1. Why lose your teeth?

There are several reasons that force the dentist to extract a tooth: For example by advanced gum disease (if you lose bone holding the tooth); it can also be for such extensive decay which makes it impossible to reconstruct the tooth; or a root fracture, usually caused by a stroke.

2. What happens when we lose our teeth?

Some of the consequences of tooth loss are: esthetic compromise; decreased masticatory efficiency (patient cost him more to chew); overload of the remaining teeth, they will have to perform the functions of lost tooth and could also be affected or lost; slurred speech or to say certain words; loss of support lips and cheeks, causing wrinkles therein; inclination of the neighboring teeth to the missing pieces; unstable bite; joint and muscle problems in the face and head; diminished self-esteem; decrease in size of the teeth holding bone (bone resorption).

3. What options are available to replace those missing teeth?

The simplest option of placing a removable prosthesis, which is retained by hooks, and is stabilized by a metal or plastic structure in the palate or the tongue area. The patient can remove and donning again for cleaning. The next option is to build a bridge, which is to do a burnout in neighboring teeth, to make porcelain crowns on them, together with another crown which is placed replacing missing tooth. The third option involves placing an artificial titanium root (dental implants), which will support a porcelain crown.

4. What it is an implant?

An implant is an artificial object that replaces a missing part of our body. Thus the implant to be placed within the body acts in the same way as the part that have lost.

5. What are dental implants and oral?

Dental implants are small titanium cylinders (3.73mm diameter) that work as artificial roots once placed within the bone that held the lost natural teeth. Thus, the crowns will be retained by these implants, two to six months when applied thereto. This is the time it takes to join the implants (oseointegrarse) tightly to the bone. With the use of implants no need to wear and damage neighboring teeth for (non-removable) fixed restorations. The osseointegrated implants have shown the highest long-term success between restore options offered by Dentistry.

6. What are the osseointegrated implants?

A type of endo-bone implants, which are attached to the bone by means of the phenomenon of "Osseointegration". Some systems attach to the bone implant by a fibrous layer of soft tissue, which have shown high percentages of failures due to instability and potential for serious infections. These were only used in the past. By contrast, the osseointegrated implants are attached directly to the bone, creating true artificial roots implanted into the jaw bone or maxilla, with a solid base on which can perform both single tooth restorations, including partial or total prosthesis, and they work exactly like our natural teeth. The osseointegrated dental implants allow us to chew with total comfort, smile and talk to the same security than with our own teeth.

7. What are the disadvantages of dental implants?

a) Dental implants are placed into the bone through a small surgery, which is painless but arouses anxiety in some patients.
b) The other disadvantage is the time to wait for the placement of implants to making crowns, or primary osseointegration time, ranging from two to six months depending on the area of ​​the mouth restored. During this time the patient can wear a temporary restoration, which may be fixed or removable.

8. What are the advantages of dental implants?

a) The main advantage of implants is not having to damage the neighboring tooth to replace the missing pieces: Although the bridges on natural teeth have been a good choice, are no longer the best. This is because they tend to have a lifespan of between 7 and 10 years; when a bridge fails, it is usually because one or more of the teeth holding it fails due to overload or because entered decay under the bridge. Therefore these teeth are also lost (sometimes saved through root canals), and to do a more extensive bridge and wear down teeth. This problem could have been avoided if he had placed an implant rather than a bridge.
b) The hygiene must be taken to maintain a bridge is more difficult than for an implant, because the bridge can not floss as natural teeth, and the tooth replenished is attached to two or more that support teeth. Therefore a special floss threaders or to pass the thread under the bridge should be used. By contrast, crowns implants restored by cleaning can receive similarly floss natural teeth, as the restoration is independent of the other teeth.
c) The lifetime of an implant is greater than a bridge or a removable prosthesis: In studies 10-year period found that implants models success rate is 90%, while the bridge or a removable prosthesis is 50%. It was also found that the failure of a bridge is often necessary to remove or submit to root canal teeth that supported it, while the few times that a failed implant only it removed and another is placed without touching neighboring teeth .
d) The removable restorations cause increased bone loss that held the natural tooth. When this process has come a long way, it makes it impossible to hold conventional dentures, therefore requires the placement of bone grafts. Conversely, implants stimulate bone that supports, thereby preventing their reabsorption.

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9. ¿What material is used for dental implants?

