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Are Dental Implants
Right for You?
The Facts
Asbjørn Jokstad, DDS, PhD
Professor and Head, Prosthodontics
Nobel Biocare Chair in Prosthodontics
Faculty of Dentistry, University of Toronto

1. What is a dental prosthesis?

Crown Bridge “etch-bridge”
(“FPD”)

Fixed (Tooth-supported)


Tooth +
Gum -
support
“RPD”

Removable
Gum-supported
“Denture”


Tooth +
Crown Bridge “etch-bridge” Gum -
(“FPD”) support
Fixed (Tooth-supported) “RPD”

Removable
Gum-supported
“Denture”

Replaces mostly Replaces
hard tissue hard + soft tissues

2. What are dental implants?
Beginning in the 1950s researchers
observed that the metal titanium formed a
very strong bond to surrounding bone, a
process termed "osseointegration."
After years of careful research and study,
dental implants (titanium cylinders placed
into the jawbone to support replacement
teeth) were refined with high success rates.

2. What are dental implants?
Implants are artificial tooth roots, made of
pure titanium or titanium-alloy, which are
inserted into the jaw, where it performs the
function of the root of a natural tooth that
has been lost.
A replacement tooth, made by a dental
technician, almost indistinguishable from its
natural counterpart, is attached to this
implant by the dentist
Dental implants can be regarded as
substitutes for the roots of missing teeth.

3. How can dental implants
support a dental prosthesis?
Dental implants act as anchors for a
replacement tooth or crown or a set of
replacement teeth.
The patient gets a solid replacement
that looks like the natural tooth.


Replacement of single teeth


Implants for bridge-support


For securing a removable denture


(Tooth-supported)

Fixed
(Tooth+gum or
gum -supported)

Implant-supported Removable

4. Benefits of implant-supported
compared to conventional
removable dental prostheses?
Many patients report improvement over
conventional dentures, such as:
Replacement teeth look, feel and
function more like natural teeth
Improved taste and appetite
Improved cosmetic appearance
The ability to chew without pain or
gum irritation

Most patients can eat and chew again
without pain or irritation. Foods that
were unavailable are now back in the
diet.

Foods that were unavailable are back in the diet.
Implants eliminate the need for
distasteful adhesives. There is no
longer a need to use "glue" when the
dental prosthesis is supported by
implants.

Foods that were unavailable are back in the diet.
There is no longer a need to use "glue" .
Implants can improve the taste of food.
With less plastic covering the roof of the
mouth, most patients can enjoy natural
flavors and sensations again.

One additional and very important benefit
can be the reduction or elimination of bone
shrinkage or “atrophy”, commonly related
with loss of teeth.
Bone atrophy not only affects jaw function,
but can cause adverse facial cosmetic
changes.

Implants can improve the patient’s health
with the ability to chew a wider variety of
foods: Eat whatever one like.

Implants can improve the patient’s health with the
ability to chew a wider variety of foods: Eat whatever
one like.
Implant supported restorations help
increase ones self-esteem. Smile with
confidence.

one like.
Implant supported restorations help increase ones
self-esteem. Smile with confidence.
Implants increase the retention and
stability of the teeth. Express oneself
clearly or simply be understood.

one like.
Implant supported restorations help increase ones
self-esteem. Smile with confidence.
Implants increase the retention and stability of the
teeth. Express oneself clearly or simply be
understood.
Decrease the likelihood of continued
bone loss and improve ones external
facial structure.

compared to conventional fixed
dental prostheses?
Adjacent teeth can be preserved when, for
instance, teeth are lost in an accident.

dental prostheses?
Adjacent teeth can be preserved.
A bridge does not offer this possibility as
the teeth next to the gap have to be
abraded and crowned.
Implants do not disrupt or negatively
impact other healthy teeth in the mouth.

dental prostheses?
Adjacent teeth can be preserved.
A bridge does not offer this possibility as the teeth next to the
gap have to be abraded and crowned. Implants do not
disrupt or negatively impact other healthy teeth.

Dental implants help the patient to keep
their remaining teeth, because they are
able to “share the load” with the
prosthetic teeth.

5. What are the steps for implant
prosthetic treatment? (1/4)
A titanium screw is inserted into the
jaw bone where there are no teeth.

