Dental Implants

Tooth loss is something no one looks forward to. If you lose one or more teeth, you have a number of options, one of which is dental implants. You owe it to yourself to be informed as possible about these options.

What are dental implants?

A dental implant is a replacement for the root of a tooth that has been lost.

Who is a candidate for dental implants?

If you're missing one tooth or all of your teeth, implants may well be for you. So long as you have enough bone in the area of the missing tooth to facilitate the anchorage of the implants, this procedure can yield terrific results. If you don't have enough bone for this purpose, a bone graft may be necessary.

Single or multiple teeth can be replaced with implant with attached dental crowns that will not be subject to decay. The success of modern dental implants is related to their manufacture in titanium, which fuses or "osseointegrates" with bone. This is a tight chemical bond which prevents the implants from becoming loose and being rejected. The success rate of treatment is high being around 95% in the lower and 85% in the upper jaws.

If you are missing teeth and wish to eat your favourite foods, increase your chewing ability and improve your appearance and speech, you are a candidate for dental implants.

If you have a small dental bridge or removable dentures, implants will be a welcome alternative. Implants are an alternative to a fixed bridge. The implant will last a lifetime, but the crown on top of it will last ten to fifteen years.

Who is unsuitable for treatment?

Contraindications for implant placement include untreated dental sepsis, chronic facial pain, abnormal jaws and dental bite (occlusion) and certain types of psychiatric illness. Patients with a history of radiotherapy to the jaws may be unsuitable for treatment.

How are Dental Implants Attached in Your Mouth?

Patients with Missing Teeth

Surgical placement of the implant or implants in your jaw bone may be carried out under local or general anaesthesia depending on the number of implants to be placed in the jaws. The implant is placed into a hole drilled into the bone in what is usually a quick and simple procedure for a single tooth. A four to six month healing period is required for the implant to fuse to the bone. This is called osseointegration. In 90% cases, immediate tooth replacement is possible with a temporary crown. Patients must however not habitually press on the temporary crown with the tongue until the implant has "taken" (osseointegrated). When the healing phase is complete a very natural permanent crown is placed on the implant.


Immediate Tooth Replacement!

Dental Implants may be placed into the jaw at the time of extraction of a tooth - with the immediate replacement of the extracted tooth with a temporary crown. When healing is complete a permanent crown is made and fitted. The whole process may take a minimum total of three chair side visits.



Immediate Tooth Replacement - Bicon Implant System

 


click for movie

   


Implant Temporary Crown Final Result Bicon

http://www.bicon.com/



Dental Implants and Teeth Whitening

As dental crowns do not respond to tooth whitening techniques It is important that any other cosmetic dentistry such as tooth whitening is carried out prior to implant placement so that the best cosmetic shade of crown may be selected.

The Difficult Case

Precision planning of cases is now possible using computers and anatomical plastic models of the jaws (biomodels) can be made from CT scans. Accurate placement of the implants can be virtually guaranteed using these techniques.

These techniques permit more complicated cases of oral reconstruction to be carried out with increased precision, and a greater chance of success.

The Difficult Case - Implant Systems (Biomodel Computer Planning)



 

In NCAFOS Clinics we are advocating the use of Bicon Dental Implant System http://www.bicon.com/. This system has greatly simplified implant dentistry and we believe this is a major advance in quality with a reduction in cost of treatment and simplified annual implant maintenance which can be carried out in general dental practice.

Bone Grafting - Who needs it?

Frequently there may be insufficient bone to receive the implant. This problem may be solved by taking bone fragments from one area (donor site) and transplanting it into the area of need (recipient site). The bone fragments are remodelled by the body to form a solid piece of bone fit to receive implants. This remodelling generally takes around 3 months.

Bone Grafting - The Procedure

Bone grafts are therefore placed in a separate procedure 3 months before placing implants. Following implant placement and a healing phase of circa 6 months, permanent crowns may be fitted to the implants.

