THE UK GUIDE TO AESTHETIC DENTAL IMPLANTS October 2010

Transcription

1 THE UK GUIDE TO AESTHETIC DENTAL IMPLANTS October 2010 Everything you need to know when considering dental implants Dr. Keith Cohen, BDS (Lon) LDS RCS (Eng) MGDS RCS (Eng) MSc MRD RCS (Eng) Member of the: British Dental Association, General Dental Council, British Society of Restorative Dentistry, British Academy of Cosmetic Dentistry, British Society of Periodontology, Royal College of Surgeons. Copyright Dentexcel, All rights reserved.

2 Table of Contents Introduction 2 Why do people need Dental Implants? 3 The Primary methods to replace missing teeth 4 The advantages of implants for missing teeth 4 Dental Implant overview 5 About The Dental Implant Procedure 6 Bone Grafting with implants 6 Gum Grafting with implants 6 Sinus Lift with implants 7 Replacing one tooth: The Crown 8 Replacing multiple teeth: The Bridge 9 Bridges secured with Dental Implants 9 Replacing multiple teeth: The Dentures 10 Dentures retained by implants or mini-implants 10 Alternatives to Implants 11 Conventional Bridges (without Dental Implants) 11 Removable Teeth: Dentures 12 Not all types of implants are equal 13 Comparison table 14 How safe are implants? 16 Frequently Asked Questions (FAQ) 17 After the procedure 19 Recovery 19 Aftercare 19 Dental implants essentials checklist 20 Copyright Dentexcel, All rights reserved. 1

3 THE UK GUIDE TO AESTHETIC DENTAL IMPLANTS Dr. Keith Cohen A Introduction Over the last twenty years, the options to replace a missing tooth or set of teeth have dramatically improved. Today Dental Implants have become the most rapidly growing dental procedure in the world. Properly done, the immediate success of implants borders on 100% and the ten-year success rate is about 95%. This guide was written to help you navigate through the many options you have available to replace missing teeth and discover which option works best for you. There is a lot of misinformation out there, and certain types of tooth replacement options are definitely better than others. Dental implants can work wonders for your teeth, including replacing a single tooth to fit seamlessly into your smile, or fixing an entire upper set of false teeth and fixing them securely on the metal post of an implant to avoid movement or the hassle of daily removal. In this guide, you ll discover why people are avoiding traditional tooth replacement methods such as bridgework. These older methods can be unnecessarily damaging to your existing teeth, and do not prevent the added problem of bone loss, which can reduce your attractiveness. You ll see how implanted teeth can help people to avoid the hassle of chewing difficulties found with traditional dentures, and importantly, you ll see how artificial teeth no longer look false. You can now get a very natural look from implanted teeth. The great news today is that most people are eligible for Dental Implant surgery thanks to new bone grafting techniques. Even people with previously inadequate bone quantity can now be treated. Better aesthetic results are possible at the front of the mouth than ever before with these new techniques of gum and bone grafting. While there are options available at every price level, with implants it is helpful to use the checklist at the back of this guide to ask your dentist the tough questions required to ensure that they are using the right materials and the right procedures that will give you an optimum result. I wish you all the best in your search for a suitable tooth replacement option. Please do your homework and choose a method that is best suited to your timeframe, budget, and lifestyle. Best Regards, Dr. Keith Cohen, BDS (Lon) LDS RCS (Eng) MGDS RCS (Eng) MSc MRD RCS (Eng) Copyright Dentexcel, All rights reserved. 2