Stage 1 surgery

A titanium screw is inserted into the
jaw bone where there are no teeth.
The screw is then protected with a
cover, and the jaw is given a few
months to heal. Stage 1 surgery


A temporary crown, etch-bridge or
removable prosthesis is used to
minimize any cosmetic or
chewing inconvenience.

A titanium screw is inserted into the jaw bone
The screw is covered + a few months to heal.

The final step is to uncover the implant
and attach the permanent crown to the
implant.
Stage 2 Surgery

6. How long does implant
prosthetic treatment take?
The healing time for implants is similar
to time required for a broken bone to
mend.

The healing time for implants is similar to time
required for a broken bone to mend.
Depending on physical and medical
situation, the titanium implants fuse to
bone in the jaw in the space of 2-6
months.

The healing time for implants is similar to time
required for a broken bone to mend.
Depending on physical and medical situation, the
titanium implants fuse to bone in the jaw in the
space of 2-6 months.
Treatment for the simple cases could
take anywhere from 4-8 months, based
on where the implants are placed and
the type of restoration desired.

The healing time for a broken bone to mend.
Titanium implants fuse to bone : 2-6 mths
Treatment for the simple cases: 4-8 mths

If a tooth is extracted, the time to heal
is usually 6 – 12 weeks before the
implant is placed at the point where the
tooth was removed.
Recent advances by implant
manufacturers are reducing the time
for initial implant procedures.

7. Can I extract a tooth and
restore it immediately using a
dental implant?
Some dentists place dental implants
immediately after tooth extraction
Some dentists even place a temporary
or permanent restoration on the dental
implant immediately after surgical
placement
There seems to be a higher risk of
unsuccessful treatment outcome with
these approaches

8. Who provides implant-
supported dental prostheses?
The general dentist is usually the first
resource for this service.
The key is the implant dentist's training,
experience and credentials.
Competent dentists include general
dentists, periodontists, prosthodontists
and oral surgeons who perform the
surgical and/or restorative procedures.

8. Who provides implant-supported
dental prostheses?
Since implant prosthodontics usually
involve two phases of treatment: 1.
surgical placement of the implant and 2.
placement of the restoration some dentists
feel they can offer better care by using the
different expertise of other team members,
e.g. performing the surgery or the
restoration.
Other practitioners feel that performing
both the surgery and the restoration within
one office is optimal for many patients.

8. Can any licensed dentist
legally perform implant surgery
or restoration?
Yes. However, education and experience is
critical. The dentist or dental specialist
should be questioned about his or her
training in implant therapy and in-office
implant experience.
A recommendation should be requested
from ones own dentist if he or she is not
involved in implant therapy
Another possibility is to talk to treated
patients of record and to referring dentists

8. Is it safe to have dental implant
surgery performed outside the
hospital, in an office-based facility?

Most cases are. Safety refers to the
nature of the procedure and the
medical andor anesthetic needs of
the patient

9. Am I too old or too frail for
implant-supported prostheses?
Dental Implant patients are of all ages
Dental implants may be the right choice for
anyone missing one or more teeth due to
injury, disease or decay.
Dental implants are especially practical for
patients who can no longer wear removable
prostheses.
Good health and adequate bone are the
most critical factors in evaluating implant
candidates

9. Am I too old or too frail? (1/2)
Dental implants cannot be placed when:
Vital anatomical structures can be
damaged
There is still active skeletal growth
There is active infection & inflammation
There are general surgical
contraindications
Systemic diseases are likely to
compromise the implant surgery

9. Am I too old or too frail? 2/2
Dental implants are more unpredictable if :
insufficient bone
insufficient space
Previous radiation therapy of head & neck
Skeletal discrepancies
Poor quality bone
Current or past history of drug/alcohol abuse
Extensive tobacco use
Poor oral hygiene
Severe tooth grinding or clenching

10. Do I have enough bone?

It is important for a patient to have
enough bone to support the implant.
If there is not enough bone, there are
many safe and effective ways to correct
bone deficiency.
A thorough clinical and radiological
examination will usually determine if it is
advisable to add additional bone material

11. What Do I Need to Do to
Prepare for Dental Implants?
As is the case for any surgery, it is best if
the patient is in good health.
Smoking and excessive drinking can
have a negative affect on the process,
and may cause dental implants to fail.
Many dentists will require that the patient
should quit smoking before beginning the
dental implant treatment process.

