Frequently Asked Questions Regarding Implants in Costa Rica
1. Why do we lose our teeth?
There are several reasons that cause the dentist to extract a tooth, such as advanced gum disease (the bone that held the tooth is lost); advanced decay that could make the tooth impossible to be reconstructed; or root fracture, normally after an accident.
2. What happens when we lose our teeth?
Some of the consequences of tooth loss are: esthetic compromise; decrease of masticatory efficiency (it is harder to chew); overload of the remaining teeth that will have to assume the function of the lost teeth (therefore the remaining teeth could be injured or lost too); difficulty to talk or to say certain words; loss of lip support (wrinkles); inclination of the neighbor tooth; unstable bite; head and face muscles and articulation problems; decrease of the size of the bone that held the lost teeth (bone resorption).
3. What are the options to replace the missing teeth?
The simplest option is the removable denture, which is retained by hooks, and stabilized by a plastic or metallic structure that covers the palate or the tongue zone. The patient can remove it from the mouth. The next option is the bridge, which consists of trimming the neighboring teeth, to make porcelain crowns on them fixed to another crown that will replace the lost tooth. The third option consists on placing an artificial titanium root (dental implant) that will support a porcelain crown.
4. What is an implant?
An implant is an artificial object that replaces a lost part of our body. This way, it will work as the part that we have lost.
5. What is a dental implant?
Dental implants are small titanium cylinders (3.75 mm. Diameter) that work as artificial dental roots, once they are placed inside the jawbone. This way the artificial teeth can be anchored in these new roots (zero to four months after their placement, once the dental implants (artificial roots) have fixed strongly to the bone), enabling us to recover a beautiful smile, as well as comfortable speaking and chewing. Dental implants will allow us to chew with total comfort, and to smile and speak with the same security as our own teeth. With the use of the dental implants, there is no need to touch, trim or injure the neighboring teeth, to replace the missing tooth. The dental implants that have shown a very long-term success rate are the osseointegrated dental implants, that actually integrate to the bone.
6. What is an osseointegrated dental implant?
They are a type of intraosseous dental implants that affix to the bone by means of the phenomenon of osseointegration, creating true artificial roots implanted inside the mandible or maxillary bone, giving a solid base to built solid restorations to replace one or several lost teeth that will work exactly the same as our natural teeth. Osseointegrated implants will allow us to chew with total comfort, and to smile and speak with the same security as with our own teeth.
7. Which are the disadvantages of using dental implants?
a) Dental implants must be placed inside the bone through a small surgery, which is painless but makes some patients feel anxious. b) The other disadvantage is the time to wait from the implant’s placement to the crown placement, or primary osseointegration time, that is two to six months, depending on the area of the mouth where the teeth were lost. During that time the patient can wear a temporary bridge or denture that could be fixed or removable.
8. What are the advantages of using dental implants?
a) The main advantage of dental implants consists of not trimming (damaging) the neighboring teeth to replace the lost teeth: even though natural tooth supported bridges have been a good option, they are no longer the best, since their life is 7 to 10 years, and when they fail it is because one or more of the supporting teeth fail, due to overload or to decay inside the tooth. Then, the supporting teeth are lost too (although sometimes they can be saved by root canals), and a longer bridge has to be done, so more teeth have to be trimmed. This problem could have been avoided if an implant had been placed the first time, instead of the bridge. b) The hygiene for maintaining a healthy bridge is more difficult than for implants, since regular dental floss cannot be used because the crowns in the bridge are fixed together. Therefore, a special technique with special floss has to be used for bridges. On the contrary, implant-supported crowns can be easily flossed (same way as natural teeth), since the restoration is independent of neighboring teeth. c) Life for an implant is longer than for a bridge or a removable denture: In 10-year studies, it was found that success rate for implants was 90%; meanwhile for bridges and dentures it was 50%. It was also found that when a bridge failed, supporting teeth had to be extracted or submitted to root canal treatment very often. The few times that implants failed, they only had to be changed, with no harm to the neighboring teeth. d) Removable dentures induce a wider loss of the bone that held the natural teeth. Once that bone loss has advanced, it is impossible to retain a removable denture, and then a bone graft has to be placed. On the contrary, dental implants stimulate the bone; therefore its loss is avoided.
