Dental Implants in Raleigh, NC
Dental implants, artificial roots and teeth (usually made of titanium) surgically positioned into the upper or lower jawbone, look very natural and enhance or restore a patient’s smile. They replace missing teeth and provide a fixed solution to partial or complete dentures. Occasionally, normal wear and tear requires implants to be re-tightened or replaced, but most dental implants are very stable, strong, and durable for many years.
What does getting dental implants involve?
Dental implants require a number of visits over the span of several months in order to be properly placed. The process involves an initial surgery to create molds of the bone, gum tissue, and teeth spacing as well as, if necessary, placing “posts” to hold the artificial teeth. After a few weeks of rest, the artificial teeth are fitted in one or more fitting sessions that can span up to two months.
Following one more healing period, the artificial teeth are permanently installed.
Once the dental implant treatment is finished, we will give further care instructions to properly care for your implant. As with any dental treatment, proper oral hygiene, good eating habits, and regular dental visits will all aid the life of your implant as well as overall good oral health.
What are the benefits of dental implants?
One of the greatest benefits of dental implants is the natural appearance they offer. If you undergo a dental implant procedure, your friends and family won’t know you have dental implants unless you tell them. Implants will brighten up your smile in a natural way while helping you maintain the shape of your face so you can look your very best.
In addition to looking natural, dental implants function just like your original teeth. As long as you brush and floss your teeth daily, they will continue to be in good shape. Also, since dental implants are permanently inserted into your mouth, you won’t have to worry about them falling. You’ll be able to eat whatever you wish.
Dental implants offer health benefits as well as aesthetic and lifestyle benefits. By getting dental implants, you can protect your jawbone and keep it from weakening and compromising the strength of the other teeth in your mouth. Implants can prevent you from losing more teeth and save your existing natural teeth because these teeth will not have to be changed in any way in order for implants to be placed.
Lastly, dental implants offer financial benefits. Unlike bridges and other teeth replacement techniques, they last a lifetime. With dental implants, you won’t have to spend more money down the road on replacing your teeth. They are considered the ideal, long-term teeth replacement solution and more dependable than other methods.
As you can see, dental implants offer a wide array of unique benefits that you may not be able to enjoy with other tooth restoration methods. If you are looking for a dentist or oral surgeon that offers Dental Implants in Raleigh, North Carolina, look no further than Wells Family Dental Group.
Everything You Want to Know About Dental Implants
You can watch a full lecture on Dental Implants here.
Everything you wanna know about dental implants. This is exciting. Dental implants are a marvelous, marvelous way to replace missing teeth. These are all the different types of models and everything dental implants.
But let’s get to the basics. Dental Implants. There are many different types of dental implants. There’s a company called 3i. Their implants are designed for hard bone. Coated, tapered, and they have what’s called a bio-reaction. Hard bone. What is hard bone called? Cortable bone. You got the “c” right.
Straumann Implants are more for softer bone, more cancellous bone. It is covered with CAL, which is designed to have better attachment. It’s on the outside of the implant. We’ll get into what CAL is a little later on.
Let’s talk about the parts of a dental implant. This is what’s very important. Here we have the dental implant. These are the threads. When a dental implant is placed into the bone, it takes three months for the bone to mature and go in between all these threads. And then once that three months is done, the surgeon will take a picture, an x-ray of this in the bone, and decide if it’s ready to have the abutment put on. The abutment is the second part. The abutment gets screwed into the implant. I’ll show you a picture of that. And the third part is the crown.
These are different types of dental implants. I’m gonna be passing around a bag. These are Straumann implants. They’re many different types. Don’t take them out of the bag. Just look and pass it over. There are many different types of implants depending what the patient needs. Now let’s take this implant here. What is the difference, do you see here, to this one? This is a bone level to implant. The surgeon may decide to use this one because the patient’s bone may be in an anterior area where they don’t want too much of the metal showing. Are you guys grading your test, or are you watching the lecture? We have a test on this next week.
