Why are implants needed
Once teeth are lost, the bone in which they are embedded gradually disappears because it is no longer required to support the teeth. The teeth and lost bone are usually replaced by removable dentures or fixed bridges to restore appearance, speech and mastication. As with all manmade substitutes for nature’s living tissues, there are drawbacks to artificial appliances. Dentures reduce masticatory efficiency and can suffer from poor retention. On the other hand, bridges involve cutting away healthy teeth in order to provide support.
An alternative method of tooth replacement is to insert implants into the jawbone to support the false tooth or teeth. Such implants may become firmly attached or integrated with the bone and act in a similar manner to a tooth root. If an implant is placed immediately or soon after a tooth is extracted, jawbone is preserved and its further loss prevented. For this reason it is best not to delay the decision to place implants, as bone will be lost with time which can make the placement of implants more difficult. However, even after considerable bone loss has occurred, it may still be possible to place an implant although additional bone grafting techniques may be required.
Type of implant placement
Implants can be inserted in one of two ways:
Immediate insertion is when the dental implant is placed at the same time that the tooth or teeth are removed. The advantages of this approach are a reduction in treatment time and bone preservation. Whether or not this is possible will depend on the condition of your bone at the time of extraction. If infection is present it may be necessary to defer implant placement for three months while new healthy bone reforms in the area.
Post immediate or delayed dental implant placement is insertion of the implant into a region of the mouth where the tooth or teeth have previously been removed or have been missing for some time.
Implant treatment may entail a combination of the above insertion types and the time required to place them will depend on the number being inserted and their position in the mouth. Every effort will be made to keep the time to a minimum whilst not jeopardising the final result.
The upper jaw is prepared for the implants by making a hole in the bone by either drilling to cut a channel or by forming the channel using small punches which are tapped through the bone. The latter may entail the use of a small mallet which can potentially cause symptoms of nausea or imbalance following the procedure. These symptoms do not persist and subside after several weeks or in rare cases a few months. Which technique is used depends on the density of the bone being prepared and occasionally may entail a combination of the two techniques. The lower jaw is prepared using drilling only.
Bone grafting with EthOss®.
Bone Grafting When you lose a tooth it is common for the supporting part of bone in your jaw to start receding / shrinking. If you are receiving dental implants then extra bone may need to be grown, or “grafted”, to support the implant in your jaw and ensure it can be mounted at the same level as your existing teeth. This is a very common procedure and nothing to be concerned about, however it can impact the length of your personal treatment plan. Your dentist will be able to advise you of this process. Bone Grafting uses advanced dental materials to encourage your body to grow new bone. In your procedure this material would be EthOss®, a synthetic material comprised of Beta Tricalcium Phosphate (BTCP) and Calcium Sulphate. This material will stimulate your body to regrow bone in your jaw. The EthOss® will be completely absorbed and replaced by new bone within approximately 6-9 months. Other Bone Grafting materials are available, including options using bovine (cow) bone, porcine (pig) bone and equine (horse) bone. There are also options using human bone (either your own bone, taken from a secondary site, or donated bone from another human) and other synthetic materials. If you have any concerns or would like to discuss your choice of grafting material speak to your dentist.
Bio-Oss® Bone Replacement Material
What are the reasons for using Bio-Oss?
In your particular case, you may not have enough bone of your own available for the dentist to be able to stabilise a tooth off to securely anchor a dental implant. Bio-Oss will be used to increase your own bone, thus providing the dentist with an adequate amount for the procedure you require.
What is Bio-Oss?
Bio-Oss is a bone replacement material that is used to increase the body's own bone. Bio-Oss is composed of the hard, mineral portion of natural bone and has a structure similar to that of human bone. It is therefore well accepted by human bone tissue and serves as a guide rail for the new bone growth.
The starting material is carefully inspected bovine bone that has undergone treatment with patented processes for purification and sterilisation. Included amongst these processes is the treatment of Bio-Oss at a high temperature for more than 15 hours, after which it is highly purified and finally sterilized.
What is the function of Bio-Oss?
Bio-Oss is a solid scaffold which serves as a guide-rail to allow new bone to grow. This scaffolding material enables and facilitates bone formation in the area where the operation is performed. It is inserted into the operation area in the form of grains or small blocks. Your own bone slowly grows into the Bio-Oss material, which at a later time is gradually broken down by the body.
