The following FAQs provide answers to many common questions about dental implants and about peri-implant diseases. They cover the symptoms, causes, and risk factors of peri-implant diseases, the best ways to prevent them, and how they can be treated by professional dentists and through good oral hygiene at home.
What are dental implants?
Dental implants are used to replace lost teeth. They are generally made from titanium, a metal compatible with body tissues and able to bond with bone. Zirconia, white rather than metallic in colour, can also be used and implants made from it have been shown to be as effective as titanium ones.
What does an implant consist of?
A dental implant is essentially a titanium/zirconia screw or cylinder, between 4mm and 16mm long, which is inserted into a prepared bony socket in the jaw and acts as a replacement root for the missing tooth. A special attachment called the abutment is fitted to the top of the implant and forms the external connection to the replacement tooth (crown). There are also one-piece implants were the abutment and the implant are part of a single piece.
How long does it take before crowns can be fitted to an implant?
Once an implant has been placed in the jaw, it needs to heal before the crowns can be added. During this healing – which can take between two and six months – the surface of the implant fuses with the surrounding bone, a process known as osseointegration. Once this process is finished, the implant is stable enough to support one or more false tooth.
Are implants safe?
A wealth of evidence from studies and from clinical experience shows that dental implants are a safe and convenient way to replace lost teeth with natural-looking results. But implants, like natural teeth, need to be looked after. So good oral hygiene at home and regular check-ups with your dentist are essential
What are the advantages of implants?
Dental implants have several important advantages over conventional crowns, bridges, and dentures:
- They look and feel like natural teeth.
- They function in the same way as natural teeth and there are no difficulties with eating or with cleaning the crown.
- Healthy adjacent teeth do not need to be cut and ground down to act as supporting teeth for bridges. This means there is less likely to be a need to carry out root-canal treatment in these teeth.
- The implant maintains the structure of the bone beneath the replaced tooth, as chewing forces are transmitted through the implant to the bone and stimulate the natural process of bone renewal. This helps preserve a good appearance – of both the restored tooth and the face.
- Dental implants can be used to give removable dentures a firm grip.
- With dental implants, there is no need to use special glues to hold the false teeth in place, as is the case with some dentures.
Are dental implants suitable for everyone?
Dental implants are suitable for almost anyone who has lost one or more teeth and would like to restore their appearance or chewing ability. But it is important that the patient’s bone tissue is fully developed, so they are not used in people younger than 18 years of age.
To be considered for implants, your mouth must be in a healthy condition, with no untreated tooth decay or active gum disease. If implants are fitted in the presence of active periodontitis, there is a danger that an infection will develop around the implant that could cause its failure and loss.
I have periodontitis. Can I have dental implants?
Periodontitis considerably increases the risk of complications with dental implants. For this reason, periodontitis must be successfully treated before implant therapy can be started.
When are dental implants not an option?
Implant therapy may not be possible if the jawbone is not wide enough to accommodate implants and bone grafting is not possible.
Implants are not suitable for patients with untreated periodontitis or uncontrolled diabetes because of the risk of failure because of infection or poor healing.
Implants are also not suitable for people who take medication for osteoporosis – bisphosphonates or Denosumab – as they are at higher risk of developing medication-related osteonecrosis of the jaws (MRONJ), a condition where bone necrosis (death of living tissue) develops suddenly and quickly. Such patients need a consultation before implant placement.
Other medical conditions that rule out the use of implants include:
- Blood-clotting disorders.
- Certain bone diseases.
- Deficiencies in the immune system.
- Severe systemic illnesses and drug abuse.
Smoking is another important consideration, as smokers have a greater risk of developing peri-implant diseases and are more likely to experience loosening of their implants. Quitting smoking will significantly increase your chances of successful implant therapy and achieving long-lasting results.
What are the stages of implant therapy?
There are four stages to implant therapy: examination, insertion of the implant, preparation of teeth and impression, and fitting of the crowns or bridges.
1. Examination: A thorough physical examination of your mouth plus x-rays and/or a cone bean computed tomography (CBCT) scan of your jaws. The dentist can then plan exactly how the implants should be placed.
2. Insertion of the implant: Implant surgery can be carried out in one or two stages, depending on your circumstances. In both cases, the surgery involves making a small incision in the gum to expose the bone and then using special drills to prepare the implant “bed” into which implants are inserted. Two-stage surgery may be necessary if there is a need to increase the quantity of bone at the implant site by using a bone graft or a technique to regenerate bone.
3. Preparation of teeth and impression: When your gums have fully healed after the insertion of the implants (after about four to six weeks), your dentist will take a new impression of your mouth. This will be used to make a model of your teeth on which the dental technician will construct your crown or bridge, taking care to achieve a natural finish that matches the rest of your teeth.
