Why should you consider dental implants?
If you, like lots of people, have lost one or more teeth, you may be all too familiar with the unpleasant consequences. For many, missing teeth lead to an unattractive smile, embarrassment from loose dentures, and pain or difficulty during eating.

Traditional dentistry can provide replacements for missing teeth using bridges, removable partials and dentures; however, each of these has its problems. Bridgework usually involves altering natural teeth to provide a stable foundation for support of replacement teeth. Partials and dentures can, at times, be very unstable leading to denture sores or speech difficulties.

Another little known problem associated with tooth loss is a process known as 'atrophy', a shrinking of the jawbone that can progress relentlessly over the years. Bone atrophy not only affects jaw function, but can cause adverse facial cosmetic changes. As a result, there may not be enough bone volume for dental implants, in which case additional treatment may be required..

Because of the remarkable advances in dentistry in recent years, dental implants offer an effective solution to many of these problems.

What are the normal stages involved in having an implant?

Stage 1 - Diagnosis, treatment plans and consent
During the first stage of care a full diagnosis is made and a provisional treatment plan formulated. The patient is then informed of their suitability for implant therapy, alternative treatment options and advantages and possible complications of each option. In my opinion only at this stage is it possible for a patient to consent to implant treatment. Implant therapy is an elective procedure and should be patient driven.

Stage 2 - Stabilisation of disease
During stage 2 the affected tooth or teeth is removed and an appropriate provisional denture or bridge is placed. It is at this stage when other general dental health requirements if required are also stabilised.

Stage 3 - Planning and implant placement
The implant is placed into the jaw using a minor surgical technique. This is normally carried out under sedation using a drug called Midazolam. This drug is a sedative not a general anaesthetic and is considered a very safe drug when used within a dental environment. It is usually administered by a second practitioner and has the advantage of making the procedure as comfortable as possible leaving the patient with few recollections of the treatment. Some patient occasionally prefers not to have sedation however in my experience especially with multiple implant placement sedation is preferable.

Stage 4 - Abutment connection
This procedure is a limited surgical procedure to locate the top of the implant and allow connection of the abutment to the implant. The abutment is the second implant section, which attaches to the implant top with a screw and holds the implant crown or bridge. This stage is carried out 4-6 months after implant placement. It is at this stage when the implants integration (bonding to bone) is confirmed.

Stage 5 - Provisional crown and bridge construction
Following confirmation of the success of the implants integration the provisional or temporary crown and bridge can be constructed. This stage is carried out 2-6 weeks after stage 4.

Stage 6 - Final construction
The final crown or bridge is made. This stage is carried out after 4-12 weeks following the provisional stage.

Stage 7- Maintenance
This stage involves clinical monitoring and patient home care advice to ensure that the implants are maintained to a high standard.

Does it hurt?
It is very uncommon for patients to experience any discomfort during implant placement. Most patients experience a small amount of discomfort following placement which is easily controlled with over the counter drugs.

Will my face well after treatment?
Most patients experience mild swelling over the implant area for one to three days. If a graft is placed or multiple implants are placed the swelling may be more pronounced however it will reduce after three days.

When can I return to work?
In most cases patients can return to work the following day. In the case where grafts have been placed or where heavy physical work is carried out 3 days should be allowed.

How long will implants last?
In my experience this will depend upon the quality and quantity of bone available at the time of implant placement, the bodies’ response to treatment and the level of maintenance carried out by the patient. Once integrated an implant should last 15 years and hopefully if bone levels remain constant a lifetime.

Will my implants require maintenance?
Yes from both the patient and our team. Dental implants can require maintenance and repair of their above gum components similar to crown and bridgework.

Can I have my implants straight away?
There are two distinct concepts when considering this question:

1. Immediate placement
The tooth is removed and the implant immediately placed. This forms the new artificial root.

2. Immediate restoration
The implant is placed and the tooth is restored at the same time. This provides a new tooth on top of the artificial root.

