How dental implants have changed, and what you need to know.

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When we need to have a tooth or two (or more) replaced, we’re fortunate to have plenty of options. But do you really need to fill that gap and, if so, which option is right for you? Two dentists with a wealth of expertise in cosmetic and restorative dentistry answer these questions and share their insights—and a few innovations—with us.

Why you need to replace that tooth

No matter why your tooth has fallen out or needs to be replaced, without it your mouth isn’t the same. “All your teeth act as a unit, so if one tooth is off or out, you’ll feel it,” explains Dr. Sol Weiss, DMD, a leading cosmetic dentist at The Art of Dentistry in Toronto. “It’s like having a fence and taking out one of the posts. With the post missing, there’s more weight distributed to the remaining posts.”

While a missing front tooth can immediately adversely affect your appearance, any missing tooth affects your ability to bite and chew. Over time, other teeth will drift into the empty space and you will experience bone loss in the jaw area. “In essence, the area collapses,” explains Dr. Raj Singh, DDS, founder of Dentistry at Vitality Health in Unionville, Ont. “When a tooth isn’t stimulating the gums or bone, the bone under the gap actually shrinks away. A dental implant puts pressure on the bone to prevent bone loss.”

How implants work

Dental implants are screwed into the jawbone to support bridges, dentures and crowns. “When they are topped with a crown, dental implants look and function like natural teeth,” says Dr. Singh.

An implanted tooth is comprised of three components: the implant that is anchored to the bone, an abutment that connects the crown to the implant and the porcelain crown. Once in place, the three components act as a single unit, with the crown being the only visible portion. “The crown is matched to the rest of your teeth for colour, translucency, lustre and shape,” says Dr. Singh.

Today’s implant choices

“Now you have two types of implants to choose from: traditional titanium metal implants and metal-free ceramic, also known as zirconium, implants,” says Dr. Weiss. Both types of implants come in different sizes, thicknesses and depths, encourage bone growth once installed into the jaw and should last a lifetime. “Zirconium implants are ideal for areas where aesthetics is critical, such as the front of the mouth when a patient doesn’t have a lot of gum tissue,” he adds.

Although there are few contraindications for dental implants, a patient may have to wait a number of months after an implant is installed to allow the bone to strengthen before the final crown is placed.

The use of CT scans

Both dentists, who together possess more than 50 years’ worth of experience performing implants, agree that the introduction CT scans makes evaluating where to place implants significantly easier. “With an X-ray, you could only see the bone in two dimensions and not be able to determine the bone’s thickness until you’d made an incision,” explains Dr. Singh. “A CT scan shows us in three dimensions exactly how thick the bone is, what the anatomy is and where critical structures such as nerves are.”

“The CT scan gives us valuable information for placement,” says Dr. Weiss, “especially in an area where we’re not sure of the bone.” Cases that would have been too challenging in the past are no longer a problem with this improved view. The best part? “All the exploring is now done on the dentist’s computer instead of while you’re in the dentist’s chair,” explains Dr. Singh.

Computer-guided dental implants

The most innovative change in dental implant procedures is computer-guided dental implants, also referred to as “Teeth-in-an-Hour.” A dentist uses the patient’s CT scan to have a three-dimensional surgical guide created to specify the ideal insertion point and angle of the implant. Once made, the guide is placed over the patient’s teeth and directs the implant into the exact position. Guides can be created for one implant or multiple implants.

“With dental surgery, you want to be in and out quickly to protect the bone and prevent the onset of bacteria,” explains Dr. Singh. “The guide shows us exactly where to create the opening. The implant goes right in, it’s sealed with the abutment and then we install the crown once it’s ready.” Using the guide lessens the amount of trauma in the area, which leads to reduced pain and faster healing. “Some of my patients go back to work or the golf course afterwards,” adds Dr. Singh.

Not all dentists believe that every implant requires a surgical guide. “I can use the CT scans to put the implants where I want them,” says Dr. Weiss. “Remember, if you’re one millimetre off with the guide, you might have a lot of finessing to do to make it fit, because we’re not machines. It’s still a human that’s drilling the implants in.”

Dr. Singh is able to reduce the number of appointments a patient would require by having all the equipment necessary at one location. “Most people don’t want to have to take a lot of time off work or wait over a year for the procedure to be completed,” explains Dr. Singh. “By using this technology, we can accomplish what used to take at least seven appointments and bring it down to three or four: the consultation, the CAT scan, the implant and, if necessary, the final crown installation.”

No matter which options you choose, both dentists advise that you go with a solution that addresses aesthetics, function and comfort.

WHAT IT COSTS:

Although actual costs depend on a number of factors, here’s what you can expect to pay.

Titanium implant and abutment + crown: $2,750 to $5,500

Ceramic implant + crown (no abutment required): $3,500 to $5,100

Additional cost for computer-guided dental implants: $1,000 to $1,500