placed into the jawbone. Each implant holds one or more prosthetic teeth. This type of implant is generally used as an alternative for patients with bridges or removable dentures.
• Subperiosteal (on the bone): These are placed on top of the jaw with the metal framework's posts protruding through the gum to hold the prosthesis. These types of implants are used for patients who are unable to wear conventional dentures and who have minimal bone height.

Are You a Candidate for Dental Implants?

The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.

Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Since periodontists are the dental experts who specialize in precisely these areas, they are ideal members of your dental implant team. Not only do periodontists have experience working with other dental professionals, they also have the special knowledge, training and facilities that you need to have teeth that look and feel just like your own. Your dentist and periodontist will work together to make your dreams come true.


PERIO.ORG

What Is Treatment Like?

This procedure is a team effort between you, your dentist and your periodontist. Your periodontist and dentist will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, your periodontist will create a treatment plan tailored to meet your needs. Click for more information about the treatment options described below.

• Replacing a Single Tooth   If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root.
• Replacing Several Teeth   If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots.
• Replacing All of Your Teeth   If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots.
• Sinus Augmentation   A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants.
• Ridge Modification   Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.

source: perio org

advantages of dental implants

Advantages of Dental Implants Over Dentures or a Bridge

Every way you look at it, dental implants are a better solution to the problem of missing teeth.

• Esthetic   Dental implants look and feel like your own teeth! Since dental implants integrate into the structure of your bone, they prevent the bone loss and gum recession that often accompany bridgework and dentures. No one will ever know that you have a replacement tooth.
• Tooth-saving   Dental implants don't sacrifice the quality of your adjacent teeth like a bridge does because neighboring teeth are not altered to support the implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health!
• Confidence   Dental implants will allow you to once again speak and eat with comfort and confidence! They are secure and offer freedom from the irksome clicks and wobbles of dentures. They'll allow you to say goodbye to worries about misplaced dentures and messy pastes and glues.
• Reliable   The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement.

source: perio.org

incisions

Surgical incisions

Traditionally, an incision is made over the crest of the site where the implant is to be placed. This is referred to as a 'flap'. Some systems allow for 'flapless' surgery where a piece of mucosa is punched-out from over the implant site. Proponents of 'flapless' surgery believe that it decreases recovery time while its detractors believe it increases complication rates because the edge of bone cannot be visualized.^[17][18]Because of these visualization problems flapless surgery is often carried out using a surgical guide constructed following computerized 3D planning of a pre-operative CT scan.

[edit]Healing time

The amount of time required for an implant to become osseointegrated is a hotly debated topic.^[19] Consequently the amount of time that practitioners allow the implant to heal before placing a restoration on it varies widely. In general, practitioners allow 2–6 months for healing but preliminary studies show that early loading of implant may not increase early or long term complications.^[20] If the implant is loaded too soon, it is possible that the implant may move which results in failure. The subsequent time to heal, possibly graft and eventually place a new implant may take up to eighteen months. For this reason many are reluctant to push the envelope for healing.

[edit]One-stage, two-stage surgery

When an implant is placed either a 'healing abutment', which comes through the mucosa, is placed or a 'cover screw' which is flush with the surface of the dental implant is placed. When a cover screw is placed the mucosa covers the implant while it integrates then a second surgery is completed to place the healing abutment.

Two-stage surgery is sometimes chosen when a concurrent bone graft is placed or surgery on the mucosa may be required for esthetic reasons. Some implants are one piece so that no healing abutment is required.

In carefully selected cases, patients can be implanted and restored in a single surgery, in a procedure labeled "Immediate Loading". In such cases a provisional prosthetic tooth or crown is shaped to avoid the force of the bite transferring to the implant while it integrates with the bone.

[edit]Surgical timing

There are different approaches to place dental implants after tooth extraction. The approaches are:

1. Immediate post-extraction implant placement.
2. Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction).
3. Late implantation (3 months or more after tooth extraction).

According to the timing of loading of dental implants, the procedure of loading could be classified into:

1. Immediate loading procedure.
2. Early loading (1 week to 12 weeks).
3. Delayed loading (over 3 months)

[edit]Immediate placement

An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rates for this procedure are now acceptable. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the implants at the same time as the surgery to place the dental implants.

