Dental implants
Implant treatment overview
What is a dental implant?
A dental implant is a titanium cylinder that is used to provide support to one or more prosthetic teeth using connections called abutments. Dental implants are the most predictable and successful means of replacing teeth and have an excellent clinical track record with over 30 years worth of clinical research supporting their use. The success of implants comes from the quality of titanium metal that develops a close union with the bone allowing tooth support.
Can I have a dental implant?
Dental implants are possible in any patient with good general and dental health. Dental implant treatment has a poorer prognosis in the following patient categories:
- smokers. At present we are unsure of the effect of e-cigs on success of implants
- uncontrolled diabetics
- patients with poor oral hygiene
- patients with history of periodontitis
- excessive alcohol intake
- patients who suffer from bruxism
How many implants do I need?
The number of implants needed depends on the number and location of the missing teeth and the quality of available bone. It is very unlikely to need an implant for every missing tooth because bridges can be used with implants so that 2 implants can replace 3 teeth for example and in the presence of good bone quality and volume, 4 implants can be used to replace 12 teeth.
What conditions are required for implant treatment?
Basic dental health is essential, which includes the treatment of gum disease, repair of decay and the elimination of abscesses will be very important in the long-term success of your treatment. You will also need a sufficient volume of bone of appropriate quality and in the right orientation for implant treatment.
Most commonly patients lose bone after tooth removal in a process called bone resorption. If it is severe then implant replacement may not be possible unless the remaining jaw bone is augmented or repaired with bone grafts.
How successful are dental implants?
Dental implants are the most predictable and most successful replacement for a natural tooth in the absence of any contra-indications. The success of dental implants has been reported to be between 90-95% after 10 years of function.
Well maintained implants placed into adequate bone can be expected to last for many years and probably your lifetime. However, just as you would expect conventional crowns, bridges and fillings need occasional repairs or replacement during their lifetime, your implant-supported teeth may also have similar maintenance requirements. It must be remembered that dental implants like teeth require regular monitoring by the dental team and effective brushing to ensure long term survival.
Implant patient journey
How long does treatment take?
For routine cases, from the time of placing the implant to the time of restoring the teeth, treatment times can vary between 6 weeks and 9 months. The availability of good bone decreases treatment time, whilst more time and care is needed if a bone graft is required. You may need to be prepared to be patient and allow nature to take its course to ensure that your implant has the best possible chance of success.
What are the stages for implant treatment?
Implant site treatment is comprised of 4 stages.
Stage 0: consists of assessment and extraction if necessary
Stage 1: consists of implant placement and possible bone augmentation
Stage 2: consists of removal of the implant protective cover screw and placement of the healing cap which will confirm the rigidity of the implant and help shape the gum cough around the implant to receive a tooth
Stage 3: is the restoration construction which could be a denture, bridge, or crown.
The time scales between these stages vary depending on your presentation and your periodontist or dentist will explain them in detail. The need for bone augmentation can increase the treatment time scales and you must be prepared to be patient in order to achieve the best possible results.
TEETH IN A DAY or IMMEDIATE LOAD PROTOCOLs can be employed to deliver temporary teeth immediately after implant placement Stage 1 above. Immediate teeth help minimize inconvenience with dentures in the healing period. Your dentist will assess you for suitability before recommending this.
Bone augmentation
The loss of a tooth due to infections or periodontitis can result in a reduction in bone volume. This could mean in ability to place implants without affecting vital structures such as nerves or the maxillary sinus. Bone augmentationis a procedure used to increase the volume of jaw bone to allow implant placement. Your own bone or tooth fragments can be used or more commonly pharmaceutical bone regenerative material from animal plant or synthetic sources can be used. Augmented bone is poorer than natural bone therefore it is essential to consider implant placement soon after a tooth is lost or ideally even before it is lost. This will reduce the amount of bone loss that increases with time after an extraction.
This is a technique aimed at reducing the volume of bone loss after a tooth extraction in order to maximise the chances of being able to replace it with a dental implant. The procedure uses bone graft materials from synthetic or animal sources to be able to encourage bone growth along with animal collagen membranes to protect the growing bone. The success of the procedure depends on various factors such was whether the patient is a smoker and the type of gum surrounding the site of the extracted tooth.
Can a bone graft and a dental implant be placed at the same time?
This process is usually considered in most cases when a tooth has been removed recently or when the bone volume is moderately deficient. It utilises bone graft material from animal or synthetic origin and is only considered in the presence of enough natural bone to anchor the implant.
When is a separate bone augmentation surgery needed?
This is usually needed with the volume of existing bone is severely compromised and as such will not provide sufficient support for a dental implant.
What is the maxillary sinus?
This is a void in the maxilla (upper jaw) that develops in childhood and grows as we get older. It is very common for it to enlarge and engulf the roots of the upper molars teeth thereby reducing the volume of bone available to replace these teeth with implants. In such cases an internal or lateral window sinus augmentation will be needed.
What is sinus augmentation or sinus lift?
This is a procedure used to increase the volume of bone in the upper jaw by encouraging bone growth in the maxillary sinus. The technique was first proposed in 1974 and has an excellent clinical track record with numerous worldwide trials demonstrating its utility for increasing bone volume for implant placement.
There are two approaches depending on the volume of remaining natural bone: internal or lateral window sinus augmentation. The internal augmentation uses a keyhole approach for placing a single implant whereas the lateral window approach is used for placing multiple implants. Both techniques are minimally invasive and are undertaken with local anaesthetic like a filling. More often than not, regenerative materials animal plant or synthetic sources can be used to maximise the sinus bone growth potential. Dental implants are increasing being placed at the same time as the sinus augmentation but if there is a contraindication then the implants are usually placed 6-9 months later.
The immediate side-effects include pain, swelling or bruising which usually lasts for 7-10 days and responds well to over the counter painkillers. You may feel sinus congestion as a result of the treatment due to the immediate inflammation that occurs after the surgery but this usually settles quickly like the other side effects. It is highly recommended NOT to blow ones nose for 14 days after the procedure to avoid disrupting the healing site within the sinus space.
