Single tooth implants can be brushed and flossed just like normal teeth. When two or more implants are tied together, special implements will be needed for daily cleaning. Bridge threaders are plastic needles that floss is threaded through the eye of the needle. The threader is passed under the bridgework, then the floss can be manipulated normally after that. Tiny brushes that look like baby bottle brushes are attached to handles and are a great way to get between teeth in areas that are accessible. A water pik can be used to clean food particles out from underneath a denture or bridge. It is important to use it on a low setting in order not to cause any damage to the gums that surround the implants. A water pik is not strong enough to clean plaque so a brush and floss is still mandatory. When a professional cleaning is done, it is important to let the dental hygienist know that you have dental implants. Special titanium cleaning instruments are necessary. Use of dissimilar metals can cause corrosion of the titanium implant surface. With proper home care, implants can last for many years.
Once an implant has had time to heal and an abutment (the metal post that protrudes through the gums) has been placed, it is now time to make the implant look and function like a tooth. Depending on how many teeth need to be replaced and how many implants are present will determine how the area will be restored. For a single tooth, it’s just a matter of constructing a conventional crown (cap). For a section of missing teeth, a row of teeth can be made and screwed into the abutments. For patients who are needing all of their teeth in a particular arch (upper or lower) replaced, there are a number of options available. If two implants are placed, then the abutments can be placed that have little balls that look like trailer hitches. Then “O” rings are placed inside the denture to allow it to snap onto the implant abutments. Although this setup doesn’t hold the denture in rigidly, it does keep it from shifting laterally, greatly improving function. If four or more abutments are present, then special clips can be placed in the denture that can hold the denture in fairly firmly. The denture can then be unclipped to allow for easy cleaning underneath. The other alternative is to screw the denture directly to the abutments. This way, the denture is rigidly held in place and is as close to having one’s natural teeth.
Once an implant has healed for a few months it is ready to restore. The implant has healed undisturbed for a number of months under the gums. At this point, the implant must be uncovered. It’s a simple procedure that can be done under a local anesthetic and results in only minimal gum soreness that can be eased with an anti-inflammatory such as ibuprofen. A healing cap is placed over the exposed implant so that the gums can heal around the area. Now it’s time to choose an abutment. An abutment is a post that attaches to the implant and protrudes through the gums. This provides a platform for a crown (cap) to be attached to the implant. If the implant was able to be placed in the bone relatively straight compared to the adjacent teeth, then a standard abutment can be placed on the same day. Otherwise, an impression (mold) of the mouth must be taken and a custom abutment would need to be constructed at a lab. The abutment is placed by tightening a screw to a specified torque. The implant is now ready to restore into a new tooth.
Dental implants need a minimum amount of bone to be sturdy enough to handle the stresses of biting and chewing. For those patients who lack adequate bone in areas where they have lost teeth, not all hope is lost. We now have very successful bone grafting techniques that can add enough bone to allow placement of an implant. In the back of the upper arch lies the maxillary sinus. It is not unusual to be short of bone in this area. A technique is now available where a small window of bone is removed and the membrane that lines the sinus cavity is raised up and bone graft material is placed in the resulting space. After a few months, new bone will grow in replacing the graft material. Then, the area is good to go for placing an implant. On a front teeth, when a tooth is removed, the bone tends to sink in when it heals. This makes it difficult at best to get a good cosmetic result around the gum line. By cutting out a block of cortical bone (the smooth hard bone on the outside of the jaw) from far back in the jaw bone and placing it over the defect, the sunken area can be corrected within a few months and will be ready to place the implant.