Dental implants are used to replace a missing tooth or teeth. An implant is a titanium screw-shaped attachment that is inserted into the jawbone to replace the root portion of a missing natural tooth. It is gently screwed into a pre-drilled socket in the bone, and then acts to support a crown or bridge, or secure a denture into place. It then integrates readily with the bone by a process called osseointegration, after which time the crown, bridge or denture can be placed onto an abutment that is fixed into the top of the implant.
What does the treatment process involve and how long will it take?
Routine dental implants are placed in the following process:
- ASSESSMENT & TREATMENT PLANNING – a thorough examination and discussion will lead to a treatment plan being formulated, including covering all options available to replace the missing tooth/teeth. Then a written plan and cost estimate will be provided.
- SURGICAL IMPLANT PLACE – this is the surgical procedure to place the implant into the bone in the desired position. It is carried out using local anaesthetic, and patients can expect some mild swelling, but little/no discomfort after the procedure. The implant surgery will usually be carried out approximately 8 weeks after a tooth extraction, to allow the site to heal.
- HEALING PERIOD – this is to allow the implant to integrate successfully and firmly with the bone. In most cases this takes between 8-12 weeks, but will depend on individual case circumstances.
- RESTORATION PHASE – this is the placement of the crown, bridge or denture onto the implant(s) once healing is complete.
- MAINTENANCE – good oral hygiene both at home and via hygienist treatments is important for preserving implants, and patients also need to attend regular review appointments following completion of treatment.
How many teeth can be replaced by implants?
Dental implants can either replace single missing teeth using implant-supported crowns, or multiple teeth using implant-supported bridges or dentures. All the teeth can be replaced by a removable denture, which is firmly anchored onto implants and can be removed for cleaning, or implant-retained bridgework which cannot be removed from the mouth.
What are the benefits of dental implants?
They act to replace natural teeth both aesthetically and functionally as closely as possible, without damaging other healthy teeth. They can replace a single tooth or multiple teeth, giving patients greater function and confidence.
Who is suitable for dental implants?
They can be used on any adult at any stage as long as jaw growth is complete. The basic requirements for treatment include a good general state of health, good oral hygiene and adequate bone quality and quantity. Some patients may have existing conditions that can adversely influence the success of any implant treatment, including smoking and periodontitis (gum disease).
Will I be left without teeth during treatment?
There are a number of methods that can be used to replace teeth during treatment. These include providing a removable acrylic denture or a fixed adhesive bridge. To ensure they do not apply potentially damaging pressure to the underlying implants during the healing phase, these prostheses often have to be adjusted at regular intervals during treatment.
Is it uncomfortable when the implants are placed?
The dental implant is inserted into the bone under local anaesthetic so that there is no discomfort during treatment. Painkillers are given before treatment and provided afterwards, although there is usually very little discomfort after surgery. There is sometimes some minor swelling and/or bruising, but this will usually subside within 4-5 days after the surgery.
How do I look after the implants?
Keeping the implants clean during and after treatment is very important. Instructions will be given and techniques demonstrated to enable thorough cleaning before, during and after treatment. You will need specific dental cleaning aids and regular review appointments to ensure you are maintaining good oral hygiene.
How is the bone assessed and what happens if not enough is present?
Assessment of the quality, quantity and location of available bone is usually carried out by visual and physical examination, specific dental radiographs (x-rays) to provide a two-dimensional image of the site, and study models of the teeth. Sometimes these processes do not provide enough information and a 3D image is required using a CBCT scan.
If not enough bone is present then a number of options are available to try and provide extra bone volume. This can be collected from a number of different areas in the mouth. Alternatively, a technique called guided bone generation (GBR) may be suitable. This uses artificial bone and membrane to serve as a template and aid bone formation in the required area.
If there is not enough bone present in the posterior regions of the upper jaw, then it may be possible to make room using a sinus lift procedure, where more bone or bone substitute is added to make room for implants to be placed.
What are the risk factors for implant treatment?
Some patients may have systemic conditions, treatments, habits or local risk factors that can either prevent or reduce the potential success of implant treatment. These risks are not limited to but may include:
- SMOKING – this is a risk factor for both general and oral health. Smokers are of increased risk of implant loss, bone loss around implants, peri-implantitis and progressions of periodontal (gum) disease.
- PERIODONTAL DISEASE – patients with a history of treated periodontitis have an increased risk of implant failure and peri-implantitis. Those patients with a history of treated periodontitis and who also smoke have an increased risk of implant failure and peri-implant bone loss. It is important to successfully treat periodontitis prior to any implant treatment, and to provide specific maintenance care following implant placement.
- MEDICAL CONDITIONS & TREATMENTS – before any implant treatment is considered a detailed medical history is taken. Some medical conditions and treatments may well affect the outcome of implant treatment. Also, implant treatment may be a potential risk for medical complications in patients with certain conditions, including those with diabetes, osteoporosis, patients taking bisphosphonate and some anti-cancer drugs, and patients who have had/are having radiotherapy.
- MECHANICAL & TECHNICAL RISKS – all implant reconstructions are planned to minimize any potential mechanical or technical problems. Local factors such as grinding habits can be an increased risk factor for such mechanical problems.
How are implants monitored and maintained?
Regular monitoring and maintenance of dental implants and their prostheses following their placement is essential to help ensure their long-term success and survival. If neglected then the health of both the soft and hard tissues around the implant can suffer.
Dental implants are only placed when a patient’s oral hygiene, teeth and gum condition are all stable and healthy. Before, during and after implant treatment, baseline recordings of gum condition and oral hygiene, and radiographs of bone levels are all taken. These measurements are then re-recorded at each yearly review appointment with the implant dentist.
Regular yearly monitoring of the implant reconstructions is important to check the screws, attachments and overall fit of these appliances.
Each patient is given and shown specific techniques and instructions to ensure optimum oral hygiene is achieved. Regular dental hygienist appointments are essential as prescribed by the implant dentist.