What is a dental implant?

A dental implant is essentially a substitute for a natural tooth root and is designed to support replacement teeth and used to fill gaps. Almost all dental implants in use today are made from titanium or titanium alloy - materials that have been shown over many years to be well tolerated by bone.


Are there alternatives to implant treatment?

There are two alternatives for replacing missing teeth. Removable dentures are relatively inexpensive and straightforward to provide. However they need to be removed for daily cleaning and many people find them bulky, loose and uncomfortable. Fixed bridges are supported by natural teeth, are non-removable and do not require a surgical procedure. However, a bridge usually involves the preparation of supporting teeth which can necessitate the removal of healthy tooth tissue.


How many teeth can be supported by implants?

If you are missing just one natural tooth, then one implant is normally all that will be needed to provide a replacement. Larger spaces created by two, three or more missing teeth can also be treated using implants, however the exact number will depend upon the quality and volume of bone at each potential implant site.


What other problems can be treated with dental implants?

A conventional lower denture can be considerably improved with two implants placed beneath the front section - this is called an 'overdenture'. The same overdenture concept, when used to treat the upper jaw, will usually require more implants as the bone is generally softer. Implant supported overdentures, just like conventional dentures, are still removed for daily cleaning. However the implants make them much more stable when in place. Whilst not suitable for everyone, with proper preparation it is sometimes possible to fit new implant supported teeth on the same day. This fast track treatment can be applied to a number of different situations, however, you do have to balance shorter treatment times against an increased risk of implant failure.


Who is suitable for dental implants?

If you have good general health then dental implants will almost certainly work for you.However, habits such as heavy drinking and smoking can increase problems associated with initial healing and may negatively influence the long term health of gum and bone surrounding each implant. If you are aware of bad breath, loose teeth, or have noticed excessive bleeding, particularly when your teeth are cleaned professionally, you may have gum problems. Periodontal (gum) disease is a major cause of bone loss and with reduced bone dental implant treatment can be more complicated. It is rare to have health problems that prevent the use of dental implants but if you have any other complicated medical problems, please speak to Dr Franks as we have considerable experience in handling patients with a complicated medical history.


How will I know if I am suitable for implants?

During your consultation you will be asked detailed questions concerning your medical history and there will be a complete examination of your mouth and remaining teeth to discover the nature and extent of any current dental problems. Routine dental x-rays will be taken and from these images it is possible to judge the height of bone available for implant placement. However, more advanced imaging techniques, such as CT scans, are usually needed to determine the equally important bone width. Dr Imam will explain the scans and discuss your suitability for treatment at the consultation appointment..


What should I know before I start treatment?

Before treatment starts you will be given a written summary of your treatment plan, highlighting your current dental situation and alternative treatments. This summary will include an overview, including an idea of how long treatment is likely to take, how many implants are required and what the fees are expected to be. There may well be other issues specific to your case and these would be dealt with accordingly.


How will I know if I have enough bone for dental implants?

Routine dental x-rays show large amounts of detail but in only two dimensions. From these views it is generally possible to judge the height of bone available for implant placement, however, more advanced imaging techniques, such as CT scans, are usually needed to determine the equally important bone width.


What causes bone loss?

Whenever the tooth is lost or extracted, a considerable amount of the bone that once surrounded the remaining root portion may disappear. This loss can be particularly rapid during the first few months and is described as 'bone resorption'. Although the rate and amount of bone resorption is highly variable between individuals, it will always occur to some extent, unless specific care is taken to reduce its effects. Sometimes, the simplest measure to minimise bone loss after an extraction is to place the implant immediately or within the first few weeks.


How are CT scans used in my assessment?

There are now a number of advanced x-ray techniques which allow your jaw bone to be looked at in all three dimensions. The most accurate and widely available is known as the CT (computed tomography) scan. Images obtained by CT scanning will normally be able to show all of the information required about your bone, including quantity and quality but most importantly the presence of anatomical structures that must be avoided.

CT scans are generally the best means for identifying the location of important nerves and allows implants to be placed with considerable confidence. Whilst CT scans are more expensive than routine dental x-rays, the information they provide is often invaluable for complex treatment planning and knowing where important anatomical structures are located.


Can dental implants preserve bone?

This is one of the most important features of dental implants. Once in place and supporting teeth, everyday functional forces stimulate the surrounding bone which responds by becoming stronger and more dense.


Can dental implants be placed next to natural teeth?

Dental implants are routinely placed beside natural teeth and this is generally very safe to do. The only exception to this would be if the natural root was very curved or tilted unfavourably in the proposed path of the implant. This could cause the root to be damaged by the implant; however this can usually be avoided by careful pre-operative planning.