4 THE UK GUIDE TO AESTHETIC DENTAL IMPLANTS Dr. Keith Cohen B Why do people need Dental Implants? It may be surprising to discover that more than 240 million people in the industrialised world are missing one or more teeth. Statistics show that 69% of adult s ages 35 to 44 have lost at least one permanent tooth, and by age 74, 26% of adult s have lost all of their permanent teeth. Starting in the mid 1960s, dental Implants have progressively become one of the most common choices to treat missing teeth. Different reasons for needing a Dental Implant: Gaps in your teeth are not nice to look at Dentures slip out of place, irritate your mouth and make it difficult to eat Decay or gum disease has led to tooth loss Accidents have resulted in tooth loss Unsuccessful root canal therapy or cracked tooth roots Prevent sunken facial features due to jawbone shrinkage from missing teeth To avoid filing away a healthy tooth on either side of the gap to support a crown (in preparation for a conventional bridge) Other options to deal with missing teeth include: Do nothing, and accept the empty space in your mouth Have removable dentures fitted (false teeth fitted onto a framework made of plastic or metal, these often can slip or make embarrassing noises) More than 240 million people in the industrialised world are missing one or more teeth. Have a bridge fitted (artificial teeth fixed onto your natural teeth adjacent to the gap), these often require shaving of the healthy teeth next to the bridge, and will decay over time and need replacing Copyright Dentexcel, All rights reserved. 3

5 THE UK GUIDE TO AESTHETIC DENTAL IMPLANTS Dr. Keith Cohen C The Primary methods to replace missing teeth Despite all the seemingly different types of solutions available, there are essentially two main types of ways to solve the problem of missing teeth. You will be treated with either fixed teeth attached to an implant or your own teeth or removable teeth, which can clip onto implants when present. Options for 1 or more teeth missing a) Implant with crown or bridge on top b) Fixed bridge attached to adjacent teeth a) Denture We ll go into each one of these options in the next sections, and there is a comparison chart on page 14. THE ADVANTAGES OF IMPLANTS FOR MISSING TEETH 1. Aesthetics Dental implants can look and feel like your own teeth. 2. Prevention of Bone Loss Dental Implants prevent the bone loss and gum recession that often accompany bridgework and dentures. 3. Tooth-saving Traditional bridge work sacrifice the neighbouring teeth on either side of the missing tooth. Implants leave more of your own teeth untouched. 4. Confidence Dental implants are secure and allow you to speak and eat with comfort and confidence. They donʼt shift around in your mouth, and offer freedom from annoying clicks and noises. Also they reduce the daily hassle of losing your dentures and having to use messy pastes and glues. 5. Reliable The success rate of dental implants is highly predictable, often lasting longer than conventional bridges. Disadvantages 1. One or two surgical procedures are required although these are usually minor if there is sufficient bone present. 2. People often worry about an allergy to titanium but this is very rare. Copyright Dentexcel, All rights reserved. 4

6 D Dental Implant overview What is a Dental Implant? A dental implant is made up of two main parts with the crown on top: 1. A metal ʻfixtureʼ which is made of titanium (the implant itself) 2. The ʻAbutmentʼ, which is like a post which screws into the implant and sticks up above the gumline to hold the tooth 3. The ʻ toothʼ itself (crown) As you can see from the images below: One metal implant can usually support one artificial tooth. Five or six metal implants are usually enough to support the replacement of all the teeth in the jaw usually 10 to 12 teeth A number of implants or mini-implants can retain a denture IMPLANT RETAINED DENTURE IMPLANT RETAINED BRIDGE SIGLE IMPLANT AND CROWN What does it do? The implant becomes essentially a simulated tooth root that is created by inserting the metal fixture into the jawbone. The implants are usually made of titanium, which will fuse with the jawbone after several months. Once the implant has fused (this is a process known as osseointegration ), it is then secure enough to allow dentures, crowns or bridges to be screwed or clipped onto them to VERY securely hold artificial teeth in place. After the dental implant procedure, the teeth can look very natural. Copyright Dentexcel, All rights reserved. 5