Grafts may be taken from:

- The mouth - from the drilling sites for dental implant placement

- From the hip

- Synthetic grafts which influence bone regenerative growth

New techniques in bone grafting involve soaking the graft in platelet rich plasma obtained from 10ml of the patient's blood during surgery. This promotes better bone formation from the grafted material and promotes healing.



Bone Grafting - Sinus Lift

Sinus Lift

Following the removal of upper back premolar and molar teeth the maxillary sinus (blue) space increases in size as bone around the tooth socket disappears. Whilst this problem can be avoided by the immediate placement of implants at the time of dental extraction, in some patients there is insufficient bone to receive the implant.

The solution to this problem is to lift up the floor of the maxillary sinus with a bone graft (Sinus Lift Procedure). This may be done through the old tooth socket for small lifts (Internal Lift) or by making a window in the bone lateral to the sinus when more bone graft is required (lateral lift).

The procedure may be carried out under local anaesthetic in many cases where small amounts of bone graft are harvested from adjacent areas in the mouth. General anaesthetic is available for more extensive lifts which may involve hip grafts.

Dental Implants - The Difficult Case

Reconstruction of the whole dentition is possible with dental implants. These cases are complex and technically difficult to accomplish. Patients should choose their surgeon carefully.

Who is a candidate for treatment?

Most patients who are physically fit and have no complications to their medical history are suitable for treatment.

What are the limiting Factors? - Treatment planning is affected by:

- Jaw alignment factors

- Bone Quality and Quantity

- Experience of the Surgeon - a crucial factor in the complex case


- Aesthetic considerations (Normal aesthetics may be impossible in the atrophic jaw with dental crowns)

- Patient's aspirations (can you accept a prosthesis without a palate?)

- Cost of treatment from 10,000 - 30,000




The Difficult Case
Bicon Implants



 

© Bicon Implants http://www.bicon.com



Edentulous Patients

The excessive loss of the upper jaw bone that may occur following the extraction of all teeth (edentulous patients) presents problems for those patients wishing to convert from a full upper denture to dental implants. The plastic flange of the denture lifts the lip forwards (blue arrow) and this cannot be achieved by dental crowns unless they are built forwards. This may cause cosmetic problems most visible when smiling - the patient may show no gum. Careful planning is essential in such cases.

Telescopic Crowns

One solution to this problem is to join crowns with gum work to create a non removable prosthesis with no palate (Telescopic Crowns). This is periodically removed for cleaning and maintenance by the Surgeon. Patients are usually delighted with the outcome and frequently state that the prosthesis feels like their natural teeth.

Jaw Surgery

Another solution for the edentulous patient to improve aesthetic with single tooth replacement (implants / crowns) is to surgically move the upper jaw forwards and downwards and bone graft the area. This treatment plan moves the gum line into the correct aesthetic position and involves detailed planning and staged operations. New temporary prosthetic devices must be made following surgical movement of the jaws until the healing phase is complete. The time from "start to finish" for these cases is in the region of one year.




Complications

As a general rule, complications increase with the complexity of treatment. In Each staged procedure will have its own list of complications ranging from medical problems related to general anaesthesia; deep venous thrombosis and pulmonary embolism in patients undergoing hip grafts (rare); oral wound breakdown, partial / complete loss of bone graft and failure of implants to osseointegrate. In some cases additional surgery may be required to correct some of these problems. In patients with a heavy dental occlusion (bite) on implants placed in bone grafts, sudden implant loss has been reported after one year (rare). With appropriate planning and consultation many of these complications can be prevented. The use of Engineering Assisted Surgery techniques has greatly simplified this kind of surgery.

Dentures - Implant Solutions

Dentures and Disability

Losing one's teeth (to become edentulous) results in a disability akin to losing a limb. Quality of life is severely affected. The ability to bite is reduced and bone disappears (atrophy) in many cases. Speech, swallowing, taste and chewing are all affected.

