Dental implantology is a new branch of dentistry which involves the reconstruction of missing teeth and their supporting structures with natural or synthetic substitutes and biomaterials (alloplastic, allogenic or autogenous).”

If you are a denture wearer, you will be all too familiar with the suffering and discomfort associated with painful dentures that do not stay in place when eating and talking. This can cause mental and physical suffering and may also lead to loss of self confidence.
Even if they are constructed to the highest possible specifications, there are many problems associated with dentures and conventional restorations (e.g. construction of dental bridges require cutting and grinding of usually healthy adjacent teeth). Once the natural teeth are lost, the bone in which they were embedded begins to shrink. This process, known as bone atrophy (similar to muscle wasting when limbs are no longer used) can alter facial appearance and may necessitate the periodic replacement of dentures. Bone loss often leads to functional and cosmetic deterioration of the oral and dental structures.

Many people soon discover that dentures are a poor substitute for their natural teeth and simple tasks such as eating or even talking can be a source of anxiety, pain and discomfort for the rest of their lives. Yet, thanks to an accidental discovery, innovation, scientific study and recent developments in biomaterials, dental and medical sciences, the suffering endured by people who wear dentures, is no longer necessary.

In 1952, Professor Per-Ingvar Branemark, a Swedish surgeon, whilst conducting research into the healing patterns of bone tissue, accidentally discovered that when pure titanium comes into direct contact with the living bone tissue, the two literally grow together to form a permanent biological adhesion. He named this phenomenon “osseointegration”.

Today, modern dental implants, developed from the principles of osseointegration are routinely used in hundreds of clinics and hospitals world-wide, and sought after by thousands of patients because they have been proven to provide comfortable, permanent and attractive tooth replacements as an alternative to removable dentures and conventional bridges.

Modern dental implants of reputable make have been shown to last many years (20- 40 years or more). Longevity of implants depend on many factors such as the general health of the patient, pre-existing history of severe gum disease and smoking. It has also been shown conclusively that dental implants require periodic oral hygiene and maintenance with regular visits to the hygienist. Failure to carry out meticulous plaque control could cause gum problems around dental implants in a similar way to gum disease around natural teeth. The research certainly demonstrates that over 95% of implants placed are healthy after 10 years but with good care and maintenance they should last longer.

The way that you look after your implant is fundamental to the long-term success of the treatment, but there may be other factors that may affect the long term success of dental implants. Usually these so called “risk factors” could be eliminated or reduced to a minimum. Your dentist will discuss any risk factors that might be significant in your individual case. The main ones are:

  • A history of gum disease; this makes it more likely to get gum disease around the implant. Therefore any existing gum disease needs to be treated and brought under control before embarking on any dental implant treatment. The implant surgeon will assess the condition of your gums carefully before recommending implant treatment.
  • Uncontrolled diabetes could affect the initial healing as well long term condition of the implant and the surrounding gum. You would be asked to bring your diabetes under control. The implant surgeon will liaise with your GP and may ask to see the results of your latest diabetic check (HBA1c results)
  • Oral Hygiene; Poorly cared for implants are more likely to have complications
  • A heavy bite or tooth grinding (known as bruxism) could result in breakages of teeth or porcelain restorations and loosening of implants or bridges. You may be advised to wear a night bite guard if you are a heavy grinder.
  • Stress can results in prolonged periods of grinding and clenching
  • Smoking; the research demonstrates that smoking is a significant risk factor, so we would urge you to give up smoking.
  • Drinking; social drinking does not affect the process particularly; however drinking above the recommended weekly intake may have an effect.
  • Poor bone and gum condition: in order to improve the long term success a staged bone grafting procedure may be indicated. This will help to strengthen the bone and allow the placement of the implant in the most optimum position

Dental implant treatment can be provided by suitably trained and experienced dental practitioners or dental specialists such as Oral Surgeons, Maxillofacial Surgeons, Periodontologist, Prosthodontists, Restorative Dentists.

Whereas straightforward treatment can be carried out by one suitably trained individual dentist, more complex cases normally require treatment by a team of dentists each providing a part of the treatment they have special expertise or interests. This is because only a few dentists can be expected to have all the necessary surgical, prosthodontics and restorative experience to undertake all aspects of complex cases. Hence, in some referral practices teams of dentists work together to treat complex cases, whereas individual dentists usually treat routine cases single-handedly.

Dental implants are not currently taught at undergraduate level at the Dental School. Therefore dentists need to develop additional skills and experience in this field of dentistry by attending postgraduate courses in order to gain the clinical skills necessary to provide both the surgical and restorative aspects of implant treatment.

The General Dental Council declared recently that dentists who wish to practise implant dentists should be trained by attending structured courses and develop clinical skills under supervision of an experienced colleague (a mentor) as well as been assessed to demonstrate that they have gained the necessary knowledge and clinical skills. There are a variety of courses available for dentists to train in implant dentistry ranging from those organised by private individual dentists to university postgraduate courses that award PGDip/MSc degrees in implant dentistry. Royal College of Surgeons of Edinburgh (RCSEd) and Faculty of General Dental Practitioners (FGDP) of England also award a PG Diploma in Implant Dentistry by assessment based on clinical experience.

