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\pgncont\pgndec\pgnstarts1\pgnrestart My name is Dr. Lawrence Singer. I'm an attending
here at George Washington University. I graduated from Vanderbilt Undergraduate, and did my
DMD, which is similar to a DDS, at the University of Pennsylvania. Now, my goal for today is
to hopefully educate you, answer questions that you have, or give you some ideas about
dental implants, what's true, what's not true. Hopefully by going through my lecture, I will
get some things cleared up for you. Dental implants, tooth loss prevalence is pretty
high in the United States. Most people over the age of 40, or the majority, have lost
at least one tooth. By the age of 60, a third of the U.S. population is edentulous, meaning
has no teeth.\par \par To give a brief history, dental implants were really invented, the
ones that we use today and we think of today, were invented in Sweden in the 70's, even
the late 60's by a physician named Branemark. Branemark was the pioneer, and he originally
developed implants for people who were totally missing their teeth and couldn't retain and
use their dentures, to be able to get function back. Certainly implants have come a long
way. I've noticed in the last 15 years, where people were afraid of them, that now generally
in the population, people know that they're a superior treatment to, say perhaps dentures
or bridges. The consequences of not having teeth is loss of function. When you lose multiple
teeth, you also have problems with speech, proper speech, proper articulation. Also,
when teeth are missing for a long time, we'll see later on that you lose the bone because
the bone stays there and it stays up around the teeth as long as there's a tooth or an
implant in the socket.\par \par If you lose the tooth and you don't replace it with an
implant or you don't graft it with bone, it sort of resorbs, or melts away. That leads
to changes in the facial features, snoring, and all sorts of breathing problems. Obviously
if you don't have teeth and you can't smile, and you can't eat comfortably or confidently,
lack of self-confidence. Gum disease, tooth decay, periodontal disease, it has a very
high correlation with heart disease, diabetes, low birth weight, premature births. There's
all sorts of links that are starting to be developed with poor oral health. Really, it's
very important to have oral health and proper chewing and function in the maskatory organ.
This here shows a woman who's had all her teeth. What happens when you lose your teeth,
the jaw resorbs on the bottom and the top, and the two jaws come closer together. We
have an aesthetic and a functional problem at the same time.\par \par Talking about implants,
dental implants are made out of titanium. It's a surgical grade used, usually what we
call grade four titanium. Other things that we have titanium implants are titanium knees
and hips. These are basically what dental implants look like. They're laying on their
side here, and I'll show you more pictures to make it clearer. This is called an implant
body, and this part here is what's screwed into the bone. They look real big here, but
they're actually very tiny. They're about, if we look at this pencil, and the silver
part on this pencil, they're much smaller than this. So, they're very small. If it means
anything to anybody, the average size is four millimeters in diameter and 11 millimeters
long. On top of the implant, which these are all implant bodies, goes what's called an
abutment, and these screw onto it. This part here, the abutment, will extend an implant
through the gum, and then you put your false tooth or crown on top of that.\par \par This
is the implant that I like to use. I think that they're the best. They are Swedish manufactured.
I wish they were American, but the Swedes developed them, and they're still kind of
ahead. This is an implant, and it's different than a tooth because the bone grows directly
into the implant surface. In a tooth, the tooth has a socket and in a tooth socket,
there's ligaments. The ligaments radiate all the way around the surface of a tooth and
insert into the bone. So, there's special cells on a tooth surface called sementil cells
that radiate into the bone, and it's a whole attachment apparatis. This is different. This
thing is solid, it can't move. So, any tooth in your mouth, you can probably touch it and
it has maybe just the tiniest or slightest bit of wiggle. It's supposed to, but an implant
is anchored like a rock. It's totally integrated into a bone, as opposed to the slight give
that a normal socket will have.\par \par Again, this is just to give you a couple representations
of this would be a tooth, this is a tooth, this is how an implant would work in between.
This is one of the older collars. This is a comparison. This is a crown on top of a
tooth on the left side, and on the right side that's an implant and an abutment. Again,
what I was saying before is it's a very complex system of connected tissue, we call it the
attachment apparatus, of how the gum attaches to the tooth, and the ligaments here. Likewise,
how the gum attaches to the implant, because if you don't have the good attachment of the
gum, a really tight attachment of the gum to your implant, that's a vulnerability.\par
\par If you start to have an infection there, and it gets past this attachment here, you're
done. It goes all the way down, an infection, and you end up losing the implant often. That's
the key, is preserving, and we change our designs, we change our techniques to really
make sure that we have a good seal. These are just showing a few implants together.
