Dental implants FAQ | Dental implants FAQ |
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Who is a candidate for implants ? Anyone who is missing one or more teeth due to injury, disease, or decay can benefit from dental implants. Implants are especially helpful to patients who can no longer wear dentures or who cannot chew or speak comfortably with dentures . An ideal implant candidate will be in good general health, have healthy gums and substantial bone to anchor the implant into the jaw, and be committed to meticulous oral hygiene post-surgery. Our dentists will carefully examine your teeth and medical history to determine if implants are right for you. Single or multiple implants ? Having one or more implants installed is a good option for patients who are missing individual teeth and do not want a fixed bridge or partial denture. Individual implants are by far the best solution when both the tooth and the root are missing or damaged. We can replace a single missing tooth, several teeth, or an entire set. Implants can also be used in conjunction with bridges and partial dentures if the patient does not want to commit to a full set of implants. How long does treatment take? During preliminary examinations the doctor checks the patient to decide if placement of dental implants can be carried out. This includes a dental examination (which teeth must be substituted, if the jaw is suitable for receiving the implants, taking of X-ray shots, etc.), and general medical examinations (laboratory tests). The insertion of implants is carried out under local anaesthesia. First the dentist prepares the given part of the jaw, and then inserts the implant. The suture is removed 4-7 days later, and following this implants begin to heal under the gums. The healing period lasts for about 3 months. During this time bone cells grow into the micro-pores created on the surface of the implant. This process is called Osseo integration, and ensures the implants fix in place and become able to support a normal biting load long-term without any damage. Then the tooth replacement is fixed onto the implants. First the implants osseo integrated under the gum are uncovered, and then abutment pieces are fitted into them to support or retain the replacement. Following this, the prosthesis is prepared in the dental laboratory in a short time in the usual way.
The complete implant reconstruction process may take from 2 to 9 months. Consultation, dental X-ray, placing the implant into the jawbone (Your bone cells need to grow around the implant before the post can be attached to the implant), Time required: 2-7 days
2. Visit 3-4-6-8 months later, Post is attached to the implant and the replacement teeth are prepared Time required: 5-10 days
Between operations you will not be left toothless but will be fitted with temporary teeth.
Contact between patient and dentist does not stop here, with placement of the new teeth. Among the most important criteria for long-run success in dental implantation are good mouth hygiene and regular medical check-ups. Patients wearing implant-based tooth replacement must regularly attend examinations once a year. Then the dentist verifies the state of the attachment of the bone and of the mucosa around the implant(s) and that of the tooth replacement, and makes the necessary corrections (e.g. removes plaque).
What can I expect after implantation? Following surgery, there will probably be bleeding, controlled by biting down on some gauze. Swelling may be controlled using an ice pack. Gums are generally sore after both surgeries for 7 – 10 days. You might be given antibiotics or painkillers to take during the period immediately following surgery. You will be able to drink but eating might be difficult for 24 hours after the implantation. How do I care for my implants?
To help maintain your implants you need to thoroughly brush and floss regularly. Your dentist will give you specific advice on caring for your implants. He or she will ask you to attend regular check-ups, and will usually take X-rays each year to monitor them.
What are the risks of implantation?
In general, dental implants have a success rate of up to 97%. With proper care, implants can last approximately 15 years. 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. Implant surgery is a safe procedure; however, as all surgeries it carries an element of risk. Before deciding whether or not to have implants, you need to be aware of the possible side-effects and the risk of complications. Our specialists will advise you so you can make an informed decision.
What are the possible side effects of implantation? Side-effects are the unwanted but mostly temporary effects of a successful procedure. Examples of side-effects include feeling sick as a result of the anaesthesia or sedation and some swelling and discomfort around the implant area. What complications can occur?
Complications are problems that can occur during or after the procedure. Most people are not affected. The complications of any surgical procedure can include excessive bleeding, an unexpected reaction to the anaesthetic or infection. It is likely that you will be prescribed antibiotics and an antiseptic mouthwash to reduce the risk of your implant becoming infected.
Your lower jaw contains nerves, which supply feeling to your tongue, chin, lower lip and lower teeth. In a small percentage of cases during implant surgery in the lower jaw the nerves may be bruised and may cause a tingling or numb feeling in your tongue, chin or lip. The chance of complications depends on the exact type of procedure you are having and other factors such as your general health.
