Spaces, especially between molar teeth can occur. Molars are roughly square to trapezoidal just under the gum before the roots separate. Implants, on the other hand, are cylindrical and rarely are as wide as the molar they are replacing. The net result is that the smaller width at the neck of the implant crown (the restoration) requires that the restoration "flare" from a more central position and creating a taper that is more likely to trap food.
The shape of the gums around the implant changes following the initial extraction. This is one of the reasons the extraction site is frequently bone grafted at the time of extraction... in order to reduce the amount of shrinkage of both bone volume and bone width.
Wider implant are now available but are not perfect. Another way is improving the restored width of the implant restoration by the use of a custom milled anatomic abutment or Patient Specific Abutment. Using computer software, the connection between the implant and the crown is custom milled on a cad/cam machine in a way to mimic the shape of the tooth that was lost. In this way, it is possible to reduce or eliminate these food traps.
Following front tooth removal, we often try to maintain the shape of that part of the socket through the gum by the use of an "ovate pontic" in the temporary restoration, which is inserted immediately after extraction—we try to maintain the height and shape of the soft tissue like it was around the tooth before it was lost. The width of the available implants more closely resembles the width of the roots of front teeth. Even then, it may be necessary to fabricate a custom abutment to maintain the original tissue contours so there can be less space issues.
It is through such tissue sculpting that a front tooth can be made to look like the one that was lost.
Which tooth is an implant? Answer: BOTH front teeth.
This was one week after insertion. The shape of the gum around the neck of the right front tooth was to be modified (you can see the anesthetic injection site toward the upper left) to look like the left and the space between the front teeth filled in over the space of one month. There are traditional ceramic caps on the lateral incisors... on either side of the two front teeth. When all was done, there were no spaces and both teeth were symmetrical.
This takes a bit if experience, skill, patience and good implant selection and placement. This takes extra time and extra appointments. All that = $$. This is why you don't let just anyone "plug in" any old implant and have Acme dental lab down the street make the crown. What can I say.
Just to give you an idea...Surgical extraction $250 plus bone grafting procedure, $500 plus the cost of bone grafting material (@$160 per bottle). Cost of the top tier, FDA approved implant used by the surgeon can be more than $300. Healing abutments, $75. Temporary abutments, $50-$75. permanent abutment screws, $75. Final abutments, $160—$380... depending on whether they are made of titanium, gold or hi-tech ceramic (zirconia). Milled custom abutments, $300. Impression copings and implant analogs, $60—$75 each. Final crown, $250-$350. Each implant site requires at least one of each.
Services of a specialist x 3 hours and a minimum of 3 visits. Services of the restorative dentist x 5 hours and a minimum of 4 visits. Practice overhead, staffing, insurance, etc. ??$ and then you have to make a profit!
Oh, I forgot to add the costs of continuing education to provide these services and continue to improve those services....
...and you also want it to look and feel good.
Tell me exactly how would this come out "cheap" or how could all this be done for $1200, all inclusive as some cut rate practices might advertise?
I can tell you that in a large city in the US, an extraction + bone graft + provisional + single implant + restoration will cost somewhere in the neighborhood of $5—$6000.
I'm not trying to discourage anyone away from these procedures... just put them and their associated costs in perspective... and why you can't expect a good outcome by scrimping.
By the way, the alternative to a single tooth implant is the 3 unit fixed bridge. You must prepare one tooth either side of the missing tooth for a cap to hold the bridge in the mouth. The cost for such a bridge, is about $3500-$4500 + the extraction. That's not a whole lot different than the implant solution (OK, I admit that $1000-$1500 is not a little bit of money) but
you must sacrifice two additional teeth. This was the preferred method prior to implants just a few years ago.
Hopefully, you get an idea of what is involved and what current technology allows us to do.
Regards, everyone.
