Dental implants in restorative dentistry

This leaflet provides an overview of dental implants and the different options available. It includes information about potential risks and benefits. If you have any further questions after reading leaflet, please ask your clinician.

About dental implants

A dental implant is a piece of titanium which is shaped like a screw. This is placed into the jawbone and is used to support a crown, bridge or denture.

What are the benefits/advantages of dental implants?

1. Offer the possibility of having false teeth that feel similar to your own.
2. Replace missing teeth without the need to drill the adjacent teeth.
3. Preserve the bone within the jaws.
4. Can be used to replace one or more teeth or to support a loose denture when all teeth are missing.

Are implants suitable for everyone?

The individual needs to be relatively fit and healthy with good oral hygiene practices and a stable dentition with no active tooth decay or infections.

Patients require certain amounts of bone height and volume within the jaws; this will be assessed. If necessary, bone can be built up with a bone graft which may be your own bone or a substitute bone. Your clinician will discuss the suitability of implants and any further procedures that may be required with you on an individual basis.

Will I need additional investigations?

This will be decided and discussed with you on a case to case basis. Normal x-rays are used during initial assessments. In some cases, more specialist techniques of imaging may be advised, these include computed tomography (CT) scans that provide information in 3D. In addition to these investigations you will usually need to have some moulds of your teeth, to help plan the surgery.

What if I do not have enough bone?

If you require bone grafting, treatment will be prolonged by at least four months. This can be discussed with your clinician in further detail following your initial assessment.

How successful are dental implants?

• Implants have a high success rate, currently at 80 to 95% over 15 years in patients with healthy mouths.
• The success rate is reduced to 80 to 85% over seven years for patients who have gum disease.
• Over 90% of implants bond successfully to the jawbone.
• The predictability and outcome of implant treatment is impacted depending on your quality of jawbone, the health of your gums and whether you smoke.
• Smokers have a much greater failure rate and will be expected to stop smoking at least six months before starting implant treatment.
• Patients who have a habit of grinding their teeth are at risk of overloading their implants; this can reduce the success rates.
• The long-term success rates of implant following healing will be dependent on your ability to maintain and keep your implants meticulously clean with regular follow-ups.

About the surgery

How many stages are there to surgery?

Implants are available to be used as a one-stage or a two-stage procedure.

• In the former, you undergo one surgical procedure to place the implants and you will be able to see a little bit of the metal covering the implant head in your mouth.
• In the latter, you have two surgical procedures: one to place the implant into the jawbone (the gum is replaced over the implant) and a second, minor, procedure to uncover the implant and connect it to the mouth.

After examining you carefully, your clinician will decide which procedure is going to be suitable for you.

Implant treatment involves two phases: the surgical phase and the restorative phase.

Surgical phase

Placement of the implant into the jawbone. The implant is then left to heal in the bone – this usually takes from three to six months but can be longer. If you require a bone graft this time is often longer. If you have a two-stage implant, you will have to have another minor procedure under local anaesthetic before the restorative phase.

Restorative phase

This involves taking a mould of the implant onto which the false tooth is attached. Depending on whether you are having a denture retained on implants, a bridge, or a crown, the restorative procedure will vary and this will also determine the treatment time.

The total treatment time is usually at least one year from start to finish.

How will I feel after the surgery?

During the first few days following surgery, you will feel some discomfort and swelling, during the next week or so it is very normal to experience some discomfort. Regular, simple painkillers can be taken to ease this. You will have had some stitches placed following surgery and your clinician will arrange a review appointment with you around one week after surgery to check that you are healing well and, if required, remove any stitches.

Can I wear my dentures after the implant surgery?

You may not be able to wear your dentures immediately after surgery for a few days. Following this healing period, your denture may need to be adjusted and relined.

What happens after the implant treatment is completed?

Once your treatment is complete, your implants need regular care to ensure they are functioning well. Meticulous cleaning and care of your implants is critical to ensure long-term success. Failure to clean your implants will lead to bleeding/swollen gums which can lead to infections in your bone and result in you losing the implant. Smoking is a significant risk factor to failing implants. As with crowns and bridges, the teeth on your implants will wear over time and may need replacement.

You will need to see your local dentist or hygienist every three to six months over the long-term in order to monitor your implants and provide any professional cleaning. This is very important in order to minimise the risk of any bacteria building up around the implants and causing bone loss and implant failure. Unfortunately the hospital cannot provide ongoing maintenance for dental implants placed in the department.

Can anything go wrong?

Complications may occur at different times during your treatment. All of these will be discussed with you before treatment.

During surgery

• Occasionally, it may not be possible to place the implants due to unforeseen circumstances. If this occurs this will be communicated to you clearly and the alternative options to replace your missing teeth will be discussed. In these situations, you may have to opt for the conventional methods of replacing your missing teeth.
• Bleeding is expected and to some extent encouraged during surgery in order to facilitate healing. It is extremely rare for severe bleeding to be a risk in dental implant treatment and your clinician will inform you if it is a specific risk for you.
• Altered sensation/ numbness of the surrounding area: this is very rare. Depending on where your implants are placed, you may suffer numbness of the surrounding area after the surgery. This usually resolves over time. However, very rarely, you may suffer permanent numbness.

After surgery

• Occasionally the implant fails to bond with the jawbone and has to be removed. Depending on the reason for the failure, it may be possible to replace the implant after a healing period.
• It is important to follow the post-operative instructions provided to you following surgery to avoid infection.
• Aesthetic failures, such as metal showing. These issues are usually dictated by your anatomy; your clinician can discuss with you if this is likely.

Long term

• Crowns, bridges or dentures may need refurbishment with time due to wear. This is not routinely provided by the hospital and will incur additional costs in dental practice. Additionally, the clips or screws retaining your false teeth (dentures) to the implant may break or wear out with use and may require replacement.
• Mucositis (inflammation around the gums) or peri-implantitis (loss of bone around the implant) can occur if the implants are not cleaned properly; this often warrants further treatment.

What do implants cost?

Due to the material from which implants are made they are an expensive treatment option. The cost of treatment depends on a number of patient-specific factors which include the number of implants you need and the type of treatment you have. The cost of restorative options for replacing teeth on your implants including dentures or fixed bridges can be discussed with you clinician.

NHS funding for dental implants is limited; strict criteria have to be met for acceptance onto this scheme.

What will happen if I choose not to have implants?

If you decide not to have implants and you wish to consider alternative forms of tooth replacement including dentures or bridges these options can be discussed with you.