QUESTIONS

There are several reasons that force the dentist to extract a tooth:

Advanced gum disease:  can cause the bone holding a tooth to deteriorate

• Extensive Tooth Decay:  makes it impossible to reconstruct a tooth with a crown.
• Root Fracture:  usually caused by trauma to the mouth.

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).

Some of the consequences of tooth loss are:

• Esthetic Compromise:  decreased masticatory efficiency (patient struggles to chew).
• Overload of the remaining teeth:  they will have to perform the functions of the lost tooth (increasing their wear and decreasing their useful life).
• Slurred speech:  difficulty of saying certain words.
• Loss of support for the lips and cheeks (also causing wrinkles).
• Inclination of the neighboring teeth to the missing pieces.
• Unstable bite.
• Joint and muscle problems in the face and head.
• Bone Resorption:  decrease in the size of the jawbone supporting ones teeth.

The simplest option is placing a removable prosthesis which is retained by hooks and is stabilized by a metal or plastic structure in the palate or tongue area.  It can be removed for cleaning purposes and easily placed in the mouth again.  The next option is to build a bridge which involves shaving the neighboring teeth and placing crowns on them providing anchors for a bridge over the missing tooth.  The third option involves placing a Dental Implant (artificial titanium root) which will support a porcelain crown.

An implant is an artificial object that replaces a missing part of our body or enhances a part of the body cosmetically.  The implant is surgically placed in the body and acts in the same way as the part that it is replacing.

Dental implants are small titanium cylinders (3.73mm in diameter) that work as artificial roots once they are placed within the bone that held the lost natural teeth. After two to six months, the crowns are then attached to the implants after two to six months has elapsed.  This is the time it takes to join the implants (Osseo-integrate) tightly to the bone.   With the use of implants, there is no need to wear and damage neighboring teeth for (non-removable) fixed restorations. The Osseo-integrated implants have shown the highest long-term success between restoration options offered by modern Dentistry.

Types of Endodontic implants which are attached to the bone by means of the phenomenon of “Osseo-integration”. Earlier systems attached implants to the bone by a fibrous layer of soft tissue which showed high percentages of failures due to instability and a potential for serious infections.  These were only used in the past.  By contrast, the Osseo-integrated implants are attached directly to the bone, creating true artificial roots implanted into the jaw bone or maxilla.  This creates a solid base on which both single and multiple tooth restorations can be done including partial or total prosthesis.  They work exactly like our natural teeth. These implants allow us to chew with total comfort and they also allow us to smile and talk with the same security we feel with our own natural teeth.

The main advantage of implants is not having to damage the neighboring teeth to replace the missing pieces.  Although the bridges on natural teeth have been a good choice in the past, they are no longer the best option.  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 decay enters under the bridge.  Therefore, these teeth are also lost (sometimes saved through root canals) and a more extensive bridge is necessary.  This problem could have been avoided if an implant had been placed instead of a bridge.

Good oral hygiene is much easier with dental implants than with a bridge which requires a special technique and floss.  With implants, one can floss each individual tooth just like ones natural teeth.

The lifetime of an implant is much greater than a bridge or a removable prosthesis.  In a study over a 10-year period, it was found that the success rate for implants was 90% while the success rate for a bridge or a removable prosthesis during the same 10-year period was only 50%.  It was also found that with the failure of a bridge, it is often necessary to remove or submit to root canal teeth that supported it, while the few times that an implant failed it is simply removed and another is placed without touching neighboring teeth.

Implants stimulate bone growth thereby preventing resorption.  Whereas, removable restorations cause increased bone loss which can easily make it impossible to hold conventional dentures; therefore, requiring the placement of bone grafts.

Dental implants are placed into the bone via a minor surgical procedure, which is painless but arouses anxiety in some patients.

The amount of time (which ranges from two to six months) that is needed in order for the primary osseo-integration process to take place.  This amount of time ranges from two to six months and is dependent on the area of the mouth being restored.  During this time the patient can wear a temporary restoration, which may be fixed or removable.

Many different materials have been used over the years, but the most commonly used at the present time is titanium.

There are countless research studies that demonstrate that titanium is the best biomaterial to use given its excellent biocompatibility to the human organism.  Biocompatibiliy is the ability to interact with the body without causing harm.  Also, the fact that titanium implants osseo-integrates or become fixed to the bone mean that they last for long periods of time.  There are research studies that have shown that titanium implants have been working for more than 35 years with very high success.  That makes titanium the ideal choice for implants.