Are there any alternatives?
As an alternative to Bio-Oss, one can use the body's own bone, which is taken from a different location, for example the chin of hip. However this procedure requires additional anaesthesia. Once the bone sample is removed from its original site it is then inserted into the operation area. In this procedure, the following must be considered:
There is now a second area of operation, which may be associated with additional pain or loss of sensitivity.
It is possible that the amount of the newly gathered bone will not be adequate for the intended purposes.
Other alternatives include the use of synthetic bone, which may be more suitable to those who object to the use of Bovine bone.
IF YOU HAVE ANY OBJECTION TO THE USE OF BONE GRAFTING MATERIALS OR PARTICULAR PREFERENCE PLEASE ADVICE YOUR DENTIST
Bio-Gide® Collagen membrane
What is Bio-Gide?
Bio-Gide is a membrane made of collagen that is generally used to cover the bone replacement material.
What is the function of Bio-Gide?
It has been proven that better healing rates are achieved when the Bio-Oss particles are covered with a membrane (Bio-Gide). Because the tissues of the gum grow more rapidly than the new bone, the membrane protects the Bio-Oss particles from this faster growing connective tissue. This ensures that the underlying bone can heal in an undisturbed fashion.
What is Bio-Gide made from?
Bio-Gide® is composed of highly purified natural collagen obtained from pigs.
Does the Bio-Gide membrane have to be removed in a second procedure?
No. The collagen membrane becomes completely broken down by the body; hence a further operation to remove it is unnecessary.
Are there any Independent Quality Controls?
The manufacturing process of Bio-Oss and Bio-Gide are subject to a Quality Assurance System, based on the international guidelines (ISO 9001/ EN 46001). These processes are checked once every year by acknowledged, independent testing institutes and international authorities.
Bio-Oss and Bio-Gide are medical devices that satisfy the safety standards and conditions required by European Union (CE - Certification) and the US Food and Drug Administration (FDA).
Do Side-Effects occur?
As with almost all natural and artificial materials incompatibility and allergic reaction are possible and can never be fully excluded. However, because of the high degree of product purity such reactions have been limited to a few mild individual cases. If you experience any reaction tell your dentist or doctor.
Rare and possible complications after tooth extraction
As part of the implant treatment it may be necessary to extract teeth to provide bone for the implants or remove diseased teeth. Extracting a tooth entails a surgical procedure inside the mouth that cuts the gum and occasionally bone removal is required. Following this procedure there may be some discomfort, swelling, limitation of opening of the mouth and possible bruising around the jaw which may last up to a week. If painkillers and antibiotics are required these will be prescribed. Depending on the degree of difficulty time off work for convalescence may be required. In the vast majority of cases the extraction of teeth only causes minor discomfort but there are occasionally rare complications associated with the procedure.
For lower teeth especially at the back of the mouth, their roots may be closely associated with nerves so, even with the greatest care, you may have some pins and needles" feeling, tingling sensation or numbness in your tongue or lower lip after the operation. This usually goes within a matter of weeks. Rarely, it takes longer (up to a few months) and, exceedingly rarely, it might be permanent.
Upper molar teeth have roots that are closely associated with the nasal sinuses. Because of this, very rarely during extraction a passage from the mouth into the nasal sinus is unavoidable. This would have to be closed with stitch and will seal in a few months. If stitches are inserted they may not be dissolvable and will need to be taken out about a week later. Occasionally a fragment of the tooth can also be accidentally displaced in the sinus and an operation will be necessary to remove it from the sinus to prevent infection.
Type of anaesthetic
The procedure is usually performed under a local anaesthetic, with conscious sedation if required.
This is a technique in which a drug is used to produce a state of depression of the central nervous system enabling treatment to be carried out, but during which with the patient remains conscious and verbal contact is maintained. This option will be offered only after careful assessment of your requirements and the level of anxiety you have regarding the proposed dental treatment.
