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
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
Immediate Tooth Replacement!
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.
Dental Implants may be placed into the jaw at the time of extraction
of a tooth - with the immediate replacement of the extracted tooth
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
Immediate Tooth Replacement
- Bicon Implant System
click for movie
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 permit more complicated cases of oral reconstruction
to be carried out with increased precision, and a greater chance of
The Difficult Case - Implant
Systems (Biomodel Computer Planning)
In NCAFOS Clinics we are advocating the use of Bicon Dental Implant
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
- 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
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
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
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
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
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.
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
- 6 MDI Sendax Implants are required for an upper
Post Treatment Care
Significant pain is unusual after implant insertion
and is controlled with mild analgesics.
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
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
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
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
Dental Implants have been used as a cost effective treatment option
- 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
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
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 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
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.
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....