It is possible to have a tooth extracted and an implant immediately placed and restored. This option has a number of advantages for the patient including speed of treatment and avoiding the need for temporary dentures or bridges. The major disadvantage especially with single teeth is the reduced success rate and difficulty in controlling the gum level.

I rarely carry out immediate placement and restoration of single teeth for the above reasons and prefer to use a delayed approach, which provides me with greater success and control of the final cosmetics.

I do however carry out immediate placement where it is clinically indicated leaving the restorative phase for the normal time.

The exception to the rule is where patients have or are about to loose all their lower teeth. Research shows that this is of benefit for the patient and the integration compared to a delayed approach.

This is possible due to the ability to link the lower implants together and the limited visibility of the necks of the lower teeth.

The options available to each patient will be discussed at the time of their initial consultation.

How long will I be in surgery when I have my implant?
Implant placement will take from 3/4 hour for a single tooth to three hours for a very complicated large case. Sedation therapy will reduce the patient’s perception of time to 10-20 minutes.

Can I have sedation during implant placement?
I recommend sedation for all cases unless the patient requests otherwise. Sedation is not a general anaesthetic and is a safe, predictable method of ensuring a patients comfort during placement.

Is age a restriction to implant care?
In my opinion a patient is never too old to benefit from implant care as long as their general health is good enough to undergo the procedures involved in implant dentistry. A patient can however be too young. I would not recommend that a female patient undergo implant care before the age of 18 and a male 20. This is because if an implant is placed before growth is complete there is a possibility that the jaw will grow leaving the implant in a non-ideal position.

What medical conditions exclude patients from implant care within our clinic?

* Chemotherapy within the past 6 months
* Radiotherapy to the oralfacial area – Hospital referral required
* Alcoholism
* Mental illness - uncontrolled
* Serious illness within the past 3 months
* General health of a level where minor surgery is not conducive to the patient’s well being.
* Uncontrolled diabetes
* Steroid therapy - Heavy doses
* Smoking - Onlay and Sinus lift grafts only

What medical conditions may exclude patients from implant care within our clinic?
Assessment will be required by another health professional following consultations

* Bleeding disorders
* Warfarin therapy
* Transplant therapy
* Bone disorders including severe osteoporosis
* Steroid therapy - moderate dose

What are the main complications of implant treatment?

The implant does not stick to the bone i.e. it does not Osseo integrate.
The possibility of this occurring is dependent upon the area of the mouth where the implant is placed and the quantity and quality of the bone available. This reflects the ability of the dentist to achieve an implant, which is placed firmly with a large surface are of bone in contact with it.

To generalize the risk of non-integration is as follows:

Lower anterior and pre molar 1 in 30
Lower and upper molars 1 in 20
Upper anterior and premolar 1 in 20
Upper last molar 1 in 15

Should the implant have failed to integrate it can be removed at the abutment connection stage and subject to healing and bone availability another implant can be placed.

The long-term success rate of implants, which have integrated, is 99% over 15 years. It would be incorrect for any practitioner to provide patients with a lifetime guarantee however in my experience if following a 5 year post placement assessment the bone level remains content around the implant, it would indicate that the implants will have a significant life expectancy.

Bleeding and infection
These complications will always be a risk in any surgical procedure however in my experience I have never had a patient who has experienced acute post operative bleeding.

Nerve involvement
There are a small number of nerves, which can be affected during implant placement. The most important of these is a nerve called the inferior dental nerve, which runs through the lower jaw to supply feeling to the lower lip. Implant placement in the back and sides of the lower jaw has to be carefully planned and carried out to prevent damaging this nerve. Should the nerve be damaged and the feeling not returned within 6 months the numbness to one side of the lower lip will be permanent. To place this into the correct perspective no patient whom I have carried out such treatment has experienced any long-term nerve complications.

Adjacent tooth involvement
During normal implant placement there is a very small risk to adjacent teeth. In certain circumstances where the tip of the adjacent root is curved towards the implant site there is a risk that the blood supply to the adjacent tooth can be lost. In these cases a root canal therapy may be required to the tooth involved.