If a tooth is inadvertently damaged by the placement of a nearby implant, any resulting problems can generally be resolved by root canal treatment in which the nerve of the natural tooth is removed.

What can you do if an implant does not work?

Straumann implants have a 97% success rate. However, if an implant does not achieve or cannot maintain a rigid fixation with the surrounding bone it will eventually become loose and no longer be able to support replacement. Commonly the failing implant causes no discomfort and if there are enough remaining, it may not be necessary to replace it at all.

How long does treatment take?

Treatment times vary for each case, but in general routine cases vary between 6 weeks and 6 months from the time of implant placement to the time of restoring the first teeth. In some circumstances treatment time can extend beyond 6 months.

Can I wear false teeth during implant treatment?

Yes. If the teeth being replaced by dental implants are in a clearly visible part of your mouth it is most likely that you will want to have some teeth present whilst the treatment is underway. There are a number of ways that this can be achieved, ranging from simple plastic dentures to removable bridges. If replacement teeth are used during treatment stages it is important that they do not apply uncontrolled pressure to the underlying implants.

Is it uncomfortable when the implants are placed?

Most patients will be very familiar with anaesthetics used for routine dentistry and will know how effective they are. Implants are placed using the same anaesthesia. Depending upon the complexity of your case, the operation can take anything from 15 minutes for a single implant, to several hours for complex bone grafting and multiple implant placements.

Is it possible to have a sedation or a general anaesthetic?

Although it is quite straightforward to provide good pain control during surgery, some patients are anxious for all but the most simple of implant cases. There is no need to suffer in silence as there are several very effective means by which you can achieve a relaxed state.

Oral sedation - A simple way to aid relaxation is to be given a dose of a short acting medication such as Temezapam. This will reduce anxiety for most patients and provides a very good effect for uncomplicated surgical stages taking less than an hour.

Conscious sedation - For treatment of greater complexity it may be suggested that you have a more controlled way of keeping relaxed and comfortable during the surgical stages. This is known as a 'conscious sedation' and is distinctly different from a general anaesthetic, because you remain alert enough to respond to simple instructions which may be helpful to the surgeon - however you will remember almost nothing about the treatment stage. For a routine 'conscious sedation' a carefully controlled amount of sedative is delivered through a vein in your arm or hand for as long as the treatment takes.

What do I have to do before sedation?

For procedures involving oral or conscious sedation you will need to arrange for an adult to take you home. You will also be advised not to operate any machinery for at least 24 hours afterwards.

If I don't have enough bone what can be done?

So far we have covered the building blocks that are part of routine implant placement. This has included the initial examination and diagnosis, special x-rays such as a CT scan, sedation during surgery and what to expect after the implants have been placed. However, for some people, bone loss after the removal or loss of teeth leaves them without enough to secure an implant.

Sinus augmentation -in the upper jaw above the back teeth, it is possible to increase the height of bone available by creating new bone in the sinus. This procedure is called a 'sinus augmentation' and can allow very predictable results. Without the general success of this technique many patients would be unable to have implants in a part of the mouth where teeth are so commonly missing.

Onlay grafting - There are many ways in which bone can be added to; however, one simple concept is to take a piece of bone from somewhere else and secure it as an 'onlay graft' to a deficient area. The new piece of bone will slowly join to the underlying region and when healed and mature, an implant can be placed in a more favourable position.

What are the sources of bone grafts?

Bone can be harvested from a number of sources such as the hip, tibia, chin and posterior regions of the lower jaw. When you use your own bone to create new bone in another area of the mouth you will have to contend with the discomfort created by the donor site as well as the surgical site. Many people feel this is well worth any additional discomfort as your own bone is normally considered the 'gold standard'.

Alternatives to your own bone for grafting?

For those who would prefer an easier, but slightly slower solution, there are other sources of bone specially prepared to make them safe for use in humans. All of these materials, including your own bone, simply provide a scaffold into which new bone will grow and consolidate ready to receive dental implants a few months later.

New bone can take anything from 3 to 12 months before it is ready to receive dental implants. Do not be in a hurry to move to the next stage. If you need a large volume of bone it will take longer to mature than a small amount.

Guided Tissue Regeneration - Each surgeon will have his or her preferred way of creating new bone. Many of them will also use a supplementary technique called 'guided tissue regeneration'. Using this technique slow moving bone cells are given time to fill a space by placing a barrier material between them and the fast moving cells of the soft tissues lining the mouth. When this technique was originally developed the barrier material had to be removed during a separate surgical stage a few months later. Whilst these original materials are still in use, it is now more common to use a 'resorbable barrier' that will disappear naturally a few months after it has done its work.

