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.
Comprehensive Eye Tests
Cataracts
Cataract is the most common cause of blurry vision in the elderly. A cataract is a clouding of the normally clear lens of the eye and usually affect both eyes, though often at different rates. While the rate of progression is usually slow, it sometimes matures rapidly in only a matter of weeks.
Cataracts are often a part of ageing and usually starts after age 60 but for some it can start as early as age 40. Not all cataracts are age-related. Cataracts can also occur from eye injury, taking certain medications or hereditary. They tend to occur more often in patient with diabetes and high myopia.
Symptoms
The typical symptom of cataract formation is a slow, progressive, and painless decrease in vision. It often starts as blurring of vision when reading or in sunlight or bright lights, glare, particularly at night; frequent eyeglass prescription change; a decrease in colour intensity; a yellowing of images; and in rare cases, double vision.
Surgical Treatment
The treatment for cataract is to replace the eye’s natural lens with an artificial lens made of biocompatible material such as silicone or plastic. The implanted lens is customized in terms of the lens power to manage the patient’s existing refractive errors to enable the patients to have better vision without glasses.
Glaucoma
Glaucoma is a disease which damages the nerve to the eye (optic nerve). It is caused by an increase in eye pressure due to a block in the drainage system of the eye. As a result, the natural fluids produced by our eyes accumulate and damages the optic nerve causing blindness. It usually progresses slowly with no pain, no redness or other symptoms until an advanced stage. The term for this is chronic glaucoma. Initially, only side vision is loss but if untreated, vision is lost progressively until only a small central ‘tunnel’ of vision is left. Glaucoma affects mainly the middle-aged and elderly. As the disease is silent, it is important for those above age 45 years to have their eye pressure checked at least once a year, especially if they have family members with Glaucoma or if they have diabetes or high myopia.
In some cases, the onset is sudden and termed acute glaucoma. This is caused by a sudden rise in the internal eyeball. There is severe pain in the eye, redness and blurring or loss of vision. There may also be nausea, vomiting and a one-sided headache. Some patients may see coloured rings or haloes. If there is sudden loss of rather than blurred vision, the eye surgeon will need to exclude other causes such as retinal detachment, block of either branches of the retinal vein or artery and diabetic eye disease.
Treatment
Vision loss due to chronic glaucoma is usually permanent. However, if diagnosed early, the raised eyeball pressure can usually be controlled by using pressure-lowering eye drops daily, and on the long-term. This either reduces the amount of fluid produced or assists in the flow of fluid out of the eye. It is a means of control, not cure as Glaucoma is a life-long disease. If control of the eyeball pressure cannot be maintained with eye drops, surgery or laser treatment may need to be carried out. Regular eye-checks are mandatory.
Diabetic Eye Disease
Diabetic eye disease is the leading cause of blindness in Singapore. Diabetes damages the blood vessels of the retina causing the blood vessels to leak blood and fluid into the retina. In the early stage of disease, vision is not affected unless the leakage of blood and fluid happens to involve the macula. Therefore, all diabetic patients should have their eye checked once a year by an eye doctor, even if they have no visual symptoms of blurred vision.
In more severe cases of diabetic eye disease, abnormal blood vessels start to grow on the surface of the retina. These abnormal blood vessels are fragile, bleed easily and cause scarring in the eye and blindness.
Examination
Diabetic eye disease requires a painless examination of the back of the eye. Eye drops are first used to dilate the pupils to allow the doctors to examine the retina thoroughly. A photograph of the retina is taken. Sometimes, a yellow dye is injected to do an investigation called fluorescein angiography before taking the photographs for closer analysis and management.
Management
Early detection and prompt treatment is important. A special laser machine produces a light beam that is focused on the retina to seal the leaking blood vessels or destroy the diseased portion of the retina to stop the growth of the abnormal new vessels.
If laser treatment cannot be used a surgical procedure, called vitrectomy, will allow the surgeon to operate directly on the retina within the eyeball itself. About 60% of these patients will have improved vision following the operation. In the past, these eyes would have been lost. Life-long follow-up of patients with diabetic eye disease is important to prevent a recurrence.