This is sort of a cross-section, a tooth here, a tooth here. This is the maxillary sinus,
or the sinus in your nose, and what implants would look like, and you could have them next
to each other. This a cutaway of the bone, and how the implants look up in there. It's
not a simple thing, just putting in implants. I've had a lot of people go to South America
for medical tourism, and they come back and they've thought they've gotten a good deal.\par
\par I didn't bring the x-rays, but people put in implants and they put stuff on top
of it, but the implants are sticking halfway out of the bone. It's about a matter of a
few months to a year until these things fail, and it's even more work to regain and restore
the bone, and get implants back in. It's not a simple thing to accomplish in a predictable
manner without proper training and proper understanding of the biological principles
of how the body heals and how the tissues interact with these surfaces, and what we're
trying to accomplish in terms of restoring on top of it. These are actual implants. They
come in different sizes and lengths. These are what we called the abutments before. They
come in colored porcelains, gold, titanium, it depends where it's going to go in the mouth.
So, we have all these different options.\par \par These things, that they're bone, it looks
complicated and if you don't make the proper choice and understand the body and its biology,
and have the proper shape with the right contour when you're putting one of these on top of
an implant, you're going to end up maybe compromising or losing that implant. Again, I can't get
into the clinical of showing everybody why it's important to know all the consequences,
but what it is important to know is that this is not Home Depot 101, putting one of these
in. You've got to understand your biological principles or you're going to end up with
infection and possibly the loss of the implant down the road. Now, this is not mine, but
this case is starting to have a problem here, where for whatever reason, they're starting
to lose the bone. That's where I talk about the soft tissue bridge. This is an old implant.
I don't know if maybe 20 or 30 years old. Somebody at some point, there might have been
some cement or something down here, but this thing starts to creep and once it gets past
a certain point, it's pretty hard. It's very hard to salvage an implant that starts to
have a problem. It's possible, but what I could say is, there's techniques we have,
but we don't get what we call osseointegration. You can't make the bone grow back into it
again once the surface is contaminated. We get one shot.\par \par An implant has to go
into clean bone, and once the area has been resorbed and gone away, then we have a dirty
implant surface. No surface treatment that we have to date makes it so that bone will
reattach to it. We can make bone grow close to it but will not reattach to it. It's an
important thing, a lot of people are afraid. When you discuss these things, the environment
of where you have your implant put in. Sedation is available for these procedures with most
clinicians, so you don't even remember what happened. Pain is a big question people ask
me. I'd say at least nine out of 10 times, people tell me there is none. Hard to believe,
but there's none. Yes, there's a screw going into your bone, but there's not very many
nerves in your bone. Sometimes if they do have some it's maybe a little soreness for
a day, maybe two, which is controlled with Advil, or Tylenol, or over- the-counter medicines.
Really, implants are truly, if you want to compare it, pain comes from root canals, live
teeth, and we're not dealing with live teeth anymore.\par \par We're dealing with a bone
that has no nerves in it, or very little. It's really the pain is a minimum. This is
my pet therapy dog. That's Disco. He helps me with the consults or gets people a little
bit more comfortable, then we also use sedation. There's a lot of things we do to help people
feel a little more comfortable today. I talked a little bit about the history. Branemark
started this with polished collars, and we've evolved towards an internal connection. These
very sophisticated surfaces, also principles of how to bio-engineer bone where we don't
have. If somebody's been missing teeth for a long time, we have techniques now to regenerate
bone and just about anywhere we need to, or regenerate a ridge can be an additional procedure.
People often say, 'Well, I was told I can't have implants.' Well, that's almost impossible.
Everybody can have implants now, because we do have these bone regeneration techniques.
Traditionally, we used to put the implant in, come back and put an implant in. Let it
heal for six months, come back and put what we call a healing screw on top of it. Let
that heal for a few months, and then start putting a crown on top of it. Now, we can
do it all in one.\par \par We've found that the success rate and the procedure... So we
take the tooth out, provided there's no huge defect or infection. You could take the tooth
out and put a temporary crown, because the permanent crown you wait until the gum tissues
mature. Usually we it's the best idea to put something temporary and then replace the temporary
later with a permanent crown after a few months after the tissues have totally matured. So
you don't go around with something that comes in and out. You don't go around without any
teeth. The process is over in just a few months a lot of times, but it does depend on the
presenting complications. Some people have been missing teeth or bone for a long time,
and there's bone grafting involved, then that can significantly lengthen the treatment time.
The idea of a bone graft is it becomes replaced with your own bone. A bone graft is tricking
your body into building bone where it isn't. These are a very typical situation, which
I can do, I've done, but I prefer to do something different. This is when you go to some of
these advertisements you've seen for all on four and teeth in in a day.}