So here’s the follow up to my last blog about fit and forget implants:

If you think that you might benefit from dental implants..

here’s a few questions to put to the dentist before you choose to go ahead:

Q. What guarantees do you offer on your dental implants?

Q. Will you replace an implant if it doesn’t take – free of charge?

Q. And in the long term – how will you ensure that I still have my implants in 10 years?

Q. What are the ongoing maintenance requirements for dental implants, and how much does that maintenance cost?

Q. Can I see some before and after photos of your work?

Q. Can I speak to any of your patients who have had implants placed by you? (Ask for testimonials)

Q. How long have you been placing dental implants?

Q. How many implants have you placed?

Q. How many of those implants have failed?

Q. Talk to me about peri-implantitis!

Q. I’m a smoker – am I still suitable for dental implants?

Q. I have had gum disease, this is how I lost my teeth (they got wobbly and fell out), will the same thing happen to my dental implants?

Its important to know everything before you choose, and of course, we’ll answer all these questions for you in the Free Consultation.  

I love talking my patients. They are my lifeline to the real world out there – you know the one where most people don’t spend all day every day think
This lady is one of my long standing dental implant patients – a few years ago we completely rebuilt her upper and lower jaws using custom porcelain bridges supported on titanium implants.ing about teeth (just ask my wife, it drives her potty!)

The thing is, they look as good today as the day we fitted them all that time ago. But this is no accident. Gill follows Laura’s (one of our lovely hygienists – yes they’re out there, honest!) advice to the letter. She cleans the bridges and implants twice a day, and visits us every 6 months for her Healthy Mouth Review to allow us to monitor the health of her mouth and implants, to clean those areas even she can’t get to, and to carry out our Oral Cancer Check.

This is routine at Winning Smiles.

Implants need as much – possibly more – upkeep than natural teeth…they are a great copy of the real thing (better than a chinese rolex) but even I don’t claim to have beaten mother nature at her own game!

So when Gill told me yesterday that she is coming across more and more people who are benefiting from this sort of dental treatment – but most of them can’t understand why she has to keep coming back to see us for what they see as ‘unnecessary maintenance’, I had to press her for further clarification! ‘Why.’ I said? And Gill went onto explain that these patients are popping into dental practices (yes,in the UK) and having implants placed ‘as if they are just expensive fillings’!

This is a worrying trend. Problems with dental implants rarely cause pain, so for a patient who has been advised in this way the first time they realise there is a problem with their dental implants might be the day they fall out! The fact that this may take 5-10 years is what is protecting both these dentists (and their patients – ignorance is bliss) for the time-being. But it’s a ticking time-bomb. These cheap ‘quick-fit’ (and forget) implants have been placed in the last couple of years as more and more of the profession learn about them – in response to greater and greater demand from patients….alas it is only a matter of time before the chickens come home to roost. And when they do, the only winners (as usual) will be the lawyers.

Leaving the cost issue aside, once implants fail it is not nearly as easy to do them a 2nd time. The bone around them disappears – which is why they fall out – so if they fall out, by definition there is often no bone left to put another one in….and this puts us right back to the 1970s: dentures for all.

Happy Easter. Lay off the eggs

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.

-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

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

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.

[media id=11 height="216" width="384"]

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.

[media id=9 height="216" width="384"]

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.

It reminded me that I should put ‘something on the website’ about this, as we’re really not here to judge anyone and people should not feel the need to be embarrassed (even if it is human nature).

You see, its only when people really need us that we get to make the most difference.

And if its not too selfish of us, we’d be delighted to see you.

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.