Dental Implants

There is hope if you lose one or more teeth due to periodontal disease, or some other cause. Dental implants are changing the way people live! They are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence.

What Are Dental Implants?

Dental implants themselves are tiny titanium screws that are surgically placed into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes.

Your jawbone grows up to the implant and bonds with the titanium, creating a strong foundation for artificial teeth. Small posts that protrude through the gums are then attached to the implant. These posts provide stable anchors for artificial replacement teeth. Dental implants also help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.

Evaluation

If, like many others, you feel implant dentistry is the choice for you, Dr. Noraian will recommend a reviewing your health history, completing a periodontal examination and obtaining a low dose cone beam CT scan to understand the 3-D bone architecture available for implant placement. Once these items are completed, Dr. Noraian will review your case with you using special 3-D software to explain your treatment options.

• For smaller cases, this consultation may be
  completed in one visit.
• For larger cases, Dr. Noraian may need to
  consult with your restorative dentist before finalizing your options for review
  so there may be a need for two or more visits to finalize your treatment plan.

During your consultation, Dr. Noraian will address your specific needs and considerations. Your questions and concerns are important to us and our team will work with you very closely to help you decide which option is best for you and to assist in making your procedure a success.

The Surgical Procedure

There are a variety of surgical procedures used for dental implant placement and Dr. Noraian is well-versed in these varieties. The preparatory procedures for dental implant have been presented on previous pages. Once the bone is ready
for implant placement, and a surgical guide is fabricated from the 3-D model of your case made from Simplant or Anatomage Software or your case has been evaluated in 3-D, the implants may be placed as follows:

1. Immediate Implant Placement – Once the jaw is numb, and a tooth has been extracted, a Dr. Noraian will place a surgical guide over the extraction site and the remaining bone will be prepared to receive an implant. If the bone is sound enough, then an immediate implant may be placed. If the bone is not sound enough, then the ridge will be repaired using bone graft and soft tissue graft material. The surgical guide will be saved for future use in a few months for implant placement.

2. One Stage Surgery – Once the jawbone is numb, Dr. Noraian uses the surgical guide to map out the incision which can be as small tissue punch which is a round circle slightly smaller than the diameter of a mechanical pencil eraser if you have enough attached gum tissue to support the implant. To preserve attached gum tissue, he may use a straight line incision over the ridge. The surgical guide is placed over the teeth, or jaw to size a hole through the soft tissue which will receive the implant. The implant will be placed and a healing post, or healing abutment, will be placed in the top of the implant to train and maintain the soft tissue shape. If a straightline incision was used, the soft tissue will require sutures to secure the soft tissue adjacent to the healing abutment. Suturing is not required for the tissue punch technique. Whenever possible, this method is preferred as the need for additional surgery is all but eliminated. Occasional minor revision of the soft tissue may be indicated. In rare cases, an immediate implant may be placed using this method.
3. Two Stage Surgery – Once the jawbone is numb, Dr. Noraian uses the surgical guide to map out the incision. To preserve attached gum tissue, he may use a straight line incision over the ridge. The surgical guide is placed over the teeth, or jaw to size a hole through the soft tissue which will receive the implant. The implant will be placed and a coverscrew that is flush with the top of the implant will be placed to keep soft tissue from growing in the top of the implant. The soft issue is closed over the implant and coverscrew with sutures, and the implant will heal for several months before a second surgery is needed to expose the coverscrew for removal and place the healing abutment. While this method was the original implant placement method, Dr. Noraian will use the option more often with immediate implants and cases where bone grafting around the neck of the implant is necessary based on the what is shown by the cone beam CT scan.
4. Split Ridge Technique – Once the jawbone is numb, Dr. Noraian will make a soft tissue incision over the ridge to expose the bone which has undergone disuse atrophy. This method is primarily used for missing lower molars that have not been replaced previously. Next, a bone incision is made with the dental handpiece, and then the bone is gently spread open. The hole which will receive the implant is made, the implant is placed followed by the coverscrew and any gaps in the bone are filled with bone and soft tissue graft material. The soft issue is closed over the implant and coverscrew with sutures, and the implant will heal for several months before a second surgery is needed to expose the coverscrew for removal and place the healing abutment. This method has been one of the most innovative ways to replace lower back teeth when the ridge is too thin to used the one or two stage techniques
   mentioned above.

