What is a dental implant?
A dental implant is a small titanium screw which is placed within the jawbone to replace a missing tooth. Once osseointegration (when the bone attaches firmly to the implant) has occurred, a replacement tooth can be secured to the top of the implant. This new tooth can look, feel and function just like a natural tooth. It is possible to use multiple implants to support a denture or bridge.
What are the benefits of dental implants?
Implants supported teeth are more secure and comfortable than conventional dentures because there is no slipping or movement. Dental implants are a better alternative to bridgework for replacing missing teeth, eliminating the need to grind down heathly teeth. When teeth are missing the surrounding bome begins to shrink. dental implants can help maintain the shape and structure of the jaw bone.
What is involved in the implant process?
Consultation, after discussing alternatives, assessment will be made for the feasibility of providing dental implants. X-rays may be taken and study models prepared.
Implant placement is a relatively minor oral surgical procedure performed under sterile conditions in a dental chair under local anaesthesia. If indicated oral sedation will be given. If, after assessment the underlying bone is deficient a number of options are available for bone regeneration. This may be carried out at time of implant placement or prior.
The integration period, usually lasts 3 months allowing for osseointegration. The patient’s denture is usually worn during this healing period.
Restorative phase, once integrated the implant or implants are uncovered and brought into function with a variety of restorations, ranging from a single crown, a bridge or removable overdenture clipped to the implants.
Maintenance, although implants do not decay and indeed have a more than 90 percent success rate when placed in the correct candidates, they still need to be cleaned and reviewed as part of a regular dental maintenance programme.
Commonly asked questions:
Will I be able to eat what I like afterwards?
Yes, once completed patients should be able to eat a normal healthy diet.
How long will it all take?
A range of techniques is available. Usually implant treatment requires a number of appointments ranging over a period of several months, but it does depend on each individual case. In some cases, implant work can be undertaken and complete in a much shorter period.
How long do implants last?
Once treatment is completed, a routine of dental hygiene and regular check-ups should ensure that implants last many years.
What are the costs involved?
The costs can vary depending on degree and extent of treatment needed. The full cost is therefore explained and subsequently confirmed in a written treatment plan.
Am I too old for implants?
There is no age limit for patients wanting dental implants provided they enjoy reasonable good health.
Is the treatment painful?
Patients are often surprised at how little discomfort they experience during and after implant procedures.
Hard and Soft Tissue Grafting
The term hard tissues refers to the jaw bones, hard palate and teeth.
The bone itself falls into several different categories.
Cortical is the hardest bone type and forms the outer part of the jaws a bit like a layer of marble.
Inside the cortical bone is found the cancellous bone which is much softer and more highly vasculated. This layer is the marrow of the jaws and serves to feed the cortical bone. The bone of the lower jaw is harder than the upper.
The term soft tissues refers to the rest of the oral tissues besides the jaws, hard palate and teeth. These include the tongue, cheeks, gums, soft palate, lips and salivary glands.
Hard tissue grafting
Often when replacing a denture with dental implants, the teeth have been missing for a long time which, has resulted in the bone that once supported the teeth, shrinking. The degree of shrinkage depends on individual cases, but as a general rule the more teeth that are missing and the longer the time elapsed since the teeth were extracted, the greater the shrinkage. Good teeth close to the gap will hold on to bone. Whereas a wide gap, an ill fitting denture and underlying gum disease will all cause accelerated bone loss.
The original extractions also determine the bone levels. We now extract teeth using atraumatic techniques so that the incidence of bone being damaged and lost is minimalized.
The importance of good bone around a tooth or a dental implant is the same as a good foundation under a house. If it is inadequate subsidence will happen and ultimately failure.
Where there has been bone loss and implants need to be placed a bone graft will be necessary. This is normally done at the time of implant placement and comes in the form of a sterile powder in a sealed vial. The graft material is sprinkled onto the surgical site where the bone deficiency exists, and then either secured under a resorbable collagen membrane or just the sutured gum. Healing takes 3-6 months, the graft material hardening into the patient’s own bone around the implant.
What is the bone graft made of?
A commonly asked question, grafts can be derived from many different sources including mineral crystals and marine coral. However, irradiated bovine bone is what we are currently using, which is taken from the long bone of cattle in a controlled herd. The commercial name of this graft material is Bio-oss which is produced in New Zealand. Naturally it is completely safe, there being a greater risk posed from the eating of a steak
What if there has been a lot of bone loss?
Where a more significant amount of bone shrinkage has occurred a block graft may be necessary. This need is much less common, and involves the harvesting of the patient’s own bone from a donor site (usually the chin or angle of the jaw), and transferring this to the future implant site. Needless to say, if required a block graft means an extra surgical event involving two sites which, carries with it added expense, time and recovery. When considering any surgical treatment the most minimally invasive technique is always chosen so costs and time factors can be reduced, and patient comfort maintained.
What is a sinus graft?
Where teeth are missing in the upper jaw in the region of the premolars and the first molar, and there is insufficient bone, the maxillary sinus can be utilised as a graft site which can then support an implant. The maxillary sinus is an air space in the shape of an upside down pyramid behind the cheek bones. It is accessed from within the mouth through a window cut in the bone above the position of the missing teeth. The sinus is then filled with Bio-oss and the window closed. Once healing has completed after 3-6 months implants can be placed.
Soft tissue grafting
Where gum recession has occurred resulting in long sensitive teeth, or bone shrinkage has left the muscle fibres of the cheeks or lips pulling on the gum around a potential implant site, a soft tissue graft may be necessary. This involves taking gum (usually from the palate), transferring it to the site in question and suturing it carefully in place. The desired effect is to either, cover up and remodel attached gum over exposed root surfaces, or release the pull of the lip or cheek from the implant respectively.