DENTAL IMPLANTS

WHY ARE IMPLANTS NEEDED? 

Once teeth are lost, the bone in which they are embedded gradually disappears because it is no longer required to support the teeth. The teeth and lost bone are usually replaced by removable dentures or fixed bridges to restore appearance, speech and mastication (chewing). As with all man-made substitutes for nature’s living tissues, there are drawbacks to artificial appliances. Dentures reduce masticatory efficiency and can suffer from poor retention. On the other hand, bridges involve cutting away healthy teeth in order to provide support.
 
An alternative method of tooth replacement is to insert implants into the jawbone to support the false tooth or teeth. Implants are tooth-root like structures made from commercially pure titanium.
 
Titanium is a very inert material and such implants may become firmly attached or integrated with the bone and act in a similar manner to a tooth root. If an implant is placed immediately or soon after a tooth is extracted, the jawbone is preserved, and its future loss prevented. For this reason, it is best not to delay the decision to place implants, as the bone will be lost with time which can make the placement of implants more difficult. However, even after a considerable bone loss has occurred, it may still be possible to place an implant although additional bone grafting techniques may be required.
 

THE PROCEDURE  

The condition of the jaws will be assessed for suitability and the treatment planned using X-ray type films, photographs and models of the teeth. It may be necessary to take a Jaw Scan (CT) type X-ray to check the amount and position of the available bone. The final decision as to whether or not to proceed with implant placement will be made at the time of surgery and will be determined by the quality and quantity of the jawbone.
 
In the lower jaw runs an important nerve that supplies sensation to the lower lip and skin of the chin. Obviously, the X-ray is important in determining the position of this nerve avoiding the slight possibility of injury which could result in altered sensation.
 
In the upper jaw, it is important to ascertain the size and position of the air sinuses and nasal cavities prior to implant insertion. Occasionally the implants may have to be placed slightly into the sinus or nasal cavity. Usually, this is not noticeable but there may be a slight nasal discharge with a small amount of temporary bleeding. The implants may be placed under the gum and so will not be visible in the mouth. 
 

TYPE OF IMPLANT PLACEMENT

Implants can be inserted in one of two ways:
1. Immediate insertion is when the dental implant is placed at the same time as the tooth is removed. The advantages of this approach are a reduction in treatment time and the preservation of bone in the area. Whether or not this approach can be used will depend on the condition of your bone at the time of extraction. If the socket is unsuitable for immediate implant placement or infection is present it may be necessary to defer implant placement for three months while new healthy bone reforms in the area. A bone graft material may be used to promote new bone growth.
 
2. Post immediate dental implant placement is the insertion of the implant into a region of the mouth where the tooth or teeth have previously been removed or have been missing for some time.
 
Implant treatment may entail a combination of the above insertion methods and the time required to place them will depend on the number being inserted and their position in the mouth.

 
TYPE OF ANAESTHETIC 

The implant(s) will be placed usually under a local anaesthetic.
 

AFTER IMPLANT PLACEMENT

After the procedure, there will be some discomfort and swelling. The degree of swelling will depend upon the number of implants placed and whether or not additional surgical procedures were carried out. Occasionally, along with the swelling, there may also be slight bruising of the skin overlying the area which will fade over a week. If you are a smoker or have a pre-existing medical condition which affects soft tissue healing, the amount of swelling may be greater. The gum tissue in the region where the implants have been placed may change appearance/colour and take on a white appearance for a short time (normally two weeks) after surgery.
 
After 6-10 days, once the soft tissues have healed sufficiently the stitches may be removed. During this period, it may not be possible to wear dentures or temporary restorations. After this stage, the implants will usually be left undisturbed for up to six months to attach to the jawbone. During this period the top of the implant may show through the gum slightly and metal may become visible. Although this is normally no cause for concern, should it occur please contact the practice to have the area checked.
 

MAKING THE NEW TEETH

After a 3-6 month period, a second surgical procedure may be necessary to expose the implant(s) and check for firm bony attachment. In the event that an implant has failed to take it can simply be removed, as it will not be attached to the bone. Once the implant(s) have been uncovered and are firm a post or abutment will be connected which will be used to support a provisional crown. This intermediate stage will last approximately 1-2 months allowing time for the gums to settle and form a tight attachment to the implant abutment. During this time the abutment may become visible as the gum shrinks slightly exposing the underlying metal. The final teeth will be made to cover as much of the exposed metallic areas as possible, improving the final appearance. Impressions will be necessary prior to the construction of the final restoration.
 

TREATMENT TIMING

The amount of time the treatment will require varies with the degree of difficulty and the amount of work needed. It is important to bear in mind that the teeth have to be made individually to suit your specific requirements and mouth. This type of precision work is very time consuming and cannot be rushed, as it must be of the highest quality. Prior to fitting the finished teeth, a variable number of visits may be necessary to make fine adjustments to the teeth. Therefore, it is important to keep your dentist informed of any travel arrangements or important engagements you may be planning and to give as much notice as possible.


WHAT HAPPENS IF THE IMPLANTS DO NOT TAKE

Fortunately, this occurs rarely as potential problems can often be anticipated and discussed with you before treatment starts. Research shows that about 5-10% of implants may fail and although the risk is small, as, with any surgical treatment, you must be aware of the possibility. Should an implant fail to take then it is often possible to replace it with a second implant at the same time as the first implant is removed. It will, of course, be necessary to wait a further six months while the second new implant attaches to the bone. It is not difficult to remove the failed implant as it will be very loose. It has been shown that alcohol and tobacco consumption can reduce the rate of success. These habits also have an effect on the rate of healing and may increase the chances of post-operative infection.
 
