FAQs

Q?Metals in dentistry

A.

What metals are used in Dentistry

The application of metals in teeth care probably began during prehistoric times with the use of various types of metal bands, orthodontic appliances, and replacement teeth by the healers or shamans of various ancient civilizations in North Africa, South America, Europe and elsewhere.

Titanium Dental Implants

Many patient have asked questions about metals used in dentistry. The most common metal alloy used in dentistry, amalgam became popular teeth fillings starting in the early 1800s. Amalgams are metal alloys that contain mercury as the primary ingredient. Amalgams include various other metals, such as silver, tin, copper, etc. For many years, amalgams became the tooth filling of choice for those who were looking for durability, convenience, and low cost. Today composite resins have been shown to be less harmful to your general health.

Modern dental braces were initially available only as metal wires that were made from a few types of metal alloys such as stainless steel or titanium. Artificial crowns and teeth bridges can be made from metal alloys that contain gold, palladium and platinum (which are noble metals), as well as silver, copper, and tin (base metals).

Until recently, dental implants had been made mostly from the purest available grades of titanium metal and titanium-aluminium-vanadium alloys or aluminium oxide ceramics. The abutments that connect dental implants to prosthetic crowns had (until recently) also been made mostly from titanium metals or alloys. There are also some custom-manufactured dental implants that are cast from chrome-cobalt-molybdenum alloys. Recently though, the newer non-metal (ceramic) zirconium dioxide dental implants have become more popular over their established metal counterparts, which have been in widespread use since the 1970s..

Titanium Dental Implants

The metal and metal alloys that have been applied for use as dental appliances are all highly non-reactive to surrounding bone and soft tissues. These biocompatible metals and metal alloys form very tough but thin oxidization layers as soon as they come in contact with ambient oxygen during manufacture. The ability to form durable, thin, and inert oxidation layers is the reason why titanium metal and the aforementioned metal alloys are suitable for in vivo prosthetic functions.

Also, many dental instruments are, quite obviously, made partially or wholly from metal alloys, particularly various grades of stainless steels and high- speed steels (for drill bits). Various kinds of examination, surgical, and restorative instruments are made from or have substantial metallic components.

Metals and metal alloys play an important role in dental care. Although ceramic-based dental products have become widely available, metals and metal alloys will still most likely remain as one of the most important classes of materials in dentistry.

Q?Smoking and alcohol during implant treatment ……is it safe ?

A.

Both smoking and alcohol consumption during implant treatment can reduce the survival of dental implants (and teeth). If you think that either of these two social habits could be a problem during your dental implant treatment, it is recommended to discuss this in detail your dental implant surgeons. In severe cases it may be advisable to avoid this form of dental treatment or accept the higher risk of implant failure.

Q?Dental implant problems

A.

Dental implants are a safe and predictable alternative for missing teeth. Dental implants can provide natural looking fixed teeth replacements. The success rate for dental implants is higher than 95%. However some times problems do occur and if this should happen to you, it is recommended to contact your dental implant clinic (who carried out the treatment) as soon as possible. If you are unavailable to contact the clinic which placed the implants it is recommended to find an implant dentist who is close and convenient for you to attend.

In a very small number of cases dental implants can fail. Should it be discovered during a routine maintenance visit that an implant has failed or is failing, appropriate remedial action will be planned accordingly. Implants that become loose will not retighten and should be removed at the earliest opportunity. Should you notice any areas of soreness, discharge or pain on chewing near any implant or tooth you must immediately report this to the dentist responsible for your maintenance.

Porcelain crowns attached to implants may break as they can when attached to natural teeth. However, removal of crowns from implant for repair is usually easier than from natural teeth. Implant supported bridges that become loose should be retightened immediately to reduce the likelihood of further unnecessary damage.

Q?Reporting problems ?

A.

If anything arises that you are concerned about, telephone immediately. Usually there is nothing to worry about, but no matter how apparently trivial, it is always better to check.

Unlike teeth, implants cannot get tooth decay. However, like teeth, they can suffer from gum problems. Teeth with untreated gum problems can become loose and be lost. This is also true of implants. Thorough daily cleaning is as important with implants as it is with teeth. It is important that regular checkups are carried out yearly. In most cases review appointments will be more frequent during the first year that the implants are in function.