After Implant Placement
After the procedure there will be some discomfort and swelling. The degree of swelling will depend upon the number of implants placed and whether or not additional surgical procedures were carried out. Occasionally along with the swelling there may also be slight bruising of the skin overlying the area which will fade over a week. If you are a smoker or have a pre-existing medical condition which affects soft tissue healing, the amount of swelling may be greater. The gum tissue in the region where the implants have been placed may change appearance or colour and take on a white appearance for a short time (normally two weeks) after surgery.
After 6/10 days once the soft tissue has healed sufficiently the stitches are removed, if dissolving stitches have been used this may not be necessary. During this period it may not be possible to wear dentures. After this stage the implants will be left undisturbed for at least three months to attach to the jawbone. During this period the top of the implant may show through the gum slightly and metal may become visible. Although this is normally no cause for concern, should it occur please contact the practice to have the area checked.
Making the new teeth
After a 3/6-month period a second surgical procedure may be necessary to expose the implants and check for firm bony attachment. In the event that an implant has failed to take it can simply be removed, as it will not be attached to bone. Once the implants have been uncovered and are firm a post or abutment will be connected which will be used to support either a provisional denture or bridge. This intermediate stage will last approximately two months allowing time for the gums to settle and form a tight attachment to the implant abutment. During this time the abutment may become visible as the gum shrinks slightly exposing the underlying metal. The final teeth will be made to cover as much of the exposed metallic areas possible improving the final appearance. Impressions will be necessary prior to construction of the final restoration.
Appearance of the finished teeth and gums
Every effort will be made to ensure your final teeth look natural and just the way you want them to appear. Unfortunately it is no always possible to guarantee the appearance of the gum tissue surrounding the implant teeth. This may be the case if you have had gum disease or been without teeth for many years or have lost jawbone as the result of an accident. This is particularly important if you show a lot of gum and tooth when smiling or have had natural teeth in the area crowned in the past. In certain situations it may be necessary to have new crowns/dentures made as a result of gum shrinkage following the procedure. In these situations it may be necessary to replace the missing or damaged gum by grafting procedures or the application of gum coloured plastic.
If any of the above is particularly relevant to your treatment then the treating dentist will explain the implications to you and will discuss the alternative with you should they be required.
What happens if the implants do not take?
Fortunately, this occurs rarely and the success rate for dental implants is 95%. However, failures are still a possibility and an understanding of this is a prerequisite for proceeding with your treatment. Any potential problems specific to your implant treatment will have been anticipated and discussed with you before treatment starts.
Should an implant fail to take then it is often possible to replace it with a second implant at the same time as the first implant is removed. It will of course be necessary to wait a further six months while the second new implant attaches to the bone. It is not difficult to replace the failed implant at this time, as it will be very loose and is easily removed.
Factors associated with an increased risk of implant failure
Overall, dental implant failure is low and there are no absolute contraindications to implant placement. However certain conditions have been found to be correlated with an increased risk of failure. If you are over age 60, smoked, had a history of diabetes or head and neck radiation, or were postmenopausal and on hormone replacement therapy there is a significantly increased chance of implant failure compared with healthy patients.
Even in otherwise healthy patients it has also been shown that alcohol and tobacco consumption can reduce the rate of success. These habits also have an effect on the rate of healing and may increase the chances of post-operative infection.
Studies have shown that smoking significantly increases the risk of implant failure. If you smoke even lightly then your chances of success are reduced by 15% and if your smoke 20 or more cigarettes a day the failure rate is 30%. For this reason implants are not recommended in smokers unless the habit is stopped. Starting smoking following implant placement is very lightly to result in loss of implants which have successfully taken and cause infection of the gum surrounding the implant.
Aftercare and maintenance requirements for implants
Implants are not "Fit and Forget” they need the same care and attention as nature teeth. On completion of treatment it will be necessary for you to attend a number of recall appointments to check the condition of the implants and to adjust the bite if required.
After this, regular six monthly dental check-ups are required to monitor the condition of the implants and any remaining natural teeth. Also regular hygiene maintenance appointments are important, as a build of plaque will cause gum problems and possible bone loss from around your implants, resulting in their eventual loss.
If you have teeth and implants mixed together it is also very important to maintain the health of the natural teeth. Should the natural teeth become infected or are lost for any reason the remaining implants may be damaged by the extra pressure caused by the addition work load.