Call us at: (780) 420-1604

Tooth Replacement and Dental Implants

What Are Implant Supported Crowns And Why Are They Used?

Implant supported crowns ('caps') are non-removable restorations which replace one or more missing teeth. Implant supported crowns are most frequently used to:

  • replace missing teeth to restore a natural smile, restore an even bite for better chewing or to facilitate normal speech sounds
  • prevent teeth on either side of a space from progressively tipping over or teeth in the opposite jaw from over erupting which can result in an unattractive smile, an uneven bite and damage or pain in the jaw joints or muscles
  • maintain the natural shape of your face by providing support for your lips and cheeks
  • prevent excessive wear on the remaining teeth when some teeth are missing

The use of dental implants to support replacement teeth has a significant advantage over other methods of tooth replacement in that the replacement teeth (crowns) are attached directly to the implants and does not involve any cutting, modification or attachment to your remaining teeth. This gives your remaining teeth the best chance of lasting a lifetime. Dental implant supported crowns are also very stable and are not removed from the mouth unlike removable partial dentures. Dental implants will also reduce the rate of bone shrinkage that occurs when natural teeth are removed from your jaw, which will help maintain a natural appearance.

Implant dentistry is best completed by a dentist who has extensive training and the appropriate knowledge and skills in implant dentistry. The bone of the jaws can give predictable long term support called osseointegration when specific types of titanium dental implants are used in combination with researched and proven techniques. The dental implants will then provide support for the crowns which are usually made using a gold alloy (usually silver colored) framework for strength and an outer layer of ceramic which is tooth colored to create a natural appearance.

Single Implant Supported Crown Multiple Implant Supported Crown

How Is An Implant Supported Crown Placed?

A number of steps are involved in placing an implant crown. The first step is to design and plan the implant crown to optimize its size and shape, your bite and access for cleaning. An implant guide stent can be fabricated which is used to guide the correct surgical placement of the implants and can also be used if additional x-ray imaging of your jaws is required prior to surgical placement. If required, temporary replacement teeth are made if not already present, usually in the form of a removable partial denture. Any removal of teeth in the area of implant placement is usually completed well before the time of implant placement.


These days, following the removal of any teeth, it is often possible to complete all the remaining surgical treatment in a single surgery. However, there are still situations when treatment is best completed in multiple surgical stages. During your surgery, the area will be anaesthetized and an implant will be placed at the selected locations in the jaw along with any other required procedures. This surgery requires meticulous care in an appropriately prepared office. Your denture will be modified for ongoing use usually at or soon after each surgical appointment. Usually three to five months is required for the bone to solidly stabilize the implants; a process called osseointegration.


Once the implants are solidly attached to the bone, fabrication of the implant supported restoration can begin. This may involve the use of a temporary crown and occasionally, some treatment situations require minor surgical enhancement of the soft tissues (gums) that surround the top of the implant to facilitate cleaning or to obtain the esthetic result desired. The making of your implant supported restoration is exacting to achieve the optimum results for you and therefore can require multiple appointments with your implant prosthodontist.

Implant Crowns Can Be Designed For Attractiveness, Comfort and Chewing

Natural looking implant crowns need to be more than just 'white', they must approximate the complex color scheme of your other teeth or they will stick out like a 'sore thumb'. Color is approximately matched using standardized color tabs which are selected with your approval and is included in basic implant crown fees. If your implant crown is prominently visible, some degree of additional customization will usually be required to more closely match your other teeth. This customization process can proceed until the best possible match is obtained subject to the limitations of man-made materials and fees based on the length of time required for customization. When skillful clinical treatment is combined with artful laboratory technical work it is often difficult to detect the difference between a well made implant crown and your natural teeth. Natural teeth will tend to slowly darken with age. Teeth replaced and restored with an implant crown will remain the same color.

Shape is extremely critical and is one of the most frequently overlooked aspects of many implant crowns. This has resulted in an otherwise attractive smile being ruined by implant crowns not matching the remaining teeth and appearing as if they stick out. Proper shape is also required to prevent food jamming between teeth and to permit fast and easy cleaning.

