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| Notes for Implant Patients |
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The objective here is to answer any questions that may still remain after an initial consultation about your implant treatment.
* Dental implants – what are they and how do they work?
* Is there always enough bone or gum for implants?
* How does surgery take place?
* How will I feel after surgery?
* Looking after the area after surgery
* Wearing dentures after surgery
* Using temporary bridgework after surgery
* The healing period
* Crown or Bridge Construction
* How will my Implant Restorations Feel?
* What problems have been encountered in the past?
*Maintaining your Implant Restorations
* Post Operative Advice For Implant Patients
Dental implants – what are they and how do they work?
Dental implants are threaded titanium screw-like fixtures, which are inserted into prepared sites in the jaw bone. They may be used alone to support a single tooth crown, or in many different configurations to support several teeth, or a bridge.
Once inserted in the jaw, the bone grows around the implant and anchors it securely. Bone stabilises the implant, and in the long term, the implant should stabilise the bone.
The actual tooth restoration is connected to the implant by means of an abutment post. This abutment screws into the implant, and the dental crown or bridge is then either cemented onto the abutment, or alternatively, is itself screwed onto the abutment.
Dental implants have been used in a variety of settings for more than 35 years. Commercial use in dental practice has taken off exponentially in the last 15 years.
The technology we use was first developed by a Swedish researcher, Professor Branemark, and was further developed by NobelBiocare a large Swedish/ American company.
Is there always enough bone or gum for implants?
When teeth are lost, the supporting bone also tends to be lost over a period of time. Bone loss proceeds rapidly if there is or has been infection around a tooth. The amount of bone very often dictates the complexity of treatment. Where there is ample bone present it should be possible to produce an excellent cosmetic result, especially when restoring small areas.
Where there is just adequate bone, the procedure may still be straightforward, but there may be an element of compromise, eg, the teeth may look longer, or it may be necessary to add pink gum work onto an implant bridge to give the impression of a normal length tooth.
Placing an implant will help to stabilise the existing bone and avoid the bone loss which usually follows on from the loss of a tooth. Where bone is in a poor state it may be necessary to consider reconstruction of the area to replace missing bone, just to enable us to place the implant. It is also sometimes necessary to reconstruct the area with bone or gum in order to improve the appearance of the gum.
Sometimes, when the gum type is quite thin or when there is little supporting bone, shrinkage of the gum may take place to reveal more of the implant tooth, or even some of the implant components. This type of “recession” is not unlike what may sometimes happen to teeth, and may often be dealt with by replacing the crown or abutment if the area becomes visible. In highly visible areas this kind of treatment may be quite challenging.
How does surgery take place?
Of course every patient is a little different, and every tooth may be a little different. For specific information you must feel free to discuss any concerns.
In general terms implant placement is straightforward and comfortable. The most unpleasant part is the initial numbing up which may require two or more local anaesthetic injections.
One – three implants may be placed very comfortably in one session under a simple local anaesthetic alone. Some patients may prefer to have implants placed under a local anaesthetic supplemented with oral sedation.
For multiple fixtures many patients are happy to have the surgery carried out under local anaesthetic supplemented with intravenous sedation. In this event, we would ask a Consultan Anaesthetist to administer the sedation. This type of sedation leaves the patient in a very pleasant dreamy state in which they are essentially unaware of what is going on. Following this type of sedation many patients have no recollection whatsoever of the procedure, despite the fact that they may be chatting throughout.
With any type of sedation patients must be accompanied home, and should avoid driving, signing legal documents and having sole charge of small children for 24 hours. Patients must not eat or drink for six hours before sedation.
Having said all this, it is not unusual to find that some patients want sedation for one implant and that others do not want sedation even for multiple surgeries.
Surgery itself usually involves a certain amount of drilling, which is painless after local anaesthetic has been given. Sometimes the jaw bone is reshaped using pressure applied to special instruments which allow us to expand the available bone. Generally stitches are used which are removed four – ten days later. After surgery a small stud may be visible in the surgical area. It is also possible to place a temporary tooth for some patients. Most patients will simply continue with whatever temporary arrangement existed before surgery.
How will I feel after surgery?
Even without painkillers, pain is seldom an issue. However despite this, we will always make sure that our patients are provided with appropriate pain relief to ensure that post-operative recovery is as comfortable as possible.
Although severe pain is seldom an issue, swelling, and very occasionally bruising may occur. Bruising and swelling are usually only present in larger surgeries; if present, any swelling or bruising should disappear within a week.
Stitches are usually placed, and these are removed three – ten days after surgery. Some patients find the presence of the stitches irritating and frequently feel much happier when the stitches have been removed.
Patients who have had implants placed towards the back of the top jaw may occasional find that a little blood may come out of the nose. This is of no significance, and there is absolutely no need for concern. We would commonly ask patients having surgery in this area to refrain from blowing their noses for a 3 day period after surgey.
