Implant

The process involved when a patient decides to get an Implant-based Restoration.

Stage 1: The consultation:

This appointment involves a detailed discussion of the patient’s needs and the various treatment options available within modern dentistry to achieve the desired goal. It involves a thorough examination, including any small radiographs if needed, to arrive at a provisional diagnosis and to have a preliminary treatment plan. During this appointment, the process involved, the further investigations needed like a CBCT scan, and the tentative cost involved will be discussed.

Stage 2: The preparatory stage and further investigative scans:

   Any treatment needs like the stability of periodontal (gum) disease, or if extractions of infected teeth are required, will be carried out in this appointment, some times it would take more than a few appointments to achieve the desired stability of periodontal and overall oral health before proceeding with any Implant placement.

Once the oral health is stabilised, a CBCT scan may be needed to assess and plan any Implant placement.

Stage3: Definitive treatment plan and Consent:

The final Implant treatment plan will be formulated and sent to the patient as a document. This document will discuss the final plan, the process involved to achieve the desired outcome, the shortfalls and problems that may arise, and the cost of the treatment. The patient can contact the practice to discuss any further queries and doubts about the treatment plan and is free to discuss any changes as per patient needs.

Stage 4: The implant procedure: This will be carried out as discussed in the final treatment plan.

Stage 5: The maintenance stage: This is an important stage where the overall oral health and the peri-Implant health will be monitored and maintained for its long term survival.

General information regarding Surgical Implant placement procedure:

What is a dental Implant?

Dental Implants are Screw like metal fixtures made from Titanium/Zirconium, placed into the jaw bone. Once placed, the implants are left in the bone for about 10-12 weeks, during which it fuses with the jaw bone by a process called osseointegration, after which the required crown or bridge are fixed onto them.

Dental Implants are shown to be a very good fixed option when restoring missing teeth. Research has shown high success rates of up to 95% over a period of more than ten years with Implant-supported restorations in the absence of factors like smoking and uncontrolled gum disease.

What are the alternative treatment options to restore missing teeth:

Other options, like removable dentures, can restore missing teeth, and if healthy adjacent teeth are present, conventional teeth-supported fixed bridges can be used.

Dentures are removable appliances, which is one of their significant drawbacks, and are less efficient during mastication and speech due to the inherent removable nature of the appliance; however, it can be an option if one does not intend to proceed with an Implant retained fixed option.

Bridges provide the option of having a fixed restoration but involve cutting away healthy tooth structure to accommodate the restoration, compromising the health of those adjacent teeth in the long run.

Timing of Implant placement after a tooth is lost:

After a tooth has been extracted, the bone around the tooth tends to slowly resorb; this natural process compromises our ability to place implants with good all-around bone support. There is a window of opportunity from extracting a tooth to about 8-12 weeks after the initial healing, during which an Implant can be placed with minimal need for grafting. However, in some cases, the Implant is placed at the same appointment as the tooth is extracted(immediate placement), which has obvious benefits, and in others, due to reasons like extensive loss of bone due to infection around the tooth, a bone grafting is carried out first, and then Implants are placed after about six months of healing.

Taking care of your Implant-supported restorations:

Implant-supported restorations require meticulous oral hygiene maintenance because plaque accumulation could cause gum disease and, in turn, affect the implants, progressing rapidly as peri-implantitis with loss of supporting bone and the eventual loss of implant-supported restoration.

Before the placement of dental implants, we would encourage you to improve your oral hygiene and show you how to carry out interdental cleaning measures using interdental brushes and floss. After the implant restorations are completed, you will need further review appointments, which will be decided depending on your particular case. You are advised to visit your own dentist at least once a year for your oral health assessment for the long-term maintenance of any implant-supported restoration.

What’s involved in the process of an Implant restoration:

Atraumatic extraction of existing teeth:

If an infected or failing tooth has to be extracted before Implant placement, then this tooth must be extracted with minimal trauma to preserve the tissues for future Implant treatment.

CBCT Scan:

In most cases, a CBCT scan of the area of interest will be taken about 6-8 weeks after the extraction. This will allow us to assess if sufficient height and width of bone is available and if further grafting is needed. A CT scan is essential in visualising and planning safe Implant placement with respect to any nearby important anatomical structures.

Additional procedures:

In some cases, when there are bone deficiencies, the area may need additional bone augmentation/ grafting. This may be carried out at the time of extraction, during implant placement, or as a separate staged bone grafting procedure, depending on a case-by-case scenario. Also, soft tissues harvested from the roof of the mouth will sometimes be used to achieve good soft tissue aesthetics, such as natural gum architecture.

The Implant placement procedure:

After achieving good local anaesthesia, using the recommended implant drills, carefully positioned holes are first prepared in the bone, followed by placing the dental Implant into them. If any simultaneous bone grafting is planned, this is carried out, and the gums are sutured back for healing.

In most cases, only a small metal peg attached to the Implant will be seen through the gum, whereas in some cases, the Implant will be completely buried inside the gum tissue and exposed at a later stage. Any temporary denture will then be adjusted to fit around the surgical area so that the patient can continue wearing it during the healing stage.

However, in some cases where sufficient stability is achieved at the time of placement, a temporary crown may sometimes be placed; this can only be confirmed after the Implant placement.

The Healing period:

Following Implant placement, the fixture is left in place to heal for about 3-4 months. This is the time the Implant takes to integrate with the bone, a process called Osseointegration, following which it can have sufficient stability to support any crown or bridge.

Uncovering and impressions:

After about 3 -4 months of healing, if the implants were buried below the gums, they would be uncovered under local anaesthesia, and a metal healing collar would be attached for the gums to form around it. This is a short procedure followed by Impression taking or scanning in about 6 weeks to construct any crowns or bridges.

Fitting of temporary or final restorations:

In some cases, if it is seen that we need additional gum shaping using soft tissue grafting or would need aesthetic and occlusal stability, a temporary or interim crown or bridge will first be fabricated as a trial prosthesis. This will be left in place for about 3-6 months, followed by the fabrication of the final restoration. This may take a further 2 -3 appointments.