7 ABOUT THE DENTAL IMPLANT PROCEDURE Does it hurt? The procedure is usually painless as it is carried out under a simple local anaesthetic where only the affected part will be without sensation. A sedative can be prescribed by the dentist or anaesthetist if needed for patients who are anxious. After lifting the gum, a small hole is made in the jaw bone and the implant is screwed into place. Usually a few stitches are placed to reposition the gum. How long does it take? Surgery time will vary greatly depending on the number of dental implants. See the section on crowns (if you need to replace one tooth), or bridges (if you need to replace multiple teeth). For a straightforward case the placement of the dental implant will take a little over an hour. Time goes up proportionally from there. The implant needs to be left for two or three months for healing of the bone. How long does it last? After more than 20 years of usage, the vast majority of dental implants continue to still function at peak performance. If properly cared for, dental implants can last a lifetime and early recipients of dental implants are still satisfied they made the right choice. BONE GRAFTING WITH IMPLANTS The success of a dental implant is often impacted by how much bone is available in your mouth at the exact location where the implant needs to be placed. If the amount of bone is not enough to anchor the implant, then in these cases, the bone must be rebuilt through modern bone grafting techniques. Bone grafts can build up or fill in jawbone defects, which then allows for the successful placement of dental implants. The bone to be grafted to the jaw can be taken from a variety of sources. The best graft technique is generally one whereby the bone is taken from your own body, usually the mouth or occasionally the hip. If this is not an option for you, usually sterile bovine (cow) bone or inert manmade synthetic materials can be used. GUM GRAFTING WITH IMPLANTS If you are considering tooth replacements with dental implants, a gum graft treatment can help prepare your mouth for a successful implant process and is especially helpful at the front of the mouth to improve the aesthetic outcome. When planning for an implant, if there is not enough attached gingiva, then a gum grafting procedure is usually performed first to increase the amount of attached Copyright Dentexcel, All rights reserved. 6

8 gingiva in the dental implant area but can also be performed at other stages of the procedure and sometimes needs to be repeated to provide enough support. The entire gum grafting procedure is simple. Gum tissue is taken from your own palate. This tissue will then be used to increase the gum area surrounding the site of the Dental Implant. Gum grafts have numerous benefits including: Improvement of the appearance of implant crowns at the front of the mouth Improvement of the success of bone grafting Covering up exposed tooth roots SINUS LIFT WITH IMPLANTS The human skull has several cavities or air spaces which are called "sinuses". Sometimes the sinus area is too large which means that there is an air cavity where bone is required for implant placement. Because your dentist must have something to attach a dental implant to, to get around this problem, they will place bone or bone growth stimulating material into the sinus, and to make room for the bone, the sinus membrane has to be moved upward, or "lifted. This bone often needs to be left for 6 to 9 months before it can be used. Sometimes, there is enough bone to place the implants at the same time that you raise the floor of the sinus. This can save time. Sinus lifts of all types have a high success rate and have become common over the past 15 years as more people have dental implant procedures to replace missing teeth. For any of the above grafting procedures there will be more swelling and a longer recovery period of up to 1 week generally. There can be some bruising or swelling. Care needs to be taken when these and implant procedures are carried out close to vital structures such as nerves and blood vessels. Research shows that success is reduced in patients who smoke. Copyright Dentexcel, All rights reserved. 7

9 E Replacing one tooth: The Crown What is it? A crown is an artificial tooth that is placed directly on top of the post which is screwed into a dental implant. What does it do? A crown is used to fill the gap from one missing tooth. Does it hurt? A local anaesthetic can be provided although this is not always necessary. This is a very straightforward procedure. How much does it cost? A single crown implant typically costs between 1600 and 3500, depending on various factors such as: the dentist s training and experience, the implant system, the crown materials used, the standard of the technician, whether additional procedures such as bone or gum grafting are required. How long does it take? After the 2 or 3 month healing period your dentist will create an impression of the implant position in order that a new tooth can be made to fit perfectly in your mouth. A temporary crown may be inserted or the temporary cover can be replaced, so that you can eat and function normally. Approximately two weeks later, your new crown will come back from the dental technician where it will have been made to fit precisely in your mouth, and be coloured the same shade as your existing teeth. The whole process from start to finish takes 1 to 3 weeks approximately. How long does it last? It is reasonable to expect that your crown can last from five to fifteen years, depending on the type of crown material your dentist uses, as well as your dental hygiene. SINGLE IMPLANT AND CROWN If properly cared for, dental implants can last a lifetime. Copyright Dentexcel, All rights reserved. 8

