Dental implants have gradually evolved to become the gold standard for tooth replacement. It has the potential to offer patients a more natural, aesthetic, comfortable and lifestyle friendly solution when compared to removable or fixed dentures. Dental implants are very versatile, it can be used to replace a single missing tooth, multiple missing teeth or function as an anchor to stabilize a removable full denture.
What is 'Osseointegration'?
Its construction consist of 3 main parts, a titanium rod that is anchored into the jawbone to replace the root of the missing tooth, an abutment that sits on top of the titanium rod, and finally a crown that fits over the abutment. Titanium is the material of choice because of its inert, highly biocompatible property with human tissues. This property allows for bone cells to attach and deposit bone around it, providing stability and retention. This phenomenon known as “osseointegration” occurs over a period of 3-6 months.
Benefits of dental implants.
Dental implants like our natural teeth have the potential to provide us with many years of service.
Keep your remaining natural teeth free from major restorations.
Dental implants eliminate the need for adjacent teeth preparation associated with traditional teeth replacement options using fixed or removable dentures.
Allow us to maintain our natural lip support and smile (age gracefully).
Dental implants help maintain alveolar bone thickness, which works together with the teeth to provide lip support and maintain the smile appearance.
Comfort and Convenience.
Dental implants are held in place by the alveolar bone itself, eliminating the inconveniences, discomfort and embarrassment associated with removable dentures, allowing patients to resume their normal lifestyle.
Dental implants have demonstrated good survival rates in conscientious patients, in many long term studies and are comparable to other forms of teeth replacement, if not better.
Dental implants mimic natural teeth in function. Its stability allows us to chew food and speak normally, without the fear of it dropping out. This has a direct impact on a person’s physical, mental and social wellbeing.
Excellent long term value.
Dental implants when placed early after tooth loss by experienced, competent surgeons in cooperative patients have a very high degree of predictability both in outcome and survival.
Who is suitable for dental implants?
Anyone who is physically well enough to undergo a routine dental extraction will often be fit enough for dental implants. Dental implants are not suitable for the growing child as their alveolar bone is still developing. There is no upper age limit for dental implant treatment for healthy adults.
Patients with existing chronic gum disease or systemic diseases will need to work with their dentist and physicians to achieve proper disease control prior to embarking on dental implant treatment. Smoking is a negative lifestyle element that will compromise the success of dental implant treatment. Many studies have documented incidences of poor wound healing and poor “osseointegration” in habitual smokers.
Patients who have lost their teeth for many years may experience significant alveolar bone loss. These patients will often require implant site preparation via bone grafting or sinus lift to ensure that there is adequate bone volume prior to implant placement.
What will the dentist do?
Firstly, the surgeon will carry out pre-treatment assessment by doing a clinical examination, taking x-ray or CT images, taking photos and constructing plaster models of your teeth. Thereafter, the surgeon will discuss the treatment options, procedure, risks and cost with you, to facilitate joint decision making.
Treatment often involves 2 distinct stages, a surgical stage and a restorative stage.
During the surgical stage, the surgeon will implant a surgical-grade titanium rod into the jaw bone under local anaesthesia. The implant site is prepared carefully using precision made drills under copious irrigation with sterile saline to ensure a snug fit. The incision is closed using stitches and allowed to heal. Patients who are easily anxious can opt to carry out this procedure under sedation or general anaesthesia. The procedure takes on average about 30 minutes per implant.
In selected cases, the surgical stage is carried out on the same visit for extraction of a tooth. Placing an implant in a fresh extraction socket have the benefit of reducing overall treatment time and convenience. The cost for such a procedure may be higher due to the need for bone grafting, as the root of the extracted tooth is often slightly larger than the titanium rod.
The restorative stage is carried out after successful osseointegration of the titanium rod. The period for osseointegration to occur may vary between 3-6 months depending on patient bone quality and quantity as well as the need for other adjunctive procedures during the surgical stage.
During the restorative stage, the dentist will proceed to expose the top part of the implant to fit an abutment. An impression is thereafter taken to enable the fabrication of a dental crown (cap) which will seat on top of the abutment. The dentist will also record the tooth shade using your natural teeth and the way you bite on the same visit. The fabrication of the final crown takes approximately 7 working days and will be fitted in on a subsequent visit.
What is the experience like?
The surgery itself is fairly painless as this will be managed using fast acting local anaesthesia agents. During the preparation of the bone, you may be able to perceive vibration or slight sensitivity.
The fitting of the abutment and crown during the restorative stage is relatively pain free. You are expected to help in the selection of your tooth shade and can expect some photographs to be taken. Patients who have high expectations with regards to the colour and shape of their crown may need to come in for more visits and incur additional cost as crown fabrication is done by hand. The crown is fitted in place once the dentist is satisfied with the way it contacts the adjacent and opposing teeth.
What to expect after the surgery?
You should expect mild bleeding and discomfort over the first 2 days after the surgery. You may also experience mild swelling and/or bruising of the overlying skin if you have had simultaneous bone grafting done on the same visit. You are encouraged to rest at home during the first 24 hours after the surgery. It is also recommended that you do not perform physical exercise and consume hot food or beverages during the first 48 hours. Painkillers will be prescribed to help manage post-surgery pain as needed. Please do not consume alcoholic beverages whenever you are on prescribed medication.
Keep the implant site clean by rinsing with the antiseptic mouthwash after every meal for a week. You can brush the other teeth as per usual. A follow-up visit with the surgeon is usually scheduled one week after the surgery to check on your progress and ensure that the implant site is healing well.
Your dentist will guide you on proper implant care and maintenance after the final crown has been placed. A follow-up visit with the dentist is usually scheduled three months after crown placement to check on your progress and ensure that the implant is being loaded normally. Thereafter like normal teeth, it is recommended that you adopt good personal oral hygiene habits and visit your dentist every 6 months for preventive care.
Are there any risks involved?
Like all other surgeries, the placement of dental implants does carry a number of risks. Common complications include the failure of osseointegration due to infection, sinus issues when placing implants in the upper molar region, injury to adjacent teeth and injury to vital structures (e.g. blood vessels and nerves) that lie within the jaw bone.
Your surgeon will explain to you the incidence of such complications and the likelihood of success as it may vary significantly between different individuals and site. Dental implant treatment is considered a complex treatment procedure that requires a significant degree of competence and proficiency on the part of the surgeon.
Like our natural teeth, its longevity will depend on a combination of good personal and professional care. The evidence over the last 25 years tell us that dental implant treatment can be a very successful treatment option for patients who are willing and ready to take an active role in their care and maintenance.