Dental Implants

How old, dodgy dentures have given way to beautiful, permanent replacement teeth

Truly transformational: the full arch titanium/acrylic fixed implant bridge:

Times (they are) a changing.  I’m actually not listening to Bob Dylan as I write this, but times are definitely changing in the world of UK dentistry, and where dentures are concerned, the change is accelerating.

20 years ago if you had lost all your teeth, false teeth or ‘falsies’ were your only option. Cheap and cheerful, available free on the NHS…and utterly hopeless as a functioning pair of teeth. Some of them looked ok and even stayed in when you were talking, sometimes!

20 years ago dental implants were in their infancy, only a few brave dentists with hugely rich patients ventured into such unchartered territory..

Fast forward 10 years and things had changed dramatically:

10 years ago if you had lost all your teeth (or a complete top or bottom set)  then it was possible to find a few dentists with the ability to replace a whole set of top or bottom teeth - but the costs, although vaguely affordable for those with serious property equity, were still somewhat eye-watering. A full set of porcelain teeth needed 10 implants to support them and each tooth was lovingly crafted – the dental technician would spend days or even weeks making them.

Some dentists realised that there must be ‘another way’ and started to use fewer implants to fix dentures in place: the implant-denture was born. The beauty of the implant denture is that instead of needing 10 implants to hold a complex custom made porcelain bridge in place, with the extra support that the implant denture gained from resting on the gums, the implant dentists could use fewer implants to hold these teeth in place:

Result! Dentures that stay put and can be used for eating most food without any fear of them falling out when discussing the latest episode of the Simpsons [Grandpa should have implant-retained dentures by now surely? -ed]

The only problem with implant retained dentures is that in patients’ eyes they are still dentures! They need to be removed for cleaning purposes every night….and no matter how well they stay in with their super-duper implant-connectors, they still have the ‘false teeth’ label.

2010

Enter the new era of ‘full arch’ implant dentistry [full arch: aka a top set, bottom set or complete set of implant-teeth].

Combining the ease of construction of implant-dentures with the satisfaction of having a set of fixed teeth that really feel like your own, without resorting to using 10 implants at a time and without the days and weeks of painstaking construction time at the dental lab…..it has become possible to completely replace a top set, bottom set or both for a rather less eyewatering fee than those huge ceramic bridges….

How?

This has been made possible by using digital scanning/CNC technology to produce titanium ‘backbones’ with micro-tolerances that are screwed into place on as little as 4 implants for a full set.

Top quality acrylic teeth are then firmly attached to the titanium backbone and the full arch titanium/acrylic fixed implant bridge is complete.

How do they look? The photographs speak for themselves.

At Winning Smiles prices start at £9500 and typical delivery time is 2 months from start to finish.

It should be fairly obvious that in order to fit dental implants safely and successfully, you need to have a skilled and experienced surgeon. But did you know just how much the procedure also relies on having incredibly precise 3D images of the jaw bone? These are the X-ray images that allow the surgeon to plan the exact position and placement of an implant and they make sure that:

-the implants don’t ‘hit’ any vital structures during insertion (like arteries and nerves)
-the implants are placed so that the final implant crown or bridge ends up in the right position in the mouth

So what are the consequences of getting this wrong?

-a numb lip (possibly forever)
-a haemorrhage during surgery
-teeth ending up in the wrong place and looking ‘goofy’!

At Winning Smiles we know how crucial this precise 3D imaging of the jaw bone is. That’s why we use the latest Specialist Dental CT scanner to produce 3D images of the jaws before surgery. These machines provide superb high resolution, high definition images. Armed with this level of information we have safely and successfully fitted around 600 dental implants in the last few years.

And because the new generation of ‘cone beam’ dental CT units work with a radiation dose many times below that of hospital CT Scanners, they are not only more convenient (the whole procedure can be carried out here at our clinic), but they are also much safer.

So if you’re looking for safe, convenient, successful implant surgery…..you can rest assured that that all comes as routine for you here.

An example screen grab from our Specialist Dental CT Scanner

The truth about Peri-implantitis….(which in English means HELP, my implants are failing!!)

I recently had a new patient consultation with a chap who had had a quote for implant work at another practice. Nothing extraordinary about that I hear you say….except that

he had been told – your implants will last a lifetime

Which prompted some immediate questions from me, like for instance

• who’s lifetime, the dentist, the patient or the implant?!
• who’s going to guarantee those implants for a life-time?

Because it’s all very well making longevity-promises to people but without a back-up plan and some ‘what-ifs’ in the

contract, those promises start to sound rather hollow!

Here’s what we do at Winning Smiles to ensure that our implants survive for the longest time possible

Having the right attitude helps!

