1.
What is a Dental Implant?
 Almost
all dental implants in use today are made from titanium or titanium
alloy, materials that have been shown over many years to be well
tolerated by bone. The terms 'osseointegrated implants' or 'endosseous
implants' are widely used to describe dental implants that can develop
and maintain a close union with bone in order to support replacement
teeth.
There are many different implant systems available and when competently
used they can all deliver a highly reliable form of treatment.
A dental implant is essentially a substitute for a natural root
and commonly it is screw or cylinder shaped. Each implant is placed
into a socket carefully drilled at the precise location of the intended
tooth. If an implant has a screw-thread on its outer surface it
can be screwed into position and if it does not, it is usually tapped
into place. The main aim during installation of any implant is to
achieve immediate close contact with the surrounding bone. This
creates an initial stability, which over time is steadily enhanced
by further growth of bone into microscopic roughnesses on the implant
surface.
In order to support replacement teeth, dental implants normally
have some form of internal screw thread or post space that allows
a variety of components to be fitted. Once fitted, these components
provide the foundation for long-term support of crowns, bridges
or dentures.
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 2.
How many teeth can be supported by implants?
All
the common forms of tooth replacement, such as bridges or dentures
can be replaced by dental implants.
If you are missing just one natural tooth, then one implant is normally
all that will be needed to provide a replacement. Larger spaces
created by two, three or more missing teeth do not necessarily need
one implant per tooth, however the exact number of implants will
depend upon the quality and volume of bone at each potential implant
site.
Occasionally, it is even possible to join natural teeth to implants
with a conventional bridge.
In the upper jaw, bone density is generally poorer than in the lower
and if you have no teeth at all, most treatment providerswill want
to place a minimum of 6 implants to support a complete arch of 10
or more replacement teeth.
In the lower jaw, the bone towards the front of the mouth is often
very strong and as a direct result, fewer implants may be needed
than are required to treat a whole upper jaw. A simple treatment
plan to provide 10 or more teeth in the lower jaw might be possible
with as few as 4 implants, although it is still more common to use
5 or 6.
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3.
What else can be done with dental implants?
If
you have no teeth in the lower jaw, and are not yet ready for multiple
implant placements, a conventional lower denture can be considerably
improved with two implants placed beneath the front section - this
is called an ‘overdenture’. The same overdenture concept when used
to treat the upper jaw, will usually require more implants as the
bone is generally softer. Implant-supported overdentures, just like
conventional dentures are still removed for daily cleaning, however,
once back in the mouth, the implants make them much more stable.
Whilst not suitable for everyone, with proper preparation it is
sometimes possible to fit new implant-supported teeth on the same
day. This fast-track treatment can be applied to a number of different
situations, however, you do have to balance shorter treatment times
against an increased risk of implant failure.
There are many options and every case can be dealt with in a number
of ways. You will therefore need to talk to someone who has examined
your mouth thoroughly, before having a clear idea as to what is
possible.
Dental implants have to obey simple engineering principles, in that
they must be placed in strong foundations with enough of them to
prevent overloading. In addition each implant must be accessible
for daily cleaning so that the biology of the mouth can be used
to maintain healthy surrounding bone and gum.
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4.
Who is suitable for dental implants?
If you have good general health then dental implants will almost
certainly work for you. However, habits such as heavy drinking or
smoking can increase the number of problems associated with initial
healing and thereafter may negatively influence the long-term health
of gum and bone surrounding each implant. Remaining teeth might
also be compromised making treatment planning less certain.
Some dentists will decline to place implants if smoking cannot be
reduced or given up altogether.
If you have any other complicated medical problems then speak to
someone with relevant experience - it is rare to have health problems
that prevent the use of dental implants.
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5.
Do you need to have a healthy mouth?
When
you first enquire about dental implants it is often in response
to an awareness of ongoing dental problems or the recent loss of
teeth. Each of these problems will need to be diagnosed and treated
in a logical manner, often placing implants in order to establish
healthier conditions.
