There are several options to replace a missing tooth, or teeth. These can be either removable or fixed in place.
Having a dental implant is a ‘stand alone’ option to replace a missing tooth, or missing teeth. A dental implant consists of a fixture, which screws into the jawbone and forms the foundation to support a crown. The dental implant fixture, is made of titanium, which is a biologically ‘inert’ material also used successfully in medicine for procedures such as hip and knee replacement. The reason dental implants are so successful is that once they are placed the bone around the implant grows on to the implant surface and the implant becomes fused to the jaw bone. This process is called osseointegration and takes from 6 weeks to 6 months depending on such factors as bone quality and biting forces.
There are over 150 companies producing dental implant systems worldwide. They are not all the same. We choose to use a limited number of systems that:
We proudly use Biomet 3i, Strauman and Astra. Feel free to ask us about the choice of implant systems & the biomaterials we use in your treatment.
As with everything in biology, nothing is 100% guaranteed, and in approximately 1% of all implants placed, the bone does not grow onto the implant surface and these implants may become loose. A loose implant is normally detected within the first 3 months after implant placement – therefore it is important you attend your 3-month review with your periodontist. On the rare occasion that this occurs, we stand by our work, and we will endeavour to remove and replace the implant free of charge.
After an implant, has successfully integrated to the bone the literature reports that around 90% of implants are successful at 10 years. This number fluctuates depending on several factors; surgical technique, patient general health and implant maintenance. It is important to remember, like everything, implants do not last forever. They require regular maintenance and if anything changes in your general health you need to let your dentist know. We have patients for which we placed implants 1990’s and they are still functioning well – surgical technique, implant type used and patient care is the key to long term success.
Your general health may affect the success rate of implants. It has been shown that factors that such as smoking and medical conditions such as poorly controlled Diabetes may influence bone healing and implant success.
The ideal candidate for a dental implant has good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.
Ideally you should attend regularly for dental treatment and have good homecare habits – keeping your teeth and implants clean, limits the risk of gum problems in the future.
At your initial consultation appointment, we do a complete assessment not only of the where you are missing a tooth or teeth, but also the rest of your mouth. This ensures that the treatment option we offer you is appropriate to your needs.
We write to your dentist to ensure that your treatment will be well coordinated. At the end of the day, you want an aesthetic and functional tooth. Therefore, it is important that the implant fixture is placed in the optimal position to support your new crown. We also send you a written treatment plan that outlines and confirms the details relating to your treatment.
Most patients who have implants are surprised at how little discomfort they have after the procedure. This does depend however on the type of procedure and to a limited extent on the number of implants being placed.
We will give you written instructions on how to take care of your mouth following implant placement and we would normally see you to check healing within the first 2 weeks. We also provide you with medication to take in the first two days following surgery. You will be given the after-hours contact phone numbers of Dr Cole, Dr Dawson or Dr Horne, if you have any questions or concerns following the procedure.
Most of our dental implant placement is carried out under local anaesthetic with intravenous sedation. You can have it done with local anaesthesia alone. This will be discussed and normally agreed upon at your initial consultation appointment.
● Replacement of a single front tooth
For single tooth replacement, an implant is often the treatment of choice. The crown made to fit on the implant is designed to look and function like a real tooth. It is the easiest option in terms of cleaning but requires that you floss around it daily.
With proper positioning the implant-supported tooth helps to preserve the surrounding bone and soft tissue to provide a natural appearing result.
See a case study of a single front tooth replacement.
● Replacement of several teeth
Using implants, we can overcome the limitations of conventional tooth supported bridges and avoid the need to wear a removable partial denture. Conventional bridges are not ideal where the adjacent teeth are unrestored or there are multiple (2 or more) teeth missing.
See a case study of a lower over denture, or lower partial denture.
● Replacement of all the teeth either in the top or bottom jaws
Previously, once you lost your teeth, removable dentures were the only option available to replace missing teeth. Today, with implants there are now options available to either improve the fit of a denture giving better retention and stability or have teeth fixed in place.
With the first option your denture can still be taken in and out to clean. In the bottom jaw placing two implants can secure the lower denture, stopping it moving around. In the top jaw you need four implants joined by a bar to support the denture. An implant-supported removable prosthesis requires fewer implants and results in less cost than the fixed option.
To have teeth fixed in place you need a minimum of four implants in the bottom jaw, more in the top jaw. You can regain the sensation of normal chewing. Cleaning however is more challenging than a removable implant supported denture.
There are several reasons to replace a missing tooth which vary from person to person. A few
reasons include:
There is an optimal time for placing implants after teeth have been lost – normally within 6 -12 weeks. After that changes start to occur which we refer to as ridge resorption or sinus pneumatization. Ridge resorption is loss of the bulk of the jaw following tooth extraction. Sinus pneumatization is an increase in the sinus of the maxillary sinus, following tooth extraction which leads to less available bone for implant placement. The degree to which this occurs varies from person to person. Also, trauma or infection may cause bone loss.
This may leave a situation where there is an inadequate quantity of bone to allow placement of dental implants. In these situations, assessment, often with 3-D x-ray, may show that implant placement is possible with bone grafting to rebuild the ridge or jaw contour.
● Bone grafting
Bone grafting can repair and rebuild implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. There are various options available for the source of graft material to rebuild the ridge. We will discuss these options at your consultation appointment. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regrowth and regeneration. Bone grafting is usually done simultaneously with implant placement, however, sometimes may be done as a separate procedure. This will be discussed at your consultation appointment.
● Sinus lift procedure
There is an air cavity inside your nose which is called the maxillary sinus. The maxillary sinuses are behind your cheeks and on top of the upper back teeth. Sometimes the roots of natural teeth can extend into the sinus and when these teeth are removed, or lost, there is a thin wall of bone separating the sinus from the mouth. Therefore, when replacing teeth with implants in the posterior upper jaw, we may need to ‘lift’ the floor of the sinus to create sufficient bone into which we can place a dental implant. There are various techniques to achieve this and we will discuss this at your consultation appointment.
There is a solution and it’s called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus above where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus.
If there is enough bone between the upper jaw ridge and the bottom of the sinus to sufficiently stabilize the implant, then the sinus augmentation or grafting and implant placement can sometimes be performed as a single procedure.
If there is not enough bone present, then sinus augmentation will sometimes be performed first and the graft will have to mature for several months before implants can be placed.