Quality & Affordable Dentistry in Malaysia

A Few Missing teeth replaced with Dental Implants

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If you are missing a few teeth, or soon will be, but the rest of your teeth are fine, then dental implants are a great replacement for you. There are several options for people who are missing a few teeth, because there are several ways to be missing a few teeth. If you are missing a single tooth from several areas, then you would best be served by several individual single tooth implants. If you are missing two teeth right next to each other, then your restoration options with implants include both single and individual implants or implants that have crowns connected to each other, or you may have one implant placed with a crown made to look like the two missing teeth together. The best option for your particular area will be discussed with your dentist or surgeon at your consultation and examination. If you are missing three or more teeth in a row, then you have the option of a bridge, technically a fixed partial denture, which is attached to the dental implants, or possibly replacing the missing teeth with individual implants. Again, the option that is best for you will be discussed at your examination and consultation.

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Implant consultation and examination in SELANGOR, Malaysia

Before having dental implants placed, you will need to have a consultation and examination with your dentist and/or surgeon. If you are already missing teeth, great, some of your healing has already begun.

If you have teeth that need to be removed, then this is done first.

Sometimes your dental implants can be put in on the same day as your teeth come out, sometimes your bone will have to heal first, either because of infection or needing to reshape or add to the bone for ideal implant placement. Whether you have teeth present or not, you may also need some work done to re-shape or improve the health of your gums and bone in the area. These will be discussed with you at your consultation.

At your consultation, expect a visual examination of the area as well as some form of X-ray, often a CT scan. The visual exam is to determine the health of your gums and to assess-aesthetic and sizing factors for your restoration. The x-rays and/or CT scan are used to determine the health of your bone as well as size and angle of placement of your dental implants. Your dentist or surgeon will discuss with you their findings and if you will need to have any other work done in the area, such as adding bone with a bone graft or re-shaping your gums for better aesthetics and cleanliness.

Your consultation will also cover some of the variations about dental implants. Implants in the maxilla, your top jaw, often take longer to heal than implants in the mandible, your lower jaw. Your exact time frames will be reviewed with you. If you still have teeth that need to be removed, sometimes your implants can be placed on the same day as your teeth come out. Sometimes your bone will need to heal first. Sometimes you can have a temporary replacement restoration attached to your implants on the same day as your implants are put in; however, this depends upon your bone health. Sometimes your gums will need to be closed over the implant and restorations done later. Again, these variables will be discussed with you at your consultation where what is best for you will be determined.

Though there are many variables, as every mouth and every patient is different, there are many things that are the same with dental implants being placed. What I have written here is the usual process and I will mention some of the more common variations as they come up.

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Dental Implant Placement in Malaysia

Dental implants replace the root of your tooth in your bone. An attachment piece, called an abutment, comes through your gums to attach your restoration to your implant. Then your restoration goes on top, either a bridge or individual crowns depending upon your treatment needs.

If you have already had your teeth removed, then a small incision is made in your gums so that your dentist or surgeon has access to your bone. If you are having teeth removed on the same day as your implants are being put in, then sometimes your gums are not changed at all, sometimes your gums will need slight modification for ideal placement.

When your dentist or surgeon has access to your bone, a space is made for the implant to go into. If you had teeth removed on the same day, the hole your tooth came out of will be re-shaped slightly. While dental implants replace the roots of teeth, they are not the exact same shape as the root of your tooth, so some re-shaping is necessary.

At this point, either your gums will be closed over your implants with a few stitches or temporary abutments will be placed and your gums closed up around them. Your bone is then allowed to heal. During this healing time, your bone fuses with your dental implants and the implant becomes a part of you in a process called osseointegration. Closing your gums completely over the implants keeps bacteria out of the area better, decreasing infection risk; however, placing the temporary abutments allows your gums to heal into a nicer shape while your bone heals at the same time. Some temporary abutments will also allow you to have a temporary bridge or crowns put onto your implants while you heal.

Which options are available to you will be discussed with your dentist or surgeon.

