Implant Dentistry


  • Atraumatic extraction and bone grafting


Atraumatic extraction is the measures used to minimize trauma during extraction and maintain maximal bone volume.  A number of measures can be taken, eg. using refined surgical instruments such as Periotome elevators, sectioning the tooth, flapping the gum, placing collagen plug etc. 

Atraumatic extraction is usually followed by another procedure called bone grafting at the same visit.  Bone grafting is a procedure used to increase the height and width of the bone at the recipient site for implant.   Implant, a Titanium fixture placed in the bone that is equivalent to a tooth root, requires adequate quantity of supporting bone circumferentially to achieve its stability.    Failure to bone graft the extraction site will result in loss of bone quantity ( ongoing bone loss after extraction, until 60% width and 30% height are lost within 3 years), which disqualifies the site to receive implant.   

During bone grafting, bone particles are added at the extraction site, covered by a resilient collagen membrane to maintain the desired height and width of the ridge, before the site is closed with suture and healing takes place.   After 3-4 months, implant placement can be attempted.     The purpose of atraumatic extraction and bone grafting is to preserve and prepare as much bone volume as possible for implant placement.  


  • Digital design with cone beam CT and surgical placement of implants 

3-4 months after the atraumatic extraction and bone grafting, the site is ready for implant surgery.   A cone beam CT scan of the teeth and jaw is obtained and the dentist designs the position and depth of the implant for your case with the aid of an implant design software using the CT image and sometimes a digital scanning of your dental arches as well.  A surgical and restorative plan is generated before the surgery which defines the angles and depth of the implant in the bone; type, length and diameter of the implant; type of healing cap, restorative abutment, screw and crown to be used etc.  

Based on the complexity level of the surgery, a surgical guide can be used to aid the accuracy of the implant placement, mostly in cases of multiple implant placement.  A gum flap was made, a series of drills were used before the implant was screwed into the bone at the right torque value.   A healing cap or abutment was screwed on top of the implant to cover it and to shape the soft tissue contour which is important for the aesthetics and hygiene of the final restoration.    The gum is sutured back around the healing cap or abutment and allows to heal for 2-4 months before making implant restoration.  

Most of the preop and postop instructions of implant surgery are the same as those of extraction, here are some additional instructions for implant surgery:  Before the day of surgery, fill all medications, eg. antibacterial mouthrinse Peridex, Motrin and Tylenol and stock up on post-surgical foods.   On the day of surgery, be sure to brush and floss and make your teeth clean. Wear loose, comfortable clothing and avoid wearing jewelry, makeup and perfume etc.  Eat a light meal so that you are comfortable.  After the surgery, care should be taken in the first 2 weeks to minimize contact with the implant.  Maintain good oral hygiene, rinse with Peridex mouthwash twice a day for 2 weeks.  Swelling and pain can be relieved by taking a combination of Ibuprofen and Tylenol, not to exceed daily maximum dosage.   Eat soft food and chew on the other side for 10 to 12 week when implant osteointegration occurs.    The healing cap or abutment is the small metal piece that’s surrounded by the gum on top of the implant, if it becomes loose or fall out,  please call our office promptly and have it replaced.  Failure to do so might risk damaging or losing the implant.  You will be asked to return to the office for a one week and a one month follow-up appointments.   2-3 months later, the implant(s) is ready to be restored.  


  • Implant-supported ceramic crown and bridge


The most common implant-supported restoration is a single implant crown restoring a missing posterior or anterior tooth.   If you miss only one tooth, implant crown is the best treatment choice according to the concepts in modern dentistry, compared to a fixed bridge in the past.  Prior to the advance in implant dentistry, a 3-unit bridge used to be the treatment choice which is subject to decay and damage to the adjacent teeth.   2 to 4 months after the implant is placed and integrated into the bone, the dentist in our office will take CEREC digital impression of your implant, the gum and the adjacent teeth, design and mill the implant crown in just one visit as the CEREC machine eliminates the lab step.   If you miss multiple teeth in one area, an implant-supported bridge is the best treatment choice, supported by two or three implants underneath.  


Implant-supported crown and bridge closely mimic your natural teeth, therefore you will feel more comfortable and natural as if it’s part of your body.  You will love the look and enjoy showing your smile in the public.  


