Dental Implants

Within the field of dentistry and oral surgery, dental implants are arguably the most significant innovation in the last 50 years, providing patients with permanent replacements for their missing teeth.

The only true surgical specialty within the field of dentistry is oral and maxillofacial surgery. Implant placement is a surgical procedure. Dr. Robert M. Dolman is a board certified oral surgeon who has had extensive training and experience in implant surgery. The single most important factor in the success of your implant treatment is the surgeon rendering your care.

For anyone with one or several missing teeth, dental implants have become important options to anchor and support new teeth that resemble the missing ones.

What Are Dental Implants?

Simply put, dental implants are titanium screws that are gently inserted into the jaw bone, where they serve as permanent, solid anchors for new teeth. These teeth provide patients with the comfort, function and esthetics similar to their own original teeth.

Who Can Benefit From Dental Implants?

Dental implants are the most solid and longest lasting treatment option for individuals who are missing one, many or all of their teeth. Two general patient categories exist:

• Patients that are missing all of their teeth in either the upper and/or lower jaw (complete edentulism) and therefore must wear complete upper and/or lower dentures, or
• Patients that are missing a single tooth or several teeth, but not all teeth (partial edentulism).

Patients With Complete Edentulism (Missing All Teeth)

Patients who wear complete dentures will often complain that their denture(s) is loose, or that they have pressure or sore spots in their mouth.

This tends to get worse with time because the bone beneath the dentures resorbs and the dentures become less retentive and loose.

These patients can really benefit from implants in a dramatic manner because the implants can reduce denture mobility and may even eliminate it completely, at the same time reducing or eliminating all sore spots or irritations.

Treatment options include:

• 2-4 implants with retentive anchors (locator abutments) that allow the dentures to snap into place.
• 5+ implants that allow for a denture or porcelain metal prosthesis to be screwed into the implants or cemented on the implants which creates a completely fixed result that cannot be removed.
• “All on 4” is a treatment method that in select cases allows for the restoration of a full dentition on 4 implants.

Patients With Partial Edentulism (Missing Some Teeth)

Patients that are just missing a single or a few teeth, have the following treatment options:

• Partial Denture: Partial dentures have the advantage of replacing many teeth with one single prosthesis with very quick results. The disadvantages however are the fact that a partial denture is removable, needs to be taken out at night, may become loose, can be unesthetic with the visibility of clasps or hooks on the remaining teeth, and can be uncomfortable.
• Conventional Crown and Bridge Work: If the position of the remaining teeth allows, then crown and bridge work may be a possible solution for the replacement of missing teeth. This also tends to be a fast and stable solution. However, in order to fabricate a bridge, the adjacent teeth need to be prepared (filed down), and often a root canal is required as well. Additionally, with the teeth fused together, they become more difficult to clean and are more susceptible to periodontal disease. Moreover, should any of the anchoring teeth require future extraction, then the bridge may be lost.
• Dental Implants: An implant can be placed in the location of each missing tooth, either a single tooth or several missing teeth. Often, a few implants can be used to act as anchors for many missing teeth. Implants preserve the adjacent natural teeth and leave them in an unused, unharmed condition. Should any treatment be required on these adjacent teeth, the implant can remain freestanding and untouched. Moreover, the implant will preserve the bone volume. Implant-supported teeth are easier to clean because they stand alone and dental floss can easily be slipped alongside, exactly like a natural tooth. A successful implant will outlast all other treatments.

Requirements For Dental Implants

Regardless of the number of missing teeth, the minimum requirement for the placement of a dental implant is the availability of sufficient bone height and bone thickness in an anatomically appropriate location.

At Dolman Oral Surgery, Dr. Robert M. Dolman will combine a thorough clinical examination together with the required radiographic images. Our onsite I-Cat CT scanner will be used when indicated to determine bone availability and to assist in the precise placement of the implant.

Contraindications For Dental Implants

There are few situations when implant surgery is not appropriate. An absolute contraindication for implant placement would be the lack of bone volume. Bone grafting and augmentation procedures would therefore be required in preparation for the placement of dental implants.

Although smoking is not a contraindication to implant treatment, it is a known compromising factor and success rates have been shown to fall by 30%.

Additionally, certain immuno-compromised patients may not be candidates for implant surgery. Moreover, patients on bisphosphonates (drugs used to treat bone loss and osteoporosis) would require additional work up, testing and evaluation with the potential for treatment determined on a case by case basis.

Certainly, each case and case history will be closely evaluated by Dr. Robert M. Dolman to make sure that there is no specific contraindication for your implant surgery.

The Team Approach Towards Dental Implants

Implant placement is a surgical procedure. By choosing Dolman Oral Surgery, you are choosing to have your treatment rendered by a board-certified oral and maxillofacial surgeon with extensive clinical experience.

The surgeon however is only part of an implant team. While the oral surgeon places the implants, it is the restorative dentist that will subsequently place teeth on top of the implants. This approach gives patients the true benefit of specialty care and optimal results.

Sequence of Treatment

Step 1: Evaluation and Planning

All implant patients are first seen at Dolman Oral Surgery for a consultation. During this initial visit, Dr. Dolman will compile a detailed medical and dental history. This will be followed by a thorough oral examination of both the hard and soft tissues along with a standard head and neck examination.