Shallow residual pockets should be monitored regularly and treated if signs of disease activity are noticed. If you are a smoker this habit may adversely affect your periodontal health & long-term prognosis for the treatment outcome. Therefore, you are constantly advised to quit smoking.
If you are a smoker this habit may adversely affect your periodontal health & long-term prognosis for the treatment outcome. Therefore, you are constantly advised to quit smoking.
 
It is important to remember that implants are not “Fit and Forget” and that they need the same care and attention as natural teeth. On completion of the treatment, it will be necessary for you to attend a number of recall appointments to check the condition of the implant(s) and to adjust the bite if required. After this, regular six-monthly appointments should be made as normal for dental check-ups. Although the gum tissue around the implants is fairly resistant to infection, you should still keep your regular hygiene appointments as a build-up of plaque will cause problems and possible bone loss from around your implants. This could result in their eventual loss. The frequency of hygienist visits will depend on your standard of oral hygiene. Long term maintenance of the implant and crown will be required, as for any other normal crown. Major maintenance may involve the replacement of the crown (not implant) due to wear and tear. Minor maintenance may include the removal of the crown to check the implant abutment and replacement of retention screws as required. These maintenance requirements will incur additional costs above the initial fees.
 
If you have teeth and implants mixed together it is also very important to maintain the health of the natural teeth. Should the natural teeth become infected or are lost for any reason, the remaining implants may be damaged by the extra pressure caused by the additional workload.
 
It is also important that you inform the surgery immediately should you detect any mobility or loosening of your implant teeth. Occasionally, the small screws which help to retain the crown become loose due to either heavy or abnormal biting. This is an easy matter to rectify if caught early as it entails retightening the screws and adjusting the bite or removing the cause of the loosening. Failure to attend early will result in possible fracture of the screw or even worse, damage to the implant.
 

The objective of the tooth replacement

  • Prevention of the adverse effects of the missing tooth on the movement of the opposing and neighbour teeth
  • Replacement of the missing tooth, aesthetic and biting function
 


Alternative treatment options

Please find below the detail of your proposed treatment options available to rehabilitate the missing tooth by means of the implant-supported crown. Please read carefully each of the following treatment options as we already discussed these choices with you during your first and second appointments. All the following restorative options shall be discussed in detail including the benefits, risks, side-effects and complications associated with each alternative option and in cases that you would not wish to have a gap, a long-term denture or a bridge.
 

Dentures

A denture is a removable appliance that will restore an element of function and appearance. Although some patients are happy with such prostheses, others find that a denture may move when chewing and they can be difficult to get used to.
 
Advantages
  1. Treatment is completed in a few weeks.
  2. Unlikely to need surgery.
  3. These are a low-cost option.
Disadvantages
 
  1. Maybe unstable, particularly when eating.
  2. Sometimes not easy to get on with.
  3. They accumulate plaque or food more readily.
  4. Do not prevent bone loss.
 

Fixed bridges

A conventional bridge is where a dentist reduces the tooth or teeth adjacent to gap and then uses these teeth to provide support for the fixed bridge.
 
Advantages
  1. Treatment is completed in a few weeks.
  2. Unlikely to need surgery.
  3. Teeth are fixed and immovable so more secure.
Disadvantages
 
  1. May require cutting healthy teeth.
  2. If one bridge support is compromised, the entire bridge may need to be discarded and replaced.
  3. Can be difficult to keep clean as flossing is not easy.
  4. There is a high cost involved.
  5. They do not prevent bone loss.
  6. There is a greater risk of decay in the teeth that hold up the bridge.
  

Adhesive bridges

A resin-retained bridge is where a false tooth is glued to one or both of the teeth next to the gap via a metal wing. These bridges mostly considered as long term temporary and are less well suited to replacing back teeth.
 
Advantages
  1. Treatment is completed in a few weeks.
  2. Unlikely to need surgery.
  3. Teeth are fixed so more secure.
  4. There is minimal or no teeth cutting required.
Disadvantages
 
  1. Can only be used to replace front teeth.
  2. Can come off as they are only glued on, or cause movement of the neighbour teeth
  3. Does not prevent bone loss.
  4. Can be difficult to keep clean as flossing is harder.



Implant supported crowns/ bridges/ dentures

The nature of dental implant treatment has been discussed with you at the practice and in writing above. A few animated videos and photographs of completed implant cases have been demonstrated to give you a realistic idea of the possible outcomes of the treatment.
 
Advantages
  1. Implants are fixed and do not move.
  2. Implants do not get decayed.
  3. Does not require cutting adjacent teeth.
  4. Easier to clean than a bridge when replacing a single tooth.
  5. Well documented success and longevity.
  6. Prevents further bone loss.
Disadvantages
 
  1. Longer treatment time.
  2. Requires surgery.
  3. Higher cost.
  4. Can be difficult to clean if several implants are bridged.


Please refer to the following links from the Straumann official patient site to access dental implant patient brochures and videos about the following subjects:

1. A solution for everybody:
https://www.straumann.com/en/patients/a-solution-for-every-need.html

2. Procedures from diagnosis to aftercare:
https://www.straumann.com/en/patients/the-procedure.html
 
3. Main benefits:
  • Reduced treatment complexity
  • Immediate function and aesthetics
  • Clinical long-term success
  • High patient comfort
https://www.straumann.com/en/patients/the-benefits.html

4. Other frequently asked questions:
https://www.straumann.com/en/patients/faqs.html

Please see our London Specialist Dentist clinic case studies in our Implant Galley Link below: 
https://www.londonspecialistdentist.co.uk/CaseStudies/20/p/0