  • 3 treatment options to restore a full arch of missing teeth: 


The advancement of dental implantology has progressed vastly over the decades, particularly for restoring a full arch without teeth.  Today there are 3 treatment alternatives that are vastly superior to the traditional complete denture which was the only restorative option decades ago.   With these implant-retained full arch prostheses, we can offer our patients who need complete dentures with significantly improved degree of retention, stability and comfortability.   Whichever type of these prosthesis is chosen, the benefits of implants added to full arch prosthesis are tremendous. Replacing teeth with dental implants maintains healthy bone, preventing continuous bone loss from the ridge in edentulous patients. The improved stability offered by fixed and removable implant-retained full arch prostheses renders a significantly higher degree of dental function than that offered by conventional dentures.


Determining which option is ideal for each patient depends upon a variety of factors, including  clinical requirement of bone and interarch space, as well as patient’s finance.    However one thing needs noting is the flexibility of converting from conventional denture to implant-assisted overdenture, to fixed hybrid prosthesis to full-arch fixed implant bridges, by adding certain number of implants.  Because of that, patients have the choice to upgrade from removable full arch prosthesis to fixed full arch prosthesis with time, which translates to increased retention, stability and comfortability with each upgrading.  


Option 1 )Fixed implant full arch bridges   

This treatment modality requires 8 implants, placed at strategically planned positions in the arch.  In Wilbraham Dental Associates, the dentist will make 4 Implant-supported bridge(s) supported by 8 implants to restore full arch.  It feels most nature and comfortable as your own teeth.  There’s no denture base as the other two options, only the teeth and occasionally pink porcelain gum might be needed if you have excess bone loss at certain spot.   It’s fixed to the implants, so you don’t take them out every night.   It’s made of ceramic, so no discoloration like the plastic teeth and denture base do with the other two options with time.  Cost-wise, it’s the most expensive among the three options and the restorative process requires precision and takes the longest to fabricate.    


Option 2) Fixed implant denture   ( aka. fixed hybrid prosthesis )


This treatment modality gains popularity in the recent years due to its hybrid nature:  retention and stability of a fixed prosthesis but lower cost than a fixed prosthesis.   It is supported by 5-6 implants instead of 8.  It is fixed to the implants, so patients don’t take it out, only a dentist can do so.  Some people don’t want others to know they wear denture, a fixed prosthesis is the solution.   The denture will not move around in the mouth as it’s fixed.   It has plastic denture base and plastic teeth with a titanium bar embedded inside the prosthesis.  Unlike that of traditional denture, its denture base is horseshoe-shaped on both upper and lower.  You might have seen the upper traditional denture which has a full coverage on the palate and the denture base also covers the entire ridge on the cheek side.   Some patients complain they can’t taste food and speak like before due to the bulkiness of traditional denture.    Thanks to the horse-shoe shaped denture base of fixed implant denture, this is not a problem anymore.  It’s also a good news for the gaggers who can’t tolerate large size of conventional denture either.    For maintaining the hygiene of this type of prosthsis, you clean it like you do with natural teeth using a toothbrush and also use a waterpik to flush out the food debris under the denture base.    Your dentist will check your prosthesis annually and determine if it’s necessary to take it off to clean.  

Option 3) Removable implant denture ( aka. implant overdenture )     

This treatment modality is supported by minimally 2 implants  ( or 4 implants which offers better stability for the anterior-posterior spread of denture).    If your current budget allows for only 2 implants, it’s suggested to have 2 implants placed at the canine area and have a lower implant overdenture made.    Lower implant overdenture offers higher level of retention, stability and function compared to traditional lower denture which is well known for its poor performance since the lower ridge is horseshoe-shaped and doesn’t allow much surface area for the denture to suck on.   

Implant overdenture is still a removable prosthesis, patients need to remove it before bedtime and clean it like the traditional denture daily.   Although the retention offered by an implant overdenture is far better than that of a traditional denture, the removable nature of the appliance may leave some patients desire a fixed prosthesis down the road which affords an even higher level of stability, function and comfort.   Therefore, remember that you can upgrade your removable implant overdenture to fixed prosthesis ( fixed hybrid prosthesis or fixed implant bridges ) by adding more implants for achieve higher level of stability, function and comfort. 

  • Implant-assisted removable cast partial denture

The benefit of Implant that help improve the retention and stability of a prosthesis can be used on the removable partial denture too.    Moreover, implant eliminates the unsightly metal clasps in the aesthetic zone of removable cast partial denture.    Removable cast partial denture needs anchorage teeth, canines and molars are the common ones, to stay in place. Some partial denture patients miss these teeth.   In situations like these, implant(s) can be placed at these strategical locations to act as these teeth and help stabilize the partial denture.    Oftentimes, metal clasps are seen around canines in traditional cast partial denture which are unaesthetic, shown especially when you smile.   With implant, clasps on canines are not necessary.