How does bone grafting affect the length of treatment?

If you need bone grafting, it will almost invariably increase the length of time your treatment will take, however when successfully applied it will greatly improve the outcome of the implant(s) placed. When used in the front of the mouth it can also allow for creation of much better aesthetics.

Bone grafting requires a considerably higher degree of skill from the operator and is often more complex to perform than the placement of the implant itself.

In certain situations we will recommend combining the implant placement with bone grafting and the placement of a barrier membrane all at the same time. This considerably reduces treatment time and can produce results that are difficult to achieve any other way. However, many surgeons will still prefer to carry out bone grafting as a distinct stage, so that the implants are only placed when the bone grafting has been successful.

Whatever method is chosen to improve the bone quantity, the time, effort and expense is generally well worthwhile.

Will I suffer post-operative pain?

Since implant surgery normally involves exposing the bone in the area where the implant and/or bone graft is to be placed, you can expect some minor swelling and occasionally bruising afterwards.

For most patients, any of the simple painkillers you might take for a headache will be all that is needed for a few days. If you experience more discomfort than this, do not hesitate to contact Dr Alistair who can prescribe stronger medication.

Same day implants - This technique is most often used to treat the lower jaw and requires considerable planning before the actual day of surgery. Several implants are installed and a few hours later a complete arch of temporary or permanent teeth can be fixed in place. If temporary teeth are used these will normally be replaced with a permanent bridge after a suitable healing interval. Not all patients are suitable for this style of treatment.

Healing is generally uneventful and any stitches are removed a week to ten days later. During the first few days you should report any unexpected levels of pain or swelling so that it can be assessed. If in doubt always ask for advice, as early detection of a problem will often lead to a simpler solution. You may also be asked to take a course of antibiotics and to follow some simple procedures such as rinsing with salt water or an antiseptic mouth rinse. It is important that you carry out these instructions.

How long will the implants last?

Once the implants and surrounding soft tissues are seen to be healthy and the new teeth comfortable and correctly adjusted, it is the quality of your home care and willingness to present for regular maintenance reviews that will have most influence on how long they will last.

When poorly cared for, implants will develop a covering of hard and soft deposits (calculus and plaque) which is very similar to that found on neglected natural teeth. Untreated, these deposits can lead to gum infection, bleeding, soreness and general discomfort, just as can occur around natural teeth. It could probably be said that implants, much like teeth, will last for as long as you can keep them clean.

Implants in their current form have only been available for twenty years so long term data is limited however, the latest research shows very good results. Over a ten year period, for non-smokers without untreated gum disease, success rates of dental implants of 95% can be expected. However, just as you would expect conventional crowns, bridges and fillings to need occasional repairs or replacements during their lifetime, your implant supported teeth may also have similar maintenance requirements over theirs.

How do I look after the implants?

Once the implants and surrounding soft tissues are seen to be healthy and the new teeth comfortable and correctly adjusted, it is the quality of your home care and willingness to present for regular maintenance reviews that will have most influence on how long they will last.

Implants in their current form have only been available for twenty years so long term data is limited, however the latest research shows very good results. Over a ten year period, for non-smokers without untreated gum disease, success rates of dental implants of 97% can be expected. However, just as you would expect conventional crowns, bridges and fillings to need occasional repairs or replacements during their lifetime, your implant supported teeth may also require similar maintenance.

How many stages are involved in providing implants?

One stage implant -The implant is placed into a new, healing or healed extraction site and is visible above the gum immediately after placement. The advantage of this method is that a second surgical stage is not necessary to expose the implant. The implant will not normally be ready to support a tooth for several weeks or months.

Two stage implant - The implant is placed into a new, healing or healed extraction site and then covered by a layer of gum so that it cannot be seen - this is the first stage. At the second stage some weeks or months later, the implant is uncovered and components added bringing it above the gum ready to begin placing a new tooth.

Same day implants - This technique is most often used to treat the lower jaw and requires considerable planning before the actual day of surgery. Several implants are installed and a few hours later a complete arch of temporary or permanent teeth can be fixed in place. If temporary teeth are used these will normally be replaced with a permanent bridge after a suitable healing interval. Not all patients are suitable for this style of treatment.

Immediate implant - For this technique a tooth is removed and an implant placed immediately into the extraction site. Depending upon the local bone and soft tissue conditions, the implant surgery may be a one or two stage procedure. Not all patients are suitable for this approach.