Dental Implant Surgery
Teeth serve an important role in our daily lives as it affects our speech, our ability to eat well and the way we look. Its loss through disease or trauma sets in motion the loss of underlying bony support resulting in tooth loss. This in turn affects support for our lips and cheek leading to a more aged appearance. Failure to replace missing teeth often leads to the opposing teeth overgrowing and the adjacent teeth tilting resulting in areas of food trapping which in turn may result in gum disease tooth decay.
What are the different ways of replacing missing teeth
Traditionally, missing teeth were replaced by either removable plastic or metal based dentures, or fixed bridges made of either metal alone, or porcelain fused to a metal base. Developments in dental material science have focused on developing more aesthetic materials with adequate strength, such as all-porcelain and zirconia bridges. While all of these are still very much in use today, implant based methods of replacing missing teeth are increasingly preferred as it provides greater biting ability and a more comfortable and natural feel.
What are dental implants?
Dental implants are sterile titanium screws which are inserted into the jawbone as artificial roots to support and retain replacement teeth. It comprises 3 parts. The first part or “fixture” is placed within the jaw bone to replace the roots of missing teeth. The second part or “abutment” emerges through the gums and is used to carry the 3rd part, which may be a single crown or a bridge depending on how many teeth are missing. If we have lost all our teeth, we can use 4 to 8 implants in each jaw which when connected can support dentures or even a fixed bridge
How do Implants compare with alternative options?
When compared with removable dentures, they provide stronger support, firmer retention and are more stable. The implant supported and retained replacement teeth occupy less space and are more comfortable. They are also able to generate much stronger biting force. When compared with fixed bridges, they can be used even when more teeth are missing as they can provide stronger support over a longer span. They are also preferred when the teeth adjacent to the gap are weak or too small to provide sufficient support. Additionally, they provide an alternative to trimming healthy teeth.
Benefits of Dental Implant
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Are permanent replacement for missing teeth
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Has predictable and good long-term success rate
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Prevents supporting bone from shrinking after tooth loss
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Does not decay as it is made from Titanium
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Able to generate stronger bite forces for better chewing and hence better digestion and nutrition.
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Restores appearance thus creating more confidence and self-esteem Able to provide better support for lips and cheeks for a more youthful look
Types of Dental Implant
Dental Implants have been widely used for more than 40 years since the original scientific research was published. While many different implant systems are now available and are generally of high quality, our clinic prefers using implants from Nobelbiocare, Sweden and Straumann, Switzerland due to the extensive research and long track record. These implants come in different sizes and lengths and are generally at least 3.5 mm in diameter and 8 mm in length which differentiates them from “mini-implants” which should be used only as temporary supports or in very specific cases.
Are you suitable for Implants
Implants can be placed in most patients from age 18-80, even if you have lost your teeth for many years as we are able to regenerate bone in order to place implants as a foundation for your denture or bridge. Patients with health conditions should inform the dentist so that additional precautions can be taken, if required. Conditions which require attention include patients with significant heart disease, unstable high blood pressure, uncontrolled diabetes and patients on therapy for cancer. Surgery can still be performed after clearance from your medical specialist.
What is the surgical procedure like?
After giving some local anaesthetic, a small incision is made through the gums and a point of insertion decided. Drills of a predetermined length and with increasing diameters are then used to gently prepare the site to receive the implant. The implant is then rotated to the desired depth. The top of the implant channel is then covered with a temporary cap and the gums stitched either over or across after cleaning the surgical site and allowed to heal undisturbed for 3-4 months. A higher temporary cap called a healing abutment is often placed to avoid a second surgery to uncover the implant.
Is Implant Surgery Painful?
No, implant surgery is generally a minimally invasive procedure and in most instances the pain is minimal. If more major treatment is required, some post-surgical pain may be present. If you are fearful, we can arrange for you to have a complete pain-free experience either by performing the procedure under intravenous sedation or general anaesthesia within an operating theatre. The mix of drugs given will help you relax, sleep and eliminate pain. You will also usually be given a painkiller to take before the procedure so that you will be comfortable after the surgery.
How long does it take to recover from the Surgery?
After the operation, you may feel uncomfortable but this can be eliminated by taking the prescribed painkillers regularly. Some swelling and bruising is to be expected for a few days after the surgery. You can resume normal activity within a day but should avoid strenuous exercise and swimming. A normal or soft diet is advised and can be commenced after the numbness from the local anaesthesia wears off, usually around 2-3 hours after the procedure to avoid biting your lip or tongue inadvertently.
Same Day Teeth Replacement
Rationale for immediate tooth replacement
Losing a tooth, especially one of our front teeth can be very distressing for most patients. In addition to the effect on appearance and confidence, it affects our speech and on the long-term, the gums and the supporting jawbone will also shrink. A common request from our patients is to get a replacement for their missing tooth immediately, hence the advent of protocols for "same day teeth replacement". This could be done by partially loading the implant on the day of the surgery, or more commonly by using the adjacent teeth as temporary supports.
How long does it take for healing after tooth extraction and implant surgery
Teeth extraction and implant surgery are fairly routine and painless procedures and you will feel back to normal in just a few days. However, it takes around three months after tooth extraction for the bone to reform before placing an implant. In addition, it takes a further three months for the bone to grow around the implant in order to anchor it firmly in the jaw. During this waiting period, removable dentures, or temporary bridges made of plastic are used to prevent direct forces on the implant allowing the implant to heal.