Most data suggests that when placed into single rooted tooth sites with healthy bone and mucosa around them, the success rates are comparable to that of delayed procedures with no additional complications.^[21]

[edit]Use of CT scanning

When computed tomography, also called cone beam computed tomography or CBCT (3D X-ray imaging) is used preoperatively to accurately pinpoint vital structures including the inferior alveolar canal, the mental foramen, and the maxillary sinus, the chances of complications might be reduced as is chairtime and number of visits.^[22] Cone beam CT scanning, when compared to traditional medical CT scanning, utilizes less than 2% of the radiation, provides more accuracy in the area of interest, and is safer for the patient.^[23] CBCT allows the surgeon to create a surgical guide, which allows the surgeon to accurately angle the implant into the ideal space.^[24]

^{source: wikipedia}

Types

Some of the more common are:

• Endodontic (surgery involving the pulp or root of the tooth)
  • Root canal
    • Pulpotomy The opening of the pulp chamber of the tooth to allow an infection to drain; Usually a precursor to a root canal
    • Pulpectomy - The removal of the pulp from the pulp chamber to temporarily relieve pain; Usually a precursor to a root canal.
  • Apicoectomy - A root-end resection. Occasionally a root canal alone will not be enough to relieve pain and the end of the tooth, called the apex, will be removed by entering through the gingiva and surgically extracting the diseased material.

• Prosthodontics (dental prosthetics)
  • Crowns (caps) — artificial coverings of the tooth made from a variety of biocompatible materials, including CMC/PMC (ceramic/porcelain metal composite), gold or a tin/aluminum mixture. The underlying tooth must be reshaped to accommodate these fixed restorations
  • Veneers — artificial coverings similar to above, except that they only cover the forward (labial or buccal) surface of the tooth. Usually for aesthetic purposes only.
  • Bridges — a fixed prothesis in which two or more crowns are connected together, which replace a missing tooth or teeth through a bridge. Typically used after an extraction.
  • Implants — a procedure in which a titanium implant is surgically placed in the bone (mandible or maxilla), allowed to heal, and 4-6 months later an artificial tooth is connected to the implant by cement or retained by a screw.
  • Dentures (false teeth) — a partial or complete set of dentition which either attach to neighboring teeth by use of metal or plastic grasps or to the gingival or palatial surface by use of adhesive.
  • Implant-supported prosthesis — a combination of dentures and implants, bases are placed into the bone, allowed to heal, and metal appliances are fixed to the gingival surface, following which dentures are placed atop and fixed into place.

• Orthodontic treatment
• Implants and implant-supported prosthesis — also an orthodontic treatment as it involves bones
• Apiectomy — also an orthodontic treatment as part of the underlying bone structure must be removed.
• Extraction — a procedure in which a diseased, redundant, or problematic tooth is removed, either by pulling or cutting out. This procedure can be done under local or general anesthesia and is very common — many people have their wisdom teeth removed before they become problematic.
• Fiberotomy — a procedure to sever the fibers around a tooth, preventing it from relapsing.
  
  source: wikipedia

basic and detail procedure

Surgical planning

Prior to commencement of surgery, careful and detailed planning is required to identify vital structures such as the inferior alveolar nerve or the sinus, as well as the shape and dimensions of the bone to properly orient the implants for the most predictable outcome. Two-dimensional radiographs, such as orthopantomographs or periapicals are often taken prior to the surgery. Sometimes, a CT scan will also be obtained. Specialized 3D CAD/CAM computer programs may be used to plan the case.

Whether CT-guided or manual, a 'stent' may sometimes be used to facilitate the placement of implants. A surgical stent is an acrylic wafer that fits over either the teeth, the bone surface or the mucosa (when all the teeth are missing) with pre-drilled holes to show the position and angle of the implants to be placed. The surgical stent may be produced using stereolithography following computerized planning of a case from the CT scan. CT guided surgery may double the cost compared to more commonly accepted approaches.

[edit]Basic procedure

In its most basic form the placement of an osseointegrated implant requires a preparation into the bone using either hand osteotomes or precision drills with highly regulated speed^[16] to prevent burning or pressure necrosis of the bone. After a variable amount of time to allow the bone to grow on to the surface of the implant (osseointegration), a crown or crowns can be placed on the implant. The amount of time required to place an implant will vary depending on the experience of the practitioner, the quality and quantity of the bone and the difficulty of the individual situation.

[edit]Detail procedure

At edentulous (without teeth) jaw sites, a pilot hole is bored into the recipient bone, taking care to avoid the vital structures (in particular theinferior alveolar nerve or IAN and the mental foramen within the mandible). Drilling into jawbone usually occurs in several separate steps. The pilot hole is expanded by using progressively wider drills (typically between three and seven successive drilling steps, depending on implant width and length). Care is taken not to damage the osteoblast or bone cells by overheating. A cooling saline or water spray keeps thetemperature of the bone to below 47 degrees Celsius (approximately 117 degrees Fahrenheit). The implant screw can be self-tapping, and is screwed into place at a precise torque so as not to overload the surrounding bone (overloaded bone can die, a condition called osteonecrosis, which may lead to failure of the implant to fully integrate or bond with the jawbone). Typically in most implant systems, the osteotomy or drilled hole is about 1mm deeper than the implant being placed, due to the shape of the drill tip. Surgeons must take the added length into consideration when drilling in the vicinity of vital structures.