INTRODUCTION:
This document gives you information about implants, the risks and benefits, and the responsibility of the patient for their maintenance.
It is also used as the consent document, and you will be asked to sign a copy on the day of your implant placement. We ask you, therefore, to read it carefully in your own time and to note any questions you may have. Please feel free to contact us with any questions you may have.
Implant Treatment
Each case is carefully and precisely planned. It is usual to take X-rays, impressions for study models, and often CT scans. From these a digital work up of the expected outcome is fabricated and a digital stent made to assist in accurate placement.
An implant comprises a fixture, an abutment and a crown:
- The fixture replaces the root of the tooth.
- The abutment is the support for the crown, or superstructure, and is screwed into the fixture after it has integrated with the bone.
- The crown is placed and usually cemented onto the abutment but screws may be the preferred option, especially in large cases.
The fixtures are allowed to integrate, usually for 3-4 months. Sometimes this can be longer dependent on bone quality. At this point an impression is taken over the head of the fixture(s) from which the abutment(s) can be selected. Following this period the fixture(s) are exposed.
Depending on the complexity of the procedure, there may be several visits at this stage for bite registrations and try-ins etc., before the crown(s) or bridge(s) are finally supplied.
As far as possible, we attempt to block book the appointments so that the shortest possible time exists between commencement and completion of implant treatment. However, with complex procedures, additional appointments may become necessary, depending on clinical presentation.
General post-operative sequelae following implant placement
Implant placement is a minor surgical procedure. As such it is associated with a small amount of postoperative discomfort; some swelling and some bruising.
Arnica may help with swelling reduction. You should be fine to return to work the day after the procedure. In the case of a full arch of implants we advise you allow up to a week off work. We also supply you with post-operative antibiotics to prevent infection. I would recommend an ice pack the evening of your treatment. You are advised to use ice over the next few days but more detailed instructions will be given at the time of placement.
When working in the lower arch, it may be that some post-operative tingling or numbness could occur. This is usually transitory.
Grafting Procedures and materials
A degree of grafting is sometimes required to enhance the long-term stability of the implant and/or to enhance aesthetics. As part of the procedure there is usually a small amount of your own bone that can be taken from the implant site. In cases where more bone is required we use bone substitutes known as Bio-Oss and Bio-Gide which are of bovine and porcine origin respectively, prepared specifically for bone grafting and bone reconstruction. Other alternatives to this may be Mineross, sterilised deproteinised donate human bone scaffold or synthetic bone, Ethoss. Generally the choice of material is determined on a case by case basis. These substitutes are safe to use and are already widely used in orthopaedic and reconstructive surgery.
Benefits of treatment
Implants are beneficial for the following reasons:
- Preservation of the jawbone.
- Maintenance of support for the soft tissues of the face.
- Prevention of unwanted tooth movements, tipping and over-eruption of opposing teeth.
- Avoidance of denture wearing.
- Preservation of adjacent teeth – implants avoid the wholesale reduction of teeth to receive crowns and bridges.
Success Rate
Implants that have been planned properly and have been carefully placed are very successful. The quoted success rates are 98% in the lower arch and 90% – 95% in the upper arch over a 10-year period.
It is, however, difficult to accurately predict success for an individual patient. Some patients do lose small amounts of bone. This does not necessarily mean the implant is lost. In others, there may be small amounts of gum recession that can expose the margin of the abutment. This could lead to soft tissue grafting or replacement crowns. However, in the majority of cases these are rare occurrences.
Other quoted factors that could lead to reduction in success rates include diabetes, smoking, certain medications, steroids and immunodeficiency diseases and inadequate cleaning or untreated periodontitis.
It is thought that persons who have had previous periodontal disease may be more susceptible to increased bone loss around implants.
In all cases, the likelihood of long-term success is dependent upon the patient’s level of maintenance. We strongly recommend that patients who have had implants should regularly attend an hygienist on atleast a 6 monthly basis.
Risks and complications
Careful planning and placement should minimise risk.
However, it is important to understand that there are major nerves running in the bone of the lower arch which could inadvertently be damaged. This could lead to a permanent sensation or numbness of the lip.
There is also the potential for damage to adjacent teeth during the placement of the fixtures. This could lead to the necessity to root fill an adjacent tooth or possibly even the loss of the tooth. Again, it is an unlikely complication.
It is also possible to perforate the sinus when working in the upper arch. The sinus heals very well and if there is any suggestion of sinus perforation, we advise additional action to prevent the onset of sinusitis. However, patients who have a history of sinusitis, or who have been long-term smokers are more at risk of developing sinusitis.
It is possible when working in the lower arch that the soft tissue of the floor of the mouth could be damaged, which could lead to excessive bleeding. In such a case, this could lead to hospitalisation. This is incredibly rare.
Implants are made of titanium, which is very well tolerated by the body. It is highly unlikely that rejection occurs.
Prosthetic conditions
Implants are superb replacements for teeth. However, they do feel ‘dead’ and have no ‘cushioning’.
As with anything mechanical, the crowns or bridge-work may be susceptible to fracture, wear and attrition and may need replacement. Very rarely there could be a defect in the manufacturing process and components may fracture or fail and need replacement.
Where a patient is known to clench or grind, we may ask that they wear a night guard to protect the prosthesis.
Aesthetic compromises may be necessary. In full arch cases it is difficult to achieve ideal gum shape. These sites are usually high and not visible in function. It can also be difficult to achieve ‘normal’ gum architecture around adjacent implants. Most gum margins however are very close to ‘normal’ and differences practically indiscernible.
Maintenance and patient compliance
- Plaque control is essential to prevent soft tissue peri-implantitis. We strongly advise all implant patients to regularly attend a hygienist.
- If a night guard has been supplied to prevent the effects of clenching, then we strongly advise that this is worn on a regular basis.
- Smoking should be avoided.
- Good diabetic control is desirable.
- Patients are asked to return on at least an annual basis for monitoring and review.
Patient Records
Radiographs and photographs form part of the dental record. Occasionally we may wish to share these with other colleagues for educational purposes. Unless you have any objection, your consent would not normally be sought, unless you could be recognised.
CONSENT FORM:
Procedures:
I consent to the above procedures as explained to me during my consultation appointment(s).
Records:
I consent to my patient records, including radiographs and photographs, being shared with professional colleagues and used for educational/training purposes.