What is a bone graft (augmentation) and why do I need one?
There are two distinct types of bone graft.

Local augmentation
This type of graft is used where some of the implant is not covered with bone following implant placement. The augmentation uses bone collected during the implant placement and local bone site near the implant site to cover the threads and regenerate bone to cover the exposed threads. Sometimes a substitute bone and membrane is also used.

Inlay augmentation
This type of bone augmentation is used when there is not enough bone to place an implant. The bone is taken from inside the mouth normally from the chin of back of the lower jaw or when a larger amount is required from the hip and placed onto the proposed implant site. The area is left for 4 months to allow healing before implants are placed.
Lately, the use of some alternative implantation systems and techniques (BOI implants), allows the implant placement without preceding bone augmentation. We offer this system to our patients as a risk-free, cost-effective procedure. It means that in many cases here is no need of bone grafting before the operation, because the implant design requires less bone volume.

What is a membrane and why is it used?
A membrane is made from a type of plastic or from specially treated pig skin. The body absorbs the membrane after a few weeks and does not require removal. The function of a membrane is to act and a barrier to keep gum cells from the local and inlay augmentation during healing. This helps the graft to change into bone rather than gum or fibrous tissue.

What is substitute bone and why is it used?
Substitute bone is derived from a number of sources. The main substitute is hydroxyapatite material, called algipore. It is obtained from a specific coral, then purified and sterilized.This material is used to avoid the need for bone transplantation from another site, during augmentation. It also has the advantage of slower resorbtion, than the patient`s own bone.It also helps in preventing the fibrous tissue ingrowth, during bone formation.

What is a “sinus lift and when is this procedure necessary?
Vertical bone augmentation in the maxillary sinus (aka “Sinus lift”) is a tissue engineering approach, indicated in cases of lost upper lateral teeth, followed by a severe bone resorbtion. In such cases, there is very little bone left for successful implant treatment. Using state-of-the-art equipment (Mectron Piezosurgery®), bone is allowed to grow in the area, increasing the amount and quality of bone tissues, and the prognosis for implant treatment. In our studio we perform 20-30 sinus lifts per year.

What is a “split crest” and when is this procedure indicated?
In cases of horizontal  deficiency (thin ridge) the implant treatment  is very often impossible. Split crest allows for horizontal augmentation and simultaneous implant placement. It is a routine procedure in our practice, performed with the Mectron Piezosurgery® unit.

What is the difference between an over denture and a fixed bridge?
An over denture is a denture which is secured into the mouth with implants. Unlike a conventional denture, it moves very little, during eating. The overdentures can be removed, to allow cleaning. A fixed bridge is directly secured to the mouth, using dental cement or screws. It does not move during function and is not removed for cleaning.

How many implants are required to replace missing teeth?
It is only possible to provide a guide to this question, as it will depend upon the number of teeth missing, the quality and quantity of bone available, the location and the load, which may be placed upon them.

Please see the chart below for a guide.

Position Number of teeth missing Number of implants
Front teeth 1 1
2 2
3 2
4 2 (4)
5 3, 4, 5
Side and back teeth 1 1
2 2
3 2-3
4 3-4
Lower overdentures All 2-4
Upper overdentures All 4-8 (6)
Lower fixed bridge All 4-8 (5)
Upper fixed bridge All 6-10 (8)

Numbers in brackets (x) represent the most common number of implants used.

How successful is the treatment?
Implantology is a tried and tested treatment and 90% of modern implants last for at least 10 years. They are firmly secured to bone, and as with natural teeth require thorough cleaning. If this is not carried out then you may experience problems similar to that of gum disease with infection around the implant resulting in bone loss, loosening and failure. Cleaning around implants is no more difficult than cleaning your natural teeth and we will strongly advise all patients to see the hygienist on a regular basis to maintain the healthy status of the implant and the rest of the teeth and gums.

On the rare occasion that integration does not occur and the implant is loosening, then it can be easily removed and the site allowed to heal, with placement of another implant at a later stage.