Dental implants are metal posts made of titanium which are placed into the jawbone and which can be used to support and retain a crown, bridge or denture. The crown or bridge is cemented or screwed into the implant structure either as a permanent or semi-permanent fixture, whilst a denture will be clipped to the implant and removed by the patient for cleaning.

Indications

Implants may be indicated for patients who are unable to wear conventional dentures for whatever reason, or where conventional treatment has failed. They can also be used effectively for patients who have lost tissue due to accidents or surgery and who as a result require relatively sophisticated treatment.

They are not suitable for all patients however and conditions such as valvular heart disease, diabetes, epilepsy and mental incapacity are often contra-indications. A suitable amount of bone must be available to retain the implant.

Operative Technique

Implant treatment requires careful planning which will include x-rays, the production of casts of the mouth, and occasionally a projected 'mock-up' of the final result. It is only after these preliminary investigations have been undertaken that a decision on appropriate treatment can be made.

Implants are generally placed under local anaesthesia, with an option of conscious sedation which lessens the patient's awareness of surgery. The operation involves drilling into the jawbone and 'tapping' the implants into place (figure 1). The procedure is undertaken on an outpatient basis and will last approximately 1-1½ hours. Stitches will be placed in the gum and there will be some after-pain together with swelling and bruising. Patients should expect to be off work for some 3 - 5 days.


Following surgery it may be some time (possibly 3-6 months) before any treatment is undertaken in respect of a crown or denture (figure 2). This is to allow the bone to form tightly around the implant and stabilise it. A temporary denture will be worn over this period to maintain appearance and function. The time for eventual crown/denture construction will vary but may range from 3 - 6 visits of approximately 45 minutes each. After placement regular professional hygiene care once every 3 months is desirable.

Prognosis

Whilst the majority of implants are successful (based on a 10 year period), there remains a failure rate of 10-20% as a result of tissue rejection. Although it is impossible to predict failure, it is much more likely in patients who suffer from diabetes, who smoke and who have poor implant hygiene. Failure of an implant will necessitate its removal.

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