The main purpose of implants is to work as artificial roots that will hold the crowns placed instead of the lost teeth. Implant restorations fulfill three basic concepts:

• Functionality and esthetics: chewing, speaking and smiling can be done comfortably; they also provide lips support.
• To stop bone resorption, since implants stimulate the bone that holds them.
• To eliminate the overload of the remaining teeth that is present when bridges are used.

Dental implants and the crowns that are subsequently placed in the implants improve the functionality and aesthetics immediately.  There is no need trim or shave the surrounding natural teeth which allows us to chew with total comfort and to smile and speak with total security for many years.  The implant-supported crowns can be easily cleaned with dental floss.

When we lose one or all the teeth in our mouth (due to tooth decay, gum disease, trauma, 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, this process of bone resorption begins which is accelerated in most cases by the pressure of the removable denture .In some cases, the resorption is so large that it is almost impossible to achieve good retention in a traditional removable denture. The esthetic and functional consequences can be dramatic. The greatest amount of bone loss occurs during the first few months after the tooth is lost.

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.

Let us imagine the example of a house that has numerous columns or pillars supporting the roof.  Our teeth would be the columns or pillars for support of the roof.
If we began removing columns, the remaining columns 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 also.

The treatment consists of two stages or phases:

1. Surgical phase
2. Prosthetic phase.

This phase consists of placing implants (or artificial roots) inside the jawbone.  It is performed with local anesthesia and is painless. Sedation and general anesthesia are options for nervous patients. The duration of this minor surgery is from one to two hours depending on the number of implants.  The patient must wait anywhere between two to six months in order for the implants to because one with the bone.

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

This phase consists of the making and placing of crowns into the dental implants.  The first step in this phase is to uncover the tip of the implants which in some cases there is a need of a very small surgical procedure.  Once the implants are uncovered, an impression of the tooth (or teeth) is taken.  This impression is sent to a lab in order for the crown to be made.  The crown is then fitted and fixed permanently into the implant.

While the dental implants are integrating to the bone, one can use their removable denture.  With the use of a special material, the denture is modified and conditioned internally so that it can be used immediately after the implants are placed until the crowns are placed two to six months later.  If a fixed bridge is used, it will be cemented temporarily immediately after the placement of the implants until the fixed porcelain crowns are ready to be placed on the implants.

The time between the surgical phase and the prosthetic phase varies depending on each individual case.  The range is between two and six months and is necessary in order to give the appropriate time for the implant to integrate or become fixed to the bone. The patient can wait longer than the recommended time if they so desire if they want to accommodate a trip during a particular month.

The system used consists of a series of very precise machine-made abutments that anchor to the implant with a gold screw that retains the crowns.

Just like one´s natural teeth, implants should receive daily flossing and brushing. The flossing of the implant-supported crowns will be much easier than for teeth supporting bridges because these teeth are fixed to their neighboring teeth which make it difficult to floss.

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, speak, or 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?

Age is not a decisive factor when being considered a candidate for implants, but it is advisable not to use them before 15 to 16 years of age which means that the maxillary (or upper jaw) growth has not been completed. Older and younger patients can receive implants with the same success rate.

No.  Implant placement treatment requires surgical intervention, but pain and all other implications can be perfectly controlled.

The treatment can take anywhere between four to ten months.  It is very important to respect the time period required for osseo-integration or integration of the implant to the bone.  This integration generally takes two to four months in the lower jaw and six months in the upper jaw.  This is the time period in between the surgical phase (implant placement) and the prosthetic phase (start of the construction of the implant-supported crowns or dentures). The prosthetic phase lasts from one to two weeks depending on the case.

In spite of the excellent clinical results obtained with implants (93% to 97% WORLD success rate), there is a 3% to 7% rate for failure WORLDWIDE. No other dental treatment has such a high success rate in the long term. DR. ANGLADA’S PERSONAL SUCCESS RATE IS 99%, AND THE FEW TIMES HIS IMPLANTS HAVE FAILED, HE PLACES A NEW ONE FOR FREE. HIS IMPLANTS ARE WARRANTIED FOR LIFE

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

In medicine it is complex to say that a treatment will last for a lifetime, especially due to the fact that one´s teeth is a tool that we use every day and also receives a lot of pressure and force when being used.  Implants are also placed in a humid and very septic area (the mouth).  Nevertheless, there are studies older than 35 years that show a very high success rate of implants.  The most recent studies show that 90% of the implants placed 10 years ago are still working in the mouth today. This percentage is much higher than the 50% success rate for ten-year periods described for tooth-supported bridges or dentures.

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

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