A baseline panoramic radiograph will be required. Dr. Dolman will combine all of this information, and he will determine the need for a 3D image using the in-house state-of-the-art I-Cat CT scanner.

At this stage, Dr. Dolman will determine the possibility of placing an implant(s) and he will discuss all associated risk and benefits of both implant and non-implant treatment options. Should it be determined that bone availability is compromised, then Dr. Dolman will also discuss bone graft options in preparation for implant placement (see section on bone grafting).

Dental impressions are often required in order to evaluate the occlusion (the way teeth bite together). These models also allow for fabrication of a surgical splint which helps guide the placement of the implants in the most prosthetically appropriate position. Alternately, as the case dictates, a 3-D computer-generated surgical guide may be employed.

Once all of the information is gathered and evaluated, Dr. Dolman will discuss and coordinate the details of your treatment with your restorative dentist to optimize your results.

Step 2: Dental Implant Surgery

At Dolman Oral Surgery, Dr. Dolman will place your implants following specific and recognized implant protocols. Surgery will be completed under either local anesthesia and/or intravenous sedation – depending on what a patient wants or needs.

Dr. Dolman will utilize custom-made surgical guides to optimize and streamline the placement of the implants. Also, Dr. Dolman will incorporate the use of customized 3-D generated guides using either STRAUMANN® CARES® Guided Surgery or NobelGuide technology or Simplant Technology depending on the specific requirements of each case.

At Dolman Oral Surgery, Dr. Dolman utilizes the highest quality materials without compromise. It would be difficult to find implants with greater success rates and history of longevity, durability and scientific validation than either the Straumann Implant or NobelBiocare Implant.

Combining his experience with both sytems, Dr. Dolman has easily placed more than 1000 implants. He trained directly with professor Branemark in the late 1980’s on what’s now known as the the Nobel System, and he has lectured on and taught others regarding the use of the Straumann Implant System.

There are two basic implant protocols to choose from:

1. Two-staged approach: In this scenario, the implant is placed into the bone and the soft tissue is closed over the top of the implant. The implant is left to heal in this submerged manner for 3 months. After 3 months, the implant is uncovered and after a brief period of soft tissue healing, the restorative dentist can proceed with fabrication of the teeth on top of the implants. This approach is generally restricted to the cosmetic zone.
2. Single-stage/Transgingival Approach: This is the preferred method at Dolman Oral Surgery – the implant is placed in the bone and the soft tissue is closed around (not over) the implant. This allows the soft tissue to heal at the same time as osseointegration is occurring. Thus, there is no need for a second intervention and the implant can be loaded sooner than in the two-stage approach. For this single-stage approach, Dr. Dolman will frequently use the Straumann Implant System, the industry leader in single-stage surgery, which allows for restoration to occur within 30 days and with success rates of 99.4%.

Step 3: After Implant Surgery

If a single-stage approach is performed, then no additional surgery is required. The implant is verified for its integration and stability between weeks 4-8 post-surgery. The patient then returns to their restorative dentist for fabrication of their new teeth.

If a two-stage approach is employed, then a minor second procedure is required at the 4-8 week time frame. The implant is uncovered, and the surrounding soft tissue must heal for an additional 2-4 weeks prior to restoration by the dentist.

Dental Implant FAQs

How do I know if I am an implant candidate?
There are no shortcuts in implant surgery. A detailed medical and dental history are combined with a thorough clinical and radiographic evaluation. 3-D imaging is incorporated as the case requires. Evaluation of adjacent and opposing dentition is vital along with both bone and soft tissue condition.

Can I have an implant if I have been missing teeth for a long time?
Yes. Most cases present in this manner. Patients will have a missing tooth, or teeth for varying periods of time ranging from weeks to years. Clinical examination combined with radiographic imaging, including 3-D imaging, will allow Dr. Dolman to determine the availability of bone for proper implant placement. If there is an inadequate amount of bone, Dr. Dolman can augment the bone volume with local bone grafting procedures.

Is dental implant surgery painful?
Implant surgery can be performed without any pain whatsoever. Local anesthesia is often adequate, however, Dr. Dolman will utilize intravenous sedation for your comfort as required. Remarkably, post-operative discomfort is usually minimal.

How long is the procedure/recovery?
Of course, the length of the procedure is dependent on the number of implants. Regardless though, experience suggests that recovery is rapid with the majority of patients being able to resume reasonable activities the day after surgery.

How long does it take to get my teeth?
Once the implant has integrated (Straumann’s SLA active implant has the fastest integration time at 30 days), then teeth can be fabricated on top of the implants. Although there are cases where the implant can be loaded immediately, this is a temporary scenario and should be done only in very carefully selected cases. The 30-day loading time is the fastest permanent loading time.

Why would I have one-stage vs. two-stage?
This is a determination that is made by Dr. Dolman. Whenever possible, Dr. Dolman will utilize a single-stage protocol. However, certain esthetic scenarios require the use of a two-stage approach.

Will implants feel exactly like natural teeth?
An implant supported tooth/teeth will be imperceptible from the natural dentition and offer the comfort, function and esthetics of natural teeth. Initially, there will be a difference in “feel” when compared to neighboring teeth. However, the new teeth will “blend in” with the natural teeth and eventually the patient will not recognize any difference at all.