Dental implants

Hundreds of thousands of dental implants are placed worldwide every year. They can be a great way to replace teeth, with some studies suggesting a survival rate of over 80 % at 16 years. Implants are composed of a screw (often made from titanium), that is put in to the jaw bone, where the root of a tooth would normally be. Implants can be placed immediately after the removal or loss of a tooth, or after the healing process is complete. The best time to place an implant varies depending on different patient factors, so this is something which should be discussed at your consultation with your implant surgeon. Most implants are placed under local anaesthetic whilst you are awake, although some patients may have a general anaesthetic or sedation to enable treatment to be completed.

Once the screw is placed, a period of healing is usually required of around 6 months before the top of the tooth (crown) can be attached. During this time, you may be given a denture (some patients may refer to this as a ‘plate’), which is a removable tooth on an acrylic (plastic) plate as a temporary measure to disguise the gap.

In some cases, a crown can be placed immediately. The implant will fuse to the bone of the jaw, becoming firmer and more stable. Once the healing process is complete, it is likely the gum will have grown over the new implant (it is said to be osseointegrated). The implant is now in a position to function in the same way as a tooth root but only if it is loaded functionally in the same way as the tooth it is intended to replace. A little cut may be needed to expose the post, allowing for crown placement. Once exposed, the crown can be placed, which is the portion of the tooth above the gum line which can be seen inside the mouth. This part is usually made in a laboratory; however some dental clinics make them in-house. The shape of the tooth will be designed to fit in with the way you bite together and to suit the rest of your teeth. The colour is often an excellent match due to modern technology and materials.

Implants can still get disease around them as with natural teeth, especially if not maintained properly. Regular dental checks, X-ray radiographs and cleaning are required to maintain the implant, as there is a risk of developing ‘peri-implantitis’. Once the implant process is complete, implants are like normal teeth in that you can eat on them, floss round them and are often very well disguised within the rest of the dentition.

It helps to have realistic expectations with implants however. Sometimes, the soft tissues (gum lines) around the implant do not follow the same contours as natural teeth, meaning there are some gaps. If there has been bone resorption/loss of bone, the implant tooth may need to be longer than the tooth next to it to disguise this, which can look unusual if you show a lot of gum when you smile. There also needs to be enough bone to place an implant, and enough space. This can mean you need a bone graft (for example from the chin) before the implant can be placed. An alternative may be synthetic bone from a variety of sources.

Not everyone is suitable to have implants due to medical reasons. This can include use of bisphosphonate medications, previous head and neck radiotherapy, smoking, uncontrolled gum disease or severe bleeding disorders. It is important to be completely open when discussing these things with your surgeon to ensure any treatment provided for you is safe.  

If you need multiple teeth replacing, there are different options available. Implants can support dentures by giving them added retention. They can be used to hold dentures in place, with small attachments built into the denture that can allow it to be ‘clipped’ onto the implants. The denture may also be fastened to implants, which can be removed by your dentist for regular professional cleaning, as well as you cleaning the denture yourself at home.

The number of implants required can vary from a single tooth to many for full-mouth rehabilitation. Patients may have two to eight, or more implants placed to hold their new artificial teeth in place. Again, this is a personal decision based on lots of factors, so your surgeon will discuss the options with you.

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