Some Common Questions
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A dental implant is a revolutionary substitute for the natural root of a tooth. Each implant is placed into a socket carefully prepared either by drilling, or tapping a series of increasingly sized instruments into the jaw bone. Surrounding bone then grows into microscopic indentations on the implant surface, to hold it securely.
Dental implants normally have some form of screw thread or post onto which different components can be fitted. In turn these components provide the foundation for long term support of crowns, bridges or dentures. According to clinical need we use Ankylos or occasionally Tatum implant systems.
Dental implants obey simple engineering principles - they must be placed in strong foundations, with enough of them to prevent overloading from the pressures of biting. Each implant must also be accessible for daily cleaning, so that surrounding bone and gum can be kept healthy, and the implant secure.
If you are missing just one natural tooth, then
one implant is normally all that will be needed. Larger spaces from
two, three or more missing
teeth, do not necessarily need one implant per tooth. The number required
will depend upon the quality and volume of bone at each potential implant
site. Ideally as many implants as possible should be used, to allow
the stresses of biting to be spread over the maximum number of implants.
In the lower jaw, the bone towards the front of the mouth is often very strong, so fewer implants may be needed. For example it may be possible to provide 10 or more teeth in the lower jaw with as few as four implants, although it is still more common to use five or six.
If you have no teeth
in the lower jaw, and are not yet ready for multiple implant placement,
wearing 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
in the upper jaw will usually require more implants). Implant-supported
overdentures are still removed for daily cleaning just like conventional
dentures, though once back in the mouth, the implants make them far more
If you are also aware of bad breath,
loose teeth, or have noticed excessive gum bleeding, particularly when
your teeth are cleaned
you may have gum problems. Periodontal (gum) disease is a major
cause of bone loss and the resulting reduced bone can complicate dental
Depending upon your clinical situation and bone quality some implants can be placed and loaded with a tooth on the same day though this may carry a higher risk of failure long term. Otherwise from the time of implant placement to the time of placing the first teeth, treatment times are between three and six months. The availability of better bone can reduce treatment time, whilst more time and care must be taken with poorer bone. This can extend treatment beyond six months and if bone grafting is required, this could lengthen treatment by four to nine months. Try not be in a hurry to move to the next stage as a secure footing for your implant is vital for its long term stability.
As the surgery normally involves exposing the bone in the area where the implant and/or bone graft is to be placed you can expect minor swelling and occasional bruising afterwards. Most patients find taking simple painkillers for a few days is sufficient.
The operation itself might take anything from one hour for a single implant to several hours for complex bone grafting and multiple implant placements.
For more simple procedures you may then need a day or two off work while more complicated procedures, such as sinus or onlay grafting, may require up to a week off. There is obviously a greater chance of pain, bruising and swelling if additional grafting procedures are used. The extent of this will depend largely on the size of the area to be grafted.
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. Cleaning is not difficult providing that you do not have impaired use of your hands. It is reasonable to expect some 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. It is important to understand that implants are more susceptible to gum disease than natural teeth and therefore daily cleaning as instructed is essential.
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 most influence how long they will last.
When poorly cared for, implants develop a covering of deposits similar to that found on neglected natural teeth. Left untreated, these 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 natural teeth, will last for as long as you care for them.
Well maintained implants, placed into adequate bone, can be expected to last for many years. However, just as with other surgical implants (such as a hip replacement) there is no lifetime guarantee.
If an implant cannot achieve, or maintain, a rigid fixture with the surrounding bone then it will eventually become loose and no longer be able to support replacement teeth. Usually the failing implant would cause no discomfort, and if there are enough other implants it may not be necessary to replace it at all.
However failures may not always be so easily handled and if you embark upon implant treatment you must be prepared to deal with this possibility. Most implant providers will want to achieve failure rates below 5%, but this still means that 1 in 20 implants placed might not survive. After placing hundreds of implants, the success rate at The Bay Tree Dental & Implant Centre is currently 98%. This high rate has mainly been achieved through the advanced training of our team, combined with thorough preparation and planning.
Just as muscle wastes away when not used, so jaw bone wastes away when not stimulated after the loss of the natural teeth.
Routine dental X-rays show good detail of the available bone but only in two dimensions. From these views it is generally possible to judge the height of bone available for implant placement. The width of available bone can usually be measured using a technique called ridge mapping, where a series of measurements are made using special calipers. However, sometimes a CT scan may be required.
For some people, bone loss after the losing teeth leaves them with too little bone to secure an implant.
Bone is generally ‘harvested’ from the chin or back regions of the lower jaw. When you use your own bone to create new bone in another area of the mouth, you will obviously have discomfort, swelling and bruising at the donor site, as well as at the surgical site.
An easier alternative are external sources of bone, specially prepared to make them safe for use in humans. These are generally used in conjunction with resorbable membranes. These materials include synthetic, bovine, porscine or cadaveric. If you have any objection to any of these being used it is important that you make your surgeon aware. All of these materials, including your own bone, simply provide ‘scaffolding’ into which your own new bone will grow and consolidate, ready to receive dental implants a few months later.
New bone can take anything from four to nine
months before it is ready to receive dental implants. Do not be in
a hurry to move to the next
stage as a secure footing for your implant is vital. If you need a
large volume of bone it will take longer to mature.
This is one of the most important features of dental implants. Once in place and supporting teeth, everyday biting pressure actually stimulates the surrounding bone to grow in density and strength.
If the teeth being replaced by dental implants are in a clearly visible part of your mouth you will understandably want to have teeth present while treatment is underway. There are a number of ways that this can be done, ranging from simple plastic dentures to removable bridges. However it is important that replacement teeth do not apply uncontrolled pressure to the underlying implants. Therefore it may be necessary to modify existing dentures or bridges to accommodate your implants. This may loosen dentures and you may need to use denture adhesive during this time.
When consulting someone to find out more about dental implants you should be asked detailed questions concerning your medical history, there should be a complete examination of your mouth and remaining teeth to discover the nature and extent of any current dental problems, and X-rays will be taken. Sometimes models and photos will be needed so that these can be examined between visits.
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 stabilize any gum or tooth related problems. It would be reasonable to expect a verbal outline of how your particular implant treatment might be approached.
Before starting treatment you should be given a written summary of your treatment plan. This should include: an overview of the anticipated treatment stages; an estimate of the length of treatment; how many implants are required; and the expected fees. There may well be other issues specific to your case and these would be dealt with accordingly. It is important that you are also made aware of the alternatives to dental implants.