Implants may not be an option for smokers or people with chronic conditions such as poorly-controlled diabetes, osteoporosis, and cancer. This is because the implants are more likely to fail due to problems with the healing process.
Routine dental x-rays show large amounts of detail, but in only two dimensions. From these views it is generally possible to judge the height of bone available for implant placement, however, more advanced imaging techniques are sometimes needed to determine the equally important bone width, which can otherwise only be estimated from clinical examination.
Dental CT scans - There are now a number of advanced x-ray techniques which allow your jaw bone to be looked at in all three-dimensions. The most accurate and widely available is known as the CT (computed tomography) scan. Images obtained by CT scanning will normally be able to show all of the information required about your bone, including quantity and quality, but most importantly the presence of anatomical structures that must be avoided.
So far we have covered the building blocks that are part of routine implant placement. This has included the initial examination 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’.
Alternatives to your own bone for grafting
For those who would prefer an easier, but slightly slower solution, there are other sources of bone specially prepared to make them safe for use in humans. All of these materials including your own bone, simply provide a scaffold into which new bone will grow and consolidate ready to receive dental implants a few months later.
New bone can take anything from 3 to 12 months before it is ready to receive dental implants. Do not be in a hurry to move to the next stage. If you need a large volume of bone it will take longer to mature than a small amount.
Guided tissue regeneration - Each surgeon will have his or her preferred way of creating new bone. Many of them will also use a supplementary technique called ‘guided tissue regeneration’. Using this technique slow moving bone cells are given time to fill a space by placing a barrier material between them and the fast moving cells of the soft tissues lining the mouth. When this technique was originally developed the barrier material had to be removed during a separate surgical stage a few months later. Whilst these original materials are still in use, it is now more common to use a ‘resorbable barrier’ that will disappear naturally a few months after it has done its work.
Does Bone Grafting affect the length of treatment?
If you need bone grafting, it will almost invariably increase the length of time your treatment will take, however when successfully applied it will greatly improve the outcome of the implant(s) placed. When used in the front of the mouth it can also allow for creation of very much better aesthetics.
Bone grafting requires a considerably higher degree of skill from the operator and is often more complex to perform than the placement of the implant itself.
In certain situations some operators will recommend combining the implant placement with bone grafting and the placement of a barrier membrane all at the same time. This considerably reduces treatment time and can produce results that are difficult to achieve any other way. However, many surgeons will still prefer to carry out bone grafting as a distinct stage, so that the implants are only placed when the bone grafting has been successful.
Whatever method is chosen to improve the bone quantity the time, effort and expense is generally well worthwhile.
One-stage implant - The implant is placed into a new, healing or healed extraction site and is visible above the gum immediately after placement. The advantage of this method is that a second surgical stage is not necessary to expose the implant. The implant will not normally be ready to support a tooth for several weeks or months.
Two-stage implant - The implant is placed into a new, healing or healed extraction site and then covered by a layer of gum so that it cannot be seen - this is the first stage. At the second stage some weeks or months later, the implant is uncovered and components added bringing it above the gum ready to begin placing a new tooth.
Same day implants - This technique is most often used to treat the lower jaw and requires considerable planning before the actual day of surgery. Several implants are installed and a few hours later a complete arch of temporary or permanent teeth can be fixed in place. If temporary teeth are used these will normally be replaced with a permanent bridge after a suitable healing interval. Not all patients are suitable for this style of treatment.
Immediate implant - For this technique a tooth is removed and an implant placed immediately into the extraction site. Depending upon the local bone and soft tissue conditions, the implant surgery may be a one- or two-stage procedure. Not all patients are suitable for this approach.
Immediate implant and early loading - This is distinctly different from an immediate implant placement. It is effectively a one-stage technique where the implant is placed into a new, healing or healed extraction site and is fitted with a new tooth at the same appointment. This first tooth will normally be kept out of direct contact with opposing teeth for a healing period of more than 3 months, after which it is finally restored. This technique tends to be more common in regions of the mouth where optimum aesthetics are important. Again, not all patients are suitable for this approach.
To find more on Association of Dental Implantology UK (www.adi.org.uk) |
