Dental implants

Published by Bupa's Health Information Team, March 2010.

This factsheet is for people who are considering having dental implants, or who would like information about them.

Dental implants are an option for replacing missing teeth. They are placed directly into the jawbone, so they hold false teeth in place in the same way that the roots support natural teeth. Implants can last for many years.

You will meet the dentist carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About dental implants

A dental implant is a metal rod that is placed in the jawbone to hold a false tooth (or teeth) in place. Implants are usually made of titanium, a metal that is well-tolerated by the body. Over several months, the jawbone fuses with the titanium rod. Dentures, crowns or bridges can be screwed or clipped onto the implant.

One implant can support one or more false teeth. Five or six implants are usually enough to replace all the teeth in the jaw.

One implant can support one or more false teeth. Five or six implants are usually used to replace all the teeth in the jaw.

There are a number of reasons why you may choose to have implants instead of conventional dentures or bridges.

• If you find that your denture moves around a lot in your mouth, implants help to anchor the denture in place.
• When you lose teeth, your jawbone may start to shrink. Implants can help slow down this process.
• Your dentist may recommend an implant to support a crown rather than filing down healthy teeth either side of a gap (in preparation for a conventional bridge).

Implants can be costly, and having them fitted involves at least one minor operation. You need to have healthy gums, and some specialists won't place implants in people who smoke as it can affect the outcome of the treatment. Implants are less likely to be successful for people with medical conditions like diabetes and osteoporosis, or those who have had chemotherapy.

What are the alternatives?

There are a number of different options.

• Do nothing - accept the space and leave it empty.
• Have removable dentures (false teeth) fitted. These are plastic or metal frameworks carrying false teeth.
• Have a bridge fitted. These are false teeth fixed onto adjacent natural teeth.

Preparing for dental implant surgery

Your dentist may be qualified to do dental implant surgery, or may refer you to another specialist dentist.

You may need to have an X-ray or a CT scan so that your dentist can check the thickness of your jawbone and the position of other structures in your mouth. A CT scan uses X-rays to build up a three-dimensional picture of your teeth and mouth.

Dental implant surgery is usually carried out under local anaesthesia. This means that your mouth will be numb but you will stay awake. If you're particularly anxious about your treatment, your dentist may give you a sedative - this relieves anxiety and causes temporary relaxation without putting you to sleep. In certain situations, people may need to go into hospital and have treatment under general anaesthetic. This means you will be asleep during the operation.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your dentist's advice.

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?

Your dentist will make a cut in your gum and then he or she will drill a hole in the jawbone. The implant fits into this hole. Some of the main treatment options are outlined below.

After the procedure

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

Immediate and delayed implants

Sometimes it's possible to remove a tooth and put the implant straight into the tooth socket. (This is called an immediate implant.) Alternatively, the implant can be placed long after the tooth has been removed and the jawbone has healed. (This is called a delayed implant and is more common. A new hole needs to be made in your jawbone for 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 small screw that pokes through your gums to connect the implant to the false tooth (abutment) are fitted at the same time.

In two-stage implant treatment, the implant rod is buried under your gum while the bone heals, so you can't see any of it in your mouth. Then, a few months later, you will have another small operation to attach the abutment.

Sometimes your dentist can attach artificial teeth on the same day you have the implant. Usually, however, you will need to wait for between three and six months while your mouth heals before it can be fitted.

While your mouth is healing, your dentist may fit a temporary bridge or partial denture 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 period.

There are many factors that will influence your personal treatment plan, and your care may differ from that described here.

Recovering from dental implant surgery

If you have had dental implant surgery under local anaesthesia, you will need to stay at the dental surgery until any bleeding is controlled. This will probably take about 10 to 15 minutes.

If you have had general anaesthesia or sedation, you will need to arrange for someone to drive you home. Try to have a friend or relative stay with you until the next day.

Wait until the local anaesthetic has worn off before having hot food or drinks - you might burn your mouth or chew the inside of your cheek while it's still numb.

Depending on the type of implant treatment you're having, your dentist will make further appointments to check on your progress, remove stitches and fit the false teeth.

What are the risks?

Dental implants have a high success rate. The surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

Side-effects are the unwanted but mostly temporary effects of a successful procedure. You may have some swelling and discomfort around the implant area. If you have any discomfort, take an over-the-counter painkiller such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

Complications

This is when problems occur during or after the treatment. Most people aren't affected. Complications depend on the type of procedure you're having and factors such as your general health. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection or excessive bleeding. You may be prescribed antibiotics and an antiseptic mouthwash to reduce the risk of your implant becoming infected.

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

Occasionally, the jawbone doesn't fuse with the implant properly and the implant becomes loose. Typically this isn't painful, but the implant won't be able to support false teeth. Although most implants are successful, failure is a possibility.

Implants can last for many years but good oral hygiene is vital. Your dentist will give you specific advice on caring for your implants. He or she will ask you to attend regular check-ups to make sure your implants are still secure.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.