Covid-19 & Safe Dental Treatment

Dental implants can be used for many different types of treatments. They can be used to replace one single tooth unit, to support an ‘implant retained’ bridge, or to retain a removable denture.

We will thoroughly investigate which type of treatment is most appropriate for you. This is based on the number of teeth to be replaced, the condition of any remaining teeth, the amount of bone support, the way you bite together, and your desired outcome in terms of appearance and oral comfort.

What is a Dental Implant?

A dental implant is a small root-shaped screw made of medical-grade titanium (similar to hip and knee prostheses) which is inserted into the jawbone. It bonds with the surrounding bone tissue over a period of 6 to 12 weeks. The tooth crown is not connected to the implant at first to allow it to integrate with the jaw without any direct pressure applying to it (this process is called osseointegration). After this period (referred to as the “healing period” ) the tooth replacement in the form of a crown or a bridge is secured to the implant using a specially produced post (known as an abutment). The tooth crown or the bridge can be either screw retained or bonded to the underlying post. One implant is required to replace one missing tooth. However, when suitable 1 implant can sometimes be used to replace two small (front teeth). This is known as a single unit cantilever bridge.

In case of a denture, a small titanium framework (bar) incorporating precision stud attachments are fitted to the implant head. The denture is made with housings that clip over the titanium framework. This is known as an overdenture (or a “clip on denture”). These prostheses are detachable to allow daily cleaning of the underlying implants. Unlike traditional dentures they do not move or become dislodged easily when eating and chewing. Implants simply provide support and retention.

An alternative to a full overdenture is a full jaw fixed bridgework of 12 to 14 teeth which is anchored to approximately 6 implants permanently. The available options, comparative advantages, disadvantages and costs will be discussed with you after your initial consultation and assessment by Professor Ucer.

What Types Of teeth (or prosthesis) Are Available?

A single crown fitted over a single implant is used to replace one missing tooth. Normally each tooth crown attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis known as clip-on denture or over denture attaches to a bar or ball in socket attachments, whereas a fixed prosthesis (e.g. full jaw tooth implants) is permanently anchored to implants. These options are explained below.

Options for Full jaw or mouth implants:
a) Implant-Supported Overdentures (clip-on Dentures)
b) Permanent full jaw tooth implants

Patients with traditional dentures find them to be inconvenient, unstable, and even painful. Unlike traditional dentures, which rest on your gums, implant-supported dentures are held in place by a number of underlying implants. Implant-supported dentures require daily removal for oral hygiene and cleaning purposes but provide a superior level of stability and support, eliminate the need for denture adhesives, returns your ability to eat the foods you used to enjoy, and restores your full smile.

Permanent full jaw implants are anchored to approximately 4 to 6 implants to replace missing teeth, aesthetics and functionality in the most optimum way. There are advantages, disadvantages and relative cost differences between these options which we would be happy to assess and explore these options for you after an initial consultation and examination appointment

Replacing one or more teeth

Picture 1Problem – Single tooth gap

Solution – Implant-supported single crown

  • Looks and functions just like a natural tooth
  • No need to damage adjacent healthy teeth
  • Continued use (loading) prevents resorption shrinkage of the underlying bone
  • Implant-supported tooth prevents lateral movement (drifting) of adjacent teeth and 
over-eruption of opposite tooth
  • Very high and predictable 
long-term success (98 percent).

Alternatives

  • Leave a gap
  • Conventional bridge
  • Denture

Replacing several missing teeth, a failed bridge of a partial denture.

Picture 1 1Problem – More than one tooth missing

Solution – Permanently fixed bridge or crowns supported by implants

  • Eat anything you choose
  • Looks and works just like natural teeth
  • Fixed in place, no need to remove it to clean
  • No need to damage adjacent 
healthy teeth
  • Prevents shrinkage of 
underlying bone

Alternatives

  • Replacement tooth-supported bridge
  • Larger tooth-supported bridge
  • Partial denture
  • Leave a gap

Replacing all your Teeth

Picture 1 2Problem – All teeth missing, Loose, uncomfortable or poorly fitting conventional complete denture

Solution

  • Implant-supported fixed or removable complete arch bridge
  • Implant-supported permanently 
fixed porcelain bridge
  • Removable (clip-retained) 
denture
  • Conventional denture 
located with two implants

Alternatives

Continue with a complete 
conventional denture.

Single tooth Replacements

An implant can be placed at the time of tooth removal. If the bone condition is unsuitable at the time of extraction, implant placement is deferred for 8 to 10 weeks to allow the bone to heal first (a temporary denture is normally fitted during this period).

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A suitable extraction socket for immediate implant placement at the time of tooth removal
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An immediately placed implant is allowed to heal for 6 weeks before a tooth is connected permanently
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Final crown permanently attached to the underlying implant
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Tooth extraction
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Immediate Implant Placement
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Final Implant Crown anchored to the implant with an abutment screw

Full Jaw Implants

Types of prostheses available for full jaw implant reconstructions:

Option 1: Overdentures (clip on teeth supported by 4 or 6 implants linked by a titanium bar)

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Illustration of a bar retained overdenture
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3 implants inserted in severely atrophic lower jaw using 3D computer guided surgical technique
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3 implants linked with a titanium custom-made bar to engage a clip on overdenture
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A view of the titanium bar anchored to the underlying implants. Precision attachments are used to retain the clip on overdenture
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Custom-made CAD CAM Titanium bar in the upper jaw
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A clip on denture engaging the underlying titanium bar anchored to dental implants
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A clip on denture (without the coverage of the palate) supported by a CAD CAM titanium bar
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A panoramic radiograph showing the titanium bar anchored to 5 underlying implants in the upper jaw

Option 2: Full jaw fixed implant reconstruction

This option involves anchoring the teeth to the underlying implants permanently (non-removable option). 4 or 6 root-form dental implants are normally required for full jaw reconstructions. Alternatively 4 zygomatic implants (Quad Zygoma) are used when conventional implants cannot be placed due to presence of inadequate bone seen in severely atrophic jaws or after cancer surgery.

