Q:Dr. Crapo I’m 63 years old and have been wearing dentures most of my life. In the past ten years I’ve gone through two sets and recently found I’ve got to have another set made. My lower denture moves around too much causing sore spots. I was told implants would stop that from happening so I decided I was going to have mini implants because they’re less painful, cheaper and faster. When I went to my dentist he said if I went the mini implant route I’d need gum grafting first but with regular implants I wouldn’t. I’m not sure I understand why. I hate the idea of more surgery, that was the major reason for the mini implants.
A:Though I’m not privy to your exact condition, your dilemma is not unique; many folks learn what you’ve discovered when investigating their implant options. The reason revolves around two very important factors – the strength of your gum tissue and the position of the implants. In the early 1980’s when the explosion of implant dentistry occurred, dentists placing implants were told that as long as there was adequate bone the implants would take and would successfully anchor teeth. Questions about “gum strength” were passed over as inconsequential. However time and research has revealed that the quality and strength of the gum around the implant is very important to implant longevity.
There are basically two types of gum tissue in the mouth. One type is bound firmly to the bone and is called attached gingival tissue. This is the type of gum tissue most important for implant health and stability. About a year ago a woman came to my office complaining of infection in the gums around her implants. Upon examination I found that none of her implants were surrounded by this attached gum tissue but completely surrounded by the second type, which is not bound to the bone. This type of gum is movable (it allows our lips and cheeks to be flexible) and unfortunately allows plaque and other irritants to slide down the crevice which exists between it and the implant.
Just as a person can easily pucker and distort his lips, movable gum tissue distorts around the implant. When this happens rapid swelling may occur leading to failure of the implant. This had happened to the woman mentioned above. She had lost fifty percent of the original bone around her four lower implants. Infection control and techniques to decrease the puckering around the implants have saved, for the present time, her four implants.
This brings me to the second factor, that of the position of the implants. Often the mini implants must be placed through this movable type of gum. If your dentist has ascertained this to be the case that is the reason he’s recommended gum grafting. Placing attached gingiva first, then placing the mini implants will ensure greater stability and longevit