Red, blue or swollen gums and gum recession are ugly and can be caused by improperly made implant crowns. The gum around the implant crown should be pink, firm and not bleed during cleaning.

A well made implant crown should feel completely even with the other teeth on the very first day and does not require time to settle in. An implant crown that is slightly 'high' can result in great pain and inability to chew properly, whereas an implant crown that is slightly 'low' will result in tooth movement and bite instability which compromises the other teeth. An implant crown should also be made to feel comfortable when you slide your teeth from side to side or back to front as in chewing. A well made implant crown should actually help stabilize your bite for many years which is important if you are planning to keep your teeth for a lifetime.

An implant crown should feel comfortable and look natural. A missing tooth replaced with an implant crown will maintain or restore your ability to eat and speak.

Success Rates?

Research has shown that high success rates of over 95% are routinely possible with appropriate implant materials and good surgical technique. The implant system and techniques we use are supported by extensive world wide research. In our office, we have achieved an even higher success rate, but success can never be guaranteed.

The most likely causes for the loss of an implant are excessive force on the implant during healing and infection. Our techniques minimize both of these risks. Before starting to build the crown on the implant, the stability of the implant and bone healing will be assessed. In the unlikely event that the bone fails to stabilize the implant, then after implant removal and subsequent healing in the area, a replacement implant can usually be placed.

Because smoking compromises the body's ability to heal, there is a somewhat reduced success rate for implants and especially bone rebuilding or grafting in smokers. You are encouraged to reduce or preferably quit smoking as soon as possible, prior to implant placement.

How Long Will An Implant Supported Crown Last?

Implants and their supported restorations will not get dental decay like teeth. However, if not carefully made, cleaned and occasionally checked, a process similar to periodontal (gum and bone) disease can develop. In the event that one of several implants is lost, or if additional teeth are lost and more implants are required, or even if the appearance of your teeth changes, this type of implant is versatile and well suited for future modification or change. The existing implants would be maintained as is, additional implants placed if needed, and the original implant crowns either modified or new ones made.

Replacement of missing teeth using these particular dental implants and techniques is supported by volumes of research and experience. Osseointegration has been researched and demonstrated to be clinically successful for more than thirty years in Sweden and was introduced into North America at the Toronto Conference in 1982. We only use implants that are manufactured with safe bio-compatible materials that have been adequately tested and are of a standardized size and shape from a large reputable manufacturer so that our patients can anticipate long term use of their implants and future maintenance and modification of the crowns will be facilitated.

By using specialized knowledge, skill and experience in combination with careful planning and attention to detail, an implant restoration will likely give you many years of service. Success is also dependent on your daily cleaning and periodic maintenance. All these details will give you the best value for your time and financial investment.

How Do I Clean My Implant Supported Crown?

Cleaning implant supported crowns may reflect some differences to cleaning non-restored natural teeth. You must thoroughly brush your teeth and clean between the teeth using either floss and floss threader, super floss or a prox-a-brush every day. You will be shown and coached on the techniques necessary to care for your implant restoration.

What Will An Implant Supported Crown Feel Like?

An implant supported crown should feel completely comfortable and look natural. Depending on the type of implant restoration and patient variables, different esthetic results are possible. Some parts of the implant or supporting framework may be visible if the lips or cheek are artificially pulled back but in most instances the implant restoration appears very natural in normal viewing. Missing teeth replaced with implant supported crowns will maintain or restore your ability to eat and speak. The gum around the implant and associated crown should be pink, firm and not bleed during cleaning. Implant dentistry has improved the quality of life for many patients, restoring confidence, comfort, chewing ability and a natural attractive smile.

Case Studies - Single Implant Crown

Ms. D.M. was 18 years old and her upper right lateral incisor was missing as it never grew. We reviewed the various treatment options, consisting of a bridge, adhesive bridge and an implant crown. The implant crown was the best option as it would be most likely to be long lasting, look and work similarly to a natural tooth and not damage the adjacent teeth. Ms. D.M. decided she wanted an implant supported crown to replace this missing front tooth but was a little nervous about having the implant work. She became much more relaxed about proceeding after her friend talked to her about the treatment, as he had recently had similar treatment completed. Coincidentally, her friend was also one of our patients! Ms. D.M.’s implant supported crown was completed in 1996.

