In the last decade dental implants have become commonly used in routine dentistry and they are usually the preferred choice of treatment for a missing tooth.
A dental implant is an artificial replacement for a tooth root. It is made from titanium. Many different brands are widely available and when used correctly they can all deliver a highly reliable form of treatment. The principal objective during placement of any implant is to obtain immediate intimate contact with the surrounding bone. With time, further growth of bone onto the implant surface increases the stability of the implant.
To allow the implant to support replacement teeth the implant normally has an internal screw thread that will allow for a number of different types of components to be connected to it. Once connected, these components become the foundation for long-term support of crowns, bridges or dentures.
Dental implants are appropriate for most adults with good general health. They cannot be placed in a jawbone that is still growing and so consequently they are not used with younger patients.
Heavy drinking and smoking are habits that can be associated with problems at the initial healing stage. Thereafter these habits may be bad for the long term health of the tissues surrounding each implant. Some dentists will not place implants if smoking cannot be reduced or stopped completely. However, each case is specific and if you have any medical problems then speak to your dentist or doctor before undertaking any treatment – it is rare that health problems prevent the use of dental implants completely.
Dental implants are appropriate for most healthy adults.
At your initial consultation with us we will assess the feasibility of providing implant treatment for you. We will ask you specific questions concerning your medical history and there will be a thorough examination of your mouth and remaining teeth to ascertain the nature and extent of any current dental problems. Usually we will take x-rays and study models will be cast so that we can examine these after your visit to us.
These x-rays and study models will be used to determine the optimal position for any implants, the number of implants that can be placed in the gap and the quality and volume of bone available.
In any treatment plan, establishing good basic dental health is very important. At this appointment we will make you aware of any problems that need urgent attention and what treatment may be required to stabilise any gum- or tooth- related problems. We will give you a verbal outline of how your specific case may be looked after.
If you need to enquire about dental implants it is normally as a result of or an awareness of ongoing dental problems or the recent loss of a tooth or teeth. The cause of these problems will need to be understood and treated before having any implant treatment.
If you are conscious of bad breath, loose teeth, or have noticed bleeding when you are brushing your teeth or having your teeth cleaned professionally it is likely you have some ongoing gum problems. Gum disease is a major cause of loss of bone and with reduced bone dental implant treatment can be more difficult but not impossible.
For uncomplicated cases, from the time of implant placement to the time of connecting the final tooth or teeth the treatment times can vary between three months and six months. With better bone quality being available the treatment time can be decreased whilst more time and care must be taken with poorer quality bone. In these instances the treatment can extend beyond six months.
We will give you a written summary of our treatment planning discussions noting your present situation and any relevance that may be to dental implants. This summary may include an overview of the anticipated treatment stages, give you an idea as to the length of time the treatment is likely to take, how many implants will be required and what the fees are expected to be. There may be other issues particular to your situation that will be dealt with accordingly.
Once the implants and surrounding soft tissues are seen to be healthy and the new teeth are correctly adjusted and comfortable the quality of your own personal attention to oral hygiene and willingness to attend regular maintenance reviews will have the most influence on how long your implants will last.
When neglected, implants will develop a covering of plaque and calculus just as natural teeth do. Untreated, these deposits can lead to subsequent gum infection, bleeding, soreness and general discomfort. It is fair to say implants will last as long as natural teeth. Well-maintained implants placed into adequate bone can be expected to last for many years and potentially, for your lifetime. However, just as you would expect conventional crowns, bridges and fillings to require occasional repairs or replacements your implant-retained teeth may have similar needs over the years.
Dental implants can be used to support one or several missing teeth. Common forms of tooth replacement, such as bridges or dentures can be supported by dental implants.
If you are missing just one natural tooth then one implant is all that is needed to provide a replacement. However, larger spaces created by two or more missing teeth do not necessarily need one implant per tooth; the exact number of implants needed will depend on the bone quality and volume at each potential site.
Patients who have a habit of clenching or grinding (bruxing) their teeth could be vulnerable to overloading of the implants. For most patients this occurs at night and they are not aware of the habit. The effects of bruxism need to be accounted for during treatment planning and can be compensated for by placing additional implants, selecting appropriate restorative materials and providing a bite guard to be worn at night to protect your teeth.
We will discuss this in your initial consultation and detail this in your treatment plan.
Implant treatment normally involves several stages that take place over a period of time from three months up to nine months. There are a number of different treatment mechanisms but a typical process often includes.
Assessment and treatment planning:
At your initial consultation, further to a full discussion of all possible alternatives, we will assess the feasibility of providing implant treatment. X-rays are taken and study models will be prepared. A written treatment plan will then be devised which will detail the sequence of treatment and the associated costs.
Implant placement is a relatively straightforward minor surgical procedure that can be performed under sterile conditions in a dental surgery. Normally it is performed using local anaesthesia. Sedation can be provided if required. If, during assessment, the underlying bone is deemed deficient, a number of options can be recommended to regenerate your bone. This can be carried out prior to or at the same time as implant placement, depending on requirements.
Implants can take from six weeks to six months to become tightly anchored by your own bone. During this integration period, temporary dentures or bridgework can be worn if appropriate. In some cases, temporary teeth can be fixed to your implants while they integrate. This process is known as ‘immediate loading’.
