Dental Implants

Dental Implants are becoming more and more popular and are being used by people in replacement of dental bridges or dentures.

Our Dental Implant Clinic in London supply the latest dental implants using the most up-to-date technology there is available in Dental Implants.

There are two types of dental implants and our London based clinic can offer you both. The first type of a dental implant will happen in stages and can take between 3 – 6 months to complete and the other is known as an immediate dental implant taking up to 12 weeks to complete. Depending on the individual circumstances will depend on which procedure can be applied.

Surgical planning

Prior to commencement of surgery, careful and detailed planning is required to identify vital structures such as the inferior alveolar nerve or the sinus, as well as the shape and dimensions of the bone to properly orient the dental implants for the most predictable outcome. Two-dimensional radiographs, such as orthopantomography or periapicals are often taken prior to the surgery. Sometimes, a CT scan will also be obtained. Specialised 3D CAD/CAM computer programmes may be used to plan the case.

Whether CT-guided or manual, a ‘stent’ may sometimes be used to facilitate the placement of dental implants. A surgical stent is an acrylic wafer that fits over either the teeth, the bone surface or the mucosa (when all the teeth are missing) with pre-drilled holes to show the position and angle of the dental implants to be placed. The surgical stent may be produced using stereolithography following computerized planning of a case from the CT scan. CT guided surgery may double the cost compared to more commonly accepted approaches.

Basic procedure

In its most basic form, the placement of an osseointegrated dental implant requires a preparation into the bone using either hand osteotomes or precision drills with highly regulated speed to prevent burning or pressure necrosis of the bone. After a variable amount of time to allow the bone to grow on to the surface of the dental implant (osseointegration), a crown or crowns can be placed on the implant. The amount of time required to place a dental implant will vary depending on the experience of the practitioner, the quality and quantity of the bone and the difficulty of the individual situation.

Detail procedure

At edentulous (without teeth) jaw sites, a pilot hole is bored into the recipient’s bone, taking care to avoid the vital structures (in particular the inferior alveolar nerve or IAN and the mental foramen within the mandible). Drilling into jawbone usually occurs in several separate steps. The pilot hole is expanded by using progressively wider drills (typically between three and seven successive drilling steps, depending on implant width and length). Care is taken not to damage the osteoblastor bone cells by overheating. A cooling saline or water spray keeps the temperature of the bone to below 47 degrees Celsius (approximately 117 degrees Fahrenheit).

The implant screw can be self-tapping, and is screwed into place at a precise torque so as not to overload the surrounding bone (overloaded bone can die, a condition called osteonecrosis, which may lead to failure of the implant to fully integrate or bond with the jawbone). Typically in most dental implant systems, the osteotomy or drilled hole is about 1mm deeper than the dental implant being placed, due to the shape of the drill tip. Surgeons must take the added length into consideration when drilling in the vicinity of vital structures.

Surgical incisions

Traditionally, an incision is made over the crest of the site where the dental implant is to be placed. This is referred to as a ‘flap’. Some systems allow for ‘flapless’ surgery where a piece of mucosa is punched out from over the dental implant site. Proponents of ‘flapless’ surgery believe that it decreases recovery time while its detractors believe it increases complication rates because the edge of bone cannot be visualized. Because of these visualisation problems, flapless surgery is often carried out using a surgical guide constructed following computerized 3D planning of a pre-operative CT scan.

Healing time

The amount of time required for a dental implant to become osseointegrated is a hotly debated topic. Consequently the amount of time that practitioners allow the dental implant to heal before placing a restoration on it varies widely. In general, practitioners allow 2–6 months for healing but preliminary studies show that early loading of dental implant may not increase early or long term complications. If the dental implant is loaded too soon, it is possible that the dental implant may move which results in failure. The subsequent time to heal, possibly graft and eventually place a new implant may take up to eighteen months. For this reason many are reluctant to push the envelope for healing.

One-stage, two-stage surgery

When a dental implant is placed either a ‘healing abutment’, which comes through the mucosa, is placed or a ‘cover screw’ which is flush with the surface of the dental implant is placed. When a cover screw is placed the mucosa covers the dental implant while it integrates then a second surgery is completed to place the healing abutment.

Two-stage surgery is sometimes chosen when a concurrent bone graft is placed or surgery on the mucosa may be required for aesthetic reasons. Some dental implants are one piece so that no healing abutment is required.

In carefully selected cases, patients can be implanted and restored in a single surgery, in a procedure labelled “Immediate Loading”. In such cases a provisional prosthetic tooth or crown is shaped to avoid the force of the bite transferring to the dental implant while it integrates with the bone.

Surgical timing

There are different approaches to place dental implants after tooth extraction. The approaches are:

1. Immediate post-extraction dental implant placement.
2. Delayed immediate post-extraction dental implant placement (2 weeks to 3 months after extraction).
3. Late implantation (3 months or more after tooth extraction).

According to the timing of loading of dental implants, the procedure of loading could be classified into:

1. Immediate post-extraction dental implant placement.
2. Delayed immediate post-extraction dental implant placement (2 weeks to 3 months after extraction).
3. Late implantation (3 months or more after tooth extraction).

Surgical timing

An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rates for this procedure are now acceptable. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the dental implants at the same time as the surgery to place the dental implants.

Most data suggests that when placed into single rooted tooth sites with healthy bone and mucosa around them, the success rates are comparable to that of delayed procedures with no additional complications.

To find out more about dental implants and if you are suitable for such treatment and which dental implant system you would require contact our dental implant, London clinic. Our consultations are in depth and they are there for you to ask as many questions as you may have to help you decide if dental implants are right for you. Our clinic is situated in central London (Kings Cross) which has many links and an international hub, the EuroStar.

Dental implants are often the preferred tooth replacement therapy and only a lack of solid bone under the tooth socket can cause this treatment choice to be rejected.

Your dental implant will look and function like your original tooth – except that it will be impervious to decay.