DENTAL IMPLANTS

What can implants do?

Implants are metal posts which are placed into bone. After some weeks they become actually attached to the bone and in most cases remain there permanently. Implants can be used to replace the root part of missing teeth. The crown part of the replacement tooth is made of metal and porcelain and can be screwed onto the head of the implant. Usually dentists like to wait 8 weeks or so before attaching the crown to the implant, but there are occasions when the crown can be added immediately after the implant has been placed. An example of the replacement of a single missing tooth is illustrated in Case 1.

Implants can also be used to stabilise a denture. A lower full denture is often unstable and makes it difficult to chew and even speak without it coming loose. Two implants can be placed in the area where the lower canine teeth used to be. The denture can be adjusted and worn within a few days. When the usual 8 weeks healing has taken place small studs are screwed into the head of the implant. A cap which fits over the stud is fitted into the denture. The denture clips onto the stud and is held in place during chewing. The denture is easily removed for cleaning and may be left out at night if desired. With the denture out, the studs may be felt by the tongue but are not sharp. An example of a denture supported by implants is illustrated in Case 2.

When teeth are lost the bone which held them in place shrinks away. Implants help to prevent bone loss by stimulating the surrounding bone to remain and not be resorbed.

Is the procedure painful?

Implants are placed with as much attention to the patient's comfort as any other dental procedure. Local anaesthetics are used to make the surrounding area numb in the same way as they are used to insure extractions are pain free. The dentist may suggest that you take some anti-inflammatory tablets an hour before the procedure so as to minimise any discomfort when the local anaesthetic wears off. There may be some swelling around the site of implant placement and even some local bruising for a day or two after the implants have been placed. Post operative swelling is more common when several implants have been placed With single implant placements there is usually no post operative swelling. It may be necessary to take some pain killers for a day or two after placement but many times no pain killers are needed the day after placement.

What are the risks associated with implant placement?

The mouth has a very substantial population of bacteria, many of which could cause post operative infection. Studies have shown that the bacteria responsible for implant infection come directly from the patient's own mouth and are the same group of bacteria which cause gum disease. For these reasons we will ask you to have you teeth cleaned by an oral hygienist a week before your implants are placed and to use an antibacterial mouthwash for a week before and a week after the procedure. Your own oral hygiene is of course crucial to preventing infection around the implants. In spite of these precautions a very small percentage may develop infection either immediately after placement or some months after. This complication may require the removal of the implant, letting the site heal and trying again a few weeks later. The normal precautions to prevent cross infection in the surgery are stepped up and sterile gowns and drapes are used but the real risk of infection lies within the mouth and not from cross-infection.

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How long will my implants last?

As the technology of implants improves the expected levels of success keep rising. Most surveys suggest between 95% and 98% success rates over 5 years. The main cause of failure is infection around the implant. We can however be fairly certain that age is not a risk factor; hence there is no upper age limit for patients to have implants. It does seem that existing or previous gum disease in other parts of the mouth is a risk as is smoking. Estimates vary but either of these two risk factors could reduce success to 85%. Good oral hygiene around the implants reduces the likelihood of infection and is therefore one of the best ways to insure implants remain for many years.

Will I have enough bone to allow implants to be placed?

In the planning stage we will take routine X rays including the panoramic ones to assess the amount of bone in the area an implant is being considered. If there is insufficient bone for the implants it may be possible to augment the bone with a graft of bone from elsewhere. The most simple augmentation is done using powdered cow bones treated to remove all the living material.

Who is qualified to place implants?

Traditionally implant placement has been restricted to dentist who have specialised in Oral Surgery or trained to become Maxillo-Facial Surgeons. During the last 20 or so years general practitioners with a special interest in implants have taken courses and become proficient in implant placement. At present more implants are placed by trained general practitioners than specialists. However this training can be quite varied as there have been no guidelines which might indicate some minimum training requirements. Recently the Association of Dental Implantology has prepared some guidelines and it is expected that dentists who want to start placing implants will find it useful to compare their training to these suggested minimal requirements.

The training required for placing implants does depend on the level of complexity of the procedure. Those procedures which require block bone grafts or sinus augmentation require greater skill and training than those, for example, which involve placing two implants in the front of the lower jaw to support a denture.

Some idea of the risk associated with the placement of implants can be assessed by the criteria used by legal liability insurers to assess the premiums of dentists placing implants. There is no increase in premiums for general practitioners who may be placing implants as part of their every-day routine, provided the procedures they use are not complex. Complex procedures may be defined as those involving sinus augmentation and block bone grafts, and dentists or oral surgeons doing this more complex work are required to pay higher insurance premiums.

What will my implants cost?

The cost of implant placement depends on the degree and extent of the treatment. The full cost can therefore only be estimated after a full examination including x rays and a provisional treatment plan has been worked out according to each individual's needs. The basic cost of a single implant without bone augmentation or any attachment or crown is £ 1800. The crown is usually in the region of £ 600.

Case1; Single Implant

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This patient had a post retained crown. After some years the root fractured leaving no other option but to extract it. For a while he wore a plastic denture to replace the single missing tooth but was not happy with it.

An implant was placed where the root had been. It was left in place for 8 weeks to attach firmly to the bone. During this waiting period he wore his plastic denture.

After 8 weeks the crown was attached to the implant and the patient was able to discard the plastic denture.

He now bites into apples and is unaware of any foreign object in this mouth.

Case 2; Denture Support

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This diagram shows the positions of two retaining studs attached to implants in the lower jaw. The denture attaches to these studs but can be removed for cleaining

The two implants in the lower jaw with the studs attached are all that is necessary to keep the lower denture in place.

For further information about implants  visit  the Association of Dental Implantology at ADI and the British Dental Association at BDA  . To discover  more about the options of implants  for you, make an appointment for a consultation with Robin Wilding  on 01647 432224.