Sinus Lift Surgery

A key to implant success is the quantity and quality of the bone where the implant is to be placed. Missing upper back teeth are among the most difficult to restore.    When the back teeth in the upper jaw are missing the sinus cavity becomes larger as the natural bone deteriorates over time.  If you’ve lost bone in that area due to reasons such as periodontal disease or tooth loss, you may be left without enough bone to place implants.

A sinus lift, also called sinus augmentation or sinus elevation, is a bone –augmentation procedure for patients who have insufficient natural bone below the sinus so that one or more implants can be placed. Sinus lift surgery can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants. Several techniques can be used to raise the sinus and allow for new bone to form. In one common technique, an incision is made to expose the bone. Then a small circle is cut into the bone. This bony piece is lifted into the sinus cavity, much like a trap door, and the space underneath is filled with bone graft material. This can regenerate lost bone and tissue. Finally, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about four to 12 months before implants can be placed. After the implants are placed, an additional healing period is required. In some cases, the implant can be placed at the same time the sinus is augmented.

3D scan imaging often is incorporated into the sinus lift and implant process. This advanced imaging shows us the height and width of bone and the location of the maxillary sinus.3D imaging allows us to map out the details of existing structure and perform the sinus lift with the greatest amount of precision.

The procedure does not affect speech, intonation or cause sinus problems. Many patients experience minimal discomfort during this procedure. Undergoing sinus lift surgery has been shown to greatly increase your chances for successful implants that can last for years to come.

by Dr. Nadia Abazarnia, DDS

 

Implant Bridge

by Dr. O. Karnakova

An implant bridge may be a good option to replace multiple missing teeth, and are far superior to removable partials or multiple tooth supported bridges. An implant bridge is very similar to a normal bridge, in which there are abutments and a pontic. They also offer many advantages such as stopping bone resorption, preserving adjacent teeth, and act and feel like natural teeth. Implant bridges also require hygiene similar to that of a normal bridge, and have a much greater long term prognosis when compared to multiple tooth bridges.

In the past, implants were bridged to natural teeth and are now not recommended.  Research has shown bridging an implant to a natural tooth can cause many complications and decrease its prognosis. Natural teeth are connected to the bone via ligaments while implants are integrated directly into the bone.  The ligaments on natural act as a cushion and provide slight mobility. The difference in resilience between the natural tooth and implant can cause fractures of the tooth, failure of the bridge, and mobility of the implant. It is highly recommended to instead place multiple implants with single crowns.

Generally, there are two types of abutments for implants. Stock (pre-fabricated) abutments are manufactured by the company, but may not fit properly to the contour of the gums. Custom abutments are made by the dental laboratory. An impression is taken of the implant and surrounding gums. A custom abutment will offer a perfect fit of the crown and will better resemble a natural tooth.

Replacing Missing Teeth with Implant

by Dr. J. Slaven

Implants have become the standard of care for the replacement of missing teeth. Prior to this development, our choices for replacing missing teeth were fixed bridges or removable partial dentures.

Replacing missing teeth with fixed bridges involves preparing the teeth on each side of the missing teeth for crowns, which are attached to the artificial tooth replacement as one piece that is cemented to the prepared teeth. While this is still an acceptable treatment it has the downside of doing a procedure on two good teeth and turning a one tooth problem into a multiple tooth problem.  Every time a tooth is subjected to a procedure that involves removal of tooth structure its living part, the pulp, becomes inflamed, and it never recovers from this 100%, which can lead to problems such as the need for root canal therapy in the future.  The happiest tooth is one that has not been drilled or ground down, which the teeth supporting a bridge have been.

If there are not teeth on either side of the missing tooth or teeth the non implant option is a removable partial denture.  This also has problems associated with it.  The clips or clasps that hold the partial denture to the supporting teeth put unnatural pressures on these teeth because even the best fitting partial denture will move slightly when chewing.  This can damage the gums and bone around the supporting teeth over time.  I liken this to what happens when you rock a fence post.  Partial dentures require meticulous oral hygiene to prevent decay or gum infection of the supporting teeth.  The clasps create what I call the perfect English Muffin full of nooks and crannies that trap food and allow plaque accumulation.  Although a partial denture is  still considered an acceptable option for replacement of missing teeth, the patient must understand its limitations.

The limitations of both fixed bridges and partial dentures that I have explained do not apply to replacement of teeth with implants.  Implants provide permanent tooth replacement that is as close as we can get to your own natural tooth and are the better choice.

History of Implants

By Dr. H. Kopel

Thousands of years ago teeth were replaced with bamboo, copper and iron implants. Even animal teeth and tooth shaped sea shells have been attempted as implants. Of course none of these ancient solutions were successful. In the 1800’s gold was tried too, but never successfully as the body would always reject these foreign substances.

In the mid 1900’s titanium was discovered to possess the properties that allowed the bone to fuse to it allowing Dr. Branemark to successfully place the first modern dental implant in 1965. Over the last few decades much research has been done regarding dental implants. Experimentation in shape and surface coating for the modern titanium implant has resulted in our current implants which are very predictable and well integrated into the jaw bones.

Implants are now considered the standard of care for replacing missing or badly damaged teeth. In the past when tooth extraction was necessary removable appliances or drilling down perfectly good teeth to make fixed bridges would be required for tooth replacement. Today’s implants allow us to provide strong, long lasting solutions to replace missing teeth for our patients.