Treatments

Dental Implants ยป Dental Implants FAQ

We are often asked if any of the team is a 'specialist' in dental implants - the answer to that question is no because, as yet, there is no specialism in the field.

Since no official specialism can be claimed in the field of dental implants, a dentist can't be called a specialist in dental implants.

Our clinic has a particular focus on dental implants and Philip's and his colleagues involved in the dental implant field have done years of focused implant training and ongoing personal development in the area to ensure they can offer the best possible standard of patient treatment and aftercare. Here's everything you need to know about dental implants and the work we can do.

Dental Implant Information

Dental implants are the modern solution to missing teeth. They have been increasing in popularity for 35 years to become a dentist's first choice when rebuilding your smile today.

An implant is a titanium substitute for a natural tooth root. A socket is usually created into which it can be screwed into place, creating an initial stability that is gradually reinforced as time goes onbyosseo-integration. This is a term for the continued growth of bone on to the surface of the implant, fusing to it. The internal design of the implant allows a variety of fitments to be attached to it. These support the replacement teeth and provide afoundation for permanent additionof bridges, dentures or crowns.

The majority of modern implants are made of titanium, as it has proved to be the material best tolerated by the bone around it.

How many teeth can be supported?

Implants can support bridges, dentures and all other forms of tooth augmentation and replacement. A single missing tooth will in all probability require a single implant, but in cases of larger spaces and multiple missing teeth it is not necessary to use one implant per tooth.

The volume and quality of bone at the point where the implant is required are integral to the success of an implant.

Bone density is ordinarily poorer in the upper jaw, for example, than in the lower and if you have no teeth at all, most treatment providers will want to place a minimum of six implants to support a complete arch of 12 replacement teeth.

In most cases, bone at the front of the mouth is very robust, and therefore fewer implants may be needed than would be required to treat a whole upper jaw - therefore a simple treatment plan to provide 10 or more teeth in the lower jaw might be possible with as few as four implants.

How else can dental implants be used?

If you have no teeth in the lower jaw, a conventional lower denture can be considerably improved with an implant retained "over denture" which effectively secures a denture with two implants placed at the front of the lower jaw. It is also possible to undergo this procedure in the upper jaw, but in this case four implants are usually linked together and inserted in the same way to increase stability.

Similarly to conventional dentures, over dentures must be removed for daily cleaning, however, once back in the mouth the implants make them much more stable in function.

There are many implant options available and it is crucial that you have a thorough dental examination to be aware of what treatment would be best suited to your specific needs. Basic physics and engineering concepts need to be taken into account and tailored to your mouth: sufficient implants must be placed in strong foundations to prevent overloading.

Every implant needs to be easily accessible for cleaning just like your natural teeth, so that the biology of the mouth maintains healthy bone and gum surrounding the implant.

Am I suitable for dental implants?

Implants are suitable for almost anyone with good general health and properly maintained oral health and hygiene. Smoking, drinking, and neglect of oral hygiene regimes can inhibit initial healing after surgery and maintenance, and cause further complications. If your dentist considers that the risk is too great then they may not allow the surgery to go forward until such a time as these factors are brought under control.

It is rare to have health problems that will prevent the use of implants. Our practice routinely liaises with general medical practitioners and other medical specialties to co-ordinate care for those patients who are on medications or have conditions, which need to be meticulously regulated. These medications includeWarfarin, a blood thinning medication, and Bisphosphonates, which decreases bone turnover and is used to treat osteoporosis. Conditions such as osteoporosis and diabetes need not be a barrier to dental work if proper planning and communication is carried out.

Do I need to have a healthy mouth?

For optimum success, implants should be placed in a well maintained, healthy mouth. Any initial treatment to remedy this, maintenance advice and planning will be included in all treatment plans to achieve the ideal environment for implant placement.

The treatment of gum disease, repair of decay and the elimination of infection, or, in summary, basic dental health, will be important for the long-term success of implant treatment.

If you are beginning to notice loose teeth, bad breath or excessive bleeding - particularly when your teeth are professionally cleaned - you may have gum problems and gum disease is a major cause of bone loss and with reduced bone dental treatment or dental implant treatment can be more complicated.

What causes bone loss?

Whenever a tooth is lost, the bone which supported it will gradually recede and reduce over time.If there has been substantial bone loss, bone grafting may be necessary prior to implant placement in order to create adequate bone volume for the creation of a socket. For some patients, grafting the tooth socket using a socket preservation technique to retain the bone, or inserting an implant directly into the socket to support and maintain the supporting bone can prevent this bone loss.

How long does treatment take?

For routine cases, from the insertion of implant to the addition of the first tooth, treatment time scales can be between several weeks and six months. If the bone already present is robust, the treatment time will be shorter. With poorer bone more time and care must be taken, which can extend treatment time beyond six months.

If there are factors that lead to prolonged treatment then it is important to be patient - nobody loses an implant from being patient and allowing nature to take its course.

