Dental implants

Why has my dentist referred me to Bristol Dental Specialists? 

You have been referred to Bristol Dental Specialists to discuss dental implant treatment. There is no such thing as a dental implant specialist, however, at Bristol Dental Specialists our Specialist in Restorative Dentistry and Specialist Oral surgeon have undertaken further training specifically in dental implants and have a wealth of experience between them.

What is the use of a dental implant? 

A dental implant replaces the root of a tooth, it can be used to replace the visible part of the tooth, known as the crown. A single implant is needed to replace a single tooth, but not every missing tooth needs to have an implant beneath it – a bridge can be used, supported by a number of dental implants, to replace many teeth. Dental implants can be used to help retain a removable partial denture, if more dental implants are used it is possible to have a fixed bridge. 

A dental implant stands alone and does not rely on healthy adjacent teeth being ground down for a crown; nor does it have to link to the neighbouring teeth in any way.  An implant forms a very strong union with the underlying bone and can withstand more load than a normal tooth. Implantologists have been using the current design of titanium dental implants for well over thirty years for the replacement of missing teeth. 

What can I expect at my first visit to Bristol Dental Specialists? 

The first appointment is for an hour and a full history will be taken, this enables us to propose a treatment plan for you, having considered all the options available to replace your missing teeth. If yours is a relatively straightforward case it is possible to provide a predictable treatment plan at the first visit.  However, for more complex cases, where other specialists need to be involved, it is usually necessary to have a second appointment which may involve the combined knowledge of more than one Specialist. At Bristol Dental Specialists we will seek your permission to share your clinical information between clinicians should you require this approach. You will receive a copy of your treatment plan, as will your dentist and other specialists if required. 

We have a cone beam CT scanner, which we use to assess the bone support for a dental implant and any vital anatomical structures which may be close to the proposed implant site. A bone scan is not always necessary and if your treatment is relatively straightforward we are likely to suggest making the second appointment for your surgery, when the dental implant will be placed under local analgesia. 

What is a dental implant? 

A dental implant is a threaded, titanium screw, which has a roughened surface to promote a very strong union between its surface and the bone of the jaw. We use the Straumann dental implant system, as the favoured implant system at Bristol Dental Specialists – Straumann are a biomedical engineering and materials science company backed by a wealth of scientific literature. The dental implant is placed when the gums have healed following a dental extraction.  The procedure is no more invasive than having a tooth extracted, provided it is a straightforward implant placement.

What is a bone graft?

Sometimes it is necessary to carry out augmentation of the jawbone, either at the same time as the dental implant is placed or, on occasion, as a separate procedure to when the dental implant is placed. It takes somewhere between five and nine months for the bone graft to be ready to receive a dental implant. We will advise you of the need for a bone graft when we carry out the cone beam CT scan. 

What are the alternatives to dental implant-retained teeth? 

Many of our patients who are already missing teeth may be satisfied with a denture (a removable plate replacing some or all of the missing teeth). Alternatively, they may have a conventional bridge, where the teeth have been ground down or an adhesive bridge where a metallic wing is bonded to the unprepared inside surface of the tooth. We continue to occasionally use these methods as a temporary measure during the dental implant treatment process, to avoid the patient being without prosthetic teeth during this time. Other patients who may not be suitable for dental implants can have the choice of these treatments.

Who is suitable for dental implants? 

If you are in good general health, dental implants are likely to be a suitable option for the replacement of your missing teeth.  However, habits such as heavy drinking and smoking can frustrate initial healing and have a detrimental effect on the long-term health of gum and bone surrounding each implant. Remaining teeth might also be compromised due to the effects of smoke and drink, making treatment planning less certain. 

Are dental implants good for the jaw-bone? 

The short answer is yes. Once an implant has been inserted and restored to support the crowns or bridgework, biting forces stimulate the surrounding bone which becomes stronger. Bone and muscle are dynamic tissues which respond well to loading and exercise. 

How long does treatment take? 

For routine cases, from the time of implant insertion to the time of placing the first tooth, treatment times can vary between 6 weeks and 6 months. Good solid bone will reduce treatment time, whilst more time and care must be taken with poor bone, which can therefore extend treatment times. 

How do I look after the implants? 