10 F Replacing multiple teeth: The Bridge BRIDGES SECURED WITH DENTAL IMPLANTS What is it? A bridge is a set of several artificial teeth that is fixed in your mouth using one or more dental implants. This contrasts with dentures (see next section) which are removable. What does it do? A bridge is used to fill the gaps from several missing teeth. IMPLANT RETAINED BRIDGE Does it hurt? A local anaesthetic is provided, although this is not always necessary. How much does it cost? Each crown and implant typically costs between 1600 and 3500, depending various factors such as: the dentist s training and experience, the implant system, the crown materials used, the standard of the technician, whether additional procedures such as bone or gum grafting are required. The bridge tooth will be charged at a lower rate because it does not have an implant underneath usually 500 to How long does it take? After the 2 or 3 month healing period your dentist will create an impression of the implant position in order that a new tooth can be made to fit perfectly in your mouth. A temporary crown may be inserted or the temporary cover can be replaced, so that you can eat and function normally. Approximately two weeks later, your new crown will come back from the dental technician where it will have been made to fit precisely in your mouth, and be coloured the same shade as your existing teeth. The whole process from start to finish takes 1 to 3 weeks approximately. How long does it last? It is reasonable to expect that your crown can last from five to fifteen years, depending on the type of crown material your dentist uses, as well as your dental hygiene. Copyright Dentexcel, All rights reserved. 9

11 G Replacing multiple teeth: The Dentures DENTURES RETAINED BY IMPLANTS OR MINI-IMPLANTS What does it do? Where many or all of the teeth are missing a denture held by implants is an alternative to a fixed bridge. This requires less implants and reduces the cost. Does it hurt? A local anaesthetic can be provided for impression stages. IMPLANT RETAINED DENTURE How long does it take? A number of stages are required following implant placement and healing: Impressions Bite registration Tooth try-in Insertion Review How long does it last? This should last around 5 years or more but more maintenance is often required for the denture clip or attachments. How much does it cost? For a lower jaw cost of 2 implants and a denture can be from 3000 to For an upper jaw cost of 4 implants and a denture can be from 5000 to Copyright Dentexcel, All rights reserved. 10

12 H Alternatives to Implants CONVENTIONAL BRIDGES (WITHOUT DENTAL IMPLANTS) What is it? A Bridge procedure that is performed without using dental implants is very different to the description above. In this case, an artificial tooth is still placed in the gap of a missing tooth, however the method of fixing the tooth in place is different. The dentist uses the support of the one or two adjoining teeth to secure the artificial tooth. They will have to remove about 1 mm of the healthy tooth structure on either side of the gap, in order to hold the false tooth. What does it do? A bridge is used to fill the gaps from several missing teeth. Does it hurt? No. A mild anaesthetic is provided to ensure the patient s comfort. After placement, it may take a few days or weeks to get used to the new bridge. How much does it cost? A fixed bridge typically costs between 200 and 2000 per tooth, depending on the dentist, materials and technician. How long does it take? A bridge procedure is generally performed in two sittings. In the first sitting, the dentist gives a mild anaesthesia to the patient to numb the area. Then he removes part of the teeth on both sides of the missing teeth in order to ensure the bridge can be securely fitted. The dentist takes an impression of the teeth, so that artificial teeth can be manufactured. They then place a temporary bridge in place of the missing teeth to protect the teeth and gums until the final bridge is ready. In the second sitting, the dentist removes the temporary bridges and fixes the permanent ones over the surrounding teeth with a special cement. The two sittings for the bridge procedures are usually 2 to 3 weeks apart. How long does it last? If you exercise proper dental hygiene and visit the dentist for regular checkups, your bridge can last for many years, however this form of bridge might not be as long lasting as a bridge fixed on dental implants. Copyright Dentexcel, All rights reserved. 11