Before After

Mr. B.M. was a student at the University of Alberta when he came to our office. He had fractured his upper right central incisor 4 years earlier and had it repaired with a crown but the tooth did not last and had been removed a little less than a year prior to seeing us. Mr. B.M. had a small space between his front teeth which he was used to and did not want additional treatment to eliminate. Because of the space, a bridge was not possible and he did not want to have a partial denture so the decision was made that an implant supported crown was the best way to replace the tooth and restore his appearance and function as close as possible to a natural tooth. Treatment was completed in 1996.

Before After

Ms. L.B. was missing her upper right lateral incisor and had a very small and narrow ‘peg’ shaped left lateral incisor. We discussed the treatment options for tooth replacement and creating a normal sized appearing tooth on the other side. Ms. L.B. and her parents decided to proceed with an implant supported crown and a veneer on the ‘peg’ shaped tooth. She was in the process of having her teeth straightened with braces at the time she first saw us. We advised the orthodontist how much space to leave for the planned implant and once the teeth were nicely aligned and Ms. L.B. was fully grown, our treatment was started. Ms. L.B. was age 16 when her treatment was finished in 2003.

Before After

Mr. B.S. was age 19 when he had an accident at work that fractured his jaw and broke many of his teeth. It was decided that the best way to repair the fractured teeth would be with crowns and for two of the teeth that were fractured beyond repair, to replace them with implant supported crowns. Mr. B.S.’s teeth also happened to be somewhat crooked which he had always wanted to have fixed. So he decided to proceed with orthodontic braces to straighten his teeth. Once the teeth were straight, we then proceeded with three crowns and two implant supported crowns, which were paid for by Worker’s Compensation. Treatment was completed in 2001. Mr. B.S. now has the straight teeth he wanted and has recovered his smile and full use of his teeth following his accident.

Before
After

Mr. R.N. was 41 years old when he fractured his lower left first molar. Two years later he was referred to our office for an implant crown to replace this missing tooth which was completed in 1995.

Before After

Mrs. T.H. was 30 years old when she was first came to our office. She had two baby ‘eye’ teeth that were still present because both of her adult lateral incisors never developed and her adult ‘eye’ (cuspid) teeth had come in next to the two front teeth. Mrs. T.H. felt self conscious about her appearance because the baby teeth looked much smaller than her other adult teeth and they were continuing to wear down. Her regular dentist did not offer her any options that she felt comfortable with. She then consulted another dentist who suggested placing 2 veneers on the central incisors as well as a bridge to replace the two missing teeth and also crowns on many other teeth to increase the height of the teeth overall, which she objected to because she felt all the other teeth were fine. She then asked a friend of the family who was also a dentist for their opinion, who recommended a consultation in our office. We suggested placing only two single implant supported crowns in the space of the baby teeth once they were removed. This treatment was completed in 2003, leaving all of her other teeth unaltered and Mrs. T.H. comfortable and very happy with her smile.

Before After
Case Studies - Multiple Implant Crowns

Miss. C.G. had an accident in which her upper front central incisor was knocked out and then was successfully put back into the socket when she was 9 years old. She then wanted her teeth straightened and had braces that were finished when she was 15 years old. Her general dentist noticed that the roots of some of her teeth had become very short, a deterioration that can sometimes result from trauma and as a consequence, a number of her teeth were becoming very loose. There was no way to stabilize the upper front four teeth and replacement with implant supported crowns was clearly the best option. After three or four years, when the family was ready to proceed, two implants were used to support four crowns, which were completed in 2003 when Miss. C.G. was 20 years old. These teeth now feel solid, don’t have any looseness and Miss C.G. has normal use and appearance of her upper front teeth.

