Maxfacts

Implants

The placement and retention in functional use of both dental and craniofacial implants often involves quite detailed treatment planning.

There may, therefore be several visits for both investigations and conversation with both the person who places the implants and the person who will make the superstructure and final prosthesis (they may not be the same person, although with dental implants performed by a restorative or general dentist, they may).

Once treatment starts there may be a period of preparation of the site where the dental implant(s) are to be placed. Once the bone and gum of the recipient site is ready, the implant is prepared and inserted, for dental implants as well as for craniofacial implants.

Craniofacial implants, which can act as a support for ear, eye and nose prosthesis are inserted in the same way as dental implants but the lengths are relatively much shorter – they are an aid to retention of the prosthesis and do not have to stand up to the burden of masticatory (chewing) forces.

Most often, a dental implant is covered in gum and left for 4 to 6 months to achieve osseointegration. There are exceptions and in cases of traumatic complete avulsion of a tooth which is lost and cannot be replanted, or immediate atraumatic extraction of an anterior tooth, immediate dental implants are sometime used.

After this 6 month period the implant is ready to be loaded and the various aspects of crown or superstructure are prepared by taking impressions. The final product should be available after a few weeks.

Implant survival is also measured as being functional after 5 years so regular follow up by the restorative or general dentist in the case of dental implants, or the maxillofacial prosthetist in the case of craniofacial implants, is usual.

Extremely high levels of oral and implant hygiene are essential. Various tactics can be used to address peri-implantitis should this develop. This includes standard approaches for dealing with periodontal disease for dental implant.  

Less conventional techniques, such as mucosal grafting around skin may be needed for craniofacial implants as this performs a much better tight epithelial attachment around the implant. All craniofacial implants are inserted through skin. Skin is much more loose than mucosa. When the connection between the osseointegrated implant and the superstructure is created, a major weak point is the tightness of the epithelial cuff around the emergence point of the implant – healthy mucosa is much better than healthy skin. So if inflammation around a craniofacial implant occurs, one solution is to excise the skin and replace it with grafted mucosa.