Dental Extractions & Implants in Brooklyn, New York

By Dr. Robert Mikhli and Dr. Theodore Goff

Missing even one tooth can result in an unsightly gap in our smile or the loss of chewing in an area of the mouth. While these consequences are esthetically displeasing, or at the least inconvenient, these are the least of the significant problems resulting in the loss of a tooth. What is of greater concern is the bone loss that inevitably follows tooth loss. The placement of a dental implant will ultimately result in the implant fusing with the bone, preserving your jaw bone, improving chewing function and enhancing or restoring the esthetics of the smile.

Dental implants have revolutionized the replacement of teeth in the field of dentistry. In the last fifty years the technology for dental implants has rapidly developed and improved. Today, dental implants may be your best option for the replacement of a tooth, multiple teeth, or the entire dental arch.

Dental implants consist of three components: the dental implant itself, an artificial tooth root that serves to replace the root of the tooth – the portion of the tooth that is below the gumline, a dental abutment, or mechanism to allow attachment between the dental implant and the crown, and a dental crown, or artificial tooth.

Figure 1: Dental Implant, Abutment, and Crown. https://www.aaid-implant.org/dental-implants/what-are-dental-implants/

Having a dental implant placed has many benefits:

The system looks just like a natural tooth when you smile, there is no visible difference.
A dental implant and the dental crown attached to the implant does not decay like a natural tooth can, meaning your dental implant crown will not get a cavity and require a filling
The bone around the dental implant will not deteriorate as it would if the missing tooth was not replaced.

Dental implants are highly stable with a very low failure rate. Modern dental implants are made with pure titanium, a metal substance that is used in dentistry and medicine because it is a substance that is well known to be accepted by the body and is osteophilic – bone loving. A dental implant will fuse, or integrate, into the jawbone through a biochemical fusion between the bone cells in the jaw and the surface of the titanium implant. With a solid integration of a dental implant into the jawbone the longevity of a dental implant system is very similar to retaining a natural tooth for the duration of an individual’s lifetime. When properly placed, a dental implant system is the ideal treatment for a missing tooth or missing multiple teeth.

What is the process when receiving a dental implant?

Dr. Robert J. Mikhli or Dr. Theodore Goff will follow routine procedures to evaluate each patient for their candidacy for a dental implant. The patient’s medical status and general health will be evaluated, the dental implant site will be carefully evaluated, the way the patient bites will be considered, and the esthetic concerns will be carefully evaluated. A special scan, called a Cone Beam Computed Tomography (CBCT), will be administered so the dentists can have a 3-D representation of the patients teeth, skull, and nerve location.

Figure 2: CBCT for Implant Planning. https://cdeworld.com/courses/4804-Clinical_Applications_of_CBCT_and_CAD-CAM_Data_Integration?c=133

The use of the CBCT allows the dentist to assure that the underlying bone is thick enough to retain a dental implant and to evaluate ideal implant placement to avoid placement of the dental implant into nerves or sinus cavities. Upon completion of a thorough planning process, the patient is ready to have their dental implant placed.

Dental implant surgery is generally a very comfortable process performed under local anesthesia. Most patients say that they feel minor vibrations from the hand piece when preparing the implant site. Upon completion of the surgery there are no open wounds and very little, if any post-operative discomfort. In most cases, the dental implant will remain under the gums for 4 or 5 months to fully integrate into the bone. Once the implant is fully integrated into the bone, the implant will be uncovered and prepared for the dental crown. The implant uncovery is performed under local anesthesia with a small incision made into the gum above the dental implant and a small cap (healing abutment) placed onto the implant to properly contour the gums in preparation for the dental crown. Most patients experience very little discomfort following the uncovery procedure. Over the course of one to three visits, following the uncovery, the patient will receive their final crown, and the implant procedure is complete.

The placement of an implant requires expert knowledge for proper surgical planning, proper implant placement and proper attachment of the crown. Dr. Robert Mikhli, owner and operating dentist, as well as Dr. Theodore Goff, operating dentist, of Precision Implant Care in Brooklyn, New York have extensive experience and training in implant dentistry. Dr. Robert Mikhli and Dr. Theodore Goff are top-rated dentists offering dental implants and oral surgery at Precision Implant Care. They utilizes state-of-the-art surgical approaches and technology to restore oral health and enhanced aesthetics to patients with damaged, diseased or missing teeth.

What types of dental implant procedures are available?

Today, the dental implant system is a commonly used procedure to replace a single missing tooth, multiple missing teeth, or to aid in the rehabilitation of the entire arch. While there are several dental procedures to replace missing teeth, dental implants are the most effective procedure to restore your smile, your chewing functions, your confidence, and most importantly, stop the loss of jaw bone surrounding your teeth. A dental implant system can look and feel almost as natural as your own tooth and in the long run, can be the most cost effective procedure necessary to restore your mouth to the most optimal state of health. According to the American Dental Association (ADA), more than 5.5 million dental implants are placed annually in individuals by dentists in the United States. During your consultation, the doctors at Precision Implant Care will discuss the various options available to replace your missing tooth or teeth.