To ensure that any problems are detected early, regular maintenance check ups are advisable. Problems are more easily treated if detected early. Check ups may be recommended three, four or six monthly. Regular checkups are every bit as important as they are with natural teeth, if not more so!

Q?I have had implant surgery and I am now in pain. Is something wrong ?

A.

The after effects of having implants placed are usually mild and may include bruising, dull aches, and swelling, the amount of which will vary dependent upon the number of implants placed and the difficulty of the surgical procedures. Patients having multiple implants and bone grafting procedures will generally experience more pain. Painkillers can be used during the healing phase. If you are unsure about the pain you are experiencing contact the clinic. If you are unable to contact the clinic, contact your local emergency dentist or your local A & E.

When choosing a date for implant placement avoid significant social engagements and work commitments for at least a week after. This is just to be on the safe side. Taking time off work is not usually necessary.

Q?What is a CT scan ?

A.

The conventional x–ray views most familiar to patients are only 2–dimensional and subject to varying degrees of distortion and inaccuracy. Where important anatomical structures must be avoided, the information they provide may therefore be inadequate. The CT scan in contrast can provide life sized 3-dimensional information of all regions of the upper and/or lower jaw from which precise measurements can be taken for pre-operative treatment planning. In some cases the CT scan may also be used to evaluate the results of bone grafting procedures prior to placing implants.

Q?How long does a Teeth-on-4 acrylic bridge last ?

A.

At Brighton Implant Clinic we have provided acrylic bridges for patients now for the last 6 years and during that time we have noted that teeth do wear down or even fracture. I would say this happens in 10-15 % of the cases. If the bridge breaks during the treatment or during the first year after the treatment has been completed, then there will no charge to have this rectified or remade. If however you have any problems after the first year you may be required to pay for a repair of the bridge. If you wish to avoid any future potential costs you may wish to join the implant guarantee scheme. For a monthly fee you will be able to cover the cost of any breakages or repairs once you are outside the guarantee period.

Q?What happens if after Teeth-on-4 surgery my implants are not stable enough to support a fixed bridge

A.

It is very unlikely that we would not be able to provide you with a fixed provisional bridge on the implants following Teeth-on-4 surgery. If however one of the implants were not stable we would provide you with a bridge on the implants which are stable. It would be very unlikely that all the implants failed the stability test however in a worst case scenario you would be provided with a removable denture. This would be for a period of 4-6 months while the implants healed and became secured and anchored in the jaw bone. After this stage we would test the implants again and if they were stable we could provide you with a fixed acrylic provisional bridge

Q?how much do implants at Brighton Implant Clinic cost ?

A.

The simplest case which requires only a single tooth, would cost £995, provided you have sufficient bone present in order for the implant to be placed.

Q?What are implants?

A.

Missing teeth can often be replaced by implants. Implants act like roots of teeth. After they have been fitted and have healed in place, dentures or crowns may be attached to them. When dentures are held in place by implants they do not slip around. If crowns are fitted on implants, they act like normal teeth.

There are various types of implants; however, the most commonly placed throughout the world are often described as root – form or endosseous implants. These generally have a cylindrical form and may be threaded on the outer surface to assist placement. Other designs such as blades or subperiosteals whilst in use by some practitioners are not the focus of this information. The success and rapid growth in popularity of the root – form implant is largely due to its predictable behaviour when trying to achieve a rigid fixation with the surrounding bone and the maintenance of this state throughout many years of function.

Implants can only be placed if there is enough bone present in the jaw. When teeth are lost, the bone around the teeth gradually disappears. If too much bone has been lost it is sometimes possible to grow bone in its place.

Q?What happens during the FREE implant assessment ?

A.

During the initial assessment the dentist will assess why dental implants may be needed. A thorough examination usually takes into account what happened prior to losing teeth. Sometimes the cause of missing teeth could be genetic, trauma, tooth decay or gum disease. The dentist will collect as much information as possible as to what caused the tooth loss. It is very important that patients are medically fit to have implant treatment. A thorough medical history questionnaire is completed prior to the initial assessment.

