Dental implants are tooth root shaped titanium devices, which are placed into the bone once occupied by a tooth. Once positioned, under sterile conditions at the practice, bone fuses to the implant surface in a process known as osseo integration. The procedure is carried out under local anaesthetic and although some soreness afterwards can be expected this is usually minimal.

Although implants are usually used to replace missing teethwe frequently use them to replace a tooth that is diseased or damaged. This introduces two important variables in the surgical process that have a direct bearing on the timing of the treatment which then takes place over two, three or sometimes four stages.

Despite all the available diagnostic tools and procedures it is impossible to predict with absolute certainty how surgery will proceed. Everybody and every case is different, and sometimes we find situations at the surgery site that dictate a change in approach, and by implication, the timing for our plan. 

Fortunately this usually only leads to a slight delay in the plan which will be fully explained, but it is important to respond to findings appropriately, and if it’s not possible to place the implant, for example if we find infected material at the implant site, it is better to deal with the complication and delay the implant than insert the implant into a compromised site.

Possible surgical options are as follows:

• Extraction of a tooth and implant site preparation
• Implant site preparation – no implant placed but implant site enhanced 
• Place the implant and cover back over with gum. This requires a further surgical stage to expose the implant after healing.
• Place implant and top off with a healing abutment (no second surgical stage). This is the most common approach and usually achievable at a single appointment.
• Place implant and temporary tooth together – not always ideal for healing, and can add significantly to the cost.

On occasions we use biomaterials to boost bone volume around an implant site. These materials can also ‘plump’ out soft tissue to create a more natural appearance of the gum and the crown.

We use bone substitute materials of bovine origin (Bio-Oss), which are gradually replaced by your own bone over a period of time, and on occasion we may need to protect this with a porcine derived collagen membrane (Bio-Gide), which is used to cover and protect the graft materials during healing.

 Use of these biomaterials is supported by many long-term studies where they have proved to be reliable for repairing or filling small defects in bone. If you have any objection to their being used please let us know, but we will discuss them further if it becomes likely that some use will be required.

As well as the benefits, we have discussed the risks that are associated with this treatment.  You should be aware that on occasion an implant may fail.  There is a risk of failure of approximately 1% to 5% depending on specific circumstances.  Generally an implant can be replaced should it fail but occasionally additional or alternative procedures may be necessary.

An implant can fail at any time, immediately after surgery, or later when it has been restored. The reasons for failure are not always clear, but it is usually possible to correct the problem by removing the implant and starting again after a period of healing.

There is also a risk of accidental damage to adjacent anatomic structures, such as teeth, nerves and sinus spaces, although with accurate planning this should be avoidable.  There is a very low risk of failure of implants after the first year in function as long as your health, both general and around the implant is maintained and no excessive forces are exerted.  Excessive forces may result in some of the component parts fracturing.

You should also be aware that implants and teeth are subject to normal wear and tear as time goes on and, depending upon the amount of wear, the need to replace the crown may arise.

 There is a risk of gum recession around the implants. Although this may not affect its survival it may require additional hygiene treatments or treatment for aesthetic reasons.

On the day you are having your implant placement you will be given a time to arrive at the practice. This won’t be when you go into the surgery, but will allow time for you to take your antibiotics and relax ahead of the surgery. We will be busy preparing the surgery and equipment for the appointment.

On entering the surgery you will notice the difference immediately – the equipment and preparation for sterile working are completely different to normal dental surgery, and once we get you numb we will all be gowned up to maintain a sterile working environment.  

For your part you will be asked to rinse with an antiseptic before we start and you will have a sterile drape placed over you that will keep the area clean and tidy.

The surgery itself involves raising a small flap of gum to expose the implant site. Then by using drills of increasing size the hole into which the implant will go will be formed. Once we are happy with the alignment and depth of the hole an implant of matching size will be selected and placed. The final tightening involves using a hand wrench that makes a bit of noise and pressure, but is done to ensure precise placement and orientation of the fitting surface of the implant.

Once placed we make the decision on how to cap the implant off – usually achieved with a healing stud (a bit like after having an ear pierced), which we call a healing abutment. The gum is then closed with suturesaround the stud. 