9. What material is used for dental implants?
Along the history of dentistry and medicine, many materials have been used. At the present time, the only material considered valid for dental implants is titanium.
10. Why titanium?
There are countless researches that demonstrate that titanium is the best biomaterial, given its excellent biocompatibility to the human organism. Since it fixes to the bone (osseointegration), it has demonstrated to last for very long periods of time. There are research studies that support the use of implants that have been working for more than 35 years, with a very high success. All this makes titanium the elected material.
11. What is the purpose of using dental implants?
The main purpose of implants is to work as artificial roots that will hold the crowns placed instead of the lost teeth. Implant restorations fulfill three basic concepts: • Function and aesthetics: chewing, speaking and smiling can be done comfortably; they also provide lip support. • To stop the bone resorption, since they stimulate the bone that holds them. • To eliminate the overload of the remaining teeth that could appear if bridges were used.
12. How do implants contribute to recover the function and the aesthetics?
Dental implants substitute the removable dentures for fixed teeth, improving the function and the aesthetics simultaneously. They support the new crowns without the need of trimming the natural teeth, allowing us to chew with total comfort, and to smile and to speak with total security, for many years. The implant-supported crowns can be easily cleaned with dental floss.
13. What is bone resorption and why does it happen?
When we lose one or all the teeth in our mouth, (probably because of decay, gum disease, traumatism, etc.), a process of bone loss or bone atrophy begins. The function of the maxillary and mandibular bone is to support the teeth. When these teeth are lost, a process of bone resorption begins that is accelerated in most of the cases for the pressure of the removable denture. On some occasions the resorptions are so large that it is almost impossible to tolerate or achieve good retention in a traditional removable denture. The aesthetic and functional consequences can be dramatic. The widest bone loss happens during the first months after the tooth is lost.
14. How do dental implants contribute to stop the bone resorption?
With implants we don’t only replace the teeth that we have lost, restoring the function and the aesthetics. The bone loss is also stopped because the bone receives the stimulus of mastication again. Therefore, it is important to replace the missing teeth with implants as soon as possible after they were lost.
15. How do dental implants contribute to diminishing overload of the remaining teeth?
Let us imagine the example of a house. The teeth would be the columns or pillars for support of the roof. If we were removing columns, the rest of them would have to support the whole weight of the structure. The remaining columns would be overloaded, and there could be a moment when the roof falls. In the mouth the same thing happens, when teeth are lost. The remaining teeth have to support all the forces of mastication, suffering a significant overload that could injure them and their bone support, and with time they could be lost too.
16. What is the treatment?
The treatment consists of two stages: a. Surgical phase b. Prosthetic phase.
17. What is the surgical phase?
The surgical treatment consists of the placement of the artificial roots or implants inside the jawbone. It is performed with local anesthesia, and is painless. Sedation and general anesthesia are options for nervous patients. The duration of the intervention is from one to two hours, depending on the number of implants, They will remain covered for two to six months (depending on the area of the mouth where they were placed). After that time sometimes there is need of a very small second surgical phase, to uncover the tip of the implants, especially in esthetically related areas.
18. What is the post-operative stage like?
It is not painful. The following day of the operation the patient will have a slightly inflamed area in the face. Painkillers, antibiotics and anti-inflammatories are prescribed for a short period.
19. Will I be able to use my removable denture or bridge as a temporary solution?
While the dental implants integrate to the bone, if you use a removable denture, it will be modified and conditioned internally with a special material, to be used temporarily from the day of the placement of the implants, until the implants are ready to receive the fixed porcelain crowns, zero to four months later. If you use a fixed bridge, it will be cemented immediately after the placement of the implants, to be used temporarily from the day of the placement of the implants, until the dental implants are ready to receive the fixed porcelain crowns, zero to four months later.
20. When will the new teeth be placed on the dental implants?
The time between the surgical phase and the placement of the crowns varies depending on the case. The range varies between two and six months, to give time for the implant to integrate or fix to the bone. If necessary, more time could be acceptable if the patient requests it (i.e. because of a trip).
21. How does the new prosthesis or crown anchor to the implants?
The system used consists of a series of very precise machine made abutments that anchor to the implant with a gold screw, and that will retain the crowns.
