Traditionally implants are placed in the jaw after complete bone healing following extraction of the tooth or teeth. An incision is made in the gum tissue and the implant site is prepared to receive the implant. The implant is placed very carefully according to a predetermined restorative plan. This is very important. The implant must be placed to best support the tooth or prosthesis in a healthy bite. The incision is closed with sutures and allowed to heal for a period of 2-6 months (depending on the case). After appropriate healing, the implant cover is gently exposed and a component called a healing abutment is connected. The healing abutment is a transitional component that is only worn during the period following implant exposure and before prosthesis delivery. This is usually 2-4 weeks. An impression is made during this time and the ﬁnal abutment and crown is fabricated at the lab. Single crowns and short span bridges (or FPDs) made to ﬁt on implants are very similar to crowns and bridges made to ﬁt on natural teeth. The ﬁnal abutment which connects the crown to the implant is a custom component which is contoured speciﬁcally for each individual case to optimize soft tissue health, esthetics and stability. The abutment may be cast from a high noble, hypoallergenic alloy or milled from titanium or zirconia.
Sometimes it is advantageous to place the implant immediately at the time tooth extraction. Dr. Hall only advocates this technique for single rooted teeth (mainly incisors, canines and some premolars). In sites that are acceptable this can improve the esthetic outcome. Bone and soft tissue respond differently to implants and implant prostheses than they do to natural teeth. Understanding these differences and sound diagnosis is critical to achieving acceptable esthetic outcomes on implant supported prostheses in the smile.
Implants provide a number of beneﬁts in tooth replacement. In the replacement of a single tooth, they do not require the preparation of adjacent teeth as a bridge/FPD would. Similarly, to replace a tooth with a natural bridge, teeth have to be on either side of the missing tooth space. This is not the case when replacing the terminal or last tooth in the arch. An implant is the ideal solution in that scenario. Single implant supported crowns can be ﬂossed just like natural teeth. The stimulation or loading that an implant provides to bone can help maintain that bone volume. Sites where teeth are extracted and no implant is placed most often show continued boney resorption over time.
While not every patient is an implant candidate, there are few absolute contraindications to implant placement. Overall systemic health is important. Patients who have compromised immune systems or have conditions or take medicines which affect bone healing are generally not candidates for implant placement. Smoking is not an absolute contraindication for implant placement, but patients are advised that the implant failure rate is higher if they smoke.
In sites where signiﬁcant bone loss has occurred due to tooth loss, bone grafting to augment the existing bone volume can make implant placement possible.
A thorough diagnostic work up will provide the framework for the decisions that you and Dr. Hall make together in determining which treatment choice is right for you.
When you schedule an appointment, that time will be reserved especially for you. We recognize that your time is valuable and strive to minimize your wait.