Although it is tempting to focus on the more glamorous aspects of
teeth supported by implants, basic dental health, which includes
the treatment of gum disease, repair of decay and the elimination
of abscesses will be just as important for the long-term success
of your treatment.
If you are aware of bad breath, loose teeth, or have noticed excessive
bleeding, particularly when your teeth are cleaned professionally,
you may have gum problems. Periodontal (gum) disease is a major
cause of bone loss and with reduced bone, dental implant treatment
can be more complicated.
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6.
How long does treatment like?
For
routine cases, from the time of implant placement to the time of
placing the first teeth, treatment times can vary between 6 weeks
and 6 months. The availability of better bone can be used to decrease
treatment time, whilst more time and care must be taken with poorer
bone, which can therefore extend treatment times beyond six months.
If there is no reason to shorten the duration of your treatment
then be prepared to wait - nobody loses an implant from being patient
and allowing
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7.
Are the new teeth joined together?
When
multiple implants are placed, they are routinely joined together
in the same way that a bridge supported by natural teeth would be
designed.
If enough implants are available, it is often easier and just as
effective to make several smaller sections of bridgework each supporting
a few teeth. The overall effect in the mouth is the same and if
you ever need to repair one of the small sections, this can be very
much easier to do.
Again the bone quality and the number and position of the implants
will largely determine which option is most suitable for you. When
implant-supported teeth are linked together, they are mechanically
stronger than the individual parts and can better resist the forces
of normal function which will try and undo the screw components,
posts and/or cements that secure the underlying structure to each
of the implants
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8.
How do I look after implants?
For
most implant-supported teeth you will be able to clean around each
supporting implant by brushing and flossing in just the same way
that you would around natural teeth and tooth-supported bridges.
In some areas special floss, interdental toothbrushes and other
cleaning aids may be needed to maintain good oral hygiene. Cleaning
is not at all difficult, provided that you do not have impaired
use of your hands.
It is reasonable to expect some of the daily hygiene procedures
to be a little more complex than around your original teeth - equally
expect to spend more time than you may have done in the past if
you wish to maintain optimum implant health.
For the first few months the implants are in function your dentist
may ask that you are seen more frequently, however once they are
satisfied your treatment is performing as planned, ongoing care
will be similar to any patient with natural teeth.
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9.
How long will the implants last?
During
the period after the new teeth are fitted, the success of each treatment
stage will be the main factor determining how the implants are performing.
Once the implants and surrounding soft tissues are seen to be healthy
and the new teeth comfortable and correctly adjusted, it is the
quality of your home care and willingness to present for regular
maintenance reviews that will have most influence on how long they
will last.
When poorly cared for, implants will develop a covering of hard
and soft deposits (calculus and plaque) which is very similar to
that found on neglected natural teeth. Untreated, these deposits
can lead to gum infection, bleeding, soreness and general discomfort,
just as can occur around natural teeth. It could probably be said
that implants much like teeth will last for as long as you can keep
them clean.
Well maintained implants placed into adequate bone can be expected
to last for many years and probably for your lifetime. However,
just as you would expect conventional crowns, bridges and fillings
to need occasional repairs or replacements during their lifetime,
your implant-supported teeth may also have similar maintenance requirements
over theirs.
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10.
How will you know if you are suitable for implants?
When
consulting someone to find out more about dental implants you will
be expected to answer detailed questions concerning your medical
history and there will be a complete examination of your mouth and
remaining teeth to discover the nature and extent of any current
dental problems. If you do not have up-to-date x-rays of your remaining
teeth you may also be required to have new ones taken. Sometimes
models and photos will also be needed so that these can be examined
after your visit.
As described earlier, establishing good basic dental health is a
key stage in any treatment plan. At this first appointment you should
be made aware of which problems are urgent, and what treatment is
required to stabilise any gum or tooth related problems. It would
be reasonable to expect a verbal outline of how your particular
implant treatment might be approached. If you are discussing this
type of treatment with a dentist that you have been seeing for many
years, much of this information will already be known.
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11.
Can dental implants be placed next to natural teeth?