13 REMOVABLE TEETH: DENTURES What are they? Complete or full dentures are a full set of artificial teeth for your upper or lower jaw that are held only by the patient. Partial dentures replace some of the teeth. Dentures can also be anchored by implants resulting in a significantly better chewing performance than conventional removable dentures see above What do Dentures do? Dentures are a solution for people who have lost most or all of their teeth. They can restore a person s ability to chew, boost their self-confidence, and give them back the smile they used to have. Traditional removable Dentures often fall short when it comes to their function. The most common complaint for traditional Dentures today is shifting or even detachment while chewing or talking. A denture fixed in the mouth via Dental Implants counteracts these problems and provides the secure and strong feeling of real teeth. Types of Denture Attachments To fit the Dentures to the Dental Implants, there are several types of attachments used to retain or provide support for the Dentures: Ball- retained: A ball-shaped attachment is placed on top of each of the Dental Implants, which then fits into socket like connectors fitted at the base of the denture. This ball and socket type is the most popular type of implant supported dentures. There are also various types of studs which have a similar action. Bar-retained: A thin metal bar is attached to between two to five Dental Implants that have been placed in the jawbone. The metal bar follows the curve of the jaw and the Denture is then securely clipped onto it. Does it hurt? No. Several stages are required to make the dentures : impressions, bite, tooth try-in and fitting. After placement, it may take a few days or weeks to get used to the new dentures. How much does it cost? Upper and lower dentures can cost from 200 up to 6000 How long does it take? It generally takes around 4 or 5 weeks to complete the various stages. How long does it last? Dentures can last for a number of years but often need relining because of bone shrinkage. Copyright Dentexcel, All rights reserved. 12

14 I Not all types of implants are equal A Dental Implant treatment plan can vary tremendously from one dentist to another. These differences affect the longevity and aesthetics of the final result: Different surgeon, training and experience Different implant system a small number are well researched systems from respected companies. There are many cheaper alternatives which may not be as reliable. Different position of implant Different timing of implant placement (placed immediately following extraction, or placed following a healing period.) Differences between whether bone or gum grafting are used to improve the aesthetic result Different materials of the crown - whether it is all ceramic or bonded to a metal substructure or resin or prefabricated resin teeth (denture teeth) Difference between a metal or ceramic post (Abutment). Ceramic is more costly but weaker. The alloy used whether the alloy is non precious or high gold content a large cost difference for a full arch restoration The difference between conventional implants and mini-implants Mini-implants are smaller than conventional implants around 1.5 to 2mm in diameter. They have been less well researched and are weaker than conventional implants. They are usually used to hold temporary bridges while having conventional implants or otherwise to hold a denture. They do not generally last so long, could fracture but are less costly, usually from 500 each. A Dental Implant treatment plan can vary tremendously from one dentist to another. Copyright Dentexcel, All rights reserved. 13

15 COMPARISON TABLE WHAT IS IT HOW LONG DOES IT TAKE? DOES IT HURT? HOW LONG DOES IT LAST? Implant This is the base onto which any restoration is fixed. Around 1 hour for 1 implant, 1 hour 30 minutes for 3 etc. A local anaesthetic is placed or in some cases sedation is used as well. There is usually very little discomfort afterwards for straightforward cases. Moderate swelling for more complex cases with grafting. Implant treatment is now very reliable with most cases lasting many years. The Crown A crown is an artificial tooth that is placed directly on top of the post which is screwed into a dental implant. After 2 or 3 month healing the dentist create a temporary implant. 1 to 3 weeks later the new crown. No. This is a very straightforward procedure. 5 to 15 years, depending on the type of crown material, as well your dental hygiene. Bridges secured with dental implants A bridge is a set of several artificial teeth that is fixed in your mouth using one or more dental implants. After 2 or 3 month healing the dentist creates a temporary implant. 1 to 3 weeks later the new crown. A local anaesthetic is provided, although this is not always necessary. 5 to 15 years, depending on the type of crown material, as well your dental hygiene. Copyright Dentexcel, All rights reserved. 14