Healing of the bone normally takes 3-4 months after which the implant becomes integrated with the bone. If we have placed any bone chips (Bio-Oss) this will have been replaced by immature bone by this stage.

Once the implant is integrated with the bone we can then proceed with the final restoration.

When the surgery is completed you will still be numb, and may be so for 1-3 hours. Our concerns at this stage are to allow things to settle undisturbed. We need the formation of good healthy blood clot and for none of this to be disturbed or washed away.

We ask you to observe these simple rules:

1. Take it easy for the rest of the day
2. Avoid rinsing – you can eat and drink, but don’t rinse for 24 hours
3. You will need to take your second dose of antibiotic 8 hours after the first
4. If you can we ask that you take ibuprofen 400mg every 6 hours to reduce any swelling – if you can’t take ibuprofen,paracetamol should be sufficient for pain relief but lacks the same anti-inflammatory benefit.

We provide an ice-pack for immediate use to prevent and relieve any swelling. You should aim to use a cold pack for 10 minutes in every hour for the first day. Small bags of peas from your freezer covered in a damp tea towel is the best – so remember to get some in!

As you should now be aware it is essential that the implants are monitored and maintained after completion of treatment.

After the initial period it is recommended that you attend the practice at regular intervals for examinations and maintenance.

You will need to maintain a high standard of hygiene around the implants and, if necessary and recommended, see our hygienist every three months. (All treatment plans exclude costs for hygiene and annual review appointments).

 Implant restorative treatment at the practice is guaranteed for a period of two years but only if recommended maintenance appointments are attended

Smoking

There is some evidence in the literature and scientific studies that smoking increases the risk of implant failure. The risk increases by about 3 times, but is still relatively low. As long as the gum condition isgood we can proceed.

Medication – Bisphosphonates

These drugs affect bone metabolism and are used to treat osteoporosis and other conditions. Intravenous bisphosphonates are a direct contra-indication for implant treatment, but taken orally implants may be considered. If there is any doubt about the risk of treatment we will recommend an alternative course of treatment for you.

Medication – Steroids

Long-term steroids can affect the healing and immune response in patients, but are not an absolute contra-indication to implant treatment. They can also affect bone, and that may have a bearing on healing times and loading considerations. 

Medication – Anti-coagulants

Aspirin 75mg daily dose is not a problem, and warfarin is also not a problem as long as the INR is below 3.0. We may need to see your INR records if you are on warfarin, so please bring them with you.

Diabetes – Type 1

As long as the glycaemic control is good and gum health is good, then implants can be done with caution.

Diabetes – Type 2 

As with Type 1 – as long as the gum health is good and the diabetes is being controlled well, implants can be done with few complications.

Gum disease

In order to be confident about the success of implants good gum health is very important. Although the connection between an implant and bone is different to that between teeth and bone, implants can suffer from poororal hygiene and develop inflammation. This results in bone loss around the implant, and while this might not result in failure of the implant it canbecome unsightly, especially if towards the front of the mouth.

An assessment of the gum condition will be made as part of the consultation process for implant treatment, and we may recommend treatment with our hygienist ahead of confirming suitability for treatment.

As you are aware the fees for implant treatments are relatively high, due in large part to the cost of the implants, components and laboratory charges. Our estimates are provided for you giving as much information as possible. As you will appreciate the findings at the time of operation can force decisions that affect costs – such as with the use of biomaterials. Where this is anticipated you will be advised accordingly.

Just as the implant treatment is staged, so will be thepayments due for your treatment. Please refer to the estimate and paymentschedule provided with details of the fees. 

The consultation fees are shown but are deducted on completion of the case as they are included in the implant and restoration fees. This distinction is made clear for those patients who pursue the consultation process beyond the point where costs are incurred but then decide to defer or decline implant treatment.

All estimates are subject to amendment, but once confirmed at the second, definitive plan stage they will become valid for a period of 6 months.

Due to the high cost of components and laboratory work forthe surgery and restoration stages we ask that you make arrangements to settleyour account on or before the day of your surgery and restoration fittingappointments. 