The restorative stage:
Once integrated, the implants can be introduced to function with a variety of new teeth alternatives (definitive restorations) ranging from a single crown, small or large bridge or a removable overdenture. Our technician, who works closely with us on these cases will create these handmade restorations.
Once your treatment is complete you must regularly and thoroughly clean the new teeth as we have instructed you to. Our dental hygienist may also advise on care and maintenance of both your new restorations and your natural teeth. Regular visits to us are essential so that the health of your soft tissue, bone levels and the integrity of the restoration can be reviewed and monitored.
Routine dental x-rays show good detail but in only two dimensions. Often this may be sufficient to determine the height of bone available for implant placement; however, more advanced imaging techniques are sometimes needed to determine the width of bone available.
Dental CBCT Scans – there are now a number of more sophisticated x-ray techniques that allow us to investigate the jawbone in three dimensions. The most widely used of these is the CBCT (cone beam computed tomography) scan. These images can normally show us all the information that is required about your bone; not only the quantity and quality but also the location of important neighbouring anatomical structures.
When you lose your tooth a significant amount of the bone that once surrounded the remaining root may disappear (resorb). This bone loss can be very rapid in the first few months following loss of a tooth (bone resorption). Whilst this is highly variable between individuals, it will always occur to some extent.
Patients with dentures often report that, after a while, their dentures have become progressively looser and that they feel loose. Initially, the increased rate of bone loss subsequent to extractions is responsible for this deterioration in denture fit. Over the longer term, the effect of chewing forces being applied directly to the gum surface causes deterioration of the supporting bone. Hence, the longer dentures are worn, the less bone you will have available for your dental implants.
Upper Jaw – provided the implants are placed within the bone that used to support your own teeth there are really no important risk areas. If you have missing upper back teeth we can show you the maxillary sinus on an x-ray. These sinuses are seen on most x-rays and CT scans. The sinuses are air-filled spaces situated in the upper jaw. They can be located on an x-ray or a CT scan and your implant treatrment planned accordingly.
Lower Jaw – the inferior dental nerve is the important anatomical structure to avoid. If this nerve is disturbed or damaged during the placement of dental implants it can lead to temporary or even permanent numbness or altered sensation. This is a rare but important complication.
CBCT scans offer the most reliable means for locating this nerve allowing implants to be placed with greater confidence. Often a CBCT scan is taken as this gives us tremendous potential for planning accurately where the implants can be placed. We have invested in modern imaging technology and have a scanner in the practice. This allows our patients to have a scan taken at greater convenience and much lower cost. The scan will only take seconds to generate an image and whilst they are more expensive than routine dental x-rays the information they provide is often invaluable for more complicated cases.
If a tooth is inadvertently damaged by the placement of a nearby implant, any resulting problems can generally be resolved by root canal treatment.
This is an important feature of dental implants. When a restored implant begins to function, the everyday forces (talking, smiling, eating) stimulate the surrounding bone, which responds by becoming stronger and denser. As with all things, there need to be limits to the function that we place our implants under. We can discuss this in more detail as it relates to your individual case.
When several dental implants are placed they are routinely joined together. This linking of implant teeth results in their being mechanically stronger than the individual parts would be on their own. If enough implants are available, it is often easier and just as effective to create smaller sections of bridgework each supporting a few teeth. The result in the mouth is the same however if repairs ever need to be made this becomes an easier process.
The bone quality and the relative position and number of implants will determine which option is best for your specific case.
Implants can be placed painlessly using the same local anaesthetics we use for routine dental treatment. Depending on the complexity of your individual case, the procedure may take anything from an hour for a single implant to several hours for complex bone grafting and multiple implant placements. You should be prepared to expect some minor swelling and occasionally some bruising however this is much less common. Ordinarily, any of the over-the-counter basic painkillers that you may take, say, for a headache will be adequate for a day or two. If you experience more discomfort than this please contact us and we will look after this.
Healing is generally straightforward and any stitches are usually removed after a week to ten days. Over the first few days you must inform us of any unexpected levels of discomfort or swelling so that this can be assessed. If in doubt always seek advice as early detection of a problem will often lead to a simpler solution. We may ask you to take antibiotics and to follow some simple instructions such as rinsing with salt water or an antiseptic mouth rinse.
Providing ample pain control during surgery is straightforward however some patients suffer from anxiety. We can also provide sedation to help alleviate your anxiety.
The sedation we can provide is known as conscious sedation. This is a very controlled method of keeping you relaxed and comfortable during the implant placement stage. It is distinctly different from a general anaesthetic because you are alert enough to respond to simple instructions – however, you will remember almost nothing about the treatment itself. For a routine ‘conscious sedation’ a carefully controlled amount of sedative is administered through a vein in your arm or the back of your hand. It is a very safe procedure during which your heart rate and oxygen levels are carefully monitored. When you have conscious sedation you will need to arrange to have an adult take you home after your appointment and you will be advised not to operate any machinery for 24-36 hours afterwards.
For some patients, bone loss after removal of a tooth can leave them without enough to secure an implant. There are procedures that can be carried out if this is the case.
In the upper jaw above the back teeth, we can increase the height of bone available by creating new bone in the sinus. This is a sinus augmentation. At The Guild Practice we carry out these procedures with great success. Without the success of this technique many patients would not have been able to have dental implants in an area of the mouth where teeth are so often missing.