12. Are there alternatives to
dental implants?
Traditional dentistry can provide
replacements for missing teeth using
bridges, removable partials and
dentures; however, each of these has
its problems.
The dentist should describe all
reasonable alternatives before
proceeding to make a treatment
decision together as to what is best for
the patient.

Single tooth
lost

Etch-bridge Fixed bridge

Removable dental Implant-supported crown
prosthesis

Partially Edentate
Upper Jaw Front

Fixed bridge
Implant-supported FDP

Removable dental prosthesis

Partially Edentate
Lower Jaw Front

Fixed bridge


Partially Edentate
Upper Jaw

Fixed bridges


Partially Edentate
Lower Jaw

Fixed bridges


Removable denture

Edentate upper jaw

Fixed bridges

Implant-
Implant- supported
supported FDP RDP RDP
Removable denture

Edentate lower jaw

Implant-supported FDP Implant-supported RDP Removable denture

13. How Much Do Dental
implants Cost?
The cost of dental implants depends on the
type of implant received and the health of the
patient’s mouth, jaw and gums
The cost of implanting one tooth can be
anywhere between $1,600 to $5,000, and a
full mouth reconstruction can be as much as
$50,000.
Dental implants rarely fail, so the patient
doesn’t need to buy them twice.
Check with the dental insurance to see what
portion of the dental implant cost they may
cover

13. Are dental implants
expensive?
There is a greater initial investment for
dental implants compared to dentures
and partials.
They should last for years, particularly
if there are no anatomical hindrances
Independent surveys of implant
patients show that they felt the
investment was worth every penny
and would do it again.

14. What happens during the
treatment planning phase?

1. Prosthodontic assessment:
2. Surgical consultation:
3. Radiological assessment


Computer x-rays

15. What material are Dental
implants made of?
Titanium, titanium alloys or surfaces
that are coated with titanium are used
Pure titanium intended for medical
applications is used, which does not
cause any known intolerance reactions
or allergies.
Titanium is a very resistant material in
the body and is biologically inert
A decreasing number of dental implants
are made from calsium-phosphate

16. Is one dental implant
system better than the others?
There are many Health Canada & FDA
approved implant systems available to
Canadian dentists.
Many shapes, sizes and brands of
dental implants are available.
More than 80 different dental implant
manufacturers market about 250 dental
implant systems

(first stage) surgery?
1. A sedative for relaxation if desired
2. Patient will be awake and able to
communicate with the surgeon
(although drowsy if sedative is taken).

2. Patient will be awake and able to communicate with
the surgeon (although drowsy if sedative is taken).
3. A local anaesthetic is normally sufficient
4. Patient is covered with sterile drapes.

2. Patient will be awake and able to communicate with
the surgeon (although drowsy if sedative is taken).
5. An incision is made in the tissues
overlying the bone in the proposed
implant site(s)
6. The tissues are pulled back so that the
surgeon can gain access to the bone

2. Patient will be awake and able to communicate with the
surgeon (although drowsy if sedative is taken).
5. An incision is made in the tissues overlying the bone in the
proposed implant site(s)
6. The tissues are pulled back so that the surgeon can gain
access to the bone
7. Gently drilling of the site(s) for the dental
implant(s).
8. Placement of the implants in the prepared
sites
9. Suturing healing

18. Do I get my teeth
immediately after surgery?
The dentist will ensure that in the
interim healing period, the patient’s
look and feel is made natural.
Thus, the patient will normally never
need to be without teeth.
Check in case of referral to surgeon
specifically for implant surgery
whether interim teeth will be delivered
immediately following surgery.

19. Does it hurt afterwards?
Usually, discomfort is not a problem.
In fact, many have said that having a
tooth pulled was more painful.
For the placement of an implant(s), the
dentist will use one of many anesthetic
regimens so there won't be any
discomfort.
After the surgery, when leaving the
office, appropriate medications will
normally be provided.

20. Can I go to work after surgery?

For single implants, the recovery time
is often less than it would take to
recover from a regular tooth
extraction.


For placement of multiple implants
under an existing denture, recovery
may vary.
In very rare instances, it can take up
to a week before the patient is
comfortable enough to resume
normal activities.