For most dental implant-supported teeth you will be able to clean around each supporting dental implant by brushing and flossing in just the same way that you would around natural teeth and tooth-supported bridges. In some areas, special floss, interdental toothbrushes and other cleaning aids may be needed to maintain good oral hygiene. Cleaning is not too difficult, provided you have a basic level of manual dexterity. Some hygiene procedures will be a little more complex than around your original teeth and you should expect to spend more time than previously, if you wish to maintain optimum dental implant health. 

For the first few months after the dental implants are placed, your dentist may ask to see you more frequently. However, once your dentist is satisfied your treatment is performing as planned, ongoing care will be similar to patients with natural teeth. 

One stage dental implant – The dental implant is placed into a new, healing or healed extraction site and is visible above the gum immediately after placement. The advantage of this method is that a second surgical stage is not necessary to expose the implant. The dental implant will not normally be ready to support a tooth for several weeks or months. 

Two stage dental implant – The dental implant is placed into a new, healing or healed extraction site and then covered by a layer of gum so that it cannot be seen – this is the first stage. At the second stage some weeks or months later, the dental implant is surgically exposed and components installed, which bring the dental implant above gum level. 

Immediate dental implant – For this technique a tooth is removed and a dental implant placed immediately into the extraction site. Depending upon the local bone and soft tissue conditions, the implant surgery may be a one or two stage procedure. Not all patients are suitable for this approach. 

What if I need a bone graft? 

Bone can be harvested from a number of sites in the body either from the jawbone, such as the chin and posterior regions of the lower jaw. Bone can also be harvested from other parts of the body such as the hips and tibia, though a general anaesthetic will be required for this to be carried out. Your own bone is called autogenous bone, it is a gold standard but has the downside of creating discomfort at the donor site. 

There are many alternatives to using your own bone for grafting. The advantage of bringing your own donor bone into site is that it not only produces scaffold into which regenerating bone is able to grow, but it also introduces viable cells into the site. All of the bone grafting materials introduce a scaffold which is slowly replaced by the surrounding native bone over a period of time. The greater the volume of the bone required, the longer it takes for healing to complete, but like any procedure it is important that the right operation is undertaken to provide the best possible outcome. 

What is guided bone regeneration? 

There is a technique called guided bone regeneration, particulate bovine-derived bone graft is introduced into a bone defect either at the time of implant placement or before a dental implant is placed. This bone graft is then covered by a porcine-derived collagen membrane, this prevents the rapidly growing soft tissue cells from infiltrating the bone graft and replacing it with soft tissue-the bone graft is effectively protected until it is stable. Aside from resorbable collagen membranes it is also possible to use titanium mesh and Gore-Tex membranes to prevent the ingress of the rapidly dividing soft tissues. 

Bone grafting is a time-consuming procedure which requires a certain level of skill and will add operative time to an implant procedure. Although every effort is made to place the bone graft at the same time as a dental implant is inserted, it is often necessary, when a great deal of bone has been lost, to consider placing the bone graft with a view to developing a bone site before the dental implant is placed. This does increase the overall time of treatment, but it greatly simplifies implant placement at the secondary procedure and is likely to lead to a superior aesthetic result and an increased success rate.

How long will a dental implant last? 

The key to successful dental implant survival comes down to good case selection and the degree of skill possessed by the operator. If the correct procedures carried out by a highly skilled operator, dental implants will last for many decades. The implants and the supported prosthesis are designed to facilitate cleaning as effectively as possible, the homecare becomes increasingly important as time goes by and it is imperative that somebody who has dental implants looks after them as directed, with the aid of your own general dental practitioner and their hygienist. It is not possible to overstress the importance of excellent homecare. 

Are dental implants for me?  

The most important visit is the initial consultation where the specialist will go through a series of questions regarding your previous dental and medical histories. This will help to determine whether or not dental implants are the best option for you. Aside from the detailed history taking, a thorough examination will also be undertaken. Any previous x-rays taken by your referring dentist will be obtained before the consultation, it may still be necessary to take more up-to-date x-rays and possibly a cone beam CT scan. 

What do I need to know before I start treatment? 

At Bristol Dental Specialists we will always provide you with a written summary of the optimal treatment plan, the risks and benefits associated with that treatment plan and also alternative treatment options. For various reasons you may decide against taking on what we consider to be the optimal treatment plan, however, a planned compromise will be a perfectly adequate alternative. This may be offered at Bristol Dental Specialists or we may refer you back to your general dental practitioner for this alternative treatment to be provided.