Missing a single tooth

If an individual is missing a single tooth, the options to restore their smile are:

A partial removable denture to fill in the gap
A dental bridge
A dental implant.

A removable partial denture is held in place by small clasps. The partial is made of acrylic, and sometimes a metal bar, and it will come in and out of the mouth. Many patients find this option unacceptable due to the movement of the partial denture and the fact that it can be taken out of the mouth.

A dental bridge restores the missing tooth by “bridging” a replacement tooth, called a pontic, between the two opposing teeth, called “abutment teeth”. To bridge teeth, the dentist will prepare the two abutment teeth for dental crowns. A special dental laboratory will fabricate a three unit restoration called a dental bridge. This restoration will be cemented over the abutment teeth and form a “bridge”, replacing the missing tooth. Many patients do not prefer this method of replacement because the two teeth prepared have to have tooth structure removed to accommodate the bridge, the bridge is one unit and each tooth cannot be flossed, and the price for a bridge is nearly the same price as a dental implant system.

A dental implant system restores the missing tooth as a single tooth. Once completed, the dental implant appears just like a natural tooth. Dental implants consist of three components: the dental implant itself, an artificial tooth root that serves to replace the root of the tooth – the portion of the tooth that is below the gumline, a dental abutment, or mechanism to allow attachment between the dental implant and the crown, and a dental crown, or artificial tooth. When properly placed, a dental implant system is the ideal treatment for a missing tooth or missing multiple teeth. The system looks just like a natural tooth when you smile, there is no visible difference. A dental implant and the dental crown attached to the implant does not decay like a natural tooth can, meaning your dental implant crown will not get a cavity and require a filling, and the bone around the dental implant will not deteriorate as it would if the missing tooth root was not replaced.

Figure 3: Dental implant replacing a single missing tooth

Missing multiple teeth

If an individual is missing multiple teeth, the options to restore their smile are:

A partial removable denture to fill in the gaps
A dental bridge or several bridges
Dental implants individually placed to replace teeth or spaced appropriately to create anchors for dental bridges.

As with a removable partial for a single tooth, there are partial dentures for multiple teeth. These are fabricated to fill in the missing teeth in any area within the arch. With multiple missing teeth, bridges are still an option, however the number of pontic teeth will increase.

In many instances, dental implants can stand in place of two missing teeth, reducing the span of a dental bridge, eliminating the need to remove tooth structure of other teeth, and replace missing roots of teeth, subsequently reducing bone loss.

Figure 4: Dental implant replacing 3 missing teeth

Dental Rehabilitation

When all of the teeth in the mouth or within a single arch are too damaged to be saved, full mouth or arch rehabilitation is the ideal option to restore function to the mouth. When a full arch or mouth rehabilitation is necessary, the options are:

A complete removable denture or dentures
Removable implant stabilized overdentures for each arch
Fixed, implant retained prosthetics for each arch.

Removable dentures are fabricated to fit over the gums and can be adhered to the tissue with temporary gel that acts as a sticky glue like substance to help hold the dentures in place during the day. Dentures are removed from the mouth every night. Many patients object to dentures due to their movement when speaking and eating, the potential for sore spots on the gums, large amounts of plastic across the palate and into the gum tissue, and the long term loss of jawbone.

Figure 5: Upper and lower dentures to replace a full arch of missing teeth. No implants are involved

Implant stabilized dentures are also removable dentures, however they are stabilized with two to four implants. The denture itself is removed each night, however the implants remain in the mouth indefinitely. Many patients prefer an overdenture over a removable non-stabilized denture because the implant stabilized denture is more secure when chewing and talking, there is no need for any adhesion gel or glue, the amount of plastic over the palate and into the gumline is significantly reduced and the placement of some implants allows the jawbone to have some structure to attach to, thus reducing the amount of bone loss.

Figure 6: Implant stabilized denture (over denture). The denture is removable, but secured by implants to improve stability and balance

Fixed, implant retained prosthetic arches are the state-of-the-art dental prosthesis for full arch rehabilitation. Also known as the All-On-Four™ Procedure or Hybrid Prosthesis, the fixed, implant retained prosthetic is the ideal treatment for full arch or full mouth rehabilitation. A hybrid prosthetic is retained in the mouth by four to eight implants. The prosthetic is secured to the implants by the dentist and can only be removed in a dental office. The prosthetic is very thin and appears like natural teeth. The base is custom fit to the contours of the patients gums so there is a very tight fit, minimizing any food getting lodged beneath the prosthetic. Patients are especially keen on the hybrid prosthesis because it is very thin and does not extend into the gumline or over the palate.

Figure 7: Implant retained prosthesis. The prosthetic can only be removed by your dentist.