While the majority of implant treatments are 100% successful, any problems with the implants integrating with the bone may result in the treatment time extending which patients must be prepared for.

Are the new teeth joined together?

A bridge supported by natural teeth would be designed in cases where multiple implants need to be routinely joined together in the same way.

It is often easier and just as effective to make several smaller sections of bridgework that each support several teeth. The end result is exactly the same and if any repair work is needed on one of the small sections, this is made significantly easier.

As with every individual case, bone quality and the position and number of the implants will determine which option is best suited to you and this would be discussed fully and planned at the treatment planning stage.

How do I take care of the implants?

Following all stages of implant treatment you will be fully advised on care and maintenance of the implants or the superstructure supported by them. You will be instructed on how to properly clean your implants and what techniques and materials to use in order to satisfactorily achieve this. While complete instruction and demonstrations will be provided, it must be acknowledged that the proper care and maintenance of the implants requires regular effort on the patient's part at home for complete, reliable maintenance. This care can be undertaken using flosses, waterpiks, brushes and inter dental brushes. Philip Friel Advanced Dental recommends using the Philips Sonicare toothbrush.

Implants should be cleaned every 3 months by the dental hygienist to ensure adequate review and maintenance.

You may also reasonably expect some of the daily hygiene procedures to be a little more complex than around original teeth, so plan to spend more time than you have done in the past to maintain optimum implant health.

Your dentist may ask to see you more frequently for the first several months, but once the implants are performing as planned, ongoing care will be similar to that with ordinary teeth.

How long will the implants last?

Once your implants and surrounding soft tissues are seen to be healthy and your new teeth are comfortable and properly fitted, it will be the quality and upkeep of your home care and the regularity of your maintenance reviews that will effectively influence their longevity. If implants are not properly cared for, theymay develop a covering of deposits, just as your natural teeth would if you didn't brush them regularly. Equally, just as neglect of natural teeth can lead to soreness, bleeding, gum infection and general discomfort, the same can occur with your implants. It is often said that implants last for as long as you properly take care of them. If you maintain a high level of care for implants that are expertly placed into healthy, robust bone, they can be expected to endure for many years. There is, however, no lifetime guarantee with any surgical implant - a doctor would say the same about a hip replacement.

How will I be assessed for implants?

As well as a complete examination of your mouth and remaining teeth you will be expected to supply details of your medical history. New x-rays will be taken and photos and study models taken if required. Additionally, an extensive discussion regarding requirements and expectations will allow us to determine if implant treatment is appropriate.

The maintenance of good basic dental health is vital to preserve the quality of dental implants.

What should I be aware of before my treatment begins?

You should be given a written summary of your treatment planning consultation. This should demonstrate your dental health at the moment, the suggested treatment and any options available other than dental implants. This summary should include an outline of the different stages of treatment to give you an estimate of how long the entire process will take, how many implants are required and the price. Further to this, patients are given plenty of information and afforded many opportunities to ask as many questions as they wish to ensure that they are comfortable with the proposed treatments.

Do I have enough bone for implants?

Both x-rays and clinical examination are used to assess and determine the volume and position of bone remaining in an area after tooth loss.

Dental x-rays can provide high definition in two dimensions, but sometimes more advanced imaging might be needed to determine bone volume in three dimensions and the position/proximity of important structures such as nerves and sinuses.

Dental CT Scans - Images obtained by CT scanning will normally be able to show all of the information about your bone that is required, including quality and quantity, but most significantly to ensure that nerves and other important tissue are avoided during surgery. Here at Philip Friel Advanced Dentistry, we are proud to be one of only a handful of clinics to own our own Cone Beam CT scanner that allows such important images to be taken efficiently and easily. More information on this scanner can be accessed in the treatments section.

Can an implant be inserted beside my natural teeth?

Implants are routinely placed beside natural teeth and this is a predictable procedure so long as there is adequate bone to allow the support of both the implant and natural tooth. Such areas are carefully measured and assessedas part of the planning process.

If an implant accidentally damages a tooth, any resulting complications can usually be resolved by root canal treatment in which the nerve of the natural tooth is taken out. However, this is very rare indeed.

Is it possible to wear temporary teeth during implant healing and treatment periods?

If the teeth being replaced by implants are clearly visible, it is understandable that you would want some teeth during treatment and healing times. We can provide this in the form of temporary bridges or simple plastic dentures. In some cases, bridges or temporary teeth can be attached immediately to the implants after placement.

If replacement teeth are used during treatment it is important that they do not put undue pressure on the underlying implants and patients may be advised not to wear temporary teeth for a few days after surgery to allow the initial healing to progress without a hitch. We will give you extensive advice regarding thisas part of the treatment planning stages.

Is the placing of implants uncomfortable?

Implants are placed using the same familiar dental local anaesthetics used for general, routine dentistry. According to the specifics of the case, the operation might vary from a duration of 20 minutes for a simple single implant to approximately 90 minutes for complex bone grafting and multiple implant procedures.

