Dental Implants

Dental implants are titanium rods that are surgically placed in your jaw bone which will subsequently support your missing tooth. The titanium surface on the implant is biologically compatible with living tissue (bone) and over time becomes “joined” or integrated with bone forming a permanent fixture in your jaw. The artificial tooth is then attached to the implant fixture either by a screw or by cementing onto a connecting abutment. Implants are very versatile and can replace a single tooth or they can be joined to each other to provide more substantial support from 2 to more teeth. Indeed, we can replace the bulk of usable teeth almost returning you to “normal”. Nothing can replace a natural tooth but implants can come close provided all care is taken to manage the situation.

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What are the stages in Implant Therapy

From our experience of over 20 years, the following protocol is currently used to provide the most predictable result for a single tooth:

Tooth Extraction and Socket Preservation
- - Extraction of the failed tooth and possible socket preservation bone grafting.
  - Provision of a temporary denture, if necessary.
Healing Period
- - The socket is allowed to heal for 6 weeks.
Radiographic and CT Scan
- - Impressions are taken to prepare a radiographic stent.
  - CT Dental scan or Cone Beam CT is taken, usually 8-10 weeks after the extraction. The patient wears the radiographic stent that has been prepared previously.
  - The volumetric information obtained from the 3-D scans ensures that we have adequate bone to place an implant and provides sufficient information about the relative position of nerves in the upper and lower jaws, as well as the position of the maxillary and nasal sinuses in the upper jaw.
  - Complex surgery, where the implant is close to anatomical structures that may pose a safety issue for the patient, will be done by our Oral & Maxillofacial Surgeon.
Stage One Surgery
- - In most cases, stage one surgery is performed under local anesthetic.
  - A healing phase of 6-8 weeks is allowed, during which time you will continue to wear your removable prosthesis.
Prosthetic Phase (2-Stage Procedure)
- - Stage 1: Construct a provisional (temporary) restoration to allow the gum tissue to heal around a tooth structure and to allow the bone to be “progressively” loaded with a “plastic” (softer) structure for optimal healing.
  - Stage 2: The final replacement of the provisional crown with the definitive crown, usually done 2-3 months after wearing the provisional or at the patient’s leisure.
Bypassing the Provisional Stage
- - In the posterior region, where gum aesthetics is not so critical, the provisional stage could be bypassed, saving you time and money. You can discuss this with your dentist if you wish to bypass the provisional stage.
  - The laboratory construction of the implant provisional or definitive crown takes approximately 12-15 working days.
  - For hybrid bridges and complex bridges, where more steps are required to fabricate the prostheses, 4-6 weeks are necessary to complete the prosthetic phase.

What are the stages in Implant Therapy

In patients who are totally edentulous (missing all their teeth), there are 3 options available using implants:

Implant-Supported Overdenture
- - Typically, a minimum of 4 implants for the upper jaw and 2 implants for the lower jaw that will clip onto a removable denture.
  - This is the cheapest option and provides good retention for your dentures.
  - Cleaning is easy, and repairs can be done easily.
  - Patients prefer the overdenture option for the upper jaw because it no longer covers the palate and securely holds the dentures in place.
  - In the lower jaw, the secured denture resists movement by the tongue, lips, and cheeks, reducing soreness under the dentures.
Implant-Supported Hybrid Bridge
- - A hybrid bridge is a denture attached by screws to the implants.
  - Works extremely well for the lower jaw, where patients no longer have to remove the denture.
  - While it can be done for the upper jaw, cleaning can be an issue, and as the patient ages and becomes less dexterous, gum disease can occur around the implants, leading to infection and eventual loss of the implant.
Implant-Supported All Porcelain or Porcelain-Fused-to-Metal Bridges
- - Custom-made teeth made entirely of porcelain or with a combination of porcelain fused to metal (usually a gold alloy) either screwed to the implants or cemented to them.
  - These are expensive due to the technical expertise required to create each tooth individually, but they are comfortable, aesthetically pleasing, and can be cleaned easily like natural teeth.
  - Ideal for the upper jaw if a “fixed” option is chosen.

Common Post-Surgery Questions

Will I have much pain after the surgery?

There may be some discomfort after any surgical procedure, but in most cases, it can be managed with over-the-counter pain medication such as Paracetamol (Panadol).
Stronger painkillers can be prescribed but are often unnecessary.
Pain medication is typically needed for 24-48 hours and then tapered off.

Will there be much bruising after the surgery?

Minor bruising may occur, and depending on the location of the surgery, your lips may feel swollen and tight.
The swelling usually settles down after a few days and can be minimized by using a cold compress after the surgery.

Can I go back to work after surgery?

Yes, as long as your work does not involve strenuous activity that could cause your blood pressure to rise, leading to more swelling and post-operative bleeding.
Usually, you do not need to take time off work for minor surgery involving 1-4 implants.

Can I have some food after surgery?

Yes, a soft diet is recommended on the day of surgery.
You can return to a normal diet the next day but avoid chewing on the side of surgery until you feel comfortable.

When can I start cleaning my teeth after surgery?

It is essential to maintain a very high level of oral hygiene before and after implant surgery.
You may start brushing your teeth the day after surgery but be careful not to disturb the wound, which may still be swollen and slightly uncomfortable.
You will be provided with a course of antibiotics, Chlorhexidine gel, and an ultra-soft toothbrush to help you clean around the implant. Apply the gel 5-6 times a day around the wound with a cotton bud until you finish the gel.

Specific Concerns and Procedures

Is there a time when I will be without my dentures?

This usually happens when you have a major grafting procedure done. In this case, we will ask you to leave the dentures out for 2 weeks if possible.
In many cases, patients take a holiday during this time. We will reline or rebase your denture soon after that, which only takes a day.

Can implants be placed immediately after extractions, and can a tooth be placed immediately?

This can occur under certain conditions. However, placing a tooth immediately on an implant carries risks, such as micromovement during everyday eating and chewing, leading to implant failure.
In cases where multiple implants are done, especially in the lower jaw, an immediate implant-supported temporary bridge may be possible.
Careful planning and coordination with the surgeon and dental technician are essential for success. Please discuss this option with your dentist if it appeals to you.

Will my implant crown look natural?

We strive to make the artificial tooth look as realistic as possible. Photos are taken, and a colourimetric evaluation of your adjacent teeth is performed using the Shade Vision colourimeter to obtain the best matching color.
There may be slight gum recession around the implant crown, which could present a slight cosmetic issue.
Your dentist will show you photos of completed cases to set realistic expectations.

What type of graft material is used if I need a bone graft?

We prefer to use your own bone (autogenous bone) whenever possible.
If more bone is needed, options include Bio Oss (a xenograft derived from cows) or totally artificial synthetic bone, such as Bio Active glass particles.
Depending on the volume used, a collagen membrane may be placed to hold the graft material in place.

It is essential that you maintain a high level of personal oral hygiene and attend for your regular dental maintenance appointment every 6 months or at the very least every year.

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