This is more of a posterior area. It’s got a higher … this is called a profile. The reason for a higher profile is … Let’s take number 30 whose lost. It has big defect on it. So a surgeon will place this because, if this is a big defect this could go down deeper into the bone, opposed to this. This, the whole crown would be underneath the gum. How does this affect us? That’s a good question. Thank you for asking. This affects us because we gotta clean these guys. When this is sticking out of the gum, the gum is basically up here. Remember when I said most dental implants poke? They poke three, they poke five, they poke six. That’s not because they lost bone. That’s because of the profile that’s coming out of the gum. That’s the reason. Because the crown is on top of here and this is all underneath the gum. So the gum cannot attach that. That’s why you have a pocket.
This is the different types of dental implants. This one is a tapered one. This is a conventional one. This is a flat bottom one. This one they don’t use anymore. This used to be called SL coated. They no longer use this. They no longer use this one. But they still use this one. So there are many different types. So when you look at the x-rays of your patients, you’re gonna say, “Wow, that’s different from Mrs. Jones’ implant. That’s very different.”
Standard dimension implant. These are standard. When implants came out in the 80s, they were one size. One size fits all. Well not anybody’s jaw is one size fits all. Some jaws are narrow. Some jaws are wide. Some have the mandibular canal is short. Some of it is long. There’s many different types. So people that were not candidates years ago for dental implants are now candidates because there are so many different kinds.
This is a standard, generalized implant. It’s 4.41mm and it’s a straight wall. See how it comes straight down into the bone? This may be used in an anterior area. It adapts easily to the bone. But we have many different kinds.
Straumann makes an implant, when you go to the conference, for those of you next year … I don’t know if you’re going to the Yankee Conference. You guys going to Yankee? In January? Alright. Go to the implant booths. Go to Straumann and go to 3i. There’s thousands of implant booths, but go to these two. Let them show you under the microscope what this coating is. Look at this coating. This coating is on the screws. You remember the threads that I showed you? This coating is on that. The reason this coating is there is it creates a rough surface. Why would we want a rough surface? Anyone? The bone attaches. You could get better attachment because all these little honeycombs, the bone could grow right into those little honeycombs. And it does. And it makes it more secure.
Coating on implants improves the adhesion to the bone and the healing. Let’s look at these. This is an old implant. This woman’s name is Mary, a patient of mine. This is an old one from the 80s. Look at all the bone loss. This is called an SA coated implanted. This is HA coated. Sorry. The other one I said. HA coated. Patients who have this are failing. The main reason is they did not have the screw-like threads. See how straight it is? This little area, the bone has nothing to adhere to other than this little nut that’s on top. So you’re gonna see many patients in the clinic with these type of implants because these implants were placed in the 80s and early 90s. In 2000 we went to screw type implants.
These are just some more different types. The rougher the surface of the implant, the more adhesion you will have to the implant. A is just straight titanium. They really don’t use that because, even though the threads are there, it’s too smooth. B is slightly etched, but not a tremendous amount. When it gets to be very rough, and the HA coated ones with the threads, those are the ones that are used today.
Tapered are a Godsend to dentistry. If you have a patient that loses a tooth between six and eight, say they lose seven, we all know what seven looks like. It’s a very narrow space. A lot of people couldn’t have a dental implant placed in there because the space was too narrow. Then came tapered implants. They come tapered at the end, similar to a root. So now these people that couldn’t have implants before because the space was too narrow, now could have dental implants because it fits. They range in all different sizes from a wide 4mm to a 2mm. They could be used in close root proximity. Here’s a tapered screw.
As you could see here, they’re trying to avoid the sinus here. They didn’t wanna do a sinus cleft on this patient. So they put this tapered screw implant in here. If they put a wide one, what would happen? It’d go right in the sinus. See here? They used this profile to get it in.
