What is Dental Implantology?
A dental implant is a rod or screw, about the size of a natural tooth root, which is screwed into a prepared hole drilled in the jaw bone. During a period of one hundred days following the insertion of a dental implant, the jaw bone grows onto the surface of the implant, a process known as osseo-integration.
Once the implant has integrated with the jaw bone, the patient returns to the dental practice where an attachment is screwed or cemented to the implant.
The attachments can be of many types. We commonly use conical cores to which crowns or bridges may be cemented, press stud or ball anchors to which dentures may be clipped and occasionally screw type anchors to which long span bridges may be attached. The latter can be removed periodically for servicing by the dentist.
Dental implants are manufactured from ultra- pure titanium and sterilised by gamma radiation. For successful osseo-integration to take place it is essential that the implants and the site are absolutely clean. Operations are carried out either in May House or at Torbay Hospital
The operations to fit the implants are usually carried out under local anaesthetic and if appropriate, intravenous sedation. Occasionally where multiple implants are to be fitted or if the patient prefers it, general anaesthesia is used and is provided by a consultant anaesthetist. Antibiotic cover and painkilling tablets are provided for the first post- operative week.
Treatment plans are varied, but can range from a single implant upon which a single crown is cemented, to as many as eight implants onto which bridges can be fitted. Dentures are commonly retained on two or four implants with “press stud” retainers
Not every patient is suitable for implant treatment. Put simply, the factors governing acceptance of a patient for treatment are these:
Patients must be healthy. A thorough medical history will be taken.
There must be adequate depth, thickness and density of jawbone.
There must be no infection in other parts of the mouth.
Patients must have excellent oral hygiene and healthy gums.
Existing dental restorations must be of the highest quality. There must be no decay, no overhanging ledges, no food traps, no exposed pulps (nerves) and no abscesses in the bone or the gums. This is because any bacteria circulating in the blood near the implant could infect it and osseo-integration would fail.
Patients should be non- smokers. Smoking hinders osseo-integration and we feel that patients who smoke would be wasting their money. (However under certain circumstances after having signed a disclaimer accepting possible failure of the implant it may be possible)
Must not exceed certain mechanical loading factors upon proposed implants. For example a patient with a shallow jaw bone, powerful facial muscles and who grinds their teeth when asleep would not be a suitable candidate.
Where implants have been fitted for the eventual retention of dentures, the old dentures may need major modification, possibly relining with a soft liner, or often a new temporary denture is recommended for use during the osseo-integration phase. A fee is charged for a temporary denture.
If a crown is planned we may recommend maintaining the space by fitting a temporary adhesive bridge which would be glued to the adjacent healthy natural teeth or cosmetic denture.
Fees for temporary dentures, an adhesive bridge or soft linings would be in accordance with my current scale of fees for routine dental treatment.
How long do implants last?
It has been shown that jawbone recedes from around an implant at about the same rate as it does around a natural tooth and that this varies from patient to patient. A shrinkage rate of between one tenth and one third of a millimetre per year could be considered normal for a patient with excellent oral hygiene who attended for regular check- up and review appointments. We recommend six monthly appointments for cleaning around the implant with an ultrasonic scaler to “flush” out any bacteria and calculus build up and x-rays every two years to review for any bone loss. We offer no guarantee upon the life of an implant once it has become integrated in the bone but we hope that by adhering to regular dental visits and meticulous oral hygiene, the implants would last for many years.
In crown and bridge cases, porcelain fused to metal superstructure is guaranteed against breakage for four years, except in the case of damage by external trauma such as a sports injury, a car accident or a fall onto the face. Personal injury or car insurance would usually cover trauma claims.
Where dentures are clipped to the implants by precision attachments, by “O-rings”, soft linings or Locators, such as clips or retainers will from time to time need to be changed. A fee will be charged for this service.
Routine maintenance or inspection appointments (for which a fee is charged) are essential for implant patients.