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.

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.

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.

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.

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.

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.

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!

Earlier this year, when we considered refreshing the Winning Smiles website, we wondered just how many people in our local areas of Romford and Brentwood (or our wider audience in Essex, London and Herts) would be using the Internet to look for implant and orthodontic dentists?

But when I discovered my aunt had been researching a new camera on the internet (I thought email was new to her) I knew that this electronic communicating thingumy was taking off!

So, a month or so in and we’re still on progress with the new site – click to leave a comment if you would like?, but recently we also had a visit from an 80 year old patient for a Dental Implant.

Here’s how it worked out by the way (click to enlarge)

When I asked him about Yellow Pages, he said that he used it as a doorstop, and he used the Internet for everything! To be fair to yellow pages, we do get quite a number of visitors from their Yellow Pages online site.

But that’s progress for you (the site and the implant).

“Before I begin, don’t you lot ever forget one thing: dentures are only ever better than nothing at all!“.

And this from the head of the Prosthetics dept. (the top specialist in false teeth – ed.)

Lower full dentures are bottom of the barrell.

With the tongue muscles getting in the way the poor old lower denture hasn’t got a snowball’s chance in hell of staying put. Meanwhile the patient struggles to speak and eat while it jumps around in the mouth with a life of its own.

Patients can’t eat solid food, they can’t speak for embarrassment, and often the movement of the denture causes friction-sores on the gum. What utter misery.

What’s more, there is absolutely nothing the concerned practitioner can do about it. Try as he might, adjusting adjusting adjusting, remaking, relining and rebasing – it just won’t fix it.

Miserable patient, miserable dentist.

But aren’t the alternatives too expensive?

Not necessarily. Enter the well proven implant-retained-denture.

Essentially the patient’s own denture can be modified with special fixings which then attach to 2 or 4 implants inserted in the lower jaw. The real beauty of this method is that it keeps the cost right down. There is no expensive bridgework and only 2 or 4 implants are required to hold that denture right where it is needed.

The treatment costs a fraction of implant-bridge treatment where up to 6 implants may be required, (coupled to 10 or 12 porcelain bridge units bonded to a metal framework.)

The implant retained denture can be removed for cleaning, but when placed in the mouth it is fixed solidly. This method can also be used in the upper jaw but more implants are required – but it’s not as great a problem as these useless lower dentures.

I’m sure that patients should rather be worrying about where to go out to eat!