Wide body. Another God’s gift. It’s used in the maxillary because you avoid a sinus cleft. These are phenomenal when you have mandibular nerves that are very … you have a lot of bone loss, you have a very thin canal. You’ll see this short, squatty implant. You may say to yourself, “What the heck is that?” Compared to the longer implant next to it. This is called a wide body. It comes in many different dimensions.
How we place an implant. The tooth is extracted and a bone graft is placed and a membrane is placed on top of the bone. When we go into the surgical PowerPoint, you’ll see a membrane is placed because we don’t the epithelial tissue to close over first. Do you remember when you did, was it head and neck? Where did you learn about primary closure, secondary closure? Was it first year Perio? No. Okay then let’s learn about primary closure, secondary closure.
Primary closure. When a tooth is extracted or something is … You wanna prevent the epithelial cells from migrating in. Epithelial cells are the first thing that want to come in. The epithelial cells are the gingiva. It grows in. When the epithelial cells migrate into a socket or an area that’s extracted, what happens is bone won’t grow. So is that what we want? No. So we put a membrane on top of the extraction site. I’ll show you a picture in a little bit of what the membrane is. There’s two types of membranes that can be removed and the kind that can stay. They dissolve.
After three months the bone matures on a healthy patient. After three months the bone matures and it’s ready for the implant to be placed. Sometimes the implant could be placed immediately. Those are very lucky people. If you extract number, let’s say number 15. And the roots are really wide, you can go right in between where the roots were. There’s enough bone to place. So sometimes it could be done immediately. Okay so let’s see if this works. Cross our fingers. Okay it doesn’t look like it’s working. Didn’t we just do this with … Okay forget about that. We’ll go to the next one. They’re having some kind of problem. I think they need new audio-visual … Okay next one.
This is what a dental implant looks like. This is the part that gets screwed into the … this is a wide body. This is the part that gets screwed into the bone. You never tell a patient, “Oh by the way, we’re placing the screw in your mouth.” You say, “We’re replacing the root.” Okay? Because you’re replacing the root, not a screw. Inside the dental implant, here on this big dental implant, it’s hollow. So when this dental implant is placed into the bone, my hand being the bone, it sits like this inside the bone. Then to close the top, because it’s hollow inside, the dentist puts … they gave me a little screwdriver … he puts in the cover screw. And that seals it. Sometimes this is placed and gum is closed on top of it. The term is “put the bed to three months.” So when he puts the bed to three months the bone is growing all through these screws and it’s having fun in there and it’s osseointegrating. That’s the term.
Three months goes by. Dentis says, “You’re ready to have a crown put on top.” Patient jumps up and cheers, they’re so happy. Now, this is in here. This part is here. They gotta put the middle part in. The middle has to go in. That is called the abutment. The abutment goes in and the dentist screws … this is done by the general dentist. He or she screws this in. The abutment. See that? That’s the second part. That’s this part that’s sticking in the middle of the implant. This is just cutting it in half so you could see what’s inside.
Don’t you need uncovering first?
Yeah. The surgeon just pops over the top and puts a healing cap on top. But it’s a big procedure. It’s a small one. The bigger one is this. Comes in. It’s custom fitted to go inside each implant. Then the dentist makes the crown that goes on top of the abutment. And that gets cemented. And that’s where the problems begin. Remember when we talked about when they don’t put enough or when they put too much cement? And the cement, they develop peri implantitis and mucositis? That’s what it’s from, when the crown goes on top of here. So I’ll pass the big implant around so you can see the big implant.
I posted it on Sunday. It’s not open? Alright. I’ll check. I’ll post them again. Alright. Let’s see if this one works. No. Okay, we’re doing well here.
What the two slides that didn’t show is you may come across a patient that has multiple implants and has a bar that connects them. The bar that connects is where the denture locks on top. So if a patient has … It used to be that say there were hooks, clearly had no teeth on the bottom. It used to be that they wanted eight implants to go on the bottom so that the bar could snap on it. They’ve changed it now. With the strength of the titanium and the different types of implants, you could do as little as two if the patient’s got a really bad bruxism.
