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Dental Implants Q&A

Additional frequently asked dental implant questions answered

What else can be done with dental implants?
Patients who have no teeth in their lower jaw may not be ready for multiple implant placements. For such patients, a conventional lower denture can be enhanced with two dental implants fitted below the front section. These implants are known as overdentures.

When applied to a patient’s upper jaw, the same procedure tends to entail a higher number of implants as the bone is usually softer. Although, like conventional dentures, implant-supported overdentures are still removed for daily cleaning, the implants make them far more stable once they are back in the patient’s mouth.

There are many options available to dental implant patients, and each individual case can be treated in various ways. As dental implant specialists in Cheltenham, we are here if you would like us to examine you and discuss your options with you.

Do you need to have a healthy mouth?
Often when patients first ask their dentist about dental implants, it will be due to recent loss of teeth or ongoing dental problems. Any such issues will need to be addressed in a logical manner to ensure a healthier status for the patient, and this may include the installation of dental implants.

It would be easy to focus on the glamorous cosmetic appeal of dental implants, but it’s important to remember that basic dental health, including treatment of gum disease, repair of decay and the elimination of abscesses, are equally vital to a patient’s treatment in the long run.

If you have noticed that you have bad breath, loose teeth or excessive bleeding after brushing, especially when your teeth are cleaned by your dentist, it is possible that you have periodontal (gum) disease. Dental implant treatment in the presence of reduced bone can be problematic, and as gum disease is a major cause of bone loss, it is important to treat this issue before receiving dental implants.

What other causes of bone loss are there?
When a patient loses a tooth or has one extracted by a dentist, a significant portion of the surrounding bone around the remaining root may be lost. The speed at which this can occur and also the amount of bone that is ‘resorbed’ depends on the individual, but without the right care from an experienced specialist, it will always happen to a certain degree. One of the most effective ways to curtail the bone loss is to install the dental implant very quickly after the extraction.

Another cause of bone loss is dentures. Patients often complain of loose dentures after they have had them for a while, and the aforementioned increased rate of bone loss following extractions is usually the cause of this initial problem. In the long term, however, the gradual loss of supporting bone is caused by chewing. After many years of having dentures, patients will require a reline procedure to compensate for this problem, so the longer a patient wears dentures, the less bone will be available for dental implants.

Can dental implants preserve bone?
One of the most significant benefits of dental implants once they have been installed is that everyday functional forces stimulate the adjacent bone, and in response to this, the bone grows stronger. Of course, each patient is different, and dental implants will have limits in terms of how much work they can do before they start to fail. As your local dental implant specialists in Cheltenham, we are happy to discuss your specific case with you in detail.

Many patients suffer from teeth grinding or clenching (a condition known as bruxism) which can cause them to exert too much pressure on their dental implants – and as this tends to happen at night, they have little control over this subconscious habit. Dentists can combat the detrimental effect of teeth grinding by placing additional dental implants, using restorative materials and equipping the sufferer with a bite guard to protect their new teeth at night.

What can be done if a dental implant fails to work?
A dental implant will eventually loosen if it fails to remain fixed to the surrounding bone. However, it will often cause no pain or discomfort for the patient and may not even need replacing as long as there are enough implants remaining.

It is not always the case that dental implant failures are this easy to deal with, and while the majority of dentists strive to achieve failure rates below 5%, this still means that around one in 20 dental implants may not achieve long-term function. It is wise to discuss the impact that a failed dental implant may have on your treatment plan, and we welcome you to book an appointment to visit us at our Cheltenham practice if you have such concerns..

Will my new teeth be joined together?
Yes. When we place multiple implants in a patient’s mouth, we join them together just like a bridge supported by natural teeth would be designed. And if there are sufficient dental implants available, it is usually easier and just as effective to make several smaller sections of bridgework each supporting a few teeth.

The quality of the surrounding bone and the quantity and position of the implants will affect which option will suit each patient. When we link implant-supported teeth, they are more robust than the individual parts and are more effective at resisting the forces of normal function that attempt to loosen the screw components, posts and/or cements that secure the underlying structure to each dental implant.