This will be confirmed to you closer to the date, and your co-operation with this is much appreciated.

While Implant surgery has a clinical success rate of around 95%, some factors place certain patients at particular risk in relation to the complications mentioned above:

• Patients who smoke or drink are at an increased risk of infection both during and after the procedure. Smoking and drinking can also each adversely affect healing time, potentially delaying the placement of the final bridge.
• Patients with poor immune systems should watch carefully for signs of infection following Implant surgery.

Your finished bridge

Once the healing phase is completed, usually after a period of 3-6 months your temporary bridge can be replaced with the permanent bridge, which will have the benefit of a reinforcing titanium beam. This makes the bridge stronger and in some cases allows it to be extended further back to allow more teeth to be added, although this is not always necessary or desirable.

The production of the permanent bridge takes several visits during which impressions and special jaw records are taken allowing the technician to construct the titanium beam for your new bridge. This is then tried in with teeth added and set in wax. You will have the opportunity to see and if necessary make changes to the appearance and bite prior to the permanent bridge being finished. It is important to know that when making the bridge that it will be necessary to add in false pink “gum”. This depends on a number of factors including the length of the teeth showing and the natural position of the lips when smiling. As a rule, if you show natural gum before having the treatment, you are likely to have to have pink gum visible on the bridge to create a natural effect. This is the reason we reshape and recontour the bone during the All on 4 implant surgery.

Your dentist will repeat any stages necessary to make adjustments and you will have the opportunity to approve the bridge before it is sent to the technician to be finished. A signature confirming your approval will be needed at this stage. Once finished the bridge cannot be changed except for very minor adjustments to the bite at the time of the fitting.

Please Note: It is important for patients to know that once the bridge has been approved and finished it cannot be changed without them incurring significant costs. Even relatively minor changes can require the removal of all of the teeth and gum from the bridge. Please take whatever time you need to approve the final fitting, and bring a trusted friend or partner if necessary to help you sign the bridge off for completion.

The day of surgery is a big day for you and for the team gathered together to see the treatment through to a successful conclusion. The surgery is booked out for the day and we have a technician in attendance throughout, and for much of the time you will be resting while the bridge is prepared ready for fitting.

You will be given an appointment time for the beginning of the day and once in the practice we will run through the procedure with you and check that you understand and consent to the treatment. You will also be given some medication to ward off any possible infection depending on what you are able to take, usually in the form of a drink.

Once started the surgery usually takes about 2 hours. The procedure involves getting you nice and numb, and if you are having sedation getting that started before the surgery begins. We start by removing any remaining teeth and lifting the gum aside out of harms way. The bone is then smoothed and prepared for the implants to go in.

The implants are placed and tightened into position by hand, and fitted with small caps. The gum is then closed around the implants and impressions taken. You are then free to relax and rest while the technician adapts the prepared work to fit the actual position of the implants. Some time around mid afternoon the work should be ready to fit. The small caps are removed and the bridge screwed into place. Once the bite is checked you are free to leave.

Some patients are happy to drive home themselves but we would suggest if possible that you arrange for someone to call to take you home.

Preparing for the surgery day

1. Smoking
   If you smoke please try to stop 6 weeks before and 28 days after surgery. Smoking affects the healing process and can lead to an increase in the implant failure rate. Smoking used to be considered a direct contra-indication for implant treatment, but we are less strict nowadays, but only on the understanding that patients who smoke risk implant failure and that the longevity of the implants is likely to be affected. If you are considering stopping smoking this is the perfect time to start.
2. Food and drink
   For 4-5 days before surgery please eat normally but you should avoid grapefruit products, especially grapefruit juice, as this can interfere with metabolism of drugs.
   For at least 24 hours before surgery please do NOT consume alcohol. On the day of the surgery please have a good breakfast unless you are having sedation, but avoid caffeine (coffee, tea, cola) and dairy products (milk, yoghurt, cream).
   If you are having sedation you must not eat for 3 hours prior to the surgery, so just have a very light meal if possible.
   If you are a diabetic, please have a piece of toast before attending for your surgery appointment.
3. Medications
   On the day of