Using implant treatments to replace missing teeth.

Why do we need implants?

Our teeth are essential for healthy, comfortable living and most of us do not wish to contemplate life without them. They are cleverly designed to grow in the bone and then emerge through the tough skin of the gum to provide a hard cutting and grinding surface. However, the join between the tooth and the skin is vulnerable to infection and damage if plaque becomes trapped or is incompletely brushed away.

In addition, increasing life span places a heavy burden on our teeth, which work very hard for us over a lifetime. Loss of teeth is often an unavoidable consequence of wear and tear and can be distressing and debilitating. Fortunately dental techniques and technology are now very effective at replacing missing teeth to maintain facial appearance and enable comfortable and effective chewing. Implants, in many cases, now represent the most effective, reliable and lifelike replacement for teeth.

What is an implant?

Implants have been used to replace teeth or provide support for dentures for many decades. The success of dental implants has increased dramatically in recent years due to the work of Professor Per-Ingvar Brånemark. In the early 1950s he observed that titanium could bond with bone, a process now known as osseointegration. His observations were used to develop systems using pure titanium implants for tooth replacement and other medical applications. The first dental implants to use this technique were placed three decades ago and many of these are still functioning perfectly. Nobel Biocare, the company that produce the Brånemark implants we use, have supplied implant components for over 400,000 patients worldwide to date.

Implants are replicas of teeth in many ways. They are made up of three parts:

1. The fixture. This is the titanium post that is placed and then heals into the jawbone to replace the roots of a missing tooth.
2. The abutment. This is the part of the implant which is connected to the fixture and emerges through the gum.
3. Prosthesis. This is a crown, bridge or other attachment that fits onto the abutment and replicates all the visible part of the missing tooth.

How is an implant fitted?

Implant treatment is carried out in a number of stages over a period of time. Each part of the implant is sequentially assembled and the bone and gum are allowed to heal around it to produce a harmonious natural result which can be difficult to distinguish from a tooth when completed.  This summary is intended to give you an idea of what is involved if you elect to proceed with implant treatment.

Preparation

In order to allow for placement of implants a thorough examination of the jaw bone in the area is required. In addition to a visual examination, x-rays, impressions and in some cases more detailed scans are required.

Your teeth, gums and the condition of the rest of your mouth are also assessed along with your general health. Smoking and diabetes may affect the success of implant treatment as does gum disease and any infection present in the mouth.

If there are any fragments of teeth or retained roots in the area where the implant is to be placed, these need to be removed before the fixture can be inserted. If a tooth has to be removed it is usual to wait for up to three months prior to commencing the first stage of implant treatment. In some cases there is insufficient bone to support the implant and a graft of bone from another site is placed in preparation for the implant.

The final position and appearance of the teeth needs to be determined at this early stage in order to allow for the correct positioning of the fixture. This may simply involve the preparation of a wax template on a plaster cast of your teeth or, where there are multiple replacement teeth, a more permanent template that can be worn in the mouth to test comfort and speech. This will then ensure that the final prosthesis has an optimal appearance and function.

First stage implant treatment

The start of the implant treatment proper is the placement of one or more implant fixtures to support the final crown or prosthesis. This treatment is routinely performed under local anaesthesia. The sterile fixture is placed carefully into the bone, a record may be taken of the position of the fixture and then the wound is neatly stitched to cover the fixture. At the end of the treatment there is nothing to see except the stitches, and the gum generally heals quickly with minimal scarring. The procedure usually takes between forty and ninety minutes.

As a result of this treatment you would expect to be slightly sore and possibly a little swollen for a day or two afterwards. Any discomfort should be manageable with the kind of painkillers you would take for a headache. We prescribe antibiotics and an antiseptic mouthwash for a few days after the treatment. Meticulous oral hygiene is an important factor in the success at this stage.

At the end of this first stage the implant fixture is left buried in your jaw to allow it to integrate with the bone. This process takes a minimum of four months in the lower jaw and six months in the upper jaw. Over this period you will need to attend for hygienist attention and a couple of short review appointments to check on progress.

Second stage implant treatment

This stage involves the critical process of establishing a connection to the fixture with a healthy collar of gum around it. The success of this part of the treatment will determine the final appearance of the implant, its ease of cleaning, comfort and ultimately its longevity. The procedure itself is a minor one, carried out under local anaesthesia. The top of the fixture is exposed through the gum and a temporary crown or a healing abutment is fitted to establish the shape to which the gum will heal. The small wound is superficial and usually heals quickly with no discomfort. The most important factor determining the success of this stage is meticulous hygiene. If bacterial plaque is allowed to accumulate around the implant at this stage an infection can develop that may compromise the fixture and the gum.

Once the second stage of treatment is completed it is necessary to wait for a few weeks, typically 6 – 10, to allow the gum to heal. Again during this period you will need to attend for hygienist attention and a couple of short review appointments to check on your progress.

Third stage implant treatment

The third stage of treatment involves a minimum of two appointments. This part of the treatment is normally performed without the need for local anaesthetic. The temporary crown or healing abutments are removed and a very accurate impression (model) is made of the teeth, gums and fixtures. A model is also made of the opposite jaw and your bite is recorded. The healing abutments or temporary crown are then replaced. This information is sent to the laboratory where your crowns / bridge / prosthesis is to be made.

At the second appointment it is often possible to fit the final crown for simple cases. For more complex cases it may be necessary to have one, two or three further appointments to check the fit of the prosthesis at various stages during its construction, before it is finally fitted. The longevity and success of the implant is dependent on a high degree of accuracy at this stage.

What aftercare is required?

Implants are an elegant and long term solution to the problem of missing teeth. They are biologically and functionally very compatible with the oral tissues and once fitted can be practically indistinguishable from natural teeth. However, like natural teeth they require daily maintenance with careful, effective tooth brushing.

For most people implant treatment represents a significant investment of time and money. We recommend that this investment is protected by means of regular visits to the hygienist at three to six month intervals to ensure that hygiene is maintained.

The crowns placed on the fixtures are usually made of porcelain. Like any other crown this may chip or crack in time, necessitating its replacement. It is now generally agreed that you should expect to have to replace the crown on a fixture about every ten years.

What is the long-term success rate?

Implants, like dentures and bridges, cannot be guaranteed to be 100% successful.  However, the overall success rate for dental implants is of the order of 90% and as the bone around the implant becomes denser with use, the success rate increases over the first two years to 98% over a lifetime.

A successful implant can be almost forgotten about, with the exception of the maintenance previously mentioned. There are a number of factors that may influence the success of implant treatment, these are identified and discussed as part of the individual planning process to allow comparisons with other treatment options. It is sometimes possible to repeat implant treatment, provided that the reasons for failure can be identified and corrected.

Consent

It is very important to understand both the benefits and possible problems of implant treatment before proceeding. In many cases implant treatment provides an attractive alternative to dentures and bridges to replace missing teeth, but it is important to discuss the issues fully with your dentist to ensure that this treatment suits your personal circumstances.

Implants may provide a near lifelong solution for the replacement of missing teeth but only if carefully maintained. Treatment is a multi-stage process that takes many months, requires your co-operation and will involve some discomfort, so it is therefore important to obtain your fully informed consent.

We are committed to helping you make the right decision for you and your dentition. There may be some complicated choices to be made and we expect to take a considerable amount of time over the planning and preparation stages. If further information or another opinion is required to help you decide, we are happy to assist you with this.