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Information Booklet for Patients Considering Implants
Frequently Asked Questions
What is a dental implant?
A dental implant is a small screw made of titanium or titanium alloy. Strictly speaking the term ‘implant’ only applies to the part which sits in the jaw bone. The implant is then used to attach a false tooth or ‘crown’, or two or more implants are used to support a group of teeth, called a ‘bridge’. Alternatively implants can be used to stabilise loose dentures.
Dental implants have shown high levels of success for millions of patients are are now a very popular method of replacing missing teeth. They are not however a miracle treatment and need to be carefully looked after for long term success.
What are the benefits of dental implants?
Dental implants allow the fixed replacement of missing teeth without the need to drill natural teeth as was the case with traditional bridgework. The resulting new teeth look, feel and function like natural teeth. Additionally, the presence of a
dental implant prevents the shrinkage of the jaw bone which often follows the loss of teeth. Implants can also be used to stabilise dentures, increasing chewing ability and enhancing self confidence.
How long do implants last?
The life expectancy of a dental implant will depend on many factors including the quality of the jaw bone, the condition of the other teeth, the health of the patient, and the level of oral hygiene. If well cared for, it is not unreasonable to expect a dental implant to last twenty years or more however, if not properly maintained, dental implants have been known to start to fail within a few years.
The crown, bridge or denture which is connected to the implant can also suffer from mechanical complications, just like those supported by normal teeth. These include chipping or fractures of ceramic, loosening of the screw which connects the restoration to the implant, or, more rarely, fracture of of the connecting screw. Actual implant fracture is a possible but unusual complication. Fortunately, most of these complications can be managed easily. It would be reasonable to expect the non implant part of an implant supported crown, bridge or denture to require maintenance or replacement after fifteen years or so, although many last considerable longer.
What are the cosmetic limitations of dental implant treatment?
It is normal to experience shrinkage of the jaw bone when teeth are extracted. This can result in a discrepancy in the level of the gum margins of the implant teeth and the neighbouring natural teeth. As a result the implant restoration/s may appear longer at the neck than the adjacent teeth and there may be a loss of the pink gum triangles (papillae) between the teeth. This might be visible if you show your gum margins on smiling and your implants are at the front of your mouth.
Where multiple teeth are missing it is not unusual for there to be a considerable loss of jaw bone height. Unfortunately this cannot be reliably remedied. This can result in longer teeth. Pink ceramic can be used to mimic the lost gum however it is often very difficult or impossible to achieve a perfect match and a compromised aesthetic result may result where a high lip line reveals the necks of the teeth.
Some patients have very thin gums and in such cases it is possible for parts of the metal implant to become visible over time, either at the neck of the new tooth or by shining through the gum to show a grey area.
Does the treatment hurt?
The implant placement procedure is carried out with normal dental injections and is painless. Following treatment the vast majority of patients report mild or moderate discomfort for the first few days which is easily controlled with over the counter medication. Bruising and swelling can sometimes occur, especially when grafting, and this usually resolves within a week.
What is a normal series of appointments?
A typical implant treatment would consist of the following appointments;
1. Placement of the implant
2. Removal of stitches two weeks later
3. Impressions 8-12 weeks later
4. Fit of crown or bridge two weeks later.
Why must I wait before attaching the tooth to the implant?
Dental implants are successful because the jaw bone grows onto the surface of the implant in a process called osseointegration and it fuses the implant to the bone. If the crown is placed too soon there can be failure of the osseointegration and failure of the implant.
What is bone grafting?
Implants need to be surrounded by bone for long term success. In about a quarter of cases there is not enough bone to fully cover the implant and some of its surface is uncovered. In these circumstances the naked part of the implant is covered in specially processed cow bone and a membrane made of pig skin. These act as a scaffold for growth of your own bone. This procedure, called GBR (guided bone regeneration), is usually carried out at the same time of the implant placement. For larger bone defects a separate grafting procedure my be required. Non animal grafting products are also available on request.
What are the risks of implant placement surgery?
In common with any minor oral surgical procedure, there is a risk of post operative pain, swelling, bruising, infection and bleeding following implant surgery. However, for most patients, these issues are short lived and can be managed with medication.
It is also possible to damage neighbouring structures when preparing the implant site. Damage to neighbouring teeth may result in the need to carry out root canal treatment. It is not uncommon to breech the sinuses when preparing for upper implants. If this does occur the sinus will generally heal by itself. In the rare cases where this does not heal, chronic sinusitis may result, requiring medical or surgical intervention. When preparing for lower implants it is possible to cause trauma to the nerve which supplies the lip, causing temporary or permanent lip numbness. It is also reported in the scientific literature that some patients suffer long term pain following nerve injuries associated with implant surgery. Fortunately, these last complications are very rare.
Can implants get gum disease?
Dental implants can suffer from gum disease (called peri-implantitis) and bone loss, just like natural teeth. This bone loss can result in failure of the implant. It is therefore very important to keep dental implants very clean with high levels of home care and regular hygienist support. Regular dental reviews and yearly X Rays will also help catch such problems at an early stage. Implants are not a ‘fit and forget’ treatment, they demand high levels of home cleaning supported by regular hygienist support, for the rest of your life!
Which patients are at higher risk of implant failure?
Not surprisingly, smokers can suffer over three times higher failure rates of dental implants that non smokers.
If you have had advanced gum disease (periodontitis) in the past you are more likely to suffer from implant failure. Whilst many patients with treated and stabilised gum disease do well with implants , a small group of patients with a history of periodontal disease seem to suffer bone loss and implant failure despite having high levels of cleaning and regular hygienist support.
Patients with unstable diabetes can also suffer higher implant failure rates, however, those with well stabilised diabetes seem to have comparable success rates to non-diabetics.
Lastly, patients with heavy bites, or those who grind their teeth (bruxers), suffer higher rates of complications with their implants such as screw loosening, ceramic fractures, screw fractures, implant bone loss and, rarely, implant fracture.
Will I set off the detectors at airports?
The answer seems to be no. They are too small and the metal is not dense enough.