Dental Implants 101

Dental Implants 101

As adults, we lose teeth for many reasons.  75% of adult tooth loss is due to periodontal disease.  However, we may also lose teeth into adulthood due to traumatic injury.  After tooth loss, it’s important to replace with an artificial root and crown.

We tend to think of our bone as a very static system.  In fact, our skeleton is very dynamic, constantly undergoing breakdown balanced with rebuilding.  One of the major stimuli for bone rebuilding are external forces.  Just as weight-bearing exercise is important to keep our large bones strong, chewing applies forces to our jaw bone that keeps them strong!

When we lose a tooth, the bone that once supported that tooth no longer experiences the forces applied when we chew our food and the bone begins to resorb (i.e., deteriorate).

If left for long enough periods of time, this bone loss can eventually alter the integrity of your facial structure, changing your appearance.  It can also compromise the function and security of the adjacent and opposing teeth (without a tooth to chew against, the opposing tooth will also suddenly lose the chewing forces it was once used to).  Ultimately, this may even change your ability to maintain a healthy diet and proper digestion.

In some cases, bone has deteriorated so drastically that Dr. Fritz or Dr. Schuldt may need to use additional bone material during the implant placement procedure to stabilize the implant.  Or, your periodontist may even need to perform a preliminary procedure to add bone, allow time for it to calcify and harden, before inserting the dental implant.

The only way to know if you are a good candidate for a dental implant and if you may require additional bone to support an implant is to visit your periodontist for a comprehensive examination.  A CBCT, 3D X-ray, is also essential in the planning stages of your dental implant to allow your periodontist to visualize in 3-dimensions your exact anatomy and the quality and quantity of your bone into which the dental implant will be placed.

Dental Implants 101

How does a dental implant integrate?

A dental implant is an artificial root that is used to replace a natural tooth root that has been lost.  Dental implants are made of titanium.  Titanium is a natural element with non-reactive properties.  That is, it causes very little, if any immune response in the body. 

Titanium does have a unique property, it attracts bone cells.  When a titanium dental implant is inserted, it undergoes a process known as osseointegration.  In this process, bone cells fuse to the implant and secure it firmly in the jaw bone.

This process of osseointegration takes several weeks.  Therefore, it is important to allow the body this time to create a strong anchor on the implant before loading it with an artificial dental crown.  Just like glue needs time to set, if a crown is placed on an implant to early, it can lose its grip and fall out.

To test the strength of the integration of the implant into the bone, an Implant Stability Quotient (ISQ) value can be calculated by your periodontist.  If your ISQ value falls within a specific range, it is safe to proceed with the final stage of your implant process, fabrication of an artificial dental crown.

Post-Operative Instructions – Care after a Dental Implant

Post-Operative Instructions – Care after a Dental Implant

After your dental implant surgery, there are some steps to follow for quick and smooth recovery.  Healing after a dental implant can be broken into periods.

In the first 24 hours:

  • Only after freezing has completely warn off, you can apply ice to the area as needed in 10 min ON/10 min OFF for 3 cycles.
  • Do not apply heat to the area as this can stimulate blood flow and increase bleeding in the area
  • Do not brush or floss the area
  • Rest with your head elevated to avoid blood pooling to the area, discomfort, and swelling
  • Do not do any activity that raises your heart rate
  • When sleeping, use an old pillow case in case your bleed through the night

After 24 hours:

  • Do not apply ice
  • Brush the area and neighbouring teeth very gently with the post-surgical toothbrush that was given (this toothbrush is even softer than a ‘soft’ toothbrush and is made specifically for surgical sites)
  • When using the post-surgical toothbrush, avoid the sutures and the gum line at the surgical site
  • Pool Peridex rinse at the surgical site twice per day (morning and night) for two weeks.  Peridex mouthrinse works like a “toothbrush in a bottle” and works to keep the surgical site clean without the manual disruption by a toothbrush at the sensitive site.
  • Do not spit, gargle or swallow Peridex.  Simply let it fall from your mouth.
  • Do not eat or drink for 2 hours post-Peridex rinse.
  • Do not floss the area
  • Brush and floss all other areas of the mouth with your regular electric toothbrush

After 48 hours until your 2 week post-operative appointment:

