What is a dental implant?
A dental implant is a hollow screw made of titanium. It is placed into your jawbone and over time the bone becomes attached to the implant in a process known as osseointegration.
Are implants always the best option?
Implants are not always the best option. The majority of dental treatments require replacement and thorough maintenance and monitoring. Implants are no different and can develop complications, including failure. The advantages and disadvantages of the treatment options available will be discussed with you before starting any elective treatment.
We are only able to consider implants to patients that fall within the Royal College of Surgeons Guidelines. These are mainly cases involving
- Trauma in a relatively unrestored and healthy dentition
- Cleft lip/palate
- Patients missing teeth from birth
- Cancer of the mouth
Patients who do not fulfil the categories above and those who smoke will not be considered for implant treatment because of the known increased risk of implant failure. Patients keen on quitting smoking should liaise with their medical practitioner for further advice or ask at the Dental Hospital for a referral.
How are implants utilized?
An implant (or multiple implants) can be used to secure a crown (diagram 1), a bridge (diagram 2) or a denture (diagram 3).
Diagram 1 Single tooth/crown on a single implant
Diagram 2 A group of teeth as a bridge on multiple implants
Diagram 3 A bar used to hold a ‘clip-on’ denture
If implant treatment has been agreed, what are the stages of treatment?
Following your assessment, an individualized treatment plan will be proposed and hopefully agreed with you. After this you will have the opportunity to have any questions answered. The stages of treatment will usually include some, or all, of the following:
1. Extraction of teeth:
If you have a broken tooth or failing tooth this will need to be removed, either at the time of implant placement or several weeks beforehand, depending on the case.
2. Temporary replacement of missing teeth:
Removable false teeth (also called a denture or plate) can be provided at the time of extraction. Sometimes, a temporary bridge is used.
3. Will I need a bone graft?
Many people do not have enough bone to place the implants and may require bone grafting either before the implant is place to build up the area or at the time of implant placement. Artificial bone is used material (derived from cows) and a membrane (derived from pigs) is often used. If you have any concerns about these products, please discuss this with your clinician.
In a small number of cases a larger bone graft is needed and the bone may be taken from other areas of your mouth or from your hip (this is performed under general anaesthetic).
A special scan (Cone Beam Computed Tomography) is usually needed to see how much bone is present or is needed when planning implant placement.
Grafted areas are left for three to six months to ‘knit’ together before implants can be placed.
The implant team will advise you on whether a bone graft is necessary in your case once you have been fully assessed.
4. Inserting implant/s into the jaw bone
This is known as “Stage one”
Stage 1 involves peeling the gum back and exposing the bone in the area where the teeth are missing. A series of drills are used to prepare the bone for the implant before the implant is placed.
Routine warnings given to patients before stage 1 are that you may experience:
- Pain – This will be moderate but can be severe but is usually managed with over the counter pain killers
- Swelling – ice packs help reduce this
- Bleeding – This is a rare complication which can be managed with pressure on the area
- Bruising – This is common and will last upto a week.
- Rejection of the implant by your body
Please be aware that if you wear a denture to replace the missing teeth, you may be asked not to wear it for one week following the surgery. Doing this will avoid pressing on the wound which should help with your healing.
Depending on the extent of surgery, you may require up to one week off work. The clinician treating you will advise you on your particular case.
5. Uncovering the implants
This is known as “Stage 2”
Stage 2 is a minor procedure after 3-4 months when the gum is numbed and a small incision made to locate the implant in the bone. a healing abutment (cylinder) is placed onto the implant to allow the gum to heal around it.
6. Impression for the crown/bridge/denture
An impression (mould) is then taken to start making the crown, bridge or denture.
7. Long term maintenance
Following implant treatment it is essential for you to maintain an excellent standard of cleaning around the implant restorations and continue with your regular dental check-ups.It may be that your own dentist does not provide care for implants so you may need to find someone who will look after you and your implants in the longer term.
Please note that you are responsible for any associated costs relating to this and any repairs or remakes that are necessary in the future. It may be wise to find a dentist who is willing to look after the implants before they are placed so that arrangements are in place for your future needs.
You will be discharged from the Hospital about 12 months after the implant restorations have been fitted.
The Dental Institute is a teaching establishment and as a such your treatment may well be carried out by a qualified dentist undergoing further (specialist) training.
8. How long will the implants last?
Failure of implants can occur either early on, during treatment, or later when the implants have been in use for some time. Implants can last a lifetime although they are at risk of mechanical (fractured/broken components) and biological problems (implant gum disease known as ‘peri-implantitis’) that can cause discomfort, pain, and significantly shorten their lifespan. In the most severe cases surgery maybe required to remove the implant(s).
If poorly cared for, implants will develop a covering of deposits (calculus and plaque) which is very similar to that found on natural teeth. These deposits can lead to gum disease with bleeding, soreness, general discomfort, and in some cases, loss of the implants.
In other cases the crowns, bridges, dentures and attachments will need replacement due to fair wear and tear. You will need to make financial arrangements for this in the future .