Dental Implant Awareness Month | Why CBCT Scanning, Bone Grafting, and other related procedures are necessary

The American Academy of Implant Dentistry (AAID) has designated the month of September as Dental Implant Month. This organization has provided educational opportunities for thousands of dentists desiring to learn and become credentialed in implant dentistry. The training provided enables dentists in this country, and worldwide, to gain expertise in this field. The quality of life for countless patients such as, improving their ability to eat in comfort, speak naturally, and smile with confidence, has been enhanced. Whether a patient is missing one tooth, or many, dental implants have become the treatment of choice.

And the dentists at Colony Square Dental Associates are especially familiar with all aspects of implant dentistry. After years of continued education and rigorous examination, Dr. David G. Hochberg became a Fellow of the American Academy of Implant Dentistry (AAID) and a Diplomate of the American Board of Oral Implantology (ABOI). He has also served as an examiner for other dentists seeking advanced credentials. This past year, Dr. Hochberg was honored to serve as the 66th president of the AAID.

Inasmuch as dental implants have become the standard-of-care, and are frequently advertised on television, many are familiar with the basic concept of dental implants. However, less known are other services, and the terminology, that oftentimes are provided to maximize the potential for success.

Cone beam computed tomography (CBCT)

One of the tools made available by today’s advancements in digital dentistry, is a CBCT scan. This is a 3-dimensional image of the jaw. Why is this a useful diagnostic tool? Seeing the entire jaw and interrelationship between the bone, the teeth, the nerves and the sinus cavity provides the dentist with a unique window in order to optimize the plan of care. The scan helps to answer questions such as:

• Is the bone volume adequate to support a dental implant?
• Has the bone resorbed causing the sinus cavity to drop – potentially being too close to the area where the implant will be placed?
• Is the location of the sinus membrane in close proximity to the implant site?
• What size implant is appropriate?
• What is the appropriate angle to anchor the implant?

BONE GRAFTING

When all is healthy – the teeth, the gums and the supporting bone, the tooth’s root is firmly held in place. And like other cells and tissue in our bodies, the bone in our jaw is always continuously repairing itself – replacing damaged cells with new ones. However, the following are some oral health concerns that can negatively impact the body’s ability to heal itself.

• Periodontal (gum) disease is a major cause for tooth loss. Left untreated, infected gum tissue pulls away from the bone, the bone is damaged, and the weakened bone no longer can support the tooth’s root. If the bone was not adequate to support the natural tooth, it cannot support an implant.
• The body continues both the formation of new cells and the replacement of damaged cells throughout our bodies as needed. In the jaw, it is the root of the tooth stimulating the bone tissue when we chew that signals the body that it is viable tissue that needs to remain strong and healthy. However, when a tooth, or teeth were lost some time ago, whether they have had replacement teeth fabricated or have not, the root of the tooth is no longer there. The signal is lost. New cells and replacement cells do not keep the bone healthy and the bone resorbs. More often than not, the tissue atrophies.
• When a tooth requires removal, be it due to trauma or dental disease, the extraction site is at risk. There is no longer a root in place; there is a void. And there is no longer a root to stimulate bone growth.

To maintain bone, to prevent atrophy, to minimize the risk for bone resorption, to augment sites without adequate bone volumes – bone grafting can be the difference between bone that can or cannot support an implant. It provides an extra measure of insurance to help increase the predictability of a positive outcome.

Bone grafts, which are comprised of different materials, are selected based upon the patient’s needs. Once in place, the stage is set to stimulate new bone growth. And once in place new tissue grows around the dental implant and bonds to it in a process called osseous integration. The newly formed bone becomes the solid foundation to support the implant.

SINUS LIFT

Everyone has heard of the sinus cavity. After all, who hasn’t had a cold? But you may wonder why they are of importance in dentistry. The sinuses sit right above the jaw; and the dental implant, like the tooth’s root, is placed in the jaw. When our adult teeth form within the natural structure of the jaw; the root has adequate space to fit and the sinus cavity is not of concern. But whether due to trauma or disease, if a tooth or teeth are lost, factors may preclude the replacement of the tooth’s root with a dental implant without consideration of the sinus cavity. Over time, the jaw atrophies when the roots of the teeth are no longer present. The maxillary sinus drops down reducing the bone height necessary to place an implant; a sinus lift is indicated. This procedure, sometimes called a sinus augmentation, involves moving the sinus membrane upwards to provide space for the placement of additional bone between the maxillary sinuses and the jaw.

A FOLLOW UP Periapical (PA)

A PA (digital image/x-ray) is taken to examine the root of a tooth; similarly, it is taken to examine the dental implant. Drs. Hochberg and Diora are able to evaluate the implant placement within the bone. It’s a quick and cost-effective measure to ensure that there are no abscesses or infection noted and that the bone tissue has sufficiently matured around the dental implant. A PA is taken routinely during the treatment phases and then is recommended annually.

Dental implants offer patients excellent alternatives to bridges and dentures. As in all areas of healthcare, technology, techniques, and materials are improving daily, giving the clinicians at Colony Square Dental Associates the tools to provide optimal patient care. And as with all advancements, there are new words for new treatment options. These are but a few. Ask Drs. Hochberg and Diora to explain all the details and all the terminology. They would be happy to answer all your questions.