Implant Consultation and Treatment
At an implant consultation a full assessment is made. This includes a full medical history to identify any conditions of significance, a thorough dental examination, radiographs and study models and photographs as appropriate. From this a written treatment plan and estimate is produced. A further appointment is then arranged to discuss the proposed treatment and answer any questions you may have. If you decide to proceed with the treatment then further planning would be carried out. There is of course no obligation to have any treatment. The cost of a full examination and treatment plan to include study models and routine radiographs is £95.00.
If you have good general health then dental implants will almost certainly work for you. However, habits such as heavy drinking or smoking can increase the number of problems associated with initial healing and thereafter may negatively influence the long-term health of gum and bone surrounding each implant. Smoking is a particular problem. Failure rates are double in smokers and therefore we would advise patients to give up smoking permanently. We do not place implants in patients who smoke. There are a few medical conditions, mainly diabetes and osteoporosis medication that are risk factors for implant treatment.
When you first enquire about dental implants it is often in response to an awareness of on-going dental problems or the recent loss of teeth. Each of these problems will need to be diagnosed and treated in a logical manner. Basic dental health, which includes the treatment of gum disease, repair of decay and the elimination of infection, is essential for the long-term success of your treatment.
By a combination of examination and x-rays there will be an assessment of the amount of bone present. Routine dental x-rays show large amounts of detail, but in only two dimensions. From these views it is generally possible to judge the height of bone available for implant placement, however, more advanced imaging techniques are sometimes needed to determine the equally important bone width, which can otherwise only be estimated from clinical examination.
There are now a number of advanced x-ray techniques which allow your jaw bone to be looked at in all three-dimensions. The most accurate and widely available is known as the CT (computed tomography) scan. Images obtained by CT scanning will normally be able to show all of the information required about your bone, including quantity and quality, but most importantly the presence of anatomical structures that must be avoided. They also allow implants to be placed onto the computer image and produce a guide for implant placement. Where a CT scan is indicated the costs would be fully discussed as part of the treatment plan.
Treatment times will vary from patient to patient and will depend for instance on the need for treatment of other teeth.
Sequence of treatment
1. Diagnosis and treatment planning.
2. Treatment of any conditions present in the mouth.
3. Construction of provisional dentures or bridge to be used whilst the implant integrates within the bone.
4. Placement of implants.
5. Healing period of up to six months.
6. Uncovering of the implant if it is buried.
7. Impressions and treatment to provide temporary and permanent restorations.
8. Reviewing and monitoring. Regular care is required for implants as it would be for natural teeth.
How long does treatment take?
For routine cases, from the time of implant placement to the time of placing the first teeth, treatment times is usually about 6 months. The availability of better bone can be used to decrease treatment time, whilst more time and care must be taken with poorer bone, which can therefore extend treatment times beyond six months.
If there is no reason to shorten the duration of your treatment then be prepared to wait - nobody loses an implant from being patient and allowing time for healing.
Can you wear teeth during the course of implant treatment?
If the teeth being replaced by dental implants are in a clearly visible part of your mouth it is most likely that you will want to have some teeth present whilst the treatment is underway
There are a number of ways that this can be done, ranging from simple plastic dentures to removable bridges. If replacement teeth are used during treatment stages it is important that they do not apply uncontrolled pressure to the underlying implants. You should expect to make a number of visits after the implants are placed and before they are brought into function, for small adjustments to any temporary teeth.
Comfort during treatment
It is important that you are comfortable during treatment. Implants can be readily placed with local anaesthetic.
Since the surgery normally involves exposing the bone in the area where the implant and/or bone graft is to be placed you can expect some minor swelling and occasionally bruising afterwards.
For most patients, any of the simple painkillers you might take for a headache will be all that is needed for a few days.
For some people where there is insufficient bone to hold an implant bone grafting may be necessary. We would discuss this with you fully.
Bone grafting can use your own bone or one of a number of substitutes. If bone grafting is required it will extend the treatment time. Sometimes grafting is carried out at the same time as implant placement. In case where this is not possible a period of six or more months healing may be required before implants can be placed.
Possible treatment sequences explained
One-stage implant - The implant is placed into a new, healing or healed extraction site and is visible above the gum immediately after placement. The advantage of this method is that a second surgical stage is not necessary to expose the implant. The implant will not normally be ready to support a tooth for several weeks or months.
Two-stage implant - The implant is placed into a new, healing or healed extraction site and then covered by a layer of gum so that it cannot be seen - this is the first stage. At the second stage some weeks or months later, the implant is uncovered and components added bringing it above the gum ready to begin placing a new tooth.
Same day implants - This technique is most often used to treat the lower jaw and requires considerable planning before the actual day of surgery. Several implants are installed and a few hours later a complete arch of temporary or permanent teeth can be fixed in place. If temporary teeth are used these will normally be replaced with a permanent bridge after a suitable healing interval. Not all patients are suitable for this style of treatment.
Immediate implant - For this technique a tooth is removed and an implant placed immediately into the extraction site. Depending upon the local bone and soft tissue conditions, the implant surgery may be a one- or two-stage procedure. Not all patients are suitable for this approach.
Immediate implant and early loading - This is distinctly different from an immediate implant placement. It is effectively a one-stage technique where the implant is placed into a new, healing or healed extraction site and is fitted with a new tooth at the same appointment. This first tooth will normally be kept out of direct contact with opposing teeth for a healing period of more than 3 months, after which it is finally restored. This technique tends to be more common in regions of the mouth where optimum aesthetics are important. Again, not all patients are suitable for this approach