Straight after the first surgical stage you may see and be aware of a metal stud sticking through the gum. This is the “healing abutment” in place. This is intended to keep the gum open above the implant, and will not be part of the final restoration. Sometimes the implant is completely buried by the gum, until it is later uncovered in a “Second Stage”.
Looking after the area after surgery
For the first 48 hours after treatment the surgical area should be avoided when eating, and when brushing teeth. Hard, crunchy, and “sharp” foods, eg, raw vegetables, toast, or baguettes, should be entirely avoided for a week or so.
After two or three days gentle brushing of the surgical site may begin. The area will heal faster if plaque free. Often, there may be some slight discomfort during brushing and sometimes, this will be accompanied by bleeding; this is of no concern. As time passes the area will slowly become less sore to brush, and will eventually not bleed at all.
It is always important to use Corsodyl antiseptic mouthwash to supplement any brushing during the recovery period. Corsodyl will occasionally temporarily stain the tongue or teeth. This is usually only a problem when patients do not brush their teeth well. The “stain” may anyway be easily removed, with routine hygiene.
Wearing dentures after surgery
If you wear a denture, the ideal situation is to absolutely refrain from wearing it for a period of one – two weeks.
Clearly this is not a realistic proposition for most patients!
When a patient has to wear their denture immediately or soon after surgery they will have to expect some discomfort, just as someone who had foot surgery would expect some discomfort after surgery when wearing their shoes.
Any patient with a denture should discuss their expectations in this regard before surgery. For many patients, it is possible to make alternative temporary arrangements such as temporary bridgework, but this would involve greater complexity and consequently additional expense.
Using temporary bridgework after surgery
Temporary bridgework has the great advantage of protecting the surgical site without resting on it. This means that patients with temporary bridgework can get back to normal faster than patients with dentures.
Even when no teeth are present, temporary bridgework may be sometimes constructed on temporary implants, or on the definitive implants, if the bone anchorage is adequate.
Brushing should proceed essentially as normal from 48 hours after surgery. “Sharp” foods should still be avoided for some days, and if the temporary bridgework is based on implants or temporary implants, hard and chewy foods should be avoided for a specified period.
The healing period
Following implant surgery a healing period is generally necessary to permit the bone to bond firmly to the newly inserted implants, and to allow the gum to settle. If the bone is extremely dense and of a high quality, treatment may resume quickly; however if the bone is of poor quality, the healing period may be extended to two – six months.
During the healing period the implant area should be completely comfortable. Occasionally healing abutments may loosen, causing some local gum inflammation. Sometimes healing abutments may even unscrew and fall out. Please let us know immediately if there is any discomfort in the implant area, or if the abutment comes loose, as this situation may be easily resolved by simply retightening the healing abutment.
Any visible implant components should be kept clean in exactly the same way as your teeth are kept clean, with good brushing technique. It is important to maintain your normal hygienist maintenance program.
If a denture rests upon the healing abutments, or if temporary crown or bridgework is based on the implants or dental implants, then hard food should be avoided.
Crown or Bridge Construction
Crowns may usually be fabricated in two appointments. Obviously in aesthetic zones treatment may take longer just as provision of a conventional crown on a tooth may take longer, where shape, precise shading and optimal appearance is of the utmost importance. Bridgework will typically take three – six appointments depending on complexity.
Very many different types of bridge are available, with different advantages and disadvantages, made with a number of materials including gold, ceramic reinforced resins, acrylic, and porcelain. You should feel free to discuss any issues related to crown and bridge construction with the dentist who will be carrying out the restorative phase of your treatment.
How will my Implant Restorations Feel?
Implant supported crowns generally feel very similar to crowns on teeth. However, as there may be missing bone or missing gum tissue in the area, the implant crown may be slightly bigger or more “gappy” than the original tooth. Again, every situation is a little different; so much depends on the amount of bone loss around the tooth.
Similarly, bridgework on implants may feel similar to bridgework on teeth. However where there has been extensive loss of bone or gum tissue, and as the bridges get bigger, there will be many differences. Sometimes food will tend to collect under the bridgework, which is designed to be easily rinsed out, and cleaned out with interdental brushes or floss on a daily basis. Patients having teeth replaced at the front of the upper jaw will sometimes be aware of changes in speech. This is generally no more than a short term problem, particularly for articulate patients who will respond to the change, and rapidly compensate.
Patients who are having back teeth replaced will very frequently find that they bite the inside of their cheek or tongue from time to time, generally for the first six – twelve weeks after the bridgework has been fitted. This will resolve, as they reacquaint themselves with the feeling of having back teeth again.
All in all, the usual experience is that chewing, smiling, taste, and confidence will be enhanced by the move to fixed implant supported restorations.
What problems have been encountered in the past?