Swelling, tenderness and occasionally bruising can be expected after the surgery and full postoperative instructions are given to patients together with antibiotics, if necessary, or any relevant medication. The precise nature and extent of any bruising, swelling and tenderness will be different for each individual and procedure but should resolve within 5-10 days after the surgery. At our practice, we provide all patients with mobile telephone contact details for dentists available 24 hours a day should they have any concerns or queries.

If my surgery is going to take longer, will I still receive sedation or anaesthetic?

Most people will be anxious over all but the most basic implants. It is important to remember that although the procedures by their nature invasive, they are carried out cautiously, gently and with great care to guarantee that the tissues, which will be prepared, are taken account of to allow them to successfully receive the proposed implant or bone graft.Implants are, in most cases, carried out under local anaesthesia. However, there are a few optionaladjunctive methods, to make the procedure as relaxing as possible for a nervous patient.

Oral sedation - Medication such as Temazepam may also be used to help relax anxious patients for uncomplicated surgery taking less than an hour.

Conscious sedation - For treatments of greater complexity conscious sedation has the advantage of keeping patients relaxed but alert enough to respond to simple instructions from the surgeon - yet they will remember almost nothing of the treatment.

A carefully controlled amount of sedative is delivered through a vein for as long as the treatment takes and heart rate and oxygen levels are observed throughout. This is an effective and very safe way of creating a relaxed state during the procedure.

General anaesthesia - General requires a hospital admission and is mainly used for very complex cases such as bone grafting from the hip to the mouth or where large numbers of implants are being placed simultaneously. It is important to remember that general anaesthesia carries risks that may outweigh its use for an elective procedure such as dental implants.

What happens if I don't have enough bone?

In some cases, loss of bone after a tooth infection or the removal of teeth leaves them without enough to secure an implant and in such cases simple bone grafting/onlay grafting or sinus augmentation may be required.

Simple bone grafting - Simple bone grafting involves the use of a bone substitute and a protective membrane, which are employed to reform the ideal contours of a particular area after loss of bone. As time goes on, the body replaces this bone with its own bone in a process known as Guided Bone Regeneration. Grafting of this kind is usually carried outwith Bovine (cow) bone graft together with a porcine (pig) barrier membrane.

Sinus augmentation - Following the loss of the upper back teeth, the resulting differences in force can allow the air sinus in the area to increase in size. This in turn means that the height of bone available in which to place the implant in this area may be diminished. Grafting procedures can be carried out in order to replace the bone in these areas and allow the successful placement of implants.This procedure is more involved, but we carry it out regularly in our clinic. During this procedure the sinus is accessed and the lining gently elevated allowing bone graft material to be placed forming increased foundation for the insertion of implants. Our expert surgeons achieve good, predictable results using this method. Without it, many of our patients would be completely unable to receive implants.

Onlay grafting - Where severe bone loss has occurred requiring either a large increase in volume, or a potential increase in vertical bone height, bone volume can be augmented by removing a section of bone from another place in the body and transplanting it in the area that is lacking. The newly grafted bone, when it has healed and adjusted, will be capable of receiving an implant. Ordinarily, these grafts are taken from the chin area or from the back section of the bottom jaw.

Will bone grafting lengthen my treatment?

The treatment time is almost invariably increasedwhen bone grafting is required - however the process greatly improves the outcome of the implant treatment.

In certain situations the placement of the implant alongside the bone grafting with the use of a barrier membrane all at the same time will be advised. This greatly decreases the length of the treatment and can produce results that are extremely hard to achieve through any other means. However, the majority of surgeons will favour carrying out bone grafting as a separate stage, so that the implants are certain only to be placed when the bone grafting has been successful.

Please see the information on bone grafting under our treatments menu for more information.

Routine dental implants procedure: journey overview

  1. Initial diagnosis and arranging treatment appointments alongside the completion of any reparative or preparatory work on remaining teeth or bone.
  2. Implant placement is usually followed by a healing period of anything from six weeks to six months. Implants are ordinarily completely hidden underneath the gum; however, procedures that span only one appointment in which the implant can be seen from the time of placement are not uncommon.It is normal to keep stitches in place for seven to ten days, but many will dissolve by themselves.
  3. More than one visit may be necessary over the first few weeks to adjust temporary teeth or dentures and to monitor healing.
  4. The time span allocated for the integration of implants may be augmented or reduced according to the condition of the bone.
  5. In some cases, the first teeth fitted in the implants are not the final product, but imitations of the proposed outcome. At this stage, restorations are assessed and particular attention is paid to the front of the mouth, in which aesthetics are more important. This also allows the gums time to accept each implant and develop before the final teeth are added.
  6. Your final, permanent teeth are usually inserted three to nine months after the implants have been inserted.
  7. Together with the commitment to a high standard of oral hygiene at home, regular examination and hygiene appointments are then all that is required to maintain the health of the mouth, teeth and implants.