After Surgery

For the first three to six months following the surgery, dental implants are beneath the surface of the gums gradually bonding with the jawbone. You may be able to wear some type of tooth temporary replacement over the implant like a flipper, an Essix retainer with replacement teeth, a Snap-On Smile Appliance, or a removable complete or partial denture. Dr. Noraian will review the option that is best for your particular situation. Regardless of the replacement option it is important to eat a soft diet at this time. At the same time, your restorative dentist designs the final bridgework or denture that will ultimately improve both function and aesthetics.

Once Integration is Complete

After the implant has bonded to the jawbone, the preparation for the restorative phase begins. Dr. Noraian may need to uncover the implants and attach a small healing collar or the small healing collar may be in place. Once cleared by Dr. Noraian after about two weeks, he will provide your restorative dentist with the appropriate components used for the laboratory component of your case. To start making your new teeth, your restorative dentist must take an impression must be taken. Then posts or attachments can be connected to the implants. The teeth replacements are then made over the posts or attachments.

How Long is the Whole Process?

The entire procedure may take four to eight months to receive your final restoration and Dr. Noraian is working hard to shorten that timeframe. One method is with the OssTell Stability Meter which helps to know how stable the implant is at any given point during your treatment. Once the stability meter reaches a certain mark he may clear you to proceed with the final restoration sooner. Most patients do not experience any disruption in their daily life.

What Types of Prosthesis are Available?

A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) attaches to a bar or ball in socket attachments, whereas a fixed prosthesis is permanent and removable only by a dental professional.

Where is the Procedure Done?

Dr. Noraian performs in-office dental implant surgery using a surgical operating suite, thus optimizing the level of sterility and providing him with the latest equipment for your comfort and safety.

Why is Implant Maintenance Important?

Dr. Noraian has the patience to help you when you experience an implant problem. He believes it is just as important to support your implant as it is to place it. Once your implant has been placed, Dr. Noraian wants you to have it for a long time. By keeping up with regular implant maintenance which may include a cleaning, x-rays and periodontal charting, Dr. Noraian wants you to get the most longevity for your investment. Our maintenance program has been so good, we have people who have had implants placed elsewhere start seeing us to maintain their implants because they know Dr. Noraian will treat you like he placed them for you.

What Implant Systems Are Supported?

If you have an implant from a system not on the list, Dr. Noraian will try to help and if you have no idea what type of system you have, he will still try to help. Below is list of the systems we currently support with components on hand or readily accessible:

Dentsply AstraTech OsseoSpeed TX S Friadent Xive Friadent Ankylos CX Zimmer Tapered ScrewVent

BioMet 3i Certain               Prevail Implant Direct ScrewPlant Legacy

Providing The Latest in Proven Periodontal and Dental Implant Therapies

One of the hallmarks of Dr. Noraian’s practice is his experience with many implant systems. Over his years in practice, some implant systems have been phased out, some have been acquired by other companies and some have continued to be improved upon and innovated. Of course during his tenure, Dr. Noraian has developed his preferred implant systems and his diverse background with implants allows him to provide support when people who did not have implants placed by him need help. Implants, like teeth, require maintenance. Even when you have good maintenance habits, your implant may be ailing or failing for a host of reasons. Hopefully, you reach Dr. Noraian before your implant fails as he does have methods to shore up an ailing implant. When your implant does fail, he may have options for you to consider another implant.

Dr. Noraian has received extensive training in Dental Implantology in addition to Periodontology. Through continuing education, Dr. Noraian is abreast of the most current information on implant dentistry and periodontics.