Before After

Mrs. J.L. had traumatized her two lower front teeth when she was 36 years old, root canal treatments had subsequently been completed and then crowns were placed on these teeth 20 years later which had been problematic. Her dentist then referred her to our office and she indicated that she wanted these teeth removed. The adjacent teeth were very small and would not make good supports for a bridge so implant supported crowns were the only good alternative. Two implant supported crowns were completed in 1996 when she was 68 years old and function with comfort like her natural teeth.

Before After

Mrs. P.W. was in a motorcycle accident in 1995 when she was 38 years old. Her upper front right tooth was knocked out and many other front teeth were chipped and damaged as well as some facial skin scarring. She had finished orthodontic braces to straighten her teeth just 6 years ago as an adult. As a result of her accident, the two upper front teeth required replacement with implant supported crowns, the adjacent tooth on either side as well as one lower front tooth required a veneer to restore the chipped areas. Most treatment was completed between 1999 and 2000 but one tooth had a small root fracture that was not evident initially and the last treatment was completed in 2003. Mrs. P.W. now feels that she has her nice smile back.

Before After

Mrs. J.G. had a bridge that was supported in the back by her lower right wisdom tooth and this bridge replaced three missing teeth. In 1994 at age 55, she had to have this wisdom tooth removed, which left her with many missing teeth in the lower right area. Because of some unrelated medical concerns, she was not able to consider proceeding with any dental treatment for a few years but she had always been interested in looking into implant supported crowns. Finally, in 1999 treatment was started and three implant supported crowns were completed in this area restoring her ability to chew on this side of her mouth.

Before After
Case Studies - Extensive Combination Tooth Replacement and Repair

Mrs. K.G. had heard of us through her office, which works with many dentists. She came to us when she was 55 years old in 2001. She had caps put on most of her teeth about 25 years ago. Her dental work was certainly quite deteriorated at this point, but in addition, unfortunately a number of her back teeth had a lot of decay and could not be saved. She had not had any dental cleanings done for a few years but now she wanted to fix her teeth. An examination revealed how many of her teeth could be saved and led to a discussion on the alternatives of replacing the missing teeth. We determined that bridges could be used to replace the missing upper back teeth and crowns would restore the upper and lower front teeth. Because all of the lower back teeth were missing, bridges in this area was not possible. A removable partial denture would not have been as strong, long lasting or felt like real teeth so it was decided to have 7 implant supported crowns to replace the missing lower back teeth. Mrs. K.G. is now on a regular cleaning program and is very happy with her restored smile and teeth that feel and work naturally.

Before After
Before After
Before After
Before After
Before After
Before After

Mr. R.B. was referred to us by his general dentist in 1997 when he was 53 years old. He said he wanted to fix his really worn down teeth because they no longer were as visible when he smiled. He had been told by his dentist that he had been wearing down his teeth with his teeth grinding habit. He had been told about a nightguard, but had never worn one. The ‘final straw’ was that he fractured a lower front tooth recently and he couldn’t ignore his tooth problems anymore. Following examination, it was agreed that the lower front four teeth as a group were not strong enough to keep and it would be stronger and likely last much better to remove them and replace them with four crowns supported by two dental implants. All of the other teeth were rebuilt with crowns once some gum work was completed on the lower teeth. A nightguard was recommended and made for use every night during sleep to minimize the risk of fracture and wear.

Before After

Mr. B.G. was 57 years old in 1993 when he decided that he would have to have his teeth fixed as they had been patched many times and were in a state of considerable disrepair and also looked that way. He experienced bleeding gums, food catching between his teeth, mouth odor, marked tooth wear and had many missing back teeth without good replacement. Unfortunately, his jaw bones had also shrunken considerably so that there was not enough bone to hold dental implants. Some options were discussed and he decided that he would prefer to keep as many teeth as possible, rebuilding the missing and damaged upper front teeth with a large bridge. The lower front teeth would be repaired simply with tooth colored fillings and the other lower teeth repaired with crowns. All the missing back teeth in both the upper and lower jaws would be replaced with removable partial dentures held in place with snap attachments to avoid the unattractive display of clasps. Several root canal treatments were required as well as foundation fillings and the removal of an extremely decayed tooth. A nightguard was also made to protect the dental work and supporting teeth from wear and fracture for use every night during sleep. Mr. B.G. can eat foods without much concern as the partial dentures stay in place quite well due to their design and the use of the snap attachments which also make the teeth look quite natural.