Along the history of dentistry and medicine, many materials have been used. At the present time, the only material considered valid for dental implants is titanium.

10. ¿Why titanium?

There are countless researches that demonstrate that titanium is the best biomaterial, given its excellent biocompatibility to the human organism. Since it fixes to the bone (osseointegration), it has demonstrated to last for very long periods of time. There are research studies that support the use of implants that have been working for more than 35 years, with a very high success. All this makes titanium the election material.

11. ¿What is the purpose of using dental implants?

The main purpose of implants is to work as artificial roots that will hold the crowns placed instead of the lost teeth. Implants restorations fulfill three basic concepts:
• Function and esthetics: chewing, speaking and smiling can be done comfortably; they also provide lips support.
• To stop the bone resorption, since they stimulate the bone that holds them.
• To eliminate the overload of the remaining teeth that could appear if bridges were used.

12. ¿How do implants contribute to recover the function and the aesthetics?

Dental implants substitute the removable dentures for fixed teeth, improving the function and the aesthetics simultaneously. They support the new crowns without the need of trimming the natural teeth, allowing us to chew with total comfort, and to smile and to speak with total security, for many years. The implant-supported crowns can be easily cleaned with dental floss.

13. ¿What is the bone resorption and why does it happen?

When we one or all the teeth in our mouth, (probably because of decay, gum disease, traumatism, etc.), a process of bone loss or bone atrophy begins. The function of the maxillary and mandibular bone is to support the teeth. When these teeth are lost, a process of bone reabsorption begins that is accelerated in most of the cases for the pressure of the removable denture .In some occasions the reabsorptions is so large that it is almost impossible tolerating or achieving good retention in a traditional removable denture. The esthetic and functional consequences can be dramatic. The widest bone loss happens during the first months after the tooth is lost.

14. ¿How do dental implants contribute to stop the bone resorption??

With implants we don't only replace the teeth that we have lost, restoring the function and the Aesthetics The bone loss is also stopped because the bone receives the stimulus of the mastication again. Therefore, it is important to replace the missing teeth with implants as soon as possible after they were lost.

15. ¿How do dental implants contribute to diminish the overload of the remaining teeth?

Let us imagine the example a house. The teeth would be the columns or pillars for support of the roof.
If we were removing columns, the rest of them would have to support the whole weight of the structure. The remaining columns would be overloaded, and there could be a moment when the roof falls. In the mouth the same thing happens, when teeth are lost. The remaining teeth have to support all the forces of the mastication, suffering an important overload that could injure them and their bone support, and with time they could be lost too.

16. ¿How is the treatment?

The treatment consists on two stages
a. Surgical phase
b. Prosthetic phase.

17. ¿What is the surgical phase?

The surgical treatment consists on the placement of the artificial roots or implants inside the jawbone. It is performed with local anesthesia, and is painless. Sedation and general anesthesia are options for nervous patients. The duration of the intervention is from one to two hours, depending on the number of implants, that will remain covered for two to six months (depending on the area of the mouth where they were placed).
After that time sometimes there is a need of a very small second surgical phase, to uncover the tip of the implants, especially in esthetic related areas.

18. ¿How is the post-operative stage?

It is not painful. The following day of the intervention the patient will have a slightly inflamed area in the face. Painkillers, antibiotics and anti-inflammatories are prescribed for a short period.

19. ¿Will I be able to use my removable denture or bridge as a temporary solution?

Meanwhile the dental implants integrate to the bone, if you use a removable denture, it will be modified and conditioned internally with a special material, to be used temporary since the day of the placement of the implants, until the implants are ready to receive the fixed porcelain crowns, zero to four months later.
If you use a fixed bridge, it will be cemented immediately after the placement of the implants, to be used temporary since the day of the placement of the implants, until the dental implants are ready to receive the fixed porcelain crowns, zero to four months later.

20. ¿When will the new teeth be placed on the dental implants?

The time between the surgical phase and the placement of the crowns varies depending on the case.
The range varies between two and six month, to give time to the implant to integrate or fix to the bone. More time could be waited if the patient asked so (i.e. because of a trip).

21. ¿How does the new prosthesis or crown anchors to the implants?

The system used consist on a series of very precise machine made abutments that anchors to the implant with a gold screw, and that will retain the crowns.

22. ¿Is it necessary to brush the new implant-supported teeth?