1. Admit that implants can and do fail both short term and long term (denial is indefensible, see above)
2. Keep abreast of the latest evidence-based studies on what causes implant failure and what the best failure avoidance strategies are recommended – (Like the European Forum on Peri-implantitis held in London in January 2010)

Having a clear, well defined follow up protocol for each and every implant patient, tailored to individual needs eg

• - Regular implant-hygiene sessions with our implant-trained hygienists
• - Bi-annual inspections (x-rays when indicated) with the implantologist
• - Hygienists trained to carry out our screening protocol for signs of early problems (eg the beginning of peri-implantitis)

Giving patients the right information

• Peri-implantitis leads to implant failure if undetected (or not looked for – head in sanditis)
• 15% of implant patients will suffer from some form of peri-implantitis (from recent long term studies in Europe)
• Patients who have lost their teeth from gum disease have a much higher risk of losing implants
• Patients who don’t manage to keep plaque off the implants also at higher risk
• Patients who smoke have a much higher risk of peri-implantitis and implant failure
• Patients don’t know when they haver peri-implantitis because it doesn’t hurt, right up until the implant tooth falls out!

But look on the bright side!

• we detect problems early using our screening protocol
• we can treat them easily in the early stages
• late stage treatment is more complex but still possible

And most of all, as with teeth, as with implants: keep them clean, stay off the fags and please please turn up for routine checks

and maintenance…..implants are not fit and forget…

To: Our dental implant page

It is quite common that patients who are considering, or about to undergo dental implant surgery to be in the dark when it comes to predicting how much pain to expect.

We hope this will help understand the implications from

a) the surgery itself
b) during the recuperation period immediately post-surgery (ie the next week or two)

And although at Winning Smiles we always encourage new implant patients to have a chat with patients who have had the whole ‘implant experience’, most patients won’t actually take us up on that offer – even though our previous implant patients are usually very happy to talk about it!

So I thought it might be useful to pen a broad classification of what pain and trouble you might expect from our implant procedures here at Winning Smiles. All implant surgery is not the same, so I have divided it up a bit (with a note on sinus surgery/bone grafts at the end)

1) Simple implant surgery ie 1-2 implants, no ridge splitting, no sinus work, no grafting

No need for sedation unless you are a nervous patient

Pain during surgery: none

Recuperation period: 2 days, mild soreness around gums, most patients will go back to work next day without the need to take even an aspirin.

2) ‘Middle of the road’ cases ie 3-4 implants or 2 implants with ‘extras’ like sinus surgery/sinus ‘tap up’/simple bone grafting/ridge expansion

Sedation recommended

Pain during surgery: none! (No, really!)

Recuperation: 3-10  days. Mild to moderate soreness around gums, mild  swelling. Individual patients respond very differently in these cases.

For some patients it is very easy and they get only minor post-op soreness. At the other end of the spectrum a few patients will have to take painkillers for a few days and may bruise (in fair skinned patients the bruising can be quite noticeable).

3) Complex cases ie a whole upper jaw/lower jaw, 4-16 implants, ‘block’ bone grafts, etc

Sedation strongly recommended

Pain during surgery: none

Recuperation: 7-14 days. Moderate soreness around gums, moderate swelling, pain killers for the first week. Bruising can be quite widespread in fair skinned patients (ladies – buy concealer before you come!)

4) Sinus surgery:

no pain during surgery, little or no pain afterwards with mild swelling. Bruising on fair skinned patients.

5) ‘Block’ bone grafts – where we take bone from the chin or lower jaw and screw it into place somewhere else (often upper front area)

Ok, again we would expect no pain during the surgery but considerable soreness/bruising and some swelling for 1-2 weeks afterwards.

Similar to ‘complex’ cases above, it’s not something we enjoy doing to patients but in some cases the only way forwards – and they do work very well.

This is a lot of detail, but we find people would rather know these things up front, rather than find out after the event.

A video!

Andrew explains the pros and cons of the implants vs bridges argument and why he generally prefers to use dental implants to replace missing teeth these days. This is the blog about dental bridges referred to in the video.

Length: 1 minute 50 seconds.

Dental implants are an increasingly popular choice for my patients as I’ve been doing a lot of them recently.

So I thought it was about time I posted a few case studies. Here they are:

Tooth replacement and smile makeover: Case Study

A full set of replacement teeth: Case Study

Implant bridge: Case Study

Implant retained dentures: Case Study

I’d love to hear what you think – or if you have any questions about dental implants at all, please do post something in the comment box below.

Just recently we’ve had an unusual number of patients coming in with serious problems with single front teeth. Perhaps it’s something in the Essex water!

