What is a dental implant?
Dental implants are one of several ways of replacing missing teeth, or teeth than cannot be saved by any other dental treatment. They can be used to replace one tooth or multiple teeth in the dental arch. They are made from titanium alloy and are bioinert, having no known harmful side effects. Titanium forms a special bond to bone, which dentists call ‘osseointegration’. Most studies have demonstrated that implants are successful in well over 90 percent of cases.
There are very few specific medical conditions that would prevent the use of implants; however there are some risk factors that make the outcome potentially less successful, such as: smoking, active periodontal disease and uncontrolled diabetes. Implants can be placed in elderly patients but they should not be placed in children, until craniofacial growth has been completed.
There are two main stages in the provision of dental implants:
1) The surgical placement of the implant into the jaw bone.
2) The attachment of the replacement tooth (prosthesis) to the implant. This dental prosthesis may be a crown, a bridge or a denture.
Before proceeding to have an implant placed, you should see a prosthodontist to ensure that this is the most appropriate means of replacing a tooth (or teeth). An implant merely serves to be an anchor point for a prosthesis, which may be a dental crown, a bridge or a denture. In our specialist practice, a periodontist is generally responsible for the implant placement and prosthodontists for the provision of the final restoration. Our specialists work intimately to treatment plan and perform each case together.
What about the tooth removal process?
Requiring a tooth extraction is not a desired outcome for any patient; unfortunately certain situations dictate that a tooth with a hopeless prognosis cannot be saved by any form of dental treatment.
When a person loses one or more teeth, the gum and bone volume supporting the tooth reduces. This can appear quite unaesthetic, especially if front teeth are lost. Your periodontist will endeavour to extract the tooth with minimal trauma, to preserve as much natural bone as possible and limit the need for future bone grafting. If there is not enough bone to support an implant, then bone grafting techniques are utilised to build up the bone volume, to provide a platform for implant placement. The bone graft is derived from the patient themselves or bone of bovine origin.
What is involved in implant surgery?
Where possible, your periodontist or surgeon is the ideal person to manage the tooth removal and implant surgery procedures, to assess the bone available and provide the best possible outcome for each patient. Your prosthodontist or periodontist may refer you for a 3D CT scan, which is usually indicated for treatment planning purposes to assess the bone volume prior to any implant placement.
Most commonly, implant surgery is scheduled several weeks after the tooth extraction to allow adequate time for gum and bone healing to occur and for any infections to resolve. On rare occasions, the extraction and implant placement can be done in the same appointment.
Placement of dental implants is a complex, yet relatively minor surgical procedure that can be done under local anaesthetic. Sometimes a small amount of bone grafting is necessary at the time of implant surgery. Most patients report that the surgical procedure is as tolerable as having routine dental treatment. Analgesics and/or antibiotics may be prescribed following the implant surgery; this is assessed on a case-by-case basis. Any stitches in the gum from the implant surgery will need to be removed 1-2 weeks later.
If a restoration is not placed immediately on the implant, then a temporary prosthesis is usually provided for patients to wear straight away, so that they are not left without teeth during the healing period. Healing time following surgery varies from person to person and is based on a variety of factors. When osseointegration of the implant is confirmed at a follow up appointment with the periodontist, usually around 2-3 months after surgery, patients are then referred back to their dentist or prosthodontist to start making the final prosthesis.
When the implant is ready for restoration, your prosthodontist will need to see you to take a special mould (impression) to record the exact position of the implant(s). This impression will be used to create a model, on which a dental technician will fabricate the crown, bridge or denture. The number and length of appointments will vary depending on the type of restoration. Although most restorations come back from the laboratory at an acceptable standard, your prosthodontist may wish to try in the restoration and return to the laboratory in order to ensure the fit and appearance are optimized.
How can I ensure I get the best long-term outcome?
Following insertion of the final prosthesis, a review appointment is scheduled with your periodontist to assess the implant. Relevant radiographs are taken to assess the bone around the implant and a clinical examination to assess the soft tissues. Oral hygiene instruction is provided to keep the implant as clean as possible. It is important to note that implants are as susceptible to periodontal disease in the same way that teeth are, therefore long-term maintenance is imperative to ensure the best long-term outcome for every patient.
What is All-on-4?
All-on-4 is a proprietary term for a specific treatment modality which involves the removal of all remaining teeth (if any), surgical reduction of the residual ridge (bone) and the placement of four implants followed by an acrylic bridge. This type of treatment is indicated in some situations, but a thorough consultation and discussion with a prosthodontist is always recommended in order to fully evaluate your options.