Dental implants

What is a dental implant..?

An implant is a metal blade or post which is surgically inserted into your jawbone.

Some older implants were made of steel, but implants in current use are made of titanium with various surface coatings for different applications. Researchers are also looking at some ceramics as an alternative.

The titanium insert is biological stable, and is considered to be osteogenic, in that it encourages new bone formation. Your bone grows right onto your implant, forming a solid structure.

We can then subsequently place single crowns, bridgework, or attachments to retain dentures on top of your implants.

This enables us to restore the form, function and aesthetics of your mouth, enabling you to eat and smile with confidence.

The placement of implants helps to prevent the loss of your jawbone which naturally occurs with loss of teeth. As such it helps maintain the strength and shape of your jaws, and contributes to maintaining a youthful appearance.

Implants can be placed in almost anyone over 16. They are not normally used in children, as their bones are not fully grown.

Current success rates with implants are over 95%.

Contra-indications

Smoking is the biggest contra-indication for implants, as it seriously affects the bone chemistry, preventing the normal uptake of calcium. It also affects wound healing and depletes Vitamin C which is also essential for healing.

Smoking reduces the success rate to under 60%. We will not normally place implants in smokers.

Alcoholism also affects bone health, and there are other factors to consider. Alcoholics are often less than fastidious about their general health and hygiene, and are therefore unlikely to be good candidates for implant treatment.

Diabetes when uncontrolled can seriously affect the healing processes, however, well controlled diabetics can be considered for treatment.

Other medical conditions need to be considered on an individual basis.

Placement of implants

Present day implants based on scientific evidence have shown a success rate of more than 95% over a 15 year period.

It is not necessary to have an implant for every tooth that is missing as gaps can be bridged in the normal manner.

Your first operation:

1. A small cut is made into your gum tissue to expose your underlying bone.

2. An implant is placed in your bone by surgically preparing a small hole in your jaw bone.

3. A screw is placed in the head of your implant, to seal it for the time it takes for your bone to grow into your implant surface.

4. Your gum tissue is closed with a number of sutures, and healing takes place.

Your second operation:

1. This is 6 weeks after your first operation.

2. Your implant is exposed and the screw removed.

3. An abutment post is placed and screwed into position, this forms the post onto which your temporary crowns and ultimately your final crowns are fitted.

4. You could wear a temporary denture whilst the implant is integrating with the bone.

For unknown reasons implants can fail to integrate with bone, even when the oral hygiene is spotless, and you should be aware that this can happen.

However, it is possible, after a period of healing to replace a new implant into the same site.
It is important to attend for all your recall appointments, keep your oral hygiene regime as effective as possible, and contact us if you have any problems or concerns.

Your implants would be left in for 6 weeks after which we will place a post in it then a crown on top of it.

The whole procedure from start to finish will be under 3 months.

Why bone grafting..?

If you have insufficient bone to place implants we can in many cases rebuild your bone by grafting.

When your teeth are lost, there is a great deal of resorption of your jaw bone, due to loss of function.

This means that your bone gets thinner.

If implants are quickly placed, this bone thinning can often be halted, but in a lot of cases there has already been a lot of bone loss due to infection. If we accept your bone as it is, we may not be able to use an implant restoration, or we may have to place them in severely compromised positions, which means that we would not get a nice looking final result. Grafting of the bony ridge in these deficient areas can improve the outcome and the aesthetics for you.

Bone grafting can be performed in most areas of your mouth where we may wish to place implants, or improve the ridge shape when making bridgework. The type of bone graft required depends on the amount of bone loss. Where there are large areas of bone loss, usually after accidents or severe infection, it is usually better to refer you to hospital where a bone graft from your hip would be the ideal treatment. In small areas, usually around one or two teeth, we can either take a small graft from your chin to place in the defect, or we can use donor bone, or bone substitutes.

How does done grafting happen..?

The procedure is usually performed under local anaesthetic, although if you are worried you could have sedation.
First of all, we take 60ml of your blood, usually from a vein in your arm. We then place this in a centrifuge to separate the different parts of the blood. We want to use the just the part with the platelets, as this has a lot of your bone growth proteins. This will be mixed with the bone or bone substitute that we will place in the graft site.

You will then have local anaesthetic to make the area really numb, so that we can work without you being able to feel anything.

The gum is lifted up from the underlying bone, and some small holes are made into the surface of the bone. This is to ensure that the graft material has a blood supply from under the surface of the bone, ensuring that the blood, which reaches the graft, is rich in your bone growth proteins.

We also save any bone chips from where we have made the holes in the surface of the bone. The bone chips or bone substitute may be mixed with a mineral solution to aid growth and are then placed over the area.

The whole of the graft area may be covered with a collagen membrane material, usually Bio-gide, to stop the gum tissue from growing into the bone area. This has to be done as your gum tissue will grow very quickly, and your new bone grows very slowly. The body absorbs the membrane after a few weeks allowing the initial formation of bone underneath.

What sort of graft material is available..?

1. Autogenous bone
This is bone from your body.
If the graft material is taken from your chin or from other areas in the mouth, this will be done at the same time as the graft procedure. It is usually performed under local anaesthesia. Your gum is lifted up over the area, and a small piece of bone is removed. This will regrow without any problem as the bone re-contours itself. The main disadvantage to using your own bone is that it can cause quite a lot of bruising. This will of course heal, but it can be unpleasant in the interim.

2. Bio-oss
If there is not enough of your own bone to fill the defect, then we will need to use a substitute. Bio-oss is derived from bovine bone from a certified BSE free herd. It is very close in structure to human bone. All the protein is removed, so that only the mineral matrix of the bone remains. It is very safe and we have had some excellent results with this. In an infection free area this would now be the material of choice, as it forms good quality bone very quickly. We would normally use it mixed with some of your bone, as we get quicker bone formation than using it totally alone. We would usually collect some bone chips when we make the holes in the surface of the bone.

3. Bio-glass
This is another bone substitute. It has been extensively researched and is proving to be a useful material for small graft sites. All the research suggests that it is bactericidal, ie kills bacteria, it is also a man-made material, and consequently does not have to be screened for transmissible diseases. It does however take longer to form bone than other graft materials. If you have religious or ethical concerns about using bone substitutes from animal sources then this is a reasonable alternative when there is not enough of your own bone .

Whatever graft material we use your graft will need to be left for around 6 months to heal and form new bone.

For more detail and pictures of surgical procedures please click here
Warning, this may be too graphic for some people