Among the causes of these problems are

• sports injuries (eg getting kicked in the face playing rugby)
• ‘other’ injuries (eg falling down the stairs or sliding on the ice)
• old crowns that have failed and cracked the root
• problems with old crowns with posts
• problems with root filled teeth

in these cases extraction is often the only option.

In the past we would have had to wait months after extracting the tooth before putting the implant in, and then a few more months of waiting before the implant could have a tooth added to it…..6-9 months of waiting with a temporary bridge in place…

With Immediate Implant techniques we can often bypass this waiting time: if the bone is intact around the failing tooth and there is no infection present then we can (very) carefully extract the root (without damaging the socket walls) and put an implant directly into the tooth socket!

And if the implant is secure in the bone then we can even put the titanium post into place and put a temporary crown on top.

Where appropriate this treatment means that the patient can literally come to the clinic with a failed tooth and leave a short while later with their new implant tooth in place.

Is it possible to walk into a dental clinic and have all your old broken, unsightly teeth replaced with shiny white new ones supported by titanium implants all on the same day?

The answer is yes in many cases – providing the case has been prepared carefully in advance.

Over in the States ‘immediate implants’ (also known as ‘teeth in an hour’) are becoming commonplace, and this technique has been available for about 10 years or so.

Here in the UK we tend to take a rather more cautious approach to our dental implant treatment so a number of us have been waiting on the sidelines to see what the outcome of these more radical treatments was going to be…. In other words, “will it work long term?”

The answer is yes once again.

We now have enough long term data (over 5 yrs) to convince even the more conservative of us that;

• immediate implant teeth work in the long term
• in some cases doing it this way can improve the aesthetic outcome
• this method can significantly reduce bone the bone shrinkage which occurs when teeth are extracted.
• the immediate implant technique can be used on single, multiple or full mouth cases

So there it is. Viable and better, in many cases.

Once again, as with ‘Painless Injections’ the future has arrived, all you need is comprehensive surgical training, advanced surgical equipment, and an open mind…..for the dentist, that is. Our patients are often the people who inspire us to strive to give them these gold standards of dental treatment.

No one mention drive through dentistry though, or it’ll be time to hang up the rubber gloves.

Did you know that dental bridges have been around for over a century?

Now I’m not one to decry something simply because its getting old – for example, I do love old cars (as friends will testify!), but how many of us would drive a 100 year old car as everyday transport? Wouldn’t that be uneconomic, wouldn’t it damage the environment?

Just like having dental bridges fitted, as it turns out.

The costs add up

The problem is, a bridge relies totally on the teeth either side for its support, and those teeth have to be drilled down to pegs would you believe.

So, installing the dental bridge actually weakens the adjoining teeth, and then to add insult to injury, the bridge leans on them for the rest of its life…..the dental bridge is ‘parasitic’. Bad for its environment.

The extra loads that that bridge imparts means those teeth are much more likely to fail in the long term……a single tooth loss leads to having 2 or 3 teeth missing…the long term costs go up.

Hardly an elegant modern solution

People should also know that with a bridge, the bone and gum underneath continues to shrink slowly over time.

At best this leaves a ‘dip’ in the gum above the bridge tooth and at worst a black hole (gap) appears so that everyone you smile at knows exactly where your false tooth is!

Dental Implants are the answer

The humble dental implant solves all these issues: It stands alone without interfering with its neighbours.

Over and above that, our bone loves the titanium surface of an implant tooth – and once an implant is inserted under the gum and into the bone, then the bone will not shrink like it does with a bridge.

The aesthetic and cost implications of implant teeth are just too good to ignore.

Let us retire the bridge, and give it the rest it deserves.

No really. I thought it was a joke at first.

Just the other day I had a gentleman turn up at my surgery for the first time with one of his front teeth missing. When I asked the obvious ‘what’s happened’ he said that his own dentist extracted the tooth but forgot/didn’t bother to replace it with a temporary tooth at the extraction appointment!

I have to say both myself and Victoria my assistant looked at each other and were too shocked to speak! (not for long -ed)

Now, I’ve had plenty of patients walk into my office with front teeth missing over the years but

• most frequently the tooth has been knocked out in an accident
• they walk out with a tooth in place where there was none before.

I find it utterly amazing that in the developed world in 2008 someone can walk into a dental office with a tooth (albeit a wobbly one) in place – and walk out with no tooth at all!!

Suffice to say, despite there being no time in hand to sort this problem out – we had a ‘working’ lunch – we had a new tooth built from scratch and glued into place in less than an hour.

Once the gum has healed where the tooth was extracted we will be putting an dental implant tooth in as a permanent solution.

Had the patient come to Winning Smiles, it may well have been possible to put the implant tooth in at the same time as the extraction. Unfortunately a few days late is too late, as the gum grows down into the socket making immediate implant placement impossible.
OK Rant over!