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All-on-4 fixed bridge reconstruction of the full jaw using TRI (swiss) Implant system. The full jaw bridge is anchored with internal screws to 4 strategically placed dental implants
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Six upper Megagen ® implants with Multi-Unit Abutment connectors are designed to anchor a fixed bridge of teeth made from porcelain. Any areas of gum recession are re-constructed in pink porcelain to optimise the dental aesthetics and lip & smile lines
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Full jaw fixed bridge constructed with CAD CAM milled titanium framework and porcelain teeth. This type of prosthesis is sometimes known as all-on-4 or all-on-6 (depending on the number of implants used)
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The bridge is permanently screwed on to the implants and screw holes are covered with white composite fillers
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A lower full jaw reconstruction on 6 Megagen ® implants with MUA abutments (all-on-6)
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Full jaw porcelain bridgework connected to the underlying implants with internal abutment screws

Option 3: Zygomatic Implants

This is the graftless option for the reconstruction of severely atrophic maxilla (upper jaw) when there is insufficient bone to place normal root-form implants. Zygomatic implants are indicated for people who have suffered gross bone loss due to jaw shrinkage or atrophy or after extensive oral cancer treatment.

Zygomatic implants are placed by Professor Ucer at our internationally accredited ZAGA Centre Manchester using the evidence based, anatomically guided, ZAGA technique.

Zygomatic implants have been documented as an alternative for the rehabilitation of the atrophic posterior maxilla. Zygomatic implants avoid grafting and sinus lift procedures and therefore contribute to a shorter and more comfortable treatment. Further indications for zygomatic implants include failed conventional implant placement, failed sinus augmentation or grafting procedures, rehabilitation after tumor and trauma resections.

In the atrophic posterior maxilla, in general one zygomatic implant is placed on each side of the maxilla, in combination with 2-4 conventional implants in the anterior region.

For the totally resorbed maxilla, when placement of anterior implants is not possible the concept can be expanded by inserting 2 additional zygomatic implants in a more anterior position (Quad zygoma). Zygomatic implants nowadays are usually immediately loaded with a fixed bridge.

Long-term prospective studies high success rates with only minimal complications. The cumulative survival rate of zygoma implants is 96% after 12 years.

The most common complication associated with zygomatic implants is sinusitis. Other complications reported during and after the insertion of zygoma implants include nerve paresthesia, oral-sinusal fistula and surgical collateral damage to adjacent structures. Appropriate pre-surgical diagnostics and evaluation of the sinus as well as using the evidence based 3D anatomically guided ZAGA technique and extra-sinus surgical approach help to limit the risk of complications and ensure long lasting successful outcomes.

Due to the long drilling distance to the zygomatic bone and in order to protect critical adjacent anatomical structures, placement of zygomatic implants requires considerable oral or maxillofacial surgical training and experience and meticulous diagnostic planning. Presurgical 3D planning with CBCT scans and anatomically guided surgical precision is essential to ensure a successful long term outcome with Zygomatic Implants.

Zygomatic implants have the added advantage of not necessitating a staged complex bone grafting. These implants are normally brought into function when an interim fixed prosthesis is connected immediately rather than waiting for months for the healing process to take place. Unfortunately not every case is suitable for this type of treatment. A clinical assessment with CBCT diagnostic imaging would be required to check suitability.

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Zygomatic Implants are anchored to dense basal bone such as the zygoma and provide very high levels of fixation for immediate function
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A panoramic image showing two implants engaging the right zygomatic bone
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Four zygomatic implants (quad zygomas) ready to support a final full jaw bridge of teeth. Zygomatic implants are sometimes supported by two additional implants engaging the pterygoid bone for added anchorage
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A full jaw fixed porcelain bridge ready to be fitted

Pterygoid Implants

In the edentulous upper jaw the placement of implants can be challenging due to limited bone quantity and the presence of the maxillary sinus. Pterygoid implants ( a variant of zygomatic implants) can present an alternative to overcome the need for augmentation procedures.

Pterygoid implants engage the very dense pterygoid plate of the base of the skull. The average success rate for pterygoid implants lies at 90.7% or more. Insertion of implants at the level of the pterygoid plate can be potentially associated with bleeding and this technique requires specialist level oral surgical training and experience.

Option 4: Individualised custom made titanium implant reconstruction

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A customised CAD CAM designed titanium implant framework is printed in 3D to support a clip on or fixed full arch reconstruction
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Printed titanium framework and the supporting titanium bar before being fitted
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The titanium implant framework is fitted in one daycare surgical operation and screwed into dense basal bone for strength and maximum anchorage. A temporary prosthesis is normally fitted immediately at the same time. Customised titanium implant reconstruction is indicated when routine dental implants or Zygomatic implant treatment is not possible due to unfavourable bone anatomy
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