16 WHAT IS IT HOW LONG DOES IT TAKE? DOES IT HURT? HOW LONG DOES IT LAST? Dentures retained by implants or miniimplants Where many or all of the teeth are missing a denture held by implants is an alternative to a fixed bridge. Depending on the individual treatment including: - Impressions, - Bite registration, - Tooth try-in - Insertion - Review A local anaesthetic can be provided for impression stages. Around 5 years or more. Conventional bridges (without dental implants) A Bridge without using dental implants. The artificial tooth is still placed in the gap of a missing tooth. Two sittings for bridge procedures are usually 2 to 3 weeks apart. No. A mild anaesthetic is provided to ensure the patient s comfort. Many years, if you exercise proper dental hygiene and visit the dentist. Removable teeth: Dentures Dentures should be a full or partial set of artificial teeth for your upper or lower jaw that are held only by the patient. Generally 4 or 5 weeks to complete the various stages. No. It may take a few days or weeks to get used to the new dentures. A number of years but often need relining because of bone shrinkage. Copyright Dentexcel, All rights reserved. 15

17 J How safe are implants? Tooth implants are the state-of-the-art in dentistry. Most often, the osseo-integrated implant (the fusing of the metal fixture into your jawbone) is more stable than a natural tooth's root. Sophisticated research across the world has recognised titanium for its biological compatibility with the human body. Studies have shown that the earliest patients treated with these modern implants continue to enjoy healthy, stable smiles. The modern-day implant has been carried out successfully for over 40 years. Nearly all implant procedures are performed with local anaesthesia in a comfortable dental chair. No pain should be felt during the surgical procedures. Depending upon the number of implants placed, there may be swelling and/or tenderness for a few days following the surgery. Pain medication is usually prescribed which alleviates this discomfort. Healing of your bone into the implant requires three to six months and after the implant is exposed through the gums, restoration can take an additional three to eight weeks. Copyright Dentexcel, All rights reserved. 16

18 K Frequently Asked Questions (FAQ) 1. How long has modern implantology been popular? Modern implantology has been available since the beginning of the 21st century, however, it gained popularity in the 1980ʼs with the increased success of the titanium cylinder. Since then, many brand name implants have been developed and are now in wide circulation. 2. What factors determine the long-term success of Dental Implants? Long-term success depends on several factors. a. Firstly, it depends on the quality and quantity of the bone. The better the bone quality, and the more bone available, the greater the chance of long-term success. b. Secondly, it depends on the experience and ability of the dental surgeon. As with any surgical procedure, there is no substitute for experience and talent. c. Finally, the quality of the restoration placed on top of the implant influences the long-term success of dental implants. If the design of the implant crowns or overdentures is defective and biting forces are not balanced, the dental implant will not succeed. Implants can last anywhere between 20 and 25 years or more. Your success is influenced by factors related to your general health (including smoking, grinding, and oral hygiene). With an evaluation prior to treatment, the probability of success is high. 3. Does the age of the patient matter? No. Any person of any age can have dental implants as long as there is enough bone available in which to place the implants and they are in reasonable health. 4. What medical and physical factors could prevent you from being an implant candidate? Uncontrolled diabetes, chemotherapy or radiation therapy, parathyroid disorders, blood disorders, rare bone disorders or bone marrow cancer are the medical factors which could prevent you from being an implant candidate. Physical factors may include insufficient or poor quality bone, low sinuses or nerve bundles. Smoking reduces the success of implant surgery and grafting techniques. Copyright Dentexcel, All rights reserved. 17

