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frequently asked questions |
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What
is a dental implant?
During
the last forty years the use of dental implants has changed dentistry beyond
recognition. Implants are no longer considered experimental but are now used
routinely the World over to replace a missing tooth or teeth. In fact, in the
United Kingdom we have been slow to use these newer treatments and trail behind
most of Europe in their use. They are, of course widely used in the USA.
In many
situations dental implants are the first choice for treatment as they offer the
best answer when all the advantages and disadvantages of different treatments
options are considered. It is rare to come across situations where they cannot
be used at all. John Grummitt has been placing dental implants since 1991 at
Compton Acres Dental Practice, West Bridgford, Nottingham.
The
dental implants John uses today are made from titanium, a material that has been
shown for over forty years to be well tolerated by bone. “Osseointegrated”
implants are dental implants that have “joined up” with bone in order to support
replacement teeth. John does not recommend other types of implants as they do
not have the same predictable and proven success rate over such a long period of
time.
A
dental implant is essentially a substitute for a natural root. The implants
John uses are a cylinder shape with a screw thread. Each implant is placed into
a socket carefully drilled at the precise location of the intended tooth. The
main aim during installation of any implant is to achieve immediate close
contact with the surrounding bone. This creates an initial stability, which over
time is steadily enhanced by further growth of bone onto the microscopic
roughness on the implant surface, when it fuses with the implant surface –
‘Osseointegration’.
In
order to support replacement teeth, the dental implants we use have an internal
screw thread that allows a variety of components to be fitted. Once fitted,
these components provide the foundation for long-term support of crowns, bridges
or dentures.
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How are
implants used?
Implants
are used to replace missing teeth. All the common forms of tooth replacement,
such as bridges or dentures can be replaced by dental implants.
If you are
missing just one natural tooth, then one implant is normally all that will be
needed to provide a replacement. Larger spaces created by two, three or more
missing teeth do not necessarily need one implant per tooth; however the exact
number of implants will depend upon the quality and volume of bone at each
potential implant site.
It is also
often possible to join natural teeth to implants with a conventional bridge.
In the
upper jaw, bone density is generally poorer than in the lower and if you have no
teeth at all, John will want to place a minimum of 5 - 6 implants to support a
complete arch of 10 or more replacement teeth.
In the
lower jaw, the bone towards the front of the mouth is often very strong and as a
direct result, fewer implants may be needed than are required to treat a whole
upper jaw. A simple treatment plan to provide 10 or more teeth in the lower jaw
might be possible with as few as 4 implants, although it is still more common to
use 5 or 6.
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What
else can be done with dental implants?
If you
have no teeth in the lower jaw, a conventional lower denture can be considerably
improved with two implants placed beneath the front section - this is called
an ‘overdenture’. The same overdenture concept when used to treat the upper jaw
will usually require more implants as the bone is generally softer.
Implant-supported overdentures, just like conventional dentures are still
removed for daily cleaning, however, once back in the mouth, the implants make
them much more stable as they “lock” into place.
Dental
implants have to obey simple engineering principles, in that they must be placed
in strong foundations with enough of them to prevent overloading. In addition
each implant must be accessible for daily cleaning so that the biology of the
mouth can be used to maintain healthy surrounding bone and gum.
In certain specific
situations it is sometimes possible to use
‘same day’ implants
but these can only be used in a limited number of situations. John can
discuss this individually with you.
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I have
teeth missing, am I suitable for dental implants?
Whatever
your age, if you have good general health, then dental implants will almost
certainly work for you. However, habits such as smoking can increase the number
of problems associated with initial healing and thereafter may negatively
influence the long-term health of gum and bone surrounding each implant.
Uncontrolled diabetes can also reduce implant success rate.
John
Grummitt has successfully placed implants in patients in their eighties, in
smokers and well controlled diabetics.
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Do I
need to have a healthy mouth?
When you
first enquire about dental implants it is often in response to an awareness of
ongoing dental problems or the recent loss of teeth. Each of these problems will
need to be diagnosed and treated in a logical manner, often prior to placing the
dental implants.