Implant treatment is classified into straight forward (S) and Advanced/Complex level of complexities(AC)(SAC classification, ITI.org). Dentist who provide treatment at a higher level of complexity are expected to have training and experience at a higher level (Training Standards in Implant Dentistry, 2012).

There is also requirement that dentists maintain a logbook of implant cases and audit these to show evidence of their clinical experience and results of their cases annually.

If you are missing one or more of your natural teeth, you may benefit from dental implants:

  • Implants bond biologically to the living bone tissue.
  • Once united with the jaw, they anchor teeth firmly and safely. Implants restore function and aesthetics to normal levels.
  • Eating, talking and chewing need no longer be painful experiences. Dental implants prevent progressive bone atrophy and shrinkage.
  • Dental implants can help to preserve bone levels and a youthful facial appearance. Like artificial joints, they have a proven scientific basis.

Implant treatment, by replacing missing teeth, or painful dentures, improves self-confidence, chewing ability and comfort as well as overall quality of life.

Dental implants are often a good alternative to replacing teeth with conventional prostheses such as plastic dentures or tooth bridges. In certain cases implants are now regarded as the treatment of choice, for example, in patients who have lost all their teeth and find traditional dentures impossible to tolerate when eating and speaking.

Implant treatment can be carried out at the time of tooth extraction (immediate implant placement) or soon (6 to 12 weeks) after a tooth loss (deferred implant placement).

Dental implants can also be considered years after tooth loss (delayed implants). However the bone and the overlying gum undergoes shrinkage (or atrophy) following tooth removal.

If an implant is not inserted to replace a tooth bone shrinkage takes place due to disuse atrophy. This makes routine implant placement difficult or complicated. In such cases, the deficient bone may require rebuilding (grafting or augmentation) with bone regenerative materials (synthetic or animal origin) or a bone graft (from patient's hip or from a bone donor).

In most cases, bone grafting can be carried out routinely using bone substitute materials (synthetic or animal bone derivative). In severely atrophic cases (including those with bone damage due to accidents or oral cancer) a bone transplant from the chin or the hip bone may be indicated before implant treatment can be provided. Diagnostic imaging including a

3-Dimensional CT scan (CBCT) is used to determine the bone level during the assessment and treatment planning phase.

For implant treatment to be successful in the long term you will need to have very health gums. Any existing gum disease, periodontal bleeding or pocketing needs to be treated/ Uncontrolled diabetes is a relative contraindication for implant treatment. Research has shown that smoking can affect the longevity of implants.

Your treatment needs will be determined following a routine examination and appropriate radiographs. Before undergoing any treatment your Implant Team will provide a detailed treatment plan and a cost estimate for you to consider according to your individual circumstances, needs and wishes.

Although majority of implant treatment can easily be carried out totally without pain under a local anaesthetic (dental injection), you may prefer to have your treatment under conscious sedation (awake but feeling relaxed and a little sleepy) or a general anaesthetic (go to sleep).

An oral surgeon is a dental specialist who is trained to perform surgical procedures on the mouth, teeth, jaws, and face. Specialist/consultant oral surgeons undergo years of surgical training which involves dealing with trauma and injuries such as the fractures of the jaw and facial bones. The speciality also deals with corrective jaw surgery, treatment of jaw cysts and tumours and cancer screening & diagnosis. Oral surgeons provide complex surgical tooth removal operations and carry out preprosthetic bone and soft tissue regenerative surgery as well as dental implant treatment.

Modern dental implants have been shown to last many years (20- 40 years or more). Longevity of implants depend on many factors such as the general health of the patient, pre-existing history of severe gum disease and smoking.

It has also been shown conclusively that dental implants  require periodic oral hygiene and maintenance with regular visits to the hygienist. Failure to carry out meticulous plaque control could cause gum problems around dental implants in a similar way to gum disease around natural teeth.  The research certainly demonstrates that over 95% of implants placed are healthy after 10 years but with good care and maintenance they should last longer.

The way that you look after your implant is fundamental to the long-term success of the treatment, but there may be other factors that may affect the long term success of dental implants. Usually these so called “risk factors” could be eliminated or reduced to a minimum. Your dentist will discuss any risk factors that might be significant in your individual case. The main ones are:

  • A history of gum disease; this makes it more likely to get gum disease around the implant. Therefore any existing gum disease needs to be treated and brought under control before embarking on any dental implant treatment. The implant surgeon will assess the condition of your gums carefully before recommending implant treatment.
  • Uncontrolled diabetes could affect the initial healing as well long term condition of the implant and the surrounding gum. You would be asked to bring your diabetes under control. The implant surgeon will liaise with your GP and may ask to see the results of your latest diabetic check (HBA1c results)
  • Poor Oral Hygiene & maintenance: Badly cared for implants are more likely to have complications
  • A heavy bite or tooth grinding (known as bruxism) could result in breakages of teeth or porcelain restorations and loosening of implants or bridges. You may be advised to wear a night bite guard if you are a heavy grinder.
  • Stress can results in prolonged periods of grinding and clenching
  • Smoking; the research demonstrates that smoking is a significant risk factor, so we would urge you to give up smoking.
  • Drinking; social drinking does not affect the process particularly; however drinking above the recommended weekly intake may have an effect.

Poor bone and gum condition: in order to improve the long term success a staged bone grafting procedure may be indicated. This will help to strengthen the bone and allow the placement of the implant in the most optimum position

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