Treatments
Implants
Tooth loss can have a considerable effect on our quality of life. Gaps in our mouths may cause us social embarrassment and difficulty with eating. Many people find the wearing of dentures unacceptable.
Modern dental care has come a long way in recent years and the availability of dental implants as a way to replace missing teeth has revolutionised the way that we can treat our patients. The benefits of dental implants can be life changing.
What are implants?
Implants are used to restore spaces that have resulted from the loss of one or more teeth. A dental implant is constructed from a very pure grade of surgical titanium. The implant itself resembles a small screw. The implants can be used to support crowns or bridges and even to hold a full set of dentures more securely.
Before any patient can have an implant placed it is essential that a thorough assessment is undertaken. This involves a highly detailed clinical examination, dental x-rays, study models and often a 3-dimensional CT scan.
The 3-dimensional scans are taken in circumstances where we need more detailed information on certain aspects of the planning - such as how close important structures are or on how much bone is available for the implant. We believe that the single most important element for successful implants is thorough and methodical planning. Once the scan is taken the electronic digital data is transferred to our computer software. This software then analyses the information and produces cross sectional and 3-dimensional images of the jawbone and lower part of the skull.
The implant is placed under local anaesthesia in a small surgical procedure. In many cases this can be done at the same time as the doomed tooth is extracted.
The implant is left undisturbed for a period of up to 6 months, during which time the bone grows onto and fuses with the titanium. This is a phenomenon known as Osseointegration and basically means that a strong biological bond develops between the bone and the implant. It is this fusion that makes surgical grade titanium unique amongst all metals. After this period a second minor procedure may be necessary to expose the implant(s) and check for firm bony attachment.
Once the implant has been uncovered a post or abutment will be connected which will be used to support either a provisional denture, a crown or a bridge. This intermediate stage will last approximately two months allowing time for the soft tissues to settle and form a tight attachment to the implant abutment. During this time the abutment may become visible as the gingiva shrinks slightly exposing the underlying metal. The final teeth will be made to cover as much of the exposed metallic areas as possible, improving the final appearance.
Immediate implants
It is now considered that the most ideal time to place an implant is immediately after a tooth is extracted, i.e. at the same appointment. Once a tooth is removed the bone underneath the space quickly starts to resorb. This can cause future problems for implants as too little bone may be left remaining to support an implant. Thus if placed immediately at extraction and before any bone resorption has occurred the maximum amount of bone (and hence the greater chance of a good successful result) will be available. There are also the cosmetic advantages of a better emergence profile and preservation of the papilla.
It has been only recently that modern advances in implant technology have made immediate implant placement possible. Another big advantage with immediate implants is the improvement in patient comfort. As the implant is placed at the same time as the tooth is extracted there is no need for any further surgical procedure for the implant insertion.
In some circumstances such as infections, cysts or where insufficient bone is already present around a tooth due for extraction, an immediate implant may not be possible.
If a patient does require the removal of a tooth it is important not to delay in the decision about whether to have an implant or not. The sooner a doomed tooth is removed and an implant placed, the less chance that an infection or other potential problem may occur in the meantime.
On rare occasions, even after careful planning with radiographs and/or scans, we may find that once the tooth is removed an immediate implant may not be possible after all, due to poor remaining bone support or infection. In these circumstances the bone must be allowed to heal either with or without the aid of a bone graft for 3-6 months whilst new, healthy bone reforms into the area.