Significant life adjustment is required and there is often little sympathy in the community.

Dentures and Cosmesis

The tone of facial muscles is affected and aesthetics adversely affected.

The face sinks backwards and downwards
Increased folds / wrinkles appear around the mouth and nose
There is a loss of vertical height of the face
A so called "Witches Chin" may develop
The upper jaw bone disappears and the denture moves upwards
The visibility of the upper front teeth may be absent



Following the extraction of teeth in the upper jaw (maxilla) the bone disappears or resorbs. In some patients this can be marked, and an upper denture must replace the lost bone and support the position of the upper lip.

Loss of the upper teeth has a secondary cosmetic effect on the nose - this is seen especially the nasal tip which may drop downwards producing a condition known as ptosis.

Edentulous patients undergoing nose re-shaping (rhinoplasty) must have these factors taken into consideration if a satisfactory cosmetic result is to be achieved.

It is clear that patients wanting to convert from dentures to dental implants and crowns must have the upper lip supported in some way if normal aesthetics are to be achieved.

If the dental condition is not addressed the results of cosmetic facial surgery may be disappointing.

The dental status must be considered in a facial cosmetic surgery service and Cosmetic Maxillofacial Surgery input is valuable in treatment planning.

Dentures and Stability

Have you ever wondered how people manage to eat with full dentures? It's amazing that patients can control them at all - especially the lower one - that's the one that is always loose, often rubbing, sore, and liable to fall out of the mouth at the most embarrassing moment...

- All full dentures are unstable

- Retention is by suction

- Upper dentures generally good retention

- Lower dentures - poor retention

- How do patients eat?



- With difficulty... The patient learns to splint the lower denture between cheeks and tongue.

 

In the UK and Adult Dental Health Survey recorded a 41% complication rate with denture patients and a 26% incidence of difficulty in eating food with dentures. These rates of complications are unacceptable in comparison with guidelines targets set for other healthcare treatments, and would not be accepted in sister surgical disciplines.

 

Denture Stabilisation - Mini Dental Implants

At last there appears to be a simple and cost effective solution!

Mini Dental Implants can be connected by a press-stud attachment in the fitting surface of the denture - or overdenture - as it is now known.

The Mini Dental Implant System was pioneered by a New York Dental Surgeon, Dr Victor Sendax system who developed the MDI Sendax System.

This implant system completely eliminates the problem of a loose denture and can be used in both upper and especially the lower jaw:


- Discomfort is eliminated in a single appointment

- Patients can chew

 

- Food long abandoned is once again enjoyed

 

- Confidence is restored

- In the Upper Jaw a Palateless Denture is possible...


With the introduction the MDI Sendax System by IMTEC, stabilisation of an existing denture may be carried out in one appointment at a much reduced cost in comparison with other dental implant systems.

 

IMTEC Training and Workshops

Ninian Peckitt, Director of NCAFOS was appointed Clinical Tutor for the United Kingdom in the MDI Sendax Mini Dental Implant System, and regularly lectures and hosts IMTEC workshops in the United Kingdom.



The Overdenture

 

http://www.imtec.com

Ninian Peckitt FRCS FFD RCS FDS RCS

IMTEC Tutor for the United Kingdom



 

In NCAFOS Clinics, we believe that overdentures should be first line treatment in view of the transformation of the quality of patients' lives which may be almost routinely expected with this treatment option. We therefore propose to offer this service to all denture patients though our new Denture Convert Service which will convert the majority of upper and especially lower dentures into overdentures with significant savings for patients entering into the scheme.

After an initial consultation with x-rays to confirm that mini dental implant treatment is possible with the existing dentures. Implants are placed literally in seconds through the gum under local anaesthesia. Existing dentures are modified at the chairside for immediate stabilisation.