Can this waiting period be shortened
Yes, it is possible to reduce this waiting period as implants can often be placed immediately into extraction sites for patients with missing front teeth. This reduces the waiting times significantly. In general, we are able to place implants to replace our front teeth on the day of extraction as there is usually adequate bone around and beyond the tooth socket to stabilise the implant. For back teeth, it is not always possible as there is usually insufficient bone after removing the tooth. Very often a bone graft will also be needed and is therefore a more technique sensitive procedure.
Immediately Loaded Implants
If the implant lies firmly within bone, it is possible to even allow partial loading immediately after the surgery. In combination, with the latest computer assisted techniques, it is possible to deliver aesthetic looking temporary teeth in selected cases within 3 hours after the surgery. The patients are however advised to avoid chewing on the implant, especially in the initial weeks after the surgery when the original bone anchoring the implant would have been resorbed with the new bone yet to form.
Is immediate loading of implants a new technique
No, the first controlled study of successful immediate loaded implants was published in 1997 after a successful 10 year study. Our lead clinician has been placing immediately loaded implants since early 1999. The success rate of immediate implants are comparable to that of implants placed using conventional protocols but is more technique sensitive as it requires the dentist to determine if the initial stability of the implant is sufficient for immediate loading. Done selectively, it is a useful option for patients with no other remaining teeth to anchor a temporary denture or bridge.
Dental Crowns
Dental crowns are customised shells made from various dental materials to fit over cracked or broken teeth in order to rebuild them to its original form. In the past, metal or gold dental crown was often used but in today's age of social media, tooth-coloured materials such as porcelain or zirconia which are strong, yet aesthetic are popular choice. Dental crowns are also known as “caps” and besides protecting teeth that are weak, can also be used to change the shape, size and colour of teeth for cosmetic dental purposes.
What Is a Dental Crown Used For?
Dental crowns are used for both functional and aesthetic reasons, for example:
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to build-up a chipped, cracked or worn tooth
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to protect weak teeth (teeth with large fillings or after root canal treatment)
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as part of support for a dental bridge to replace missing teeth
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for cosmetic dental purposes, like covering misshapen or discoloured teeth
What are the Different Types of Dental Crowns?
A dental crown can be made from different materials depending on function and budget. Traditional dental crowns using metal alone, or in combination with porcelain (porcelain-fused-to-metal) generally cost less. While dental crown. it is still commonly used, the trend is towards using tooth-coloured materials such as full-ceramic (porcelain) or zirconia that look more natural. In addition, through the use of 3D computer technology to design and make these new generation crowns, the waiting time is far less as they can now be made within a day or two, and in some cases within 3 hours.
Pros and Cons of metal and metal-bonded crowns
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Metal crowns are strong and long-lasting but because of their colour, their use is usually restricted to the back teeth, and when the patient has very strong bite forces.
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Porcelain-fused-to-metal crowns provide a fair colour-match as tooth-coloured porcelain is layered over metal and then fused together in a laboratory.
They have a proven track record and in general last for between 7-10 years. However, there is a tendency for some of the porcelain to chip off, or for the margin of the crown to stain over time. They are a suitable long-term moderately priced solution.
Pros and Cons of porcelain and zirconia crowns
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All Porcelain crowns provide the most aesthetic and natural looking solution. Recent advances in technology have increased the strength of porcelain significantly and they can now be used even for back teeth.
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A popular option is E.max made of Lithium Disilicate by Ivoclar. Zirconia crowns are an even stronger option and is suitable for patients who grind their teeth but is more opaque. The recent introduction of multi-layer Zirconia has made the cosmetics comparable to all-porcelain crowns. They are also used when the underlying tooth is very discoloured.
What are post crowns?
Post crowns utilise the root canal of a tooth to provide the necessary retention and stability needed for a crown. In a badly broken down root-treated tooth, a post made of carbon fibre, a strong lightweight material, can be inserted into the root canal to provide a scaffold for a resin core to be built around it so that a crown can attach onto it. Alternatively, a mould of the canal can be made and a specially casted metal post made to fit into the canal. In either case, the tooth is then rebuilt sufficiently to receive the final crown.
What is crown lengthening surgery
Teeth may sometimes be too short to retain a crown or extensively damaged to below the level of the gum. A surgical procedure will be required to extend the crown margin or expose the edge of the defect. The gums are first pushed back to expose the underlying bone. A clearance of 3 mm is required between the level of the bone and the margin of the crown and the dentist may need to gently remove some bone before suturing. This procedure is known as crown lengthening and is required to enable the new crown to achieve a proper marginal fit. After healing a crown can be made.
Facial Symmetry, Proportion and the Golden Ratio
Cosmetic surgeons and dentists use the same concepts as artists in determining what is a pleasing appearance. The face can be divided into three equal parts based on imaginary horizontal lines drawn through the forehead, the brow, the base of the nose, and the tip of the chin. As the resting position of the teeth determine the lower facial height, tooth wear will lead to the lower third of the face being shorter and out of proportion. This can be corrected by crowning the teeth to increase the height of teeth and at the same time increase the facial height to the desired dimensions.