Impressions are taken of the current status of the mouth. This will help the dentist discuss the case if needed with the dental laboratory or colleague.

Radiographs are usually taken to identify tooth positions, decay, anatomy of the jaws and general health of the jaw bone. At Brighton Implant Clinic there is NO CHARGE for radiographs, both small radiographs as well as Panoramic Radiographs.

Photographs are taken of the ‘before’ status of the mouth. This will help the dentist and laboratory to accurately plan the implant treatment.

In some circumstances, a more comprehensive three dimensional scan may be required. At Brighton Implant Clinics we have in house Cone Beam CT to facilitate accurate planning for implant surgery.

Q?My dentist has recommended that I see a hygienist before having implant treatment ?

A.

Implants survive best in a healthy environment. Any tooth decay or gum problems need to be corrected before implants are placed to give them the best chance of success. This may involve seeing a hygienist for a thorough cleaning to remove plaque deposits or debris. The hygienist will also show how to use special brushing methods, flossing, tooth picks and small “bottle” brushes. Sometimes more extensive gum treatment may be necessary. In this case you may recommended to see a periodontist first. Periodontists specialise in the treatment of gum disease and the associated tissues.

Q?Why can’t implant treatment commence until problem teeth are addressed ?

A.

It is vital to treat or remove all pre-existing oral infection wherever possible. The success of implant treatment can be seriously affected by infections resulting from failed gum or root canal treatments. Long standing infections of the soft tissues beneath dentures can also adversely affect healing at the various surgical stages. Your treatment may be delayed whilst these areas are resolved.

Although gum infection arising in opposite jaws have no clearly proven link with problems around implants, there is at least the theoretical risk of bacterial transmission; therefore for the meantime it would be considered prudent to assume that there is a risk. Your mouth should be treated as a whole and not simply as unrelated regions.

Q?How many implants?

A.

Usually to replace a single tooth, at least one implant is needed. In a small number of cases it is possible to replace 2 teeth with just a single implant. When replacing three teeth two implants will be required as a minimum. It has been proven that as little as 4 implants can be used to support unto 12 teeth ( this is of course provided that the implants are correctly positioned and correctly placed). Dental implants need to be correctly positioned to allow the stresses of biting to be spread evenly, thus diminishing the load on each particular implant.

Q?Is the implant surgery itself painful ?

A.

Generally speaking, having implants isn’t painful. Most straight forward cases are carried out under local anaesthetic. For anxious patients or the more complex procedures it is recommended to be sedated during the surgery. Intravenous sedation can make dental implant surgery a lot less stressful. Most patients sleep during the procedure and this makes the entire procedure more comfortable.
What is it like after having the implants placed?

Q?Why do I need bone grafting ?

A.

It is a natural phenomenon that after teeth have been removed the bone that once supported them slowly resorbs away. This occurs faster when prolonged gum problems have been present or poorly fitting dentures are being worn. The result is that there is sometimes not enough bone to support implants.

When there is not enough bone present, it may be necessary to create new bone to fill in missing areas allowing implants to be fitted. A variety of techniques are available to do this and these are referred to as “bone – grafting”.

The bone used in these situations may be specially treated donor material from a “Bone Bank”, a synthetic substitute, or taken from areas in the mouth where there is some spare. In special cases where larger amounts of bone are needed, it is possible to move bone from other places such as the chin to the deficient area of the mouth. The area from which the bone is taken will regrow.

If bone grafting is required to increase the amount of bone into which implants are placed, it will generally mean that the time taken to complete treatment will increase as well. Under routine circumstances where no bone grafting is required the implants are commonly ready to begin function between 3 and 6 months later. If the bone grafting can be undertaken at the same time that implants are placed, treatment is more likely to take 6 to 12 months. Where implant placement must be delayed until after maturation of the bone graft, overall treatment may take 12 to 18 months.

Q?Sinus augmentation why is it needed ?

A.