Dental
implants are routinely placed beside natural teeth and this is generally
very safe to do. The only exception to this would be if the natural
root was very curved or tilted unfavourably in the proposed path
of the implant. This could cause the root to be damaged by the implant,
however this can usually be avoided by careful pre-operative planning.
If a tooth is inadvertently damaged by the placement of a nearby
implant, any resulting problems can generally be resolved by root
canal treatment in which the nerve of the natural tooth is removed.
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12.
Is it uncomfortable when the implants are placed?
Most
patients will be very familiar with the dental anaesthetics used
for routine dentistry and will know how effective they are. Implants
are placed using the same anaesthesia. Depending upon the complexity
of your case, the operation might take anything from 30 minutes
for a single implant, to several hours for complex bone grafting
and multiple implant placements.
Since the surgery normally involves exposing the bone in the area
where the implant and/or bone graft is to be placed you can expect
some minor swelling and occasionally bruising afterwards.
For most patients, any of the simple painkillers you might take
for a headache will be all that is needed for a few days. If you
experience more discomfort than this, contact your treatment provider
who can prescribe a stronger medication.
Healing is generally uneventful and any stitches are removed a week
to ten days later. During the first few days you should report any
unexpected levels of pain or swelling so that it can be assessed.
If in doubt always ask for advice, as early detection of a problem
will often lead to a simpler solution. You may also be asked to
take a course of antibiotics and to follow some simple procedures
such as rinsing with salt water or an antiseptic mouthrinse. It
is important that you carry out these instructions.
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13.
If you do not have enough bone, what else done?
 So
far we have covered the building blocks that are part of routine
implant placement. This has included the initial examin-ation and
diagnosis, special x-rays such as a CT scan, sedation during surgery
and what to expect after the implants have been placed. However,
for some people, bone loss after the removal or loss of teeth leaves
them without enough to secure an implant.
Sinus
augmentation - In the upper jaw above the back teeth, it
is possible to increase the height of bone available by creating
new bone in the sinus. This procedure is called a ‘sinus augmentation’.
A skilled surgeon can deliver very predictable results in this location
and without the general success of this technique many patients
would be unable to have implants in a part of the mouth where teeth
are so commonly missing.
Onlay
grafting - There are many ways in which bone can be added
to, however one simple concept is to take a piece of bone from somewhere
else and secure it as an ‘onlay graft’ to a deficient area. The
new piece of bone will slowly join to the underlying region and
when healed and mature, an implant can be placed in a more favourable
position.
Where can you get extra bone from?
Bone can be harvested from a number of sources such as the hip,
tibia, chin and posterior regions of the lower jaw. When you use
your own bone to create new bone in another area of the mouth you
will have to contend with the discomfort created by the donor site
as well as the surgical site. Many people feel this is well worth
any additional discomfort as your own bone is normally considered
the ‘gold standard’.
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14.
Summary of stages
1.
Diagnosis and treatment planning after which it may be necessary
to carry out repairs or treatment to any remaining teeth.
2. Implant placement is usually followed by a period of healing
lasting from 6 weeks to 6 months. Often the implants are completely
hidden beneath the gum, however one-stage procedures where the implant
is visible from the time of placement are also commonplace. Stitches
are normally removed 7 to 10 days after the implant placement.
3. Several visits may be needed over the next few weeks to adjust
temporary teeth or dentures and to monitor healing.
4. Once the implants have healed uneventfully for the required time,
they are uncovered if necessary and made ready to connect the teeth.
Sometimes the time allowed for implants to integrate may be increased
or decreased to suit the local bone conditions and the overall quality
of healing.
5. In some cases the first teeth fitted to your implants are not
the final ones, but replicas of the intended design. This stage
can be used to assess the implants, control early loading and in
areas where aesthetics are more critical, also gives the gums time
to mature around each implant before final teeth are fitted.
6. Final teeth are commonly fitted between 3 and 9 months after
the implants were first placed. The way that the teeth fit together
is carefully adjusted so that they do not interfere with each other.
7. Regular examination and hygiene appointments are then all that
is required to maintain the health of the mouth, teeth and implants.
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