This comes in great when someone doesn’t have a lot of jaw bone, that they could place two implants and then have the dentures snap right inside of it. They told me that the PowerPoints didn’t come up, so I’m gonna put it on. Hopefully, you can open it on your own. This worked in the other classroom when I tested it and …
It only shows the Exam 2. That’s the last thing that shows up.
Okay. Maybe it just didn’t open. I’ll check it. So the bar. When the bar is placed, you have to clean under the bar. The bar is hard to clean under. Has anyone seen the bar in clinic yet?
Bar. That connects the dental implants. No. Okay. Hopefully, we can get that PowerPoint up. Yes, Tony.
Can you explain?
I’ll explain this one. This is a new kind that they’re using. It’s really great, but it’s very difficult for a patient. What this is is this mouthpiece in the middle is the bar. And the bar has a hole that goes through it. So the implant is placed, the abutment goes in, and it has this bar that comes on top. This is the denture. It’s got a pushpin. If the patient goes on the outside, pushes it in, and pushes it in, and then they have to take it out. And they give them this little thing that looks like a paperclip and they’re in there thinking, “Oh my God, I hate these things.” And it’s very difficult for the patient to get out. So they use this instead of using the type that sits on top of the implant.
Say this was the implant. The denture would come on top and it’s got like an O-ring that secures the denture for you. You’ve seen those? Has anybody seen the denture locator yet? In clinic? How about in private practice? No. Okay. These locators go inside the denture and they snap, and they’re really tight. Except never put them in an Ultrasonic because the little rubber gaskets come off. And the patients are not happy when they leave and they can’t get them out. So if you want to clean that denture, you just brush that denture. You can tell the difference because they’re usually green, red, blue, orange. They come in all different colors and when you turn the denture over you see these little holes. Okay? So this is just a new kind of bore-like mechanics that they’re using.
Let’s see if this one works. Okay. Oh yeah. This one does. Good. We got one to work. This is when we say, “Why should a patient have implants? Why?” Let’s do a bridge on this person. So let’s compare. Both of these patients lost number nine. Terrible. They both lost number nine. The patient to the left decides, “I’m gonna do a bridge.” And the patient to the right says, “I’m gonna do a dental implant.” The patient on the left is having everything prepped. Then we do the bridge, and now the implant crown is in. That’s bone. There’s no gingiva, so you see the little silver part on top of the dental implant.
Now the dentist is gonna prep the other decent teeth for the bridge. Let’s go back one. Those were virgin teeth. Number 10 and number eight, they don’t have crowns on them. So now the dentist is gonna prep number eight and number 10. He’s breaking them down. Or she. He she. They’re gonna place the bridge on top, cement that bridge, and the patient has the hole in the front. When the patient smiles sometimes you see that and it’s not always very attractive. But time goes by and we look at both of them, and we say, “Oh, they’re both not bad. Very similar.”
Time goes by and the gum starts to erode away because it’s got no support. It’s got nothing to build upon. So now you have this big gaping hole. When the patient smiles, you see this face. Uh oh. There’s a cavity on number eight. Got a PAP on number eight. That’s big. Oh boy, that’s ugly. Not it’s got an infection. It’s got a fistula. So now let’s look. We got a gaping hole where number nine was, and we have a fistula and a cavity. And the implant still looks great. Oh boy. Now it breaks. So now we’re in a situation where we’re gonna make a bigger bridge. And let say this patient’s a bruxxer. Now we have missing number eight, number nine’s missing, and we have two skinny little teeth, number seven and number 10, holding this bridge in place. That’s what it looks like. Isn’t it beautiful?