For placement of multiple implants
under an existing denture, recovery
may vary.
In very rare instances, it can take up to a
week before the patient is comfortable
enough to resume normal activities.
It is advised to often cleanse the site
of surgery by vigorous rinsing and
swishing of warm salt water to
dislodge any debris clinging to the
sutures.

For placement of multiple implants under an
existing denture, recovery may vary.
In very rare instances, it can take up to a week
before the patient is comfortable enough to resume
normal activities.
It is advised to often cleanse the site of surgery by
vigorous rinsing and swishing of warm salt water to
dislodge any debris clinging to the sutures.
Liquid food for the first 2 days following
surgery and a soft diet for 10 days is
advisable while the gums are healing.
Eating hard foods during this period,
e.g. steak and nuts, is discouraged

21. Are there risk of
complications during surgery ?
Including, but not limited to, bleeding and bruising
Post-surgical pain Temporary speech problems
Delayed healing Post-surgical infection
Bone fracture Loss of bony ridge
Osteomyelitis Damage to opposing dentition
Chronic pain Local or systemic infection
Abscess Fistula to nose or sinus
Sequestrum Haematoma
Gingivitis Transient or permanent damage
to the nerves in the jaw

22. What’s the difference between
“one-” and “two-stage” surgery?
Two surgical procedures techniques are used:
Single stage technique
The dental implant is inserted and remain
exposed in the mouth

Two stage technique
One-stage surgery:
The dental implant is inserted and covered
over to not be exposed in the mouth
Two-stage surgery:
The dental implant is uncovered and
exposed in the mouth

restorative treatment phase?

24. How long does it take before
I get my teeth?
This depends on the type of dental
restoration required - usually it takes
around 4-12 weeks.
Treatment time can vary greatly. Each
situation needs a separate evaluation

25. What will it feel like when it
is done?
Once the entire procedure is complete
and the final restorations placed, an
implant supported fixed dental
prosthesis will actually feel or function
like natural teeth.

26. Risks and Discomforts
following treatment
For the last ten years, success rates at
many treatment centers are
consistently over 90% with proper
personal and professional care.
Few forms of medical, orthopedic or
dental treatment have such high
success rates.

following treatment
Failure of the implant or attached restorative
work
This might require removal of an implant(s),
remaking part of the dental restoration, or
constructing an alternative prosthetic appliance
to replace the missing teeth.

following treatment
Failure of the implant or attached restorative
work
This might require removal of an implant(s), remaking
part of the dental restoration, or constructing an
alternative prosthetic appliance to replace the missing
teeth.
If an implant has to be removed (“explanted”), a
local anaesthetic is administered.
The implant is subsequently removed with the aid
of a drill which fits over the implant

following treatment
Failure of the implant or attached restorative work
This might require removal of an implant(s), remaking
part of the dental restoration, or constructing an
alternative prosthetic appliance to replace the missing
teeth.
If an implant has to be removed (“explanted”), a local
anaesthetic is administered.
The implant is subsequently removed with the aid of a
drill which fits over the implant
Depending on circumstances, another implant
may be placed after 3 months healing

following treatment

Perfect result

Opacity (due to Exposed implant
misalignment)

Adjacent tooth
Gum inflammation damage

27. How long do dental implants
last?
As a general rule it can be said that the
better care the patient takes of the mouth
and teeth, the longer the implants will last.
Given correct oral hygiene and regular
check-ups by a dentist (known as recalls),
dental implants can last for decades.
If properly followed up, one should expect
implants to last for 10 years, but there are
patients who have had solid dental implants
for 35 years.

28. How do I take care of my
implants?
Normal routine home care and
professional cleaning visits are advised.
Most dentists will offer special training
and professional dental cleaning.
Taking care of ones teeth nevertheless
has a major influence on the long-term
success of the dental implants.

28. How do I take care of my
implants?
Patients should have a routine cleaning
and re-care treatment and evaluation
regularly – varying between 4 to 12 months
depending on treatment.
An individualized program is usually
designed for the patient to optimally care
for their new teeth

Bottom line….
Dental implants are an effective,
safe and predictable solution to
the problems resulting from
missing teeth.

Thank you for your
kind attention

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