These are metal screws placed within the jaws to which artificial teeth can be supported. The process involves the surgical placement of a titanium screw in the jawbone.
There are two main stages in the implant process. The first is the surgical placement of the implant into the jaw, and the second is the restorative attachment of the replacement tooth to the implant. The replacement tooth (prosthesis) may be a crown, a bridge, or a denture.
Most studies have shown that implants are successful in more than 95 percent of cases. Those inserted into the lower jaw are slightly more successful than those in the upper jaw.
There are very few specific illnesses that would prevent the use of implants. But there are some things that make the outcome potentially less successful and one of the most important of these is smoking.
Implants can be placed in the elderly, but they should not be placed in children until skeletal growth is completion.
If a large amount of bone has been lost where the false tooth needs to be positioned (due to a difficult extraction or to ongoing bone shrinkage), there may not be enough anchorage for an implant. A bone grafting procedure may be required to rebuild the bone volume prior to implant placement.
The placement of implants is a minor oral surgery procedure that can be performed under local anaesthesia, IV sedation or general anaesthesia. Most patients say it was as easy if not easier than having a tooth extracted. Any stitches in the gum will need to be removed a few days later.
Implant surgeons will often prescribe painkillers after the placement of the implants; but most patients do not need to take them.
Implants in grafted bone or with low insertion torque values may be required to be covered under the gum and left to heal for up to six to nine months. A second minor surgical exposure of the implant will be performed followed by the placement of a taller implant cover (healing abutment).
Certain cases will require a staged approach if bone augmentation (grafting) is required for a large bony defect in the jawbone, then the operation becomes more complex which may be performed as general anaesthetic procedure prior to an additional implant surgery.
Careful implant surgical planning and preparation is completed before placement to ensure the implant is placed in the optimal position to retain the final restoration with minimal long term mechanical complications. Some of this work is done outside the dental surgery prior to the day of surgery.
A single implant replacing one tooth is aptly described as an implant supported crown (ISC). This option is stronger and more durable than a root filled crown should the original tooth be saved in most circumstances. A natural unrestored tooth can be expected to last a lifetime.
An implant crown may have biological complications with bone loss if the patient has the risk factors (previous gum disease) that predisposes them to it. Furthermore, every chewing stroke and biting (especially hard foods) can cause chipping of the overlying porcelain or the abutment screw that attaches the crown to the implant.
One or more implants replacing multiple teeth is described as an implant supported fixed partial denture or bridge (ISFPD). Surgical treatment planning coupled with basic oral biomechanical engineering design will help determined the ideal number of implants supporting the number of missing teeth.
For some people the exciting prospect is that dentures can be discarded after implant therapy. Unfortunately, not everyone can move away from dentures completely. If there is a major loss of the alveolar bone (jawbone) a denture is the only way to achieve a successful result to support the teeth, lips, and face.
In such a case, the implants act as a secure support for a denture and prevent the embarrassment and pain of it moving during eating and speaking. The appearance is restored with the denture teeth and gums.
They are more expensive than a conventional denture or most other methods of replacing teeth but have these advantages over other treatments:
A full arch implant fixed prosthesis is a ‘treatment philosophy’ where all the missing lower teeth are replaced with between four and six implants supporting a full arch bridge. This treatment enables the patient to function without requiring a full denture. The material of the bridge can be made of acrylic (usually used as a temporary prosthesis due to poor strength), metal framework with a veneer of acrylic or zirconia ceramic.
In certain cases where there is poor bone volume or quality, additional implants maybe required to improve the long-term stability and biomechanics of the bridge. The implants will need to be maintained regularly to prevent gum inflammation or bone loss. Long term wear of the bridge may result in chipping of teeth requiring prosthesis removal and laboratory repair. Some patients have a second acrylic temporary bridge made as a spare set so that they can have function whilst the original first set is being repaired.
Although there are reports of implants being used immediately to support bridges, the standard, well researched and tested protocol is to leave the implants for between three and six months to allow the bone to fuse to it (osseo-integration), the construction of the final restoration.
Immediate loading of the implant runs the risk of non-healing of the implant resulting in its removal and loss of the surrounding bone. Further bone grafting and surgical procedures may be required to rectify the situation.
Age is not an important factor although implants are not generally recommended for growing individuals. Smoking has been conclusively shown to reduce success.
Not everyone is suitable for this form of treatment. Enough bone is necessary to hold the implant in place and an excellent standard of oral hygiene is necessary for long-term success.
For complex cases, such as when a patient has a complex medical history, pre-existing gum, and bone (periodontal) disease, or a lack of bone volume, an implant case may be managed by a joint face to face consultation and planning between the implant surgical specialist (oral and maxillofacial surgeon or periodontist) and one of our clinicians at White Light Prosthodontics. The surgical sequence of soft/hard tissue grafting together with implant placement is determined to provide the best chance of success will be chosen.
Implant complications are divided into two groups. Biological and mechanical complications.
Biological complications are often described as peri-implantitis (bone loss around the implant). Left untreated the bone around the implant dissolves as a result (lose of osseointegration) with the implant eventually falling out. Treatment will require the removal of the overlying prosthesis to allow for treatment access to the implant by a periodontist (gum specialist).
Most common mechanical complications include chipping of the veneering material and loosening of the prosthetic screw. The complication is usually a result of a poorly placed implant relative to the prosthesis and/or poorly designed prosthesis with inferior materials. A redesign and fabrication of a new prosthesis with stronger and well researched materials is the ideal rectification to the problem.
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We are a specialist prosthodontic practice involved with all aspects of prosthodontic and implant therapy
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* All treatment carries risks. Individual consultations are required with one of our practitioners to ensure that the treatment is right for you. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner. Contact us for more information. Rebates may vary depending on your individual health fund.
