Dental Implants

Dental Implants

Definition:

Dental implants are metal posts usually cylindrical or tapered frames that are surgically positioned into the jawbone beneath your gums. As you heal, your implant will osseointegrate  (fuse with) your natural jawbone, with the two growing together. This will allow your dentist to mount replacement teeth onto them.

What is an Implant Retained Denture?

An implant retained denture is a type of over- denture that is supported by and attached to implants in the jaw. A regular denture rests on the gums, and is not supported by implants. The denture clips on to the implant to keep it in place.

An implant retained denture is used when a person doesn’t have any teeth in the jaw, but has enough bone in the jaw to support implants. It is usual that at least 2 implants are needed to support the denture, but that will be decided depending on your particular needs.

Implant retained dentures usually are made for the lower jaw because regular dentures tend to be less stable there.  However, you can receive an implant retained denture in either the upper or lower jaw. This can be assessed and discussed at your consultation with Rikki

It is easy to look after your implant retained denture, you will be shown how to remove and clean the denture and how to clean around the implants. As with normal dentures they should be removed before going to bed.

Advantages of Dental Implants.

  • Implants don’t slip or shift, giving you the same stability and security as your natural teeth.
  • Implants are cleaned in the same way as your natural teeth, so there’s no need to take them out at night for cleaning or soaking.
  • Implants don’t rely on neighboring teeth for support; therefore, no tooth structure is lost, as is necessary when fabricating a bridge.
  • Implants prevent the shifting of nearby teeth, preserving jawbone and the contour of your face.
  • Implants are an ideal cosmetic solution to missing teeth, allowing you to chew and speak with ease.

Are Dental Implants right for me?

If you’re missing one or more teeth, probably so. Nearly anyone in good health whose jaw has finished growing is a candidate, whether they were simply born without a tooth or lost one or more teeth due to injury, decay, gum (periodontal) disease, infection or another reason. Dental implants also are a great option for patients who don’t want the drawbacks of or can no longer wear removable dentures.

The best way to determine if you are a candidate is to see a dental implant expert. Be sure to mention if you are a smoker, any medical conditions you have and any over-the-counter and prescription medications you take.

What is the process for Dental Implants?

One of the most important parts of the surgical procedure is what is referred to as “site preparation.” A relatively small channel, a hole actually, is prepared in the bone. This is referred to as an osteotomy (“osteo” – bone; “otomy” – to cut or separate). Small incisions into the gum tissue are used to access the bone thereby creating small “flaps” as they are called (like flaps on an envelope), to allow visualization of the bone’s shape and location.

If a surgical template or guide has been made, it will be placed in the mouth, and the osteotomy sites prepared through it to ensure accurate positioning of the implants. A drilling sequence is used that progressively increases the size of the site until it mirrors the implant shape exactly to ensure the necessary precision fit. Sometimes implants can be placed without flaps or incisions if there is a guarantee that the osteotomies can be made in exactly the right place, which requires good bone quality and very accurate surgical guides.

The drilling procedure is critical to implant success, to ensure the implants “take” by fusing to the bone. Living bone tissue requires very careful handling, using gentle pressure and generous water-cooling so that it is not damaged by overheating, which can lead to bone loss where it is needed most — in direct contact with the implant surfaces. Mild vibration is associated with the bone preparation process and may be noticeable but is invariably well tolerated.

The next step is to place the implants straight into the sites so that the healing process can begin, this is called IMMEDIATE PLACING. Dental implants are sterile and it is critically important that their surfaces are untouched. The implants go from their sterile packaging into the osteotomy sites. Radiographs (x-ray pictures) are generally taken during or after the procedure to verify correct implant positioning.

The surgical procedure ends with closure of the gum flap tissues. Often, sutures (stitches) are used that are self-absorbing and therefore do not need to be removed. Other types that are not self-absorbing need to be removed in a week or two.

Do Dental Implants hurt during the procedure?

All of this drilling and screwing may sound painful, but you’ll be comforted to know that placing an implant is easier than taking a tooth out. Usually a local anesthetic is used, which means you are awake during the surgery.

You shouldn’t feel any pain during the surgery, especially if it is done with healthy tissue. Also, the bone where the implant is placed does not have many pain-sensing nerves.

Do Dental Implants hurt afterwards?

Immediately after the surgery and for a few days you will likely experience some discomfort. After all, this is a major dental procedure. However, any pain should be manageable.

Discomfort may be felt in the chin, cheeks, or underneath the eyes. You may also experience bruising of the skin and gums, pain at the implant site, and minor bleeding. Painkillers, such as Ibuprofen and paracetamol will be recommended.

After dental implant surgery, you should use an ice pack (or packages of frozen vegetables – make sure to wrap them in a towel to avoid ice burns) to reduce swelling. Soft foods should be eaten after each stage of the surgery for up to 10 to 14 days.