Let’s look at the difference. Uh oh. Patient bruxed a little too hard. Fractured that tooth. Now they lose their tooth. Here comes a bigger bridge. This becomes even more of a nightmare. Let’s compare it to the other side. So you see the difference? Patient says to you, “I can’t afford a dental implant. My insurance is not gonna cover a dental implant.” Well, your insurance may not cover the placement of the implant, but your insurance will definitely cover the crown that goes on top of the implant. So what costs more money? Financially. How many times did he change that bridge? Three times. And what happened to the one implant? Still there.
You see the difference? So when a patient says to you, “Oh my God, I can’t afford it” I want you to remember this slide. Because this slide’s very important because they damaged two virgin teeth to make one virgin at first. Where they could’ve just placed one implant and that would’ve been it. I know finances are always the thing. I understand that. It is a major thing. I’m not everybody. Where I work is a very affluent area and people come in and they have multiple implants. I understand, but we still have people that can’t afford it. There are dental schools that perform this procedure. There are other avenues where you recommend someone, if they have a complicated mouth you go to a peri implantologist. But there are other avenues that can go if they do a little research to find out different avenues.
What happens when someone does an implant?
Yes, that’s a good question. When an implant fails, then you have to do the whole procedure all over again. You have to put bone. They have to get a little flipper to cover the area. Then you have to put bone in. Then you have to wait three months. And then after the three months go by, then another implant is placed. Then you have to do a new crown because that original crown no longer fits. So you have to repeat that whole process all over again. Yes.
What factors would make the body reject the …
Implant? Bodies generally don’t reject it. Titanium is a very stable metal in our body. Titanium is used for hips, it’s used for joints, it’s used for places. Generally it doesn’t reject. What it does do though is develops peri implantitis from periodontal disease. If you’re replacing a tooth that had severe periodontal disease, what makes you think that that implant’s not susceptible to periodontal disease? It’s susceptible to the same bacterias that it was. So that’s where we have to teach them how to take care of it. Home care, and we gotta take good care of it.
Every one. Now this is another implant company. I just want you to watch this video because this is a very important video because it shows how to place an implant. They’re placing a five by two implant. And it’s not boring. Couldn’t find a non-boring one. This is it. The flap is being prepared. That means they’re separating the tissue. They’re cutting the gum tissue and they’re gonna come in with an instrument called a periosteal elevator that’s gonna separate the tissue and expose the bone. Well they didn’t show it, but that’s what they did. It just doesn’t go like that.
Now I’m gonna choose the drill. There are multiple size drills for multiple different types of implants. All those implants you see had different size drill bits. We’ll start with the smallest and work our way to the largest. This takes a lot of planning. Don’t just walk in for a dental implant. Okay so we’re gonna choose what size implant we’re gonna use. Now we’re gonna choose what size drill. This is called a pilot drill. It’s gonna go in and it’s gonna make a small hole. It’s markings. Each one of those are millimeters. What do they look like? Periodontal probe.
Now we’re gonna come with the first drill. It’s gonna go down to a certain height. We’ve taking x-rays. We’ve taken scans, and we decide now, this pilot drill we’re gonna use. See the different size implants? See the different size lines. That’s how deep we’re gonna drill. Now we take a reading and we take an x-ray. This measures how deep we are, if we’re near the nerve, we’re near the sinus, where we’re near. Now we’re gonna make that hole just a little bit bigger. We just increased from 2mm to 2.8. So it’s a little wider. Now we’re gonna go even a little wider. This is all being done with constant flows of water. The reason is this is hot. This drill is hot. We don’t wanna cause what’s called necrosis of the bone. If heat hits bone it causes necrosis. So this is going on and water is being constantly flowed to the drill bit.
Because it cancels bone. You don’t want too much bone to chip away on the inside. It’s only spongy bone. It’s not solid. We don’t wanna lose and we don’t wanna cause any necrosis of the bone. So now we’re gonna go with the final drill bit. Now we got the hole exactly the size. It’s a half a millimeter. This is just gonna prepare the crestal part. What it’s doing is it’s creating like a shelf. So when the implant …