Implants are generally very reliable indeed, and failure is seldom a problem, especially when the implant has been placed in the relatively hard bone at the front of the upper jaw, or in the lower jaw. When implants do fail, however the failure usually takes place within 2 or 3 months of the surgery, before the restoration has been placed. Published success rates are better than 95% in good bone, and better than 90% even in poor bone. Our own experience, is of an even higher success rate than this.
Late failure of implants is extremely rare. Smoking and diabetes are the most important risk factors for Implant failure, but will also increase the incidence of less dramatic, but sometimes very frustrating problems with the gums, as a result of the substantial and well known effects on healing. If you currently smoke, giving up will have a dramatically positive effect on both implant survival, and problem avoidance. It will of course have a similar dramatic positive effect on the health of your teeth.
When cement is used to fix a crown or bridge, it is common practice to use a soft adhesive. This allows access to the implant later on, should any kind of maintenance prove necessary. This type of cementation process is extremely reliable, but occasionally a crown or bridge may become loose, especially if the pressure from the gum is high immediately after cementation, or very much later on if the soft cement dissolves away. It is quite unusual for a crown or bridge to actually fall out, but in this event it is generally straightforward to replace the restoration with new adhesive. In the unlikely event that a cemented on tooth loosened it is important to contact the dentist who made the restoration as soon as possible. Every attempt should also be made to keep the tooth in position until you have seen the dentist, so as to prevent the gum from growing over the implant.
Bridges held on by screws may also occasionally come loose, but when this happens it is generally a simple matter to retighten the retaining screws. Occasionally, abutment screws can also loosen, or screws may actually break. This is generally just a matter of retightening or replacing the failed screw.
The implant restoration itself is of course subject to the same kind of wear and tear and chewing forces that ordinary crowns and bridges, and indeed teeth, may be exposed to, and this means that there will be some wear and tear, occasional chipping, and breakages.
How long the restorations will last, will depend to some extent on what it is made from, and how challenging is the “bite”. Some patients have grinding habits, which will often significantly challenge their own teeth, as well as any form of restoration.
An insurance policy has been introduced for implant patients by CIGNA, which covers accidental damage to bridgework or loss of implants. For the vast majority of patients there are very few complications, however when there are problems it is reassuring to know that the financial impact is cushioned, allowing peace of mind for all. If you are worried about the financial upkeep of your implant work, please contact us for details.
Maintaining your Implant Restorations
Most implant restorations need to be maintained in very much the same way as conventional crown and bridgework, or indeed, the original teeth.
Implants and implant restorations are susceptible to many of the conditions that affect teeth; you must always be vigilant in guarding against gum problems with excellent home care and hygiene maintenance with the dental hygienist. We expect our surgical patients to see the dentist who is constructing their implant restorations at least yearly for a check-up.
The restorations themselves will be subject to wear and tear, just as crown and bridgework on the teeth are subject to wear and tear. Bridges constructed from Acrylic Resin or Ceramic Filled Resins on gold frameworks may well need to be resurfaced on an approximately 10 yearly basis.
Further Information You should feel very free to contact us to discuss any issue that occurs to you regarding your treatment. We pride ourselves on our approachability, and our experienced staff will always be pleased to help.
Post Operative Advice For Implant Patients:
Swelling
This may take up to 48 hours to appear, and is particularly noticeable if the upper jaw has been operated on, or where bone grafts have been carried out.
Discomfort
Is to be expected, but can usually be controlled by the pain killers that have been recommended to you. These tablets should be taken for the first two days even if the discomfort is not severe.
Bruising
Will sometimes appear two to three days after surgery, and would persist for up to a week. Bruising is most likely in patients with a slender build, and where there has been extensive surgery.
Bleeding
May occur one to two days after surgery. However a small amount of blood mixed with saliva will give the impression of far more bleeding than is actually taking place. Biting on a moist handkerchief for 20 minutes should relieve this. If significant bleeding continues contact us.
No smoking
Smoking has been shown to affect healing after surgery. The less you smoke the better!
Alcohol
In moderation is generally acceptable.
Ice packs
Place an ice pack over the area operated on. This will ease any discomfort, reduce swelling and help prevent bruising and bleeding.
Brushing
Do brush your teeth as normal avoiding the area operated until instructed to clean – generally one week later. This assumes that you are using Corsodyl Mouthwash, which is absolutely critical.
Mouthwash
Corsodyl mouthwash is an antiseptic mouthwash, which will help to keep the surgical area clean at a time when it is healing and difficult to brush. It must be used gently three times a day to assist healing and prevent infection. Frequent use over a long period of time may result in temporary staining of the teeth and tongue.
Diet
A soft diet is recommended for the first two to three days after surgery. Pasta, rice, soup and yoghurt are all great soft foods! Avoid bread, toast, crisps, and raw vegetables. |
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