Before After

Mr. W.F. was referred by his general dentist in 1995 when he was 45 years old as he had been in a severe hang gliding accident, losing many front teeth, damaging the jaw bone and a lot of his other teeth and dental work. Mr. W.F. wanted to spread out the costs of his treatment and he was also very nervous about dental implants so he proceeded with his treatment in stages, starting first with the teeth in the lower jaw. The back teeth that remained required new extensive bridges and the missing front teeth he wanted to replace initially with a removable partial denture, to delay implant treatment. The removable partial denture was of a specific design that required no clasps in the front because of the special design of the bridges that restored and replaced all the other lower back teeth. Once the lower teeth were completed, attention was turned to the upper teeth as Mr. W.F. then felt more comfortable considering the implants and required associated treatment. Only two crowns were required on damaged teeth. Before the implants could be placed, the remaining deficient bone had to be rebuilt. Then the missing 6 teeth were replaced with 5 dental implants supporting a complicated structure that not only replaced the 6 teeth but also a large area where the bone and gum had been damaged in his accident and could not be fully repaired. The implant crowns were designed to be fixed and not removable. Mr. W.F. is convinced he will proceed with implant crowns eventually to replace the missing teeth in the lower front but the partial denture we made is working so well he is happy to just enjoy things the way they are for now.

Before After

Mrs. L.J. was 41 years old in 1996 when she was referred to us by her dentist. She wanted to restore her chewing ability because her jaws got tired easily when she ate and also wanted to eliminate the gaps between her teeth. She told us that she was not keen on having dentures and she had stopped wearing her previous partial dentures that had been made 20 years ago because they made her teeth ache. She did not like the color match of a bridge that had been placed on some of her upper teeth 5-10 years ago and some of her teeth were sensitive to hot and cold. Following examination, we outlined the possible alternatives to improving the damaged and replacing the missing teeth. There was not enough bone without augmentation procedures for implant supported crowns to replace the missing back teeth. Enough upper teeth remained to build cantilever bridges that rely on supporting teeth in the front and extend back a short distance to replace some of the missing back teeth. This created a situation where a removable partial denture was not necessarily required in the upper jaw. Because even fewer teeth remained in the lower jaw, cantilever bridges were not recommended and specially designed crowns were fabricated on some teeth with snap attachments allowing the use of a snap attachment retained lower partial denture.

The teeth in the very front of the lower jaw were simply reshaped and polished to create a more even bite and straighter looking teeth. Mrs. L.J. was pleased with her new teeth and the attachment partial lower denture has worked out to her satisfaction.

Before After

Ms. M.A. was only 17 year old in 1996 when she first sought out our office. She had been born with a type of inherited genetic condition that resulted in many missing adult teeth and some other traits. She had previously received some initial care elsewhere and was aware that a great deal of treatment was going to be required, but wanted to avoid having orthodontic braces and it was paramount that her appearance was satisfactory at all times. Following examination, some recommendations were made that included crowns and bridges in some areas of her mouth to create normal sized teeth and implant supported crowns in the other areas where she was missing the most teeth. All of the baby teeth had to be removed so in all, 10 adult teeth remained and 10 implants were placed with 6 in the upper jaw and 4 in the lower front with a total of 24 replacement teeth consisting of crowns, bridges and implant supported crowns. It took a little time to explain what was being done and reassure Ms. N.B. that at each step of the way she would have some form of temporary teeth allowing her to work, go to school and socialize with her friends. In all, a large amount of co-ordination was required as she lived a thousand kilometers from the office. Ms. M.A.’s smile made the effort worthwhile for all concerned but we will especially remember the looks of appreciation from her family.

Before

 

After