INTRODUCTION TO IMPLANT TREATMENT

WHY ARE IMPLANTS NEEDED? 

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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.

 

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.

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An alternative method of tooth replacement is to insert implants into the jaw bone to support the false tooth or teeth. 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, jaw bone is preserved and its further loss prevented. For this reason it is best not to delay the decision to place implants, as bone will be lost with time which can make the placement of implants more difficult. However, even after considerable bone loss has occurred, it may still be possible to place an implant although additional bone grafting techniques may be required.

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THE PROCEDURE AND ASSOCIATED RISKS

The condition of the jaws will be assessed for suitability and the treatment will be planned using X-ray 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 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 jaw bone.

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METHODS OF IMPLANT PLACEMENT 

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Implants may be inserted in one of two ways:

1. Immediate insertion is when the dental implant is placed at the same time that the tooth or teeth are removed. The advantages of this approach are a reduction in treatment time and bone preservation. Whether or not this is possible will depend on the condition of your bone at the time of extraction. If infection is present it may be necessary to defer implant placement for three months while new healthy bone reforms in the area.
    

2. Delayed dental implant placement is 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 types and the time required to place them will depend on the number being inserted and their position in the mouth. Every effort will be made to keep the time to a minimum whilst not jeopardising the final result.
 

The upper jaw is prepared for the implants by making a hole in the bone by either drilling to cut a channel or by forming the channel using small punches which are tapped through the bone.

 

Which technique is used depends on the density of the bone being prepared and occasionally may entail a combination of the two techniques. The lower jaw is prepared using drilling only.

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TYPE OF ANAESTHETIC

The procedure is usually performed under a local anaesthetic, with conscious sedation if required.

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CONSCIOUS SEDATION

This is a technique in which a drug is used to produce a state of depression of the central nervous system enabling treatment to be carried out, but during which with the patient remains conscious and verbal contact is maintained. This option will be offered only after careful assessment of your requirements and the level of anxiety you have regarding the proposed dental treatment.

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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 or colour and take on a white appearance for a short time (normally two weeks) after surgery.

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After 6/10 days once the soft tissue has healed sufficiently the stitches are removed.  If dissolving stitches have been used this may not be necessary. During this period it may not be possible to wear dentures. After this stage the implants will be left undisturbed for at least three 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 Dental Clinical Centre to arrange to have the area checked.

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MAKING THE NEW TEETH

After a 3/6-month period a second surgical procedure may be necessary to expose the implants 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 bone. Once the implants have been uncovered and are firm a post or abutment will be connected which will be used to support either a provisional denture or bridge.

 

This intermediate stage will last approximately two 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 possible improving the final appearance. Impressions will be necessary prior to construction of the final restoration.

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APPEARANCE OF THE FINISHED TEETH AND GUM

Every effort will be made to ensure your final teeth look natural and just the way you want them to appear. Unfortunately it is not always possible to guarantee the appearance or level of the gum tissue surrounding the implant teeth. This may be the case if you have had gum disease in the past, been without teeth for several years, smoke or have lost jawbone as the result of an accident.

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This is particularly important if you show a lot of gum and tooth when smiling or have had natural teeth in the area crowned in the past. In certain situations it may be necessary to have new crowns made as a result of gum shrinkage following the procedure. In these situations it may also be necessary to replace the missing or damaged gum by using additional gum grafting procedures or by the application of artificial gum coloured plastic.

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If any of the above is particularly relevant to your treatment then the treating dentists will explain the implications to you and will discuss the alternatives with you should they be required.

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ADJUSTMENT OF THE NATURAL TEETH

If the implant tooth or crown is biting against natural teeth occasionally it may be necessary to adjust the height or size of the real teeth. This is because natural teeth have a tendency to continue growing out of the gum or drift when they have no corresponding tooth to bite against. As a result the size of the tooth may need to be reduced by slight grinding to correct the over-eruption or to increase the amount of space required to accommodate your new implant tooth. This tooth adjustment if required in your particular case will be discussed with you before any alterations are made. As the tooth modification procedure is only minor a local anaesthetic is not required.

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ADJUSTMENT OF THE IMPLANT TEETH

On the day of fitting the new implant-supported teeth it may be necessary to reshape them and adjust their length in the mouth. This is normal and does not mean the teeth are not correct but that fine tuning to the bite can often only be carried out in the mouth itself. Occasionally, if a lot of modification is required the teeth may have to be returned to the laboratory for final alterations to be made prior to fitting.

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During the first few months following fitting of the implant restoration if the bite is not quite in balance the new teeth may chip slightly as part of the bedding in process. Often all that is required is to smooth the area to complete the adjustment. If more severe damage has occurred it will be necessary to return the teeth to the dental technician for renovation.

 

TREATMENT TIMING

The total treatment time required will vary 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.

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WHAT HAPPENS IF THE IMPLANTS DO NOT TAKE

Fortunately this occurs rarely and the success rate for dental implants is 95%. However, failures are still a possibility and an understanding of this is a prerequisite for proceeding with your treatment. Any potential problems specific to your implant treatment will normally have been anticipated and discussed with you before treatment starts.

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 at this time, as it will be very loose and is easily removed.

 

FACTORS ASSOCIATED WITH AN INCREASED RISK OF IMPLANT FAILURE

Overall, dental implant failure is low and there are no absolute contraindications to implant placement. However certain conditions have been found to be correlated with an increased risk of failure. If you are over age 60, smoked, had a history of diabetes or head and neck radiation, or were postmenopausal and on hormone replacement therapy there is a significantly increased chance of implant failure compared with healthy patients.

Even in healthy individuals 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.

Studies have shown that smoking significantly increases the risk of implant failure. If you smoke even lightly then your chances of success are reduced by 15% and if you smoke 20 or more cigarettes a day the failure rate may be 30%. For this reason implants are not recommended in smokers unless the habit is stopped. Starting smoking following implant placement is very likely to result in loss of implants which have successfully taken and cause infection of the gum surrounding the implant.

 

AFTER CARE AND MAINTENANCE REQUIREMENTS FOR IMPLANTS

Implants are not "fit and forget”; they need the same care and attention as natural teeth. On completion of treatment it will be necessary for you to attend a number of recall appointments to check the condition of the implants and to adjust the bite if required.

After this, regular 6/12 monthly dental check-ups are required to monitor the condition of the implants and any remaining natural teeth. You should also maintain regular 3/6 monthly hygiene appointments, as a build-up of plaque will cause gum problems and possible bone loss from around your implants, resulting in their eventual loss.

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 addition work load.

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ACCEPTANCE FOR TREATMENT

Patients will only be accepted for this treatment if they can demonstrate that they can maintain a high level of plaque control and oral hygiene. There should be no medical conditions that would contraindicate the procedure. It is important to inform the dentist of any changes to your general health or medical condition.

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