Is there anything I should know before I start my treatment?
Before we begin your dental treatment, we would provide you with a summary of your treatment planning discussion, outlining your current dental situation and informing you of alternative options to dental implants if applicable. We will give you any other relevant information such as the estimated duration of the treatment, the number of dental implants required and the estimated cost. We will therefore ensure that you are well informed of any treatment before you decide to go ahead.

What anatomical structures need to be avoided during dental implant placement?
There are no important risk areas in the upper jaw as long as the dental implants remain within the bone that used to support your natural teeth. For patients who are missing any upper back teeth, the region above the roots known as the maxillary sinus should be avoided, and this area will show up on most X-rays.
The most important anatomical structure to avoid in the lower jaw is a nerve known as the inferior dental nerve which runs from the area behind the wisdom teeth through to where your pre-molar teeth are (or once were).

Can dental implants be placed next to natural teeth?
It is standard procedure to place dental implants next to natural teeth. This is considered to be extremely safe unless the natural root happens to be very curved or angled unfavourably in the path of the planned implant, causing potential damage to the root. In most cases this can be avoided by careful planning prior to the surgery.

Is it uncomfortable when the implants are placed?
We place dental implants using the same form of anaesthesia used for routine dentistry as this is very effective and will minimise the discomfort that you will feel. In most cases the surgery entails exposing the bone in the area where the implant and/or bone graft is due to be fitted.

There tends to be some minor swelling and bruising post-operation, but most patients will just require some standard painkillers for a few days to keep the discomfort at bay. If you feel that you are in considerable discomfort despite the painkillers, please contact us at our Cheltenham practice.

What do I have to do before a sedation?
Prior to your implant surgery, we may ask you not to eat or drink for at least four hours. You will also require an adult to take you home, and you must refrain from operating machinery for up to 36 hours afterwards.

General anaesthetic
In cases where bone needs to be grafted from the patient’s hip to their mouth or where a high number of implants are being placed simultaneously, a general anaesthetic may be required, and this would involve admission to a hospital. However, the majority of patients will not need to undergo a general anaesthetic as conscious sedation is highly effective and considerably safer

What can be done if I do not have enough bone?
For some patients, the amount of bone loss they have suffered after the removal or loss of teeth means that they do not have enough bone left to support a dental implant. Fortunately there are solutions to this problem: sinus augmentation and onlay grafting.

Employing a procedure known as sinus augmentation, it is possible to boost the height of available bone in the upper jaw above the back teeth by creating new bone in the sinus. This technique provides implants for patients who would otherwise be unable to have them in a part of the mouth where teeth are so often missing.

Onlay grafting is a simple concept that involves taking a piece of bone from another part of the body and applying it as an ‘onlay graft’ to a deficient area. Over time, once the bone has successfully joined to the underlying region and has healed and matured, a dental implant can be placed in a more favourable position.

Are there alternatives to using my own bone for grafting?
Yes, there are other sources of bone available which have been prepared for safe use on humans. Just like with your own bone, these materials simply supply you with a scaffold into which the new bone will grow and consolidate so that you are eventually ready for your dental implants to be placed. The time it takes for the new bone to be ready can vary from three months to a year.

There are numerous ways of generating new bone, but one of the most common methods used today is ‘guided tissue regeneration’. It allows slow-moving bone cells time to fill a space by placing a barrier material between them and the fast-moving cells of the soft tissues lining the mouth. Originally the technique involved having to remove the barrier material during a separate surgical stage a few months later, but these days it is more typical to employ a resorbable barrier, which disappears naturally a few months later once it has performed its function.

Does bone grafting affect the length of treatment?
Yes, bone grafting will almost always prolong your treatment as it requires greater skill from the dentist than the dental implant procedure itself – but it will also dramatically improve the outcome of your implants. It can also lead to far more aesthetically pleasing results when used in the front of a patient’s mouth.

There are ways of shortening the length of treatment where bone grafting is used. For instance, a dentist may choose to perform the implant placement with bone grafting and the placement of a barrier membrane simultaneously. However, many surgeons still like to keep the bone grafting as a discrete stage, ensuring that the implants are only fitted once the bone grafting is deemed a success. Whatever approach is used by the dentist to maximise the bone quantity, it is usually well worth the time, energy and expense.