Although
it is tempting to focus on the more glamorous aspects of teeth supported by
implants, basic dental health, which includes the treatment of gum disease,
repair of decay and the elimination of abscesses will be just as important for
the long-term success of your treatment.
If you are
aware of bad breath, loose teeth, or have noticed excessive bleeding,
particularly when your teeth are cleaned professionally, you may have gum
problems. Periodontal (gum) disease is a major cause of bone loss and with
reduced bone; dental implant treatment can be more complicated. John Grummitt
has considerable experience in treating gum disease, having a Masters degree in
periodontology and restorative dentistry.
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I lost
my teeth many years ago, can I still have implants?
Whenever a
tooth is lost or extracted a considerable amount of the bone that once
surrounded the remaining root portion may disappear. This loss can be
particularly rapid during the first few months and is described as ‘bone
resorption’. Although the rate and amount of bone resorption is highly variable
between individuals, it will always occur to some extent.
Many
patients who have had dentures for years will report that after a while their
dentures become progressively looser and do not fit as well as they once did.
Initially the increased rate of bone loss following extractions is responsible
for the observed deterioration of denture fit. Over the long-term it is the
direct effect of chewing forces that causes slow resorption of supporting bone.
Most people who have had dentures for many years will have needed a reline
procedure to compensate for this bone loss. Therefore the longer dentures are
worn, the more the amount of bone available for dental implants may be reduced.
Fortunately, if there is currently insufficient bone for an implant or implants
to be placed there are many techniques to generate new bone or augment the
existing bone so that implants can still be placed. These can be discussed in
detail with you at your consultation and initial assessment stage of your
treatment.
John
Grummitt has helped many patients who have been missing teeth for many years by
providing them with implants. In some cases they have lost their teeth over
twenty years before but still been able to have implant based treatments to
restore their teeth.
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Can
dental implants preserve bone?
This is
one of the most important features of dental implants. Once in place and
supporting teeth, everyday functional forces stimulate the surrounding bone
which responds by becoming stronger and denser and helps maintain the bone.
Sometimes, the simplest measure to minimise bone loss after an extraction is to
place the implant immediately or within the first few weeks.
John
Grummitt therefore likes to place implants at the same time as the teeth are
extracted or in some situations (for example when there is an infection present)
a few weeks later. This helps preserve the bone and produces the best ends
result.
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I
grind/clench my teeth is that a problem?
Bruxism
- Patients who have a habit of clenching or grinding (bruxing) their teeth may
be at risk of overloading their implants. For most people bruxism occurs during
sleep, which is why they are generally not aware of it. Heavily worn or
flattened teeth, chipped enamel edges and/or regularly breaking pieces of
heavily filled teeth are the most common clinical signs of bruxism. The effects
of bruxism need to be considered during treatment planning and can be
compensated for by placing additional implants, selecting appropriate
restorative materials and providing a night time bite guard to protect the new
teeth.
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What
can you do if an implant does not work?
If an
implant does not achieve or cannot maintain ‘Osseointegration’ with the
surrounding bone it will eventually become loose and no longer be able to
support replacement teeth and may have to be removed.
The 3i
Osseotite implant currently used by John Grummitt is one of the most successful
and widely used implants in use in the World today. Their published success
rates are 97.2% at five years from placement of the implant and 99.4% success at
five years from when the implants are brought into function in normal bone
quality. However implants can fail to osseointegrate or be lost in the future.
If you
embark upon this type of treatment you have to be prepared to deal with the
possibility of failure of an implant. A failure rate of less than 3% is to be
expected, and it should not be forgotten that this means that 1 in 30 of the
implants placed might not survive in long-term function. It is important to
discuss how your treatment plan might be affected by the loss of an implant.
Commonly
the failing implant can be removed and if there are enough remaining, it may not
be necessary to replace it at all. Often another implant can be placed and this
one will be successful. Occasionally alternative treatments may need to be
considered.
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How
long does treatment take?
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