Now for the healing phase. It takes some time for your bone to fuse to your implants and the implant to become part of you. It is very important to thoroughly, but gently keep the area clean while you are healing to prevent infection. An infection can prevent your bone from fusing with your implant. Exactly how to best keep the area clean while you heal will be discussed with you as you progress through treatment.

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Once your implants have fused with your bone, your definitive restoration, either a bridge or individual crowns, will be made for you.

An impression of the area will be taken, then your restorations custom made for you. The abutment, a connector between your implant and your restoration that comes through your gums, will be placed and the restoration attached to it. Depending upon your restoration, either the restoration will be attached to the abutments at the lab when it is made or it will be cemented onto the abutment in your mouth. There are benefits and detriments to each type of restoration and which is best for you will be discussed with you.

The restorations that are attached to your abutments at the lab, also called screw retained, have an access hole in them that will be filled with tooth colored filling material once everything is in place. These provide easier access if your restoration ever needs to have something about it changed, such as if you choose to change the normal tooth shaped restoration to permanently look like a fang because you have landed a life-long acting position as a vampire. It also provides easier access if the restoration ever needs to be removed if you have trouble cleaning it. The drawback of the screw retained restoration is that the filling material can pick up stain, just like a filling in your natural teeth. Screw retained restorations are not cemented in your mouth, and so, you do not have to worry about the cement irritating your gum tissue.

The cemented restoration allows for better aesthetics because it does not have screw access holes. These are also sometimes the necessary restorations due to the positioning of your bone. These restorations are much more difficult to remove if you ever need to have them taken off later, often needing to be cut off and completely replaced instead of being able to be repaired. They also have the possibility of the cement irritating your gums around the restoration if any excess remains after the restoration is placed.

Please note that anything that can break a natural tooth can also break your implant restoration, because the restoration is made out of the same materials as crowns and bridges for natural teeth and is designed to be as close to natural teeth as possible so, in the event that you happen to break your implant restoration, for example, by being kicked by a horse, then a screw retained restoration would be easier to remove than a cement retained restoration.

Maintenance and care of Dental Implants

Yes, you do still have to clean your teeth and your dental implants. While you cannot get a cavity in your implant restoration, like you can in natural teeth, you still have to take care of your gums and bone around the implant, which is best done by keeping your implants clean. You can still get gingivitis, inflammation of your gums, or peri-implantitis, an infection between your gums and implant, if you do not keep them clean.

Gingivitis and peri-implantitis are caused by bacteria. Gingivitis is inflation of your gums and is reversible by removing the bacteria.

Gingivitis usually makes the area look red and irritated and may bleed when brushing and flossing. Peri-implantitis is the same infection as periodontal disease around your teeth; just this is around your implants.

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Peri-implantitis is an infection between your implant and your gums that causes your bone and gums to detach from your implant. As this is the same infection as periodontal disease, it has all of the same complications: bone loss, possible implant loss, increased risk of cardiovascular disease, increased risk of heart attack, increased risk of stroke, increased risk of Alzheimer’s disease, etc. There are whole text books and courses on periodontal disease and periimplantitis for dentists. I will be working on a guide just like this to translate all of the information for my patients after I have finished this implant book. If you already have periodontal disease on your natural teeth, you are at increased risk of the infection spreading to your implants and need to be extra vigilant with your home care.

So, how do you take care of your implants? First, the big don’ts. Do not do anything to or with your dental implant that could break a tooth. The restoration on your dental implants is made of the same materials as a crown or bridge on your natural teeth, and they are made to mimic your natural tooth structure as closely as possible. Therefore, anything that can break your natural tooth can also break your implant restoration. Do not chew on ice. Avoid grinding your teeth. Do not eat rocks. Avoid being kicked by a horse. Yes, that has happened to one of my patients. The horse won.

Now, how to take care of your implants. You can eat any normal food unless advised otherwise by your dentist. This is common if you have had a temporary restoration put on. You then will need to clean your implants, just as you will your other teeth. You need to clean the biting/ chewing surface, the lip/cheek side, the tongue side, and in between our implants and between your teeth. The chewing, cheek/lip, and tongue sides are easy; brush them. You can use either a manual or electronic tooth brush, whichever works best for you. The key is to be thorough but gentle. Angle the bristles so that you sweep out under your gums edge. Then sweep across the tooth surfaces. You do not need to scrub.