4. Fitting of crowns or bridges: Your dentist will cement or screw the crowns onto the abutments over the dental implants, check that they fit well and look good, and check that your upper and lower teeth work together comfortably when you bite. You will usually need to return for several review appointments to make sure that the implants are stable and functioning well, and that you are completely happy with the finished result.
What are bone grafting and bone regeneration?
In some cases, bone grafts or bone regeneration are needed to prepare the jawbone to be able to support the implant. Bone grafts are carried out to increase the width and height of the jawbone at the implant site. Bone regeneration, using the guided bone regeneration technique, helps to give bone cells an advantage over other types of cell to multiply and fill an area where bone loss has occurred.
How do I look after my implants properly?
The three most important things you can do to maximise the lifespan of your implant is to avoid smoking, carry out good oral hygiene daily at home, and visit your dentist regularly for check-ups of your teeth, gums, and implants.
Daily oral hygiene should involve:
- Brush your teeth at least twice a day, for at least two minutes, using a manual or an electric toothbrush.
- Clean between teeth at least once a day using interdental brushes and dental floss if the gaps are too small for brushes. You may need to use differently sized brushes for differently sized gaps. This interdental cleaning should be done before brushing your teeth.
- After brushing your teeth, antiseptic mouthwashes may be used as they can prevent plaque accumulation for up to 12 hours. Chlorhexidine mouthwashes are the most efficient, but have some side effects such as tooth staining, black tongue, change in taste, and sometimes erosions of the mouth’s soft tissues. Chlorhexidine mouthwashes are recommended to be used for a maximum of two weeks. Ask your dentist whether you should use a mouthwash, and which one would be appropriate to your situation.
Having your teeth and implants examined and cleaned professionally on a regular basis means any problems can be dealt with promptly before they threaten the stability of your implant.
With very good oral hygiene, regular check-ups, and the avoidance of smoking, your dental implant has every chance of lasting for many years.
What are peri-implant diseases?
The most common causes of implant failure are poor oral hygiene, history of periodontitis, and smoking. If tooth cleaning is poor, bacteria will build up on the implant surface and cause inflammation of the mucous membrane surrounding the implant – this is known as peri-implant mucositis. If left untreated, mucositis can progress to a more dangerous condition called peri-implantitis, in which there is greater inflammation and bone around the implant is lost. Eventually, the implant loses its anchorage in the bone and becomes loose, which means it will have to be replaced – and this could require additional surgery to restore the lost bone.
It is important to note that peri-implant diseases can develop and damage tissues and bone much more rapidly than is the case with periodontitis. In addition, peri-implantitis is usually much more difficult to treat than periodontitis.
Warning signs of peri-implant diseases include:
- Increased tendency for the gums to bleed during brushing and interdental cleaning.
- Swelling of the gums.
- Bad breath or a bad taste in your mouth.
- The loosening of the implant, bridge, or dentures.
Regular check-up visits with your dentist will help ensure that any problems are picked up early and thus help prevent the onset of peri-implant mucositis or peri-implantitis. If you notice any signs of inflammation around your implant, it is vital you make an appointment with your dentist or periodontist as quickly as possible.
What is the treatment for peri-implant diseases?
Peri-implant mucositis: Like gingivitis, peri-implant mucositis is prevented and treated by good oral hygiene and by professional cleaning, which should be done at least twice a year.
Peri-implantitis: If peri-implant mucositis progresses and turns into peri-implantitis several approaches can be adopted, depending on the severity of the bone loss around the implant:
- Professional non-surgical therapy together with the use of chlorhexidine mouthwashes and gels to decrease the number of bacterial deposits.
- At re-evaluation, usually after six weeks, if the bleeding has stopped or decreased and if the probing depths (the depth of the “pockets” around the implant measured by the periodontal probe) have also decreased, recall appointments are scheduled according to the professional’s assessment of each patient’s needs.
- If there is significant bone loss with bleeding and pus that has not been resolved by the non-surgical therapy, various forms of treatment can be adopted. However, non-surgical treatment should first be repeated to control the bleeding and inflammation.
- Antibiotics: in some cases, following non-surgical treatment, antibiotics may be given to help control the infection before other treatments are tried.
- Once the inflammation around the implant has been controlled, if the problem requires surgical treatment the dentist or periodontist will decide which approach to use. This will depend on the nature of the damage caused by peri-implantitis.
The earlier that peri-implant mucositis and peri-implantitis are detected, the better are the chances of successful treatment. But better still is preventing disease in the first place, through correct oral hygiene and regular professional cleaning of teeth, implants, and gums.