 

MDI Sendax System

 

As a general rule

- 4 MDI Sendax Implants are required for a lower overdenture

- 6 MDI Sendax Implants are required for an upper palateless overdenture

 

Post Treatment Care

Significant pain is unusual after implant insertion and is controlled with mild analgesics.

 

Oral Hygiene


IMTEC's Mini Implant Tooth Brush

The implants must be cared for and kept clean as with normal dental hygiene. The use of IMTEC's Mini Implant Toothbrush is recommended.

A six monthly visit to the dental surgeon for scaling is required. Dentures should not be worn at night as this may be a cause of oral thrush. They should be cleaned with a propriety denture cleansing agent.

MDI Sendax Outcomes

Success rates of the MDI Sendax system are in excess of 95% in the lower jaw and around 90% in the upper jaw. As a general rule the loss of an implant is not usually critical to the success of an overdenture case. Implants are simple to replace and complications are easily solved with the overdenture option.

In view of the low cost of the minidental implant system many patients choose to have (an) additional implant(s) placed as a "spare(s)". This is especially relevant in the upper jaw, where bone quality is sometimes compromised.

Numbness of the lower lip due to injury of the sensory nerve in the jaw bone should not occur with correct planning. Your surgeon will discuss these details fully at the time of consultation.

 

Mini Dental Implants and Single Tooth Replacement

Mini Dental Implants have been used as a cost effective treatment option for:

- crown and bridge salvage

- single tooth replacement

- complex jaw regeneration



The outcome of long term studies are still awaited, but early figures suggest comparable outcomes with other implant systems.

Whilst the cost of replacement of multiple teeth with mini implant retained crowns is much reduced with Mini Dental Implants (in comparison to standard dental implants), it is to be stressed that long term outcomes are unknown.

Patients choosing a mini dental implant crown and bridge option should discuss all other treatment options carefully with their surgeon.

 

Advantages & Disadvantages of Dental Implants

Pros and Cons of Dental Implants

Advantages:

As our life span increases, a permanent dental replacement like implants is increasingly important as we get older. While dentures and removable bridges are usually loose and unstable, implants provide you with dental replacements that are both natural looking and very functional. Implants look much better, and feel better, than traditional removable bridges, and offer the same force for biting as bridges that are fixed in place. Implants will last your lifetime.

Disadvantages - Choose your Surgeon Carefully.....

Dental Implants are a major investment and not without risk.

Patients should be advised that the certification of a doctor in a particular dental implant system, confers no recognised expertise in the field of dental implantology, and does not admit the doctor for specialist registration in the field of surgical dentistry nor oral and maxillofacial surgery.

Whilst the majority of single tooth replacement cases are well managed by appropriately trained general dental practitioners, the management of more complex cases and extensive use of dental implants is not routine in general dental practice.

Treatment can cost tens of thousands of pounds to achieve a great result. It can also be a very time consuming procedure when having many implants placed. The NCAFOS advocates that the use of computer planning and the use of custom drill guides for accurate implant placement should be mandatory for the complex case..

 

Patient / Practitioner Contract

At the NCAFOS we advocate the use of a patient/practirioner contract which, in layman's terms, defines:

  • The nature of the Diagnosis
  • The treatment options / choice of treatment modality
  • The description of the procedure using computer graphics.
  • The Post Operative Care Regimen - Patient / Practitioner responsibilities
  • The Success Rates / Lists possible Complications
  • A strategy for the management of complications / Dental Implant Insurance Cover
  • The cost of treatment

 

Dental Implant Insurance

Complex cases involving reconstruction and regeneration of the jaw with bone grafts require different skills than those for routine dental implant treatment. It is therefore very important to research and find anl accredited surgeon on the oral and maxillofacial surgery specialist register treatment.

 

griggs.dip@talk21.com

 

Insurance cover is now available for patients undergoing dental implant treatment. Please contact Richard Griggs of Legal and Medical Protection for details.



We look forward to seeing you soon....