Implant Basics:

Implants are the state-of-the-art replacement for teeth, from a single tooth to all teeth. Our mission is to attempt to have our patients keep their teeth for a lifetime, and when that is not possible, to replace them with implants, still keeping the remaining teeth and new implants for a lifetime. Teeth are lost for only a limited number of reasons:

• They had decay that lead to restorations, from fillings & composites to complete crowns.
• They broke, cracked or were traumatized.
  
• Their root canals failed. Root canals are excellent solutions to many dental problems but make a tooth brittle. Many of the teeth I replace with implants fall into this category.
  
• They became lost due to periodontal disease: Bone loss around teeth often associated with mobility or inflammation. Incidentally, if you have ever had a history of periodontitis, then you have a significantly higher chance of having problems with implants.
• They never developed or you were born without some of them.

While implants are a good solution to missing teeth, it's important to know that implants are far from a perfect solution, and the only advantages of implants are that they can't decay and are resistant to fracture.

The problems with implants:

The disadvantage of dental implants are that they are prone to Peri-Implantitis or Peri-Implant Disease. This is because only the bone attaches to implants and not the gum. This is a critical distinction: Hygiene is more important for implants, in may ways, than for teeth. I encounter many people who thought that, "Well, I have implants so I don't have to worry any more." This is far from the truth!

Peri-Implantitis usually occurs without any pain or discomfort, because there is no nerve in the implant, like a tooth.

The early signs of Peri-Implantitis include:

• Signs of bone loss on x-rays, especially "peri-apical" x-rays, which I advise should be taken at the same time as "bite-wing" x-rays.
• Signs of periodontal pocketing or inflammation around teeth or implants; e.g. bleeding or puffiness of the gums.

Moderate Peri-Implantitis occurs when

• There is more bone loss around the implant, up to half of the implant threads are without bone.
• Discharge is seen from your implant(s).

Severe Peri-Implantitis occurs when

• There is loss of more than half of the supporting bone. Treatable in some occasions.
  
• There is mobility of the implant. Untreatable, the implant must be removed.
  

I see the consequences of Peri-Implantitis almost daily and it's best treated if caught at an early stage. At the risk of seeming simplistic, it's like buying a new car and then refusing to change the oil or have it serviced. Implant "ownership" has requirements that place responsibilities on you, your hygienist and your dentist/periodontist. Your first and second set of teeth were pretty much "free" but they are the beginning of the story and not the end!

To "service" your implants:

Maintaining dental implants is an evolving art. In our opinion the frequency of Peri-Implantitis is high enough that, if you teeth were originally lost to periodontal disease, you should alternate your recalls between your family dentist and a periodontist, every 3-4 months. Dr. Mintzer or an experienced hygienist will provide a "cleaning" now referred by many names such as a Periodontal Maintenance Procedure, Supportive Periodontal Therapy, Prophy, Recall, etc. The name isn't nearly as important as what is done during this appointment.