Implants

A dental implant is a metal rod that has an internal screw or clip (abutment) that can hold a false tooth (or teeth) in place. Implants are usually made of titanium.

Over several months, your jawbone will fuse with the titanium rod. Dentures, crowns or bridges can be attached to the implant to replace your missing teeth. One implant can support one or more replacement teeth. In your upper jaw you would need at least six implants to replace all your teeth and you would need between four and six implants in your lower jaw.

Having dental implants will involve at least one minor operation. You need to have healthy gums. Some dentists won’t offer you dental implants if you smoke as it can affect the outcome of the treatment. Implants are less likely to be successful if you have a medical condition such as diabetes or osteoporosis, or have had chemotherapy. Ask your dentist if implants are an option for you.

What are the alternatives to dental implants?

Alternatives to dental implants include:

• removable dentures (false teeth) – plastic or metal frameworks that carry false teeth
• a bridge – false teeth that are fixed onto adjacent natural teeth

Preparing for dental implant surgery

Your dentist will explain how to prepare for your procedure.

You may need to have an X-ray or a CT scan so your dentist can check the thickness of your jawbone and the position of other structures in your mouth.

Dental implant surgery is usually done under local anaesthesia. This completely blocks pain from your mouth and you will stay awake during the procedure. You may have a sedative – this relieves anxiety and helps you to relax. It’s rare, but you may need to go into hospital and have treatment under general anaesthesia. This means you will be asleep during the operation.

Your dentist will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during dental implant surgery?

Once the anaesthetic has taken effect, your dentist will make a cut in your gum and then drill a small hole in your jawbone. The implant will fit into this hole.

If you need to have teeth removed before dental implant surgery, your dentist may be able to remove a tooth and put an implant straight into your tooth socket – this is called an immediate implant. However, usually your dentist will fit the implant after a few weeks, which is called an immediate-delayed implant. Sometimes he or she will fit it after several months once your tooth is removed and your jawbone has had time to heal – this is called a delayed implant.

Immediate and delayed implants can be done in one or two stages.

• In one-stage implant treatment, the implant rod and the abutment that pokes through your gums to connect the implant to the false tooth will be fitted at the same time.
• In two-stage implant treatment, the implant rod will be buried under your gum while your bone heals (you won’t see it in your mouth). Then, a few months later, you will have another small operation to attach the abutment.

Your dentist may attach artificial teeth on the same day you have the implant. Usually, however, you will need to wait between three and eight months to allow your mouth to heal. Your dentist may fit a temporary bridge or partial dentures so you can’t see the spaces between your remaining teeth. If you have complete dentures, they can be adjusted so that you can wear them throughout this time.

After your mouth has healed, you will have a second, smaller surgical procedure to uncover the gum over the top of the implant if necessary. Your dentist will then fit your artificial teeth onto the implant. The teeth may be fixed permanently or attached in a way that allows you to remove them for cleaning. Your dentist will ensure that they fit properly, match your other teeth and feel comfortable.

What to expect afterwards

You may need to rest until the effects of the anaesthetic have passed. After a local anaesthetic it may take several hours before the feeling comes back into your mouth. You may need pain relief to help with any discomfort as the anaesthetic wears off. You will usually be able to go home when you feel ready.

If you have a general anaesthetic you will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

General anaesthesia and sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your dentist’s advice.

It’s important to only eat soft foods for the rest of the day after having dental implant surgery. Try to keep your mouth clean by brushing but don’t directly brush the implant site. Your dentist may advise you to use a chlorhexidine mouthwash every day during the first week after your operation.

Recovering from dental implant surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your dentist may prescribe you antibiotics and an antiseptic mouthwash to reduce the risk of your implant getting infected.

The time it takes to make a full recovery from dental implant surgery will vary depending on your treatment plan, so it’s important to follow your dentist’s advice.

Once you have recovered, your implants and replacement teeth should function as natural teeth do in terms of eating.

If you damage the implant it may be removed and replaced. If it’s too difficult to remove, it can be safely left in your jaw and another implant will be placed alongside it.

What are the risks?

As with every procedure, there are some risks associated with dental implant surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your dentist to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

You may have some swelling and discomfort around the implant area. If so, you can take an over-the-counter painkiller such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Complications

Complications are when problems occur during or after the procedure.

The possible complications of any operation include an unexpected reaction to the anaesthetic, or excessive bleeding.

Your lower jaw contains nerves that supply the feeling to your tongue, chin, lower lip and lower teeth. If the nerves are damaged by the implant, you may feel temporary or even permanent tingling or numbness. X-rays and CT scans help your dentist to see the position of the nerves in your jawbone to minimise this risk.

Occasionally, the jawbone doesn’t fuse with the implant properly and the implant can become loose and fail. This isn’t usually painful, but the implant won’t be able to support false teeth. Your dentist will ask you to attend regular check-ups to make sure your implants are still secure.