Reconstructive Dentistry Waterloo
Implant treatment is one of the most life-changing treatments in dentistry. For people who have lost their teeth, dental implants provide a second chance to eat, speak, and smile again with comfort and confidence. If you have lost even a single tooth, the ability to replace it without damaging adjacent teeth is a modern day miracle. The impact of dental implants is so life-changing that in a recent study of dental implant patients, 90% of those surveyed said they would have them all over again and that their biggest regret was not having had the treatment sooner.
What happens when a tooth is lost?
What You Need to Know About Tooth Loss
One of the most common misconceptions I encounter in my office is that the easiest solution to any dental problem is removing the offending tooth. Many people feel that once the tooth is lost, their dental problem is over. Most find out too late that removing the tooth is not the end of the end of your problem, but the beginning of many more.
Traditional techniques for removing a tooth frequently involve destroying anywhere from 20% to 30% of the bone that holds it in place. Additionally, once the tooth is lost the remaining bone will naturally atrophy or shrink if it isn’t being used. Up to 50% of the surrounding bone will be lost during the initial healing period and even more over time.
What happens when the back teeth are lost?
When all of your posterior teeth are missing, the back of your mouth actually collapses as the bone deteriorates. The teeth in the front begin to flare out as the corners of your mouth begin to droop. Your appearance begins to change as the height of the jaw decreases. If your posterior teeth are replaced with a partial denture, the resorptive process is accelerated as the partial presses down on the gums and underlying bone as you eat. Replacing the posterior teeth with implant supported teeth preserves the bone, preventing this deterioration and collapse.
What happens when all the teeth are lost?
When all of your teeth are missing, the jaws deteriorate rapidly. In addition, as the bone melts away your muscles migrate, or pull back from their natural position. Your lips cave in as they lose support and wrinkles increase dramatically as your facial structure collapses. This can also result in significant overall health problems related to improper digestion and malnutrition. Dentures accelerate the bone resorption process as they put pressure on and compact the gums and underlying bone. As facial structures continue to collapse, the dentures must be relined (made thicker) to compensate for additional bone loss. As the years go by and bone continues to be lost, less and less tissues are left to support the denture. The dentures become harder and harder to keep in. Foods like corn on the cob, apples, and salad become impossible to eat. Fear of the denture falling out in public erodes self confidence and people become afraid to smile or eat in public.
Replacing your missing teeth with implant supported overdentures or bridges will preserve the bone and prevent the further deterioration of facial structures and the related health and functional problems that would normally be associated with complete tooth loss.
How Can this Bone Loss and Facial Structure Collapse be Prevented?
Dr. Arvanitis uses new techniques for tooth removal that have been designed to preserve the bone by not removing it during the surgery. The best techniques available today also involve placing the implant right into the socket of the extracted tooth at the time of extraction. Additionally a grafting material is then placed into the socket around the implant which will support and feed the surrounding bone during the healing period preventing the initial atrophy. If the patient is not ready to proceed with the implant then a bone graft alone will be used to preserve the bone. Over time however, the natural atrophy will still occur if the implant is not placed. Thus it is imperative that the critical areas of the jawbone needed to support implants are preserved. If you have lost one or two teeth, then the area should have dental implants placed within the first year to prevent the long term bone loss. If you already have dentures then implants can be used to hold them in place and the areas where these implants would be placed need to be protected. Only by placing dental implants can the bone be preserved.
What is a Sinus Lift?
When an upper back tooth is lost, not only will the outer bone and gum shrink but the maxillary sinus that sits at the root tips will begin to expand as well. Just the simple act of breathing in and out is enough pressure to cause the sinus to expand once the tooth roots no longer hold up the sinus floor. Consequently, if you decide after a few years to replace this missing tooth with an implant you may be told that the sinus floor is now in the way.
The analogy I usually give to my patients is to imagine that you want to hang a very heavy picture on your wall. We all know that despite the wall looking very solid on the outside, that your wall is actually hollow behind the drywall. Thus if we put our anchor into this wall it will punch through into the air space behind the drywall. This isn’t a good idea if that space is in your sinus.
So how do we get around this? Well we need to add some plaster behind the drywall so that the implant anchor will be totally in plaster. This is what a sinus lift entails. Lining the bony floor of the sinus is a lining we call the sinus membrane. Imagine the skin on the inside of your nose that lines your nasal passages extending through all your sinuses. It is this lining that we lift up. Between the lifted sinus lining and the bony sinus floor we place our bone graft. This is then left to harden and turn into new bone and eight to nine months later the new bone will be ready to have the implant anchor placed. This, is a Sinus Lift and it has become a very common procedure with a high success rate.
What is Platelet Rich Plasma?
PRP is a secret ingredient now being used by many Plastic Surgeons and Dentists that helps patients to heal faster post surgery. It is short for Platelet Rich Plasma. A small amount of your own blood is drawn at the time of surgery, and treated to remove all the red blood cells leaving behind the white immune system cells and the platelets. These platelets and white blood cells contain many of your body’s own natural growth and healing factors which are then replaced into the surgical site. Why all the excitement about PRP? PRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate.
During the healing process, the body rushes many cells and cell-types to the wound in order to initiate the healing process. One of those cell types is platelets. Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. These GF (platelet derived growth factors PDGF, transforming growth factor beta TGF, and insulin-like growth factor ILGF) function to assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more growth factors released into the wound, the more stem cells stimulated to produce new host tissue. Thus, PRP permits the body to heal faster and more efficiently.
A subfamily of TGF, is bone morphogenic protein (BMP). BMP has been shown to induce the formation of new bone in research studies in animals and humans. This is of great significance to the surgeon who places dental implants. By adding PRP, and thus BMP, to the implant site with bone substitute particles, the implant surgeon can now grow bone more predictably and faster than ever before.
PRP has Many Clinical Applications:
- Bone grafting for dental implants. This includes onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures, and closure of cleft, lip and palate defects.
- Repair of bone defects creating by removal of teeth or small cysts
- Repair of fistulas between the sinus cavity and mouth
PRP also has Many Advantages:
- Safety: PRP is a by-product of the patient’s own blood, therefore, disease transmission is not an issue.
- Convenience: PRP can be generated in the doctor’s office while the patient is undergoing an outpatient surgical procedure, such as placement of dental implants.
- Faster healing: The supersaturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and thus
- Faster tissue regeneration.
- Cost effectiveness: Since PRP harvesting is done with only 30-60 cc of blood in the doctor’s office; the patient need not incur the expense of the harvesting procedure in hospital or at the blood bank.
- Ease of use: PRP is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.
Frequently Asked Questions About PRP
1. Is PRP safe?
Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the IV. This blood is then placed in the PRP centrifuge machine and spun down. In less than fifteen minutes, the PRP is formed and ready to use.
2. Should PRP be used in all bone-grafting cases?
Not always. In some cases, there is no need for PRP. However, in the majority of cases application of PRP to the graft will increase the final amount of bone present in addition to making the wound heal faster and more efficiently.
3. Will my insurance cover the costs?
Unfortunately not. The cost of the PRP application is paid by the patient.
4. Can PRP be used alone to stimulate bone formation?
No. PRP must be mixed with either the patient’s own bone, a bone substitute material such as demineralized freeze-dried bone, or a synthetic bone product.
5. Are there any contraindications to PRP?
Very few; Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in-office procedure.