Implanting confidence

Implanting confidence
February 24, 2005
By Sharon Klehm
NewsTribune online
Anyone who has ever lost a tooth, certainly wishes they could grow a new one. The reality is that it is not possible. However, modern dentistry has come up with the next best thing ÇƒÓ a dental implant.
The procedure involves extracting a tooth that cannot be saved and placing a titanium post or screw into the jawbone. Once the post is firmly anchored into the jawbone, a small titanium cover, called an abutment, is placed on top of the implant. Once the abutment is in place, temporary crowns are put on and left in place for four to six months while the gum tissue molds around the abutment. After this time period, a permanent porcelain crown is cemented onto the abutment. The final result is a porcelain crown, which looks, feels and functions as a natural tooth.
John Derango, a La Salle dentist, has performed dental implants for about 16 years, working with oral surgeons who, in some cases, do the extractions and prepare the bone tissue to accommodate the implant.
According to Derango, in the past, heroic measures were used to try and save teeth. Large fillings and posts were put in to hold crowns that didnÇƒÙt always last. Sometimes the crown came loose, taking some tooth substructure with it.
Çƒ?Implants work well on structurally comprised teeth, rather than performing heroic dentistry. By taking the tooth out and putting in an implant, it increases longevity,Çƒ? he said.
Dental implants also can be used to firmly anchor long bridges, partials and dentures. When the bridges were attached to healthy teeth by wires or cement, sometimes the attachments put the teeth at risk, eventually causing a deterioration of the healthy teeth. Implants also can be used to anchor partial dentures after they have begun slipping or causing discomfort.
A La Salle woman, Kelly Quesse, 24, says she is grateful for implant dentistry. Two years ago this June, she was injured in an early Sunday morning automobile accident. As a front-seat passenger, her face hit the dashboard, knocking out three front upper teeth.
Çƒ?I didnÇƒÙt feel a thing right away,Çƒ? she said. Çƒ?But it was quite bloody.Çƒ?
Her mother immediately contacted Derango, who had been KellyÇƒÙs dentist all her life. Even though it was Sunday, Derango contacted a colleague, Dr. Ian Elliott, an oral surgeon with offices in Joliet and Aurora. Quesse saw Elliott on Monday afternoon. After that, she made weekly trips to Joliet for months to get X-rays and plan the appropriate steps necessary to restore her teeth.
However, about four weeks after the accident, Quesse was no longer toothless. She said Derango designed a temporary flipper prosthesis that hooked onto three teeth and could be taken out.
So far, Quesse has had two oral surgeries. The first was a bone graft to restore the damaged upper jawbone. Bone was taken from her lower jawbone and grafted to the top jaw.
Quesse said the procedure resulted in only some mild tenderness in her lower jaw. Last December, two temporary implant screws were placed along with three temporary teeth by Derango and Elliott in Aurora.
Çƒ?The reason for the temporary screws is to allow the tissue to grow and mold around the screws so when the permanent crowns are put in, the teeth will look real,Çƒ? Quesse said.
It still has to be determined whether some tissue grafting will be necessary. Quesse said it will depend on how much the tissue has molded around the temporary teeth, but she is hoping for the whole implant procedure to be finished by June or July as she is engaged to be married in September.
Çƒ?I have been comfortable knowing that it is all fixable and I am in the best hands possible,Çƒ? Quesse said. Çƒ?ItÇƒÙs not been fun at all times. I was not able to eat for a while. First, I was on a liquid diet, then only soft foods.Çƒ?
Quesse was under anesthesia for the bone grafting and while she admits there was some discomfort, she was given pain medicine to take, which she did not need.
Çƒ?The worst part was the shots to numb the jaws for the temporary screws,Çƒ? she said. Çƒ?I am so happy with Dr. Derango. He has been my dentist my whole life. He told me everything was fixable and it was.Çƒ?
Dr. Thomas Rooney, an oral surgeon in Peru, said sometimes oral surgery is necessary as the first procedure in implant dentistry. The cylinder inserted in the jawbone that holds the implant screw and the hole left by the tooth extraction are not the same exact shape. The cylinder is round, but when a tooth is pulled, the hole left by the extraction is not.
Çƒ?If the shape is not right, it can lead to gaps in the jawbone that may or may not fill in. I like to be cautious and make sure,Çƒ? Rooney said.
Rooney said implants were invented about 35 plus years ago in Sweden there have not been leaps and bound made since then.
Çƒ?Sure, there are better tooth surfaces, more is known on healing and patient comfort, but the actual implants have not changed that much,Çƒ? he said.
Anytime teeth have been removed, the jawbone naturally shrinks. There is a benefit in getting something (an implant) back in the jaw before the bone shrinks. Rooney said when dealing with shrunken bone, the oral surgeon must decide if the smaller jawbone is adequate or to restore the bone structure.
Rooney said there are different types of grafting material used for bone restructuring. It can be a synthetic material similar to coral or irradiated and freeze-dried animal bone from cattle. Sometimes, the patientÇƒÙs bone can be harvested from the other jawbone.
In accident cases, bone can be taken from the patientÇƒÙs hip. It takes four to six months to restore the jawbone and involves two procedures ÇƒÓ bone and skin.
Çƒ?You want to get as much bone bulk as you need,Çƒ? he said.
Once the mouth is prepared, crowns are the next step in implant dentistry.