  • Apply a warm compress to cheeks as needed
  • You may begin to exercise at 50% intensity being careful to monitor for any bleeding at the surgical site
  • Eat only soft foods on the opposite side of the mouth.  A general rule of thumb is to eat foods that require 3 chews or less.
  • Do not eat extreme temperature foods as this can damage the tissues and can increase blood flow in the area – eat room temperature foods only
  • Avoid alcohol, tobacco and cannabis during the healing phase (2 weeks)
  • Do not pull at the lip to see the healing area.  This may loosen the stitches and can disrupt the healing tissues.
  • Do not use straws, whistles, wind instruments as the force applied may damage the delicate healing tissues
  • Avoid wearing a denture or flipper as much as possible as this may rub against the healing tissues

It is important to take all medications as prescribed, especially an antibiotic.

To manage pain, Ibuprofen can be taken by the clock, as necessary.  Any antibiotics prescribed are essential to take until completion.  Use the Peridex mouthrinse twice daily for 2 weeks.

Patients report experiencing their peak discomfort immediately following surgery and experience a steady decline in discomfort through to Day 5.  However, patients report the greatest level so swelling, which can sometimes be accompanied by bruising, 3 to 5 days following surgery.

Should you experience any bleeding, swelling, bruising, or discomfort that is out of greater concern, it is important that you contact your periodontist.

How do I care for my implant?

How do I care for my implant?

Just like natural teeth, dental implants require care and attention to remain healthy and viable.  Although the implant is artificial, the gum and bone tissues that anchor and support it are living and susceptible to infection and deterioration.

When the tissues around an implant become infected with bacteria, they can become red, inflammed, sore, and can bleed.  The tissues can even have a thick, yellow, pus-like substance come from the gums when the infection has worsened.

Together, these symptoms cause peri-implantitis.  Similar to what happens around natural teeth in periodontal disease, in cases of peri-implantitis, bacteria infiltrate the spaces around the implant and cause infection, inflammation, and deterioration of the supporting bone tissues.

Any deviation from health at the implant site is a cause for concern and requires immediate assessment by your periodontist.

The best strategy to keep your implants healthy and sturdy for years and years is proper home care and regular visits with your dentists and periodontist.

If you have a removable crown or denture, it is important to remove it daily and to thoroughly clean the locators.

If you have a fixed crown, it is important to clean around it using the cross-over floss technique.

Link between Periodontal Disease and Diabetes

Link between Periodontal Disease and Diabetes

The human body is a single unit composed of a seemingly infinite number of biological processes that are so intertwined that a problem in any one system can have a profound effect on multiple other areas of the body.

As the entry point to the body, the mouth is no exception.

The two-way relationship between periodontitis and diabetes is the strongest among all systemic diseases.  Diabetes has been shown to increase the prevalence, severity (Stage), and rate of progression (Grade) of periodontitis.  And, periodontitis has been shown to influence blood sugar control in diabetic patients.

This link between gum disease and diabetes is not direct, but instead diabetes affects the pathogenesis of periodontal disease by altering the immune response and inflammation, increasing the risk of infection via high blood sugar, and by causing oral microbiome changes.

In the other direction, periodontal disease increases insulin resistance through persistent and chronic systemic inflammation.

Several studies have investigated the effect of a deep periodontal cleaning on diabetes.  They found that with the elimination of the bacterial infection, patients saw improved insulin sensitivity, improved glycemic control, and reduced HbA1c levels by 0.48% for at least 3 months following treatment.

This drastic reduction in glycosylated hemoglobin (Hba1c), which is a chronic measure of blood glucose, is similar to if you had added a second drug to a person’s usual diabetes medication regiment.

The link between gum disease and diabetes is so strong, that it has been suggested that periodontal disease be listed among the “classic complications” of diabetes, alongside stroke, kidney failure, and retinopathy.

Although the link is strong, 33% of people living with diabetes are unaware that it can affect their gum health.

Periodontal disease is a chronic bacterial infection resulting in inflammation.  Periodontal disease causes an immune response throughout the entire body, affecting many of the body’s systems.

Periodontal disease severity has been linked to many auto-immune, genetic, and acquired immune disorders.  These include:

  • Type I Diabetes
  • Rheumatoid Arthritis
  • Lupus
  • Crohn’s and Ulcerative Colitis
  • Irritable Bowel Syndrome
  • HIV
  • Vitamin D deficiency
  • Down’s Syndrome