22. Is it necessary to brush the new implant-supported teeth?
Like natural teeth, implants should receive daily flossing and brushing. The flossing of the implant-supported crowns will be much easier than for tooth supported bridges, because they will not be fixed to the neighboring teeth.
23. Am I an ideal candidate for dental implants?
If your answer is affirmative to some of the following questions, you can be considered an ideal candidate to be treated with implants: • Have you lost one, some or all of your teeth?• Do you have difficulties with your removable denture (bad retention, pain, etc) • Do you feel insecure when you smile, when you speak or when you eat? • Has a dentist told you that you have teeth in very bad shape? • Is there an area in your mouth where the corresponding tooth never showed up?
24. Is age a limit?
Age is not a decisive factor for being a candidate for implants, but it is advisable not to use them before 15 to 16 years of age, until the maxillary growth has completed. Older patients can receive implants as well as young ones, with the same success rate.
25. Is it a painful treatment?
No. A treatment with implants demands a surgical operation, but pain and all the other implications can be perfectly controlled.
26. How long does the treatment take?
It is very important to respect the times of osseointegration or integration of the implant to the bone. In general it takes two to four months for the lower jaw, and six months for the upper jaw, between the time of the implant placement and the prosthetic phase (start of the construction of the implant supported crowns or dentures). The prosthetic phase lasts from one to three weeks, depending on the case.
27. Could there be a failure?
In spite of the excellent clinical results obtained with implants (93 to 97% success rate) there is a 3 to 7% rate for failure. No other dental treatment has such a high success rate for long terms.
28. What happens if a dental implant fails?
If an implant fails, it is possible to substitute it for another one to solve the problem. Nevertheless, most of the implant-supported prostheses are designed to work, even if an implant fails.
29. Will the dental implants last a lifetime?
In medicine it is complex to say that a treatment is for a lifetime, especially because of the fact that teeth are a tool that we use every day and in each moment, that receive a lot of pressures and forces, and placed in a humid and very septic area (the mouth). There are studies older than 35 years that show a very high success rate. The most recent studies say that 90% of the implants placed 10 years ago, are still working in the mouth today. It is much higher than the 50% success rate for ten-year periods described for tooth-supported bridges or dentures.
30. Is dental implant treatment expensive?
The implant treatment is sophisticated and it demands a very complex armamentarium. More than one experienced professional (specialist) is required; the components used have to be very precise, and precious metal alloys (gold, silver, palladium) have to be used in the prosthetic phase. The implants and the prosthetic components have to be from a recognized brand. All of this makes the implant treatment more expensive than the tooth supported treatment, at first. But with time, since implant treatments last longer, with the re-doing of the tooth-supported bridge or denture (sometimes it implies root canals, extraction of supporting teeth, longer bridges, etc) it is likely that the implant treatment becomes less expensive, and will prevent the loss of the natural teeth.
31. Why Costa Rica for dental implants?
Costa Rica is a peaceful small country in Central America that is also known throughout the world for its high quality, low cost dental care. Politically stable, and with no army, Costa Rica is one of the most bio-diverse countries in the world: 25% of its territory is dedicated to parklands and wildlife refuges. Tourists love Costa Rica’s natural attractions, from beaches, deep-sea fishing, white water rafting, and surfing, to mountains, rain forests, volcanoes and hiking. The capital city of San José offers museums, a national theater, and casinos. All visitors love San José’s central market. You can also visit coffee plantations, butterfly farms, and villages offering local handcrafts – all within a twenty-mile radius! Costa Rican’s are known for their warmth and hospitality. It is safe and easy for patients from other countries to have their dental implant treatment done in Costa Rica, and meet this beautiful country between appointments, all for a much lower price, even though most of the materials, including the dental implants we use, are made in the United States and Europe.
32. What is a specialist?
According to Costa Rican Law, a specialist is a dentist who, after the regular six years of Dentistry, has studied at least two more years (full time) in a specific branch of dentistry. This has to be certified by the official Costa Rican Board of Dentists, that reviews the program and the University that offers the specialty (some programs may not be accepted as a specialty, if they do not reach a degree of excellence). The Costa Rican Board of Dentists prohibits (article 29th, Code of Ethics) the dentists to say or announce a specialty, if they have not accomplished these requirements. There are only six certified Specialists in Oral Implants in Costa Rica, and my favorite dentist is one of them.