Dental Implants

Dental Implants and Related Surgeries

Dental implants are designed to provide foundation for replacement teeth that look, feel, and function like natural teeth. A person who lost teeth can regain the ability to eat virtually anything.  They can smile with confidence knowing that their teeth appear naturally and their facial contours will be preserved.

Implant is a titanium root that is placed into the jawbone where tooth is missing. The bone bonds together with the titanium, creating a strong foundation for the artificial tooth. The implants can also help preserving the facial structure and preventing bone deterioration that often occurs when teeth are missing.

For most patients, the placement of a dental implant involves two surgical procedures. First, the implant is placed within your jawbone (stage 1). The healing period varies from person to person, based on multiple factors. After the implant has integrated with bone (3 months), Dr. Wang will uncover the implant and attach a healing abutment (stage 2). After two weeks, your general dentist will be able to start making your new tooth.

The entire procedure usually takes about three to four months. Most patients do not experience any disruption in their daily life. In some situations, stages 1 and 2 can be done simultaneously to shorten the healing period and avoiding additional procedures.

Immediate Implant Placement after Tooth Extraction

In many cases, an implant can be placed at the time of tooth extraction. Since the diameter of the implant is slightly smaller than the extracted tooth socket, bone graft is necessary to fill the gaps between implant and extracted socket wall.   The advantages of immediate implant placement are 1) shortening the waiting time, 2) minimize surgical procedure, and 3) faster healing process.

When front teeth need to be replaced and cosmetics are of concern, Dr. Wang will extract the tooth and place an implant without cutting the gum.  He will also fabricate a temporary crown and attach it directly to the implant so that no temporary removable appliance is required.  When implant is healed, the temporary crown will be removed and replaces with a permanent crown.

Following diagrams are illustration of the Immediate Implant Placement with Implant Support Temporary Crown.

The front incisor is fractured

The root is removed without cutting gum

Implant drills are used to shape the extraction socket

Implant is inserted into the extraction socket

Bone graft is placed to fill the void area between the implant and extraction wall

Temporary crown is fabricated

Temporary crown is fabricated

Temporary crown is attached to the implant

Tooth Extraction and Bone Graft – Site Preservation

After tooth is extracted, the surrounding bone begins to shrink.  Excessive bone shrinkage may result into a thin bony ridge, which cannot accommodate implant.  Placing bone graft into the extraction socket prevents excessive bone shrinkage and preserves bone thickness.  Implants can be inserted after a healing period of 3 to 4 months.

The following diagrams are illustration of Site Preservation Procedure

Teeth are removed

Gum is pulled away from the bone.  Bone graft is placed into the extraction sockets

A resorbable membrane is placed over the bone graft

Gum is re-attached to bone with sutures

After 3-4 months of healing period, implants are placed and restored

Sinus Lift

Every person has two maxillary sinuses (right and left) that are located above the upper molars and premolars.  After the removal of tooth, the sinus cavity will gradually expand into the surrounding bone.  The available bone height (distance between gum and floor of sinus) is reduced as sinus expands. The minimum desire implant length at the molar and premolar area is 8mm.  Sinus Lift procedure is indicated when the available bone height is less than 8mm.

Sinus Lift is a surgery procedure that places bone graft into the sinus cavity.  This procedure can be accomplished with two different approaches:  “Lateral Window” and “Osteotome” technique. In general rule, Osteotome technique is recommended if the implant site has at least 5 mm of available bone height. “Lateral Window” technique is more suitable when the implant site has less than 5mm of existing bone height or multiple implants are scheduled.  Only doctor can determine the appropriate technique for a given situation.  In some instances, implants can be placed simultaneously with sinus lift procedure.

The following diagrams are illustration of the Sinus Lift Procedure with “Lateral Windowtechnique and “Osteotometechnique

Lateral Window” Technique

The gum is retracted from the bone.

Osteotome” Technique

Drills are used to create a hole just below the sinus cavity

A window is made with high speed handpiece and bur

A special instrument is positioned

Carefully elevating the sinus membrane

Water is pumped and expands the balloon which elevates the sinus membrane

Placed bone particle with PRP into the empty space beneath the sinus membrane through the lateral window

Inserted bone particle into the empty space beneath the sinus membrane through the hole

A resorbable membrane covers  the “lateral window”

Implant drills are used to shape the hole

Gum is sutured back

Implant is inserted

After approximately 4-6 months of healing period, the implant is placed

Ridge Augmentation

Particulate bone (small bone particles) and tenting device are the most common materials utilized for this procedure. The tenting device creates the desired ridge shape (bone thickness and/or height) that will be sufficient for future implant placement. The bone particles are placed between the space created by the tenting device and existing bone structure.  Then, gum is stretched to cover the tenting device and bone particles completely. During the healing period, the tenting device prevents the gum growing into the bone graft area and maintains the desired ridge shape.  Approximately 6 months of healing period is required for your body to convert the bone particles into your own bone.  At the time of implant placement, the tenting device is removed and exposes the newly regenerate bone.  The rebuilt bone ridge has proper thickness and height to accommodate implant.

Following diagrams are illustration of the Ridge Augmentation Procedure

The ridge is severely resorbed after teeth are removed

The ridge is too thin to accommodate dental implants

Small tenting screws are inserted

Bone particles with PRP are placed around the tenting screws

Resorbable membranes cover the bone graft

In some situations, pieces of bone can be obtained from patient. In this diagram, the bone is harvested at the patient’s chin region

These bone pieces (block) can be screwed to the bony ridge

Tenting screws are removed after healing period between 6 – 9 months

Implants are inserted and completely surrounded with bone