Rinsing gently with warm salt water throughout the days following the procedure will help bathe and soothe the tissues and will offer additional relief.

How to look after Dental Implants and what to do after the procedure.

FIRST HOUR: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not controlled. The packs may be gently removed after one hour. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 30 to 45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning.

EXERCISE CARE: Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects. You may brush your teeth gently. Smoking will retard healing, causing increased discomfort and increased chance of dry sockets. We strongly discourage smoking during the healing phase.

ORAL HYGIENE: It is important to keep the mouth clean. You should brush your teeth the night of surgery, but be gentle around the surgical sites. If there is minimal bleeding, saltwater rinses may begin 24 hours after surgery (mix 1 tablespoon of salt with 8 ounces of water.) Swish gently and allow the water to drip into the sink. Rinses should be done 2-3 times a day, especially after eating.

ACTIVITIES:  We advise sofa/bed rest for the first day. Bending, lifting, or strenuous activity will result in increased bleeding, swelling and pain. You should be careful going from the lying down position to standing. You could get light headed when you stand up suddenly. If you exercise regularly, be aware that your normal fluid and caloric intake is reduced. Exercise in the post-operative period may also result in increased bleeding, swelling and discomfort. Exercise should be avoided for 3-4 days following surgery.

OOZING: Bleeding will occur after surgery, and it is not uncommon to ooze blood for 24-48 hours after surgery. Keep in mind that oral bleeding represents a little blood and a lot of saliva. Placing a gauze pack over the area and biting firmly will control bleeding. If oozing is still active, replace gauze as needed every 30-45 minutes.

PERSISTENT BLEEDING: Bleeding should never be severe. If so, it usually means that the packs are being clenched between teeth only and are not exerting pressure on the surgical areas. Try re-positioning the packs. If bleeding persists or begins again sit upright or in a recliner, avoid physical activity, use ice packs and bite on gauze for 1 hour or on a moistened tea bag for 30 minutes. The tannic acid in the tea leaves helps to promote blood clotting. If bleeding remains uncontrolled, please call our surgery: 01922624900.

SWELLING: Swelling is a normal occurrence after surgery and will not reach its maximum until 2-3 days after surgery. It can be minimized by using a cold pack, ice bag or a bag of frozen peas wrapped in a towel and applied firmly to the cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 24 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed.

SUGGESTED WAY TO APPLY ICE: Fill two zipper lock bags with crushed ice. Cut a pair of tights at the thigh and slide both ice bags halfway down the leg (to the knee area). Tie the ends of the tights on top of the patients head and adjust ice to sides of face over surgical sites.

PAIN: Unfortunately most oral surgery is accompanied by some degree of discomfort. If you take painkillers before the anesthetic has worn off, you should be able to manage any discomfort better. Some patients find that stronger pain medicine causes nausea, but if you take each pain pill with a small amount of food, chances of nausea will be reduced. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first, you may supplement each pain pill with an analgesic such as aspirin or ibuprofen. Some patients may even require two of the pain pills at one time. Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medicine should lessen. If you find you are taking large amounts of pain medicine at frequent intervals, please call our surgery: 01922 624900.

DIET: Eat any nourishing food that can be taken with comfort. Avoid extremely hot foods. Do not use a straw for the first few days after surgery. It is sometimes advisable, but not absolutely required, to confine the first days intake to liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.) Avoid chewing food until tongue sensation has returned. It is best to avoid foods like rice, nuts, sunflower seeds, popcorn, etc., which may get lodged in the surgical areas. Over the next several days you may gradually progress to solid foods. It is important not to skip meals. If you take nourishment regularly you will feel better, gain strength, have less discomfort and heal faster. If you are a diabetic, maintain your normal eating habits or follow instructions given by your doctor.

NAUSEA: Nausea and vomiting can occur as a result of swallowed blood, discomfort, anaesthesia or pain medicines. Post-operative nausea is usually self-limiting and sipping on flat cola or ginger ale often helps. Soda crackers also may be used. If nausea persists, stop taking the pain medicine and substitute an over the counter pain medicine for the next dose. If nausea persists call our surgery: 01922 624900.

MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use 1/4 teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily.

BRUSHING: Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but it is extremely important to clean your teeth within the bounds of comfort. Maintaining a clean environment adjacent to the healing surgical wounds is required for optimum and speedy healing.

HEALING: Normal healing after placement of dental implants should be as follows: The first two days after surgery are generally the most uncomfortable and there is usually some swelling. On the third day you should be more comfortable and, although still swollen, can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement. If you don’t see continued improvement, please call our surgery.

What materials are used for Dental Implants?

Titanium and Zirconia

What are the pros and Cons of both these materials?