As natural teeth, implants should receive daily flossing and brushing. The flossing of the implant-supported crowns will be much easier than for teeth supported bridges, because the first ones will not be fixed to the neighbor teeth.

23. ¿Am I an ideal candidate for dental implants?

If your answer is affirmative to some of the following questions, you can be considered a ideal candidate to be treated with implants:
• Have you lost one, some or all of your teeth?
• Do you have difficulties with your removable denture (bad retention, pain, etc)
• Do you feel insecure when you smile, when speak or to eat?
• Has a dentist told you that you have teeth in very bad shape?
• Is there an area in your mouth where the corresponding tooth never showed up?

24. ¿Is age a limit?

The age is not a decisive factor when being candidate for implants, but it is advisable not to use them before the 15 to 16 years of age, until the maxillary growth has completed. Older patients can receive implants as well as the young ones, with the same success rate.

25. ¿Is it a painful treatment?

No. A treatment with implants demands a surgical intervention, but pain and all the other implications can be perfectly controlled.

26. ¿How long does the treatment take?

It is very important to respect the times of osseointegration or integration of the implant to the bone. In general it takes two to four months for the lower jaw, and six months for the upper jaw, between the time of the implant placement, and the prosthetic phase (start of the construction of the implant supported crowns or dentures). The prosthetic phase last from one to three weeks, depending on the case.

27. ¿Could there be a failure?

In spite of the excellent clinical results obtained with implants (93 to 97% success rate) there is a 3 to 7% rate for failure. No other dental treatment has such a high success rate for long terms.

28. ¿What does it happen if a dental implant fails?

If an implant fails, it is possible to substitute it for another one to solve the problem. Anyways, most of the implant-supported prosthesis are designed to work, even if an implant failed.

29. ¿Will the dental implants last a lifetime?

In medicine it is complex to say that a treatment is for a lifetime, specially being the teeth a tool that we use every day and in each moment, that receive a lot of pressures and forces, and placed in a humid and very septic area (the mouth). Anyways, there are studies older than 35 years that show a very high success rate. The most recent studies say that 90% of the implants placed 10 years ago, are still working in the mouth today. It is much higher than the 50% success rate for ten-year periods described for tooth-supported bridges or dentures.

30. ¿Is the dental implant treatment expensive?

The implant treatment is sophisticated and it demands a very complex armamentarium. More than one experienced professional (specialist) is required; the components used have to be very precise, and precious metal alloys (gold, silver, palladium) have to be used in the prosthetic phase. The implants and the prosthetic components have to be from a recognized brand. Al that makes the implant treatment more expensive than the tooth supported treatment, at first. But with time, since implant treatments last longer, with the re-doing of the tooth-supported bridge or denture (sometimes it implies root canals, extraction of supporting teeth, longer bridges, etc) it is possible that the implant treatment results less expensive, and will prevent the lost of the natural teeth.

31. ¿Why Costa Rica for dental implants?

Costa Rica is a peaceful small country in Central America that is also known throughout the world for its high quality, low cost dental care.
Politically stable, and with no army, Costa Rica is one of the most bio-diverse countries in the world: 25% of its territory is dedicated to parklands and wildlife refuges.
Tourist love Costa Rica's natural attractions, from beaches, deep-sea fishing, white water rafting, and surfing, to mountains, rain forests, volcanoes and hiking. The capital city of San Jose offers museums, a national theater, and casinos. All Visitors love San Jose's central market . You can also visit coffee plantations, butterfly farms, and villages offering local handicrafts - all within a twenty-mile radius!
Costa Rican's are known for their warmth and hospitality.
It is safe and easy for patients from other countries to have their dental implants treatment done in Costa Rica, and meet this beautiful country between appointments, all for a much lower price, even tough most of the materials, including the dental implants we use are made in the United States and Europe

32. ¿What is an specialist?

According to Costa Rican Law, an specialist is a dentist who, after the regular six years of Dentistry, Studied at least two more years (full time) of an specific branch of dentistry. This has to be certified by the official Costa Rican Board of Dentists, that review the program and the University that offered the specialty (some programs may not be accepted as specialty, if they do not reach a degree of excellence).
The Costa Rican Board of Dentists prohibits (article 29th, Code of Ethics) the dentists to say or announce an specialty, if they have not accomplished those requirements.
Dr. Anglada is a Certified Specialist in Oral Implants.