It is very common to find that the softer bone in the area above the upper back teeth (molars and sometimes premolars) is very shallow and not suitable for normal implant procedures. To solve this problem a procedure know as a “sinus augmentation” or “sinus lift” was developed.

Bone may be successfully grown in the sinus spaces above your upper back teeth allowing implants to be placed. Specially treated donor bone from a “Bone Bank”, synthetic bone substitutes, or bone from other areas of the mouth or body is placed into these empty areas. Over a period of time this is replaced by new bone thus providing a bed into which implants can be fixed.

If the amount of bone overlying the sinus is adequate, some surgeons prefer to place the implants at the same time as the grafting procedures. Whatever type of bone is added to the sinus it must be left to mature before implants are placed or brought into function. If the implants are placed as a secondary procedure, (depending on the amount of bone being grown and the nature of the graft material used), they can be inserted after four to nine months, although occasionally it may be necessary to wait longer.

As with other bone grafting procedures, the implants are left to become firmly attached to bone. Commonly a slightly extended healing period is chosen with an average of six to nine months before a denture or crown and bridgework is fitted. However, all bone grafting is unique to each individual and this information is for guidance only.

Q?Additional procedures at the time of implant placement

A.

Additional procedures

Despite the thoroughness of the planning, extra procedures are sometimes required during treatment to procedure the best results. It is important that in this event you accept that appropriate alternative treatment is performed at the same time of treatment, although it may be different to that already planned.
Fee variations

During treatment fees may vary due to:
# • Alternative procedures required due to changes in the treatment plan.

• New treatments becoming available in the course of you treatment.

• Treatment extending over a longer period of time than expected.

If for some reason it is not possible to proceed with the planned procedure at the treatment appointment, the time spent will be charged at the normal hourly rate. An alternative treatment may be performed if considered appropriate.

Q?After implant placement

A.

Bone loss after Implant Placement

Sometimes bon may be lost around an implant. There are techniques available to treat these problems if the cause can be identified. In some situations however, progressive bone loss might results in the loss of the implant.
New advances
New techniques and materials

Implantology is a rapidly advancing science. We may take advantage of some of the new procedures or materials as they become available if they promise to significantly improve the outcome. Alterations to your original plan may therefore be made during your treatment.

Q?How long does the treatment take to complete?

A.

The need for patients

This depends on the complexity of the treatment. Initially there is a treatment planning stage, which may last a month or so. Then there may be some time spent on such preparatory procedures as improving gum health, removing any unsavable teeth and growing bone. This may take anything from a few weeks to many months.

After the implants are placed they are left so to settle in place from three to six months. The final fitting of crowns or bridges or the attaching of dentures to the implants takes a month or two. The time depends on your individual situation. In some cases the implants are suitable for immediate function with either transitional or permanent teeth fitted at or soon after the placement.

Special medication will be prescribed for you to help healing and produce minimal discomfort. To gain the most benefits please follow the instructions given.
Do not rush your treatment
Respect nature

It is important that neither the patient nor the implant provider attempt to rush the treatment or try to advance the various stages faster than the time required for complete healing and maturation of bone and soft – tissues.

Even treatment that is well – planned and executed can fail as a result of moving too quickly from stage to stage. If you do not have the time available, then it may be more sensible to consider conventional forms of dentistry, which can be completed more rapidly.

Your implant provider may suggest that procedures to grow bone are undertaken separately from placing the implants, even though under certain conditions it is possible to combine these stages.

Q?Denture wearers immediately following surgery ?

A.

Denture wearers may require their dentures to be modified or be asked to leave them out for a period of time to prevent them resting on newly placed implants. During the healing phase, metal framework dentures may need to be replaced with a plastic set, as they are more easily adjustable. The fitting surface can then be altered when the implants are placed.

Q?Successful treatment

A.

Success depends on your body’s reaction to implants and your personal care of them. Implants can fail due to gum disease, just as teeth do. Success is constantly improving due to improved techniques. Natural teeth last longer today as awareness of the need for looking after them becomes more accepted. However, there would not be a need for implants if teeth were totally successful.

“Success rates for implants now compare very favourably with all other forms of dentistry
Smoking and Alcohol Consumption