Scrubbing is for tile and grout. Think of your implants and your teeth as the world’s finest hardwood floors and your gums as the most expensive cabinets. Your brush is your broom. You want to show off your floors without damaging your cabinets, so you angle your broom to get the dust bunnies out from under the cabinet overhang and gently remove them with little wiggles, then gently but thoroughly sweep across the rest of your floors. Do the same for your implants and your teeth.

Now to take care of the places between your teeth and between your implants. There are multiple ways to do this, and which is your best option is best discussed with your dentist or dental hygienist.

The simplest method of cleaning the in-betweens is floss. When done correctly, floss is an excellent way to clean in between. If you have individual implants with individual restorations that are not connected to each other, then your flossing will be very similar to flossing individual teeth, which will be described shortly. If you have a bridge on your implants, then it is likely that you will need a special tool to floss under the connected area called a floss threader. The floss threader looks like a large, plastic, sewing needle. Thread the floss into the floss threader’s eye, and then use the floss threader to pass the floss under the connected part of the bridge. Once the floss is through proceed as follows for flossing.Use a slight sawing motion to move the floss through the tight spot between your teeth and implant, then take your length of floss and hold it against the side of your implant so that it curves slightly around it. Slide the floss up and down gently below the gum line. Do the same for the tooth or implant next to it and any other teeth or implants that you want to keep. If you used a floss threader to pass the floss under a connected area, then slide the floss to the side of the implant, curve around it and gently slide up and down the implant surface below the gum line and up until you touch the restoration. Slide the floss along under the connected portion of your restoration to the next implant and do the same. To remove the floss, simply pull it out from under the connected area and floss normally everywhere else.

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There is an alternative flossing technique that works well for implants, but not for teeth. Place the floss between on one side of the implant as usual, take the other end and wrap it around the tongue side of the implant and come through the other in-between, so that both ends are on the lip/cheek side of the implant. Cross the ends in front of the implant then slide up and down and shimmy back and forth. Think of an old fashioned belly dancer doing the dance of many veils. She takes off a veil, wraps it around her tush and shimmies back and forth and up and down. The image is corny, but you get the picture.

You also have alternatives to floss. So no, you do not need to floss, however, you still have to clean in between. There are two main alternatives: water irrigation systems and interdental brushes, water irrigation systems, the most well-known being Waterpik brand, use a stream of water to flush out any debris and bacteria between teeth and implants as well as under your gums. There are two types of water irrigators, interrupted pulse and Continuous stream. The interrupted pulse irrigators can clean between individual teeth, but only the in-betweens. Continuous stream, such as the Waterpik, can be uses for more areas, such as under bridges, with better results in such areas.

Interdental brushes come in a variety of styles, and which can work best for you your dentist or dental hygienist can help you to figure out.

There are end tuft brushes, which look like a regular tooth brush with only a few tufts of bristles at the end; these allow you to push the bristles between teeth and implants as well as under bridges. There are interdental brushes that look like a pipe cleaner on a stick, which is also slide between teeth and dental implants and under bridges, cleaning with an in and out motion. There is also a mechanical tooth brush, the Rotadent, which has a pointed brush tip that can clean in between your teeth and implants. Please note that Rotadent brushes can only be purchased through a dental office, however, the replacement heads are available online.

Of course, you will still need regular cleanings at your dentist’s office as well, for both your implant and your other, natural teeth. Right after your implant is placed, these may be increased in frequency, until you are able to keep it clean at home, then you will return to your regular routine cleanings.

Remember, you need to clean your dental implants, just like you need to clean your teeth, if you want to keep them.

Dental implants are the closest you can get to having your natural teeth back. You clean them just as you would the same restoration on natural teeth. You eat with them just like natural teeth. And you speak with them, just like natural teeth. Once your implants are in place, most people think of them as being just more teeth, like any other tooth that they have.

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