Periodontal Disease

Dental implants provide a very predictable outcome, but not all dental implants are successful. Current data on long-term survival of dental implants suggests that 90% of dental implant restorations will be successful over at least 10 years. ​ A small number of dental implants (around 2.5%) do not successfully osseointegrate after placement. These are lost in the first two months after placement (early failure) and generally, Capital Periodontics and Dental Implants will replace these without cost to the patient, once there has been healing of the bone. ​ Dental implants can also fail after some years (late failure). The causes for this are related to infection (peri-implantitis) for which smoking, poor oral hygiene and susceptibility to periodontal disease are risk factors.

People who have had problems with periodontal disease must be advised that they can develop similar problems with dental implants. For these people, regular checks and professional cleaning of their natural teeth and implant restorations are essential to ensure longevity of the dental implants as well as their remaining natural teeth. ​ Similarly, smokers are more prone to bone loss around dental implants as with their natural teeth. ​ Diabetics are more susceptible to oral infections and more likely to have problems with dental implants as with their natural teeth. ​ Bone density varies around the jaws and can affect the healing period required as well as the success of dental implants. The least dense bone is found in the upper molar area and healing times are sometimes extended in this area if particularly soft bone is encountered during implant placement.

Modern dentistry has a number of solutions for missing teeth, ranging from dentures and bridges to dental implants. Although dental implants can be a solution in most situations, other options may be more appropriate depending on a number of factors. These options need to be carefully considered in every case. ​ Dental implant restorations have the advantage of being self supporting. They do not require adjacent teeth to be modified and can be brushed and flossed the same as natural teeth.

Most implants are placed while the patient is under local anaesthesia in a standard dental surgery. The procedure is performed under sterile conditions and infection is an uncommon complication. After numbing the area with conventional dental local anaesthesia, the gum is lifted from the site and the bone is prepared with special drills to the correct position and length. The implant is threaded into position and the gum repositioned with sutures. ​ The healing period for osseointegration is usually between six and 12 weeks depending on individual circumstances. The implant is then tested for integration before impressions are taken by your dentist to construct the crown, which is attached to the implant via an intermediary component, called the abutment.

Placement of dental implants is not usually associated with much post-operative pain. In the first six to eight hours following the procedure, some discomfort is experienced which is well controlled with analgesics. Swelling of the lips or cheeks of the gum tissue around the site can be expected for several days. This swelling is variable and more related to additional soft tissue procedures that may be required rather than the actual implant placement. The likely post-operative course should be discussed with your periodontist, as it will depend on the type of implant procedure that is planned.

To be successful, dental implants require bone of adequate dimensions. Often, when teeth are injured or become infected, supporting bone is lost. In addition, when teeth are extracted, there is always some loss of bone which varies from one person to the next. Occasionally, the bone loss can make it difficult to place a dental implant unless a bone graft is placed prior to the implant placement or, if the problem is less severe, at the same time as implant placement. ​ The maxillary sinus is a chamber in the upper jaw which is situated above the upper premolar and molar teeth and can limit the amount of bone available for implant placement in these areas. For successful implant placement it is sometimes necessary to place a bone graft in the floor of the maxillary sinus or perform the “osteotome” technique whereby the sinus floor is carefully uplifted to permit bone grafting and the simultaneous placement of an implant of adequate length.

Dental implants can be placed at the time of tooth extraction. This has the advantage of reducing the number of procedures required to replace a compromised tooth. However, it is not always desirable to have “immediate” replacement of teeth by dental implants as the success of an implant is dependent on initial stability of the implant in the extraction socket. Allowing an extraction socket to heal for even six to eight weeks will result in bone healing within the socket to ensure primary stability of the implant. Similarly the presence of an acute infection associated with a badly compromised tooth should be resolved following tooth extraction and before the placement of a dental implant.