19 5. How often do you need to have your Dental Implants checked? The success of your implants will depend greatly on how well you maintain them. Implants need to be professionally cleaned by a hygienist or dentist and examined by your implant dentist every 6 to 12 months. The hygienist should have been trained in the specific procedure of maintaining dental implants. Also, brushing and flossing daily is absolutely necessary for long-term success. 6. Is dental implant surgery painful? No. An effective local anaesthetic is used during surgery so the patient does not have any discomfort when implants are placed. The mild discomfort the patient might experience after surgery can be controlled with medications. 7. When can you resume work after implant surgery? You can resume work the next day, unless some particular surgical circumstance arises. Some of the more complicated procedures of bone or gum grafting or sinus-lift procedures will require more recovery time and medication. 8. Can an implant be used as an alternative to root canal treatment? Yes, it can be. Not all teeth are good candidates for root canal treatment. Root canal-treated teeth are susceptible to decay and fracture, while implants are not susceptible to decay and rarely break. 9. Between implants and other cosmetic procedures which should I choose and why? Dental implants are fixed and permanent. They are never removed. They never shift around while speaking or eating. Dental implants can be maintained effortlessly. They are not susceptible to cavities. With dental Implants, you can regain chewing ability. You can easily relish all the food you love. Because dental implants function as effectively as natural teeth, they preserve the facial structure by preventing bone loss and improving the health of the individualʼs smile by ensuring that the surrounding teeth are not damaged. 10.When an implant fails, can another be placed in the same spot? Yes. You seldom hear of an implant that has failed, however if an implant fails, it is simply removed. If conditions are favourable, the site is prepared for another implant. Copyright Dentexcel, All rights reserved. 18

20 L After the procedure RECOVERY Initial gum healing usually occurs within about 1 week but the bone around Implants heals in 2 or 3 months. Augmenting the bone, performing sinus lifts, or additional needs such as jaw reconstruction, etc, will lengthen the healing period. Each person s healing period is unique. About one week after the integration of the dental implant, the first check-up should take place. If there is any prolonged pain, the patient should contact the dentist immediately. While prolonged pain is rare and does not always indicate a serious problem, the cause of the pain should be determined. An implant may have to be removed if an infection develops or if the implant is not properly integrating into the adjacent bone. AFTERCARE Aftercare is just as important as the professional installation and monitoring of your implant. This includes: A daily thorough cleaning of the teeth in order to avoid implant inflammations (periimplantitis). Sugar-induced tooth decay, smoking, and insufficient oral hygiene increase the risk of inflammation on or around the implant. To clean the teeth, dental floss or interproximal brushes should be used. In general, you should visit the dentist at least twice a year for check-ups (more frequently if you have been advised that you are at increased risk for periimplantitis). Your dentist will examine the implant and the surrounding area before employing professional dental cleaning techniques. Such check-up sessions and thorough oral hygiene are fundamental requirements for a long-lasting implant. Aftercare is just as important as the professional installation and monitoring of your implant. Copyright Dentexcel, All rights reserved. 19

21 M Dental implants essentials checklist Questions to ask your dentist Ideal Answer Write down the answer you are given here QUESTION 1: Which implant system are you using and Is this one of the well researched systems? QUESTION 2: How long have you been placing implants / how many implants have you placed before? Have you received specific training? There are around 5 or 6 well researched implant systems /well known companies such as: Straumann, Nobelbiocare, Friadent (Ankylos, Xive, Frialit), 3I, Astra, It is now compulsory to have completed a training course before starting to place implants, although some dentists have gained experience from many years of practice. QUESTION 3: What materials will the final restoration be made of? Materials can vary from the more expensive ceramic and gold to nonprecious materials with preformed plastic teeth. This clearly can affect the cost. QUESTION 4: Will I require additional bone or gum grafting and do you have experience of these techniques? Not all dentists placing implants are experienced at bone, gum grafting or sinus-lift techniques. Copyright Dentexcel, All rights reserved. 20