Both materials can integrate with bone with equal success provided certain protocols are  followed. We do, however, have a much longer history with titanium. Some of my patients have titanium that is still functioning after 20-35 years. We may find the same success with zirconia, but until the material has been tested for the same amount of time as titanium, we simply will not know.

Titanium implants are much more versatile than zirconia because they can be made as one piece or two-piece systems. In two-piece systems, the implant replaces the root and is generally placed at the level of the underlying bone. Attached to this is a post or abutment—the part that sticks through the gums and is used to support or attach the teeth.

Two piece systems are a lot more versatile and offer many more options prosthetically. They can be used for over dentures (removable teeth) that snap into place as well as permanent teeth that are cemented or screwed onto the implants. Additionally, the implant can even be placed slightly off-angle and an angled or customized post can be fitted to correct it. Zirconium implants can also be modified if they are slightly off but are not as prosthetically ideal as what can be done with a separate post.

In some cases, placing an implant slightly off-angle is not a surgical error, but rather a necessity due to the volume and location of bone in the implant site. I could go on for pages, but basically titanium implants offer much more versatility with the final teeth and flexibility with their surgical placement.

Zirconium implants (the implant body and the post or abutment) on the other hand, are made as one piece. Therefore, the only option for the prosthetics is to cement the teeth into place. Secondly, there is very little room for error—one has to be very careful not to place an implant at an improper location or angle. Therefore surgical placement and volume of bone is absolutely critical.

In some cases, I have placed implants to find the bone is less than ideal. With titanium implants, I am often able to place the implant, leave it buried under the gums and graft the area simultaneously. If it had been a zirconium implant which sticks above the gums, the ability to graft would be reduced or risky, and may need to do a separate procedure first to ensure the bone is 100%.

Both types of implants require several months for the bone to fuse or grow against the implant before we can place the final teeth. With one-piece zirconia implants, this healing phase can be a little more tricky as we cannot bury the implant under the gum tissue. if there is pressure or movement of the implant, it will not osseointegrate.

Another concern is the long-term strength. We no longer see fracture of titanium implants since the alloys were introduced, but zirconia implants have been known to fracture. If this occurs, usually the only option is to remove them and that can create a large defect in the bone. The smaller diameter implants (3.25 mm) are at the greatest risk. I have had patients come in with fractured zirconia crowns or bridges but fortunately I have not had to remove a fractured zirconia implant (yet). Therefore anyone with heavy function (clenching or grinding) probably would not be an ideal candidate for zirconia.

Advantages of Zirconia Dental Implants

Advocates of zirconia state several advantages of the material:

  1. No dark colour of the metal showing through the gums
  2. No corrosion of the zirconia as with titanium
  3. No piezo-electric currents between dissimilar metal in the mouth
  4. It is thermally non-conductive

According to CeraRoot, a manufacturer of zirconia implants: “The gradual degradation of materials by electrochemical attack is a concern particularly when a metallic implant is placed in the hostile electrolytic environment provided by the human body.” On the other hand, while zirconia has its perks, much less is known about the role played by surface modifications on the osseointegration of zirconia dental implants, according to a study by the Faculty of Dentistry at the University of Toronto. So who is right?

Are dental implants safe?

Proven safe and effective at replacing missing teeth, contemporary dental implants have been in use for more than 30 years.

Dental implants are typically made of titanium, a biocompatible material that is accepted by the body and serves as a strong and sturdy foundation for replacement teeth. Your natural bone locks the implant into place by fusing, or attaching itself, to the implant. This process, known as osseointegration, gives teeth replaced using implants the stability and strength to support replacement teeth, withstand daily use, and function like regular teeth.

Dental implant surgery is one of the safest and most predictable procedures in dentistry when performed by a trained and experienced dental implant dentist. A dental implant is the strongest device available to support replacement teeth, and it allows your replacement teeth to feel, look and work naturally. In addition, dental implants are the only restoration method that stimulates your natural bone underneath the missing tooth.

 Who can do Dental Implants?

Only Dentists who have taken extra training can do Dental Implants as this is required by law.

How much do Dental Implants cost?

As of April 2016 we charge £2000 per dental implant. Please come in for your free consultation. We also offer interest free credit over 12 months for amounts over £2000. Please note that our prices change every April and check our price guide for the latest prices.

Interest free credit on your Dental Implant/s.

If you spend over £2000, you can benefit from our interest free credit offer. You can split the payments over a 12 month period.

Free no-obligation consultations for your Dental Implants.

It is difficult to know what you need and what you can have – every client is different! Therefore to help you understand what options there are for you and the implications of those options, you are welcome to come for a free of charge initial consultation. We promise not to pressure you into anything, just give you a fair and honest evaluation of what you could have and what it would involve.