Dental Implants - Are they for me?

Some Common Questions

(Click on the relevant question to see the answer or scroll down)

• If I have missing teeth what are the alternatives?
• What is a dental implant?
• How many teeth can be supported by an implant?
• Who is suitable for dental implants?
• How long does the treatment take?
• Is the procedure uncomfortable?
• How should I look after the implants?
• How long will the implants last?
• Will the implant be successful?
• Will I have enough bone for dental implants?
• What can be done if you do not have enough bone?
• Where else can you obtain extra bone?
• Can dental implants really preserve bone?
• Can you wear teeth during implant treatment?
• How will I find out if I am suitable for implants?

If I have missing teeth what are the alternatives?

• Implants to secure their dentures in place
• Implants to support crowns and bridges
• Traditional full removable dentures
• Nothing to replace their missing teeth

• Implants to secure their partial dentures in place
• Implants to support crowns and bridges
• Traditional partial removable dentures
• Nothing to replace their missing teeth

What is a dental implant?

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.

How many teeth can be supported by an implant?

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 upper jaw, bone density is generally poorer than in the lower jaw. Therefore if you have no upper teeth at all, most clinicians will want to place a minimum of 6 implants to support a complete set of 10 or more replacement teeth.

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 stable.
There are many options and every case can be dealt with in a number of ways.

Who is suitable for dental implants?

• Your General Health -If you have good general health then dental implants will almost certainly work for you. However, habits such as heavy drinking or smoking can increase the problems associated with initial healing, and thereafter may harm the long-term health of gum and bone surrounding each implant, making the implant more likely to fail. Conditions such as diabetes, osteoporosis, previous steroid or radiotherapy treatment to the jaw area may also have detrimental effects. This does not mean that implant therapy cannot be carried out, simply that there is an increased risk of failure of the implant to firmly integrate.
  
  
• Bruxism - Patients with a habit of clenching or grinding their teeth (bruxism) may risk overloading their implants. For most people this habit occurs during sleep, so they are generally not aware of it. The most common signs are heavily worn or flattened teeth, chipped enamel edges, or pieces of heavily filled teeth breaking regularly. However placing additional implants, careful selection of restorative materials, and providing a night time bite guard to protect the new teeth can all help to compensate for the problem.
  
  
• Oral Health - When you first consider dental implants it is often because of ongoing dental problems or recent loss of teeth. The cause of these problems will need to be diagnosed and treated, to establish healthier conditions before placing implants.

If you are also aware of bad breath, loose teeth, or have noticed excessive gum bleeding, particularly when your teeth are cleaned professionally, you may have gum problems. Periodontal (gum) disease is a major cause of bone loss and the resulting reduced bone can complicate dental implant treatment.
Although it is tempting to focus on the more glamorous end results, the long term success of your treatment depends upon basic dental health including treatment of gum disease, repair of decay and elimination of abscesses.

How long does the treatment take?

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.

Is the procedure uncomfortable?

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.

How should I look after the implants?

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.

How long will the implants last?

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.

Will the implant be successful?

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.

Will I have enough bone for dental implants?

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.

What can be done if you do not have enough bone?

For some people, bone loss after the losing teeth leaves them with too little bone 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. 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. (Dr David Fox has been personally tutored by the originator of this technique, American Dr Hilt Tatum).
  
  
• Onlay grafting – There are many ways in which bone can be supplemented. 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.

Where else can you obtain extra bone?

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.
In certain situations it may be recommended to combine implant placement with bone grafting and the placement of a barrier membrane all at the same time. However, in other situations it will still be necessary to carry out bone grafting as a separate stage, so that implants are only placed once the bone grafting has been successful.

Can dental implants really preserve bone?

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.

Can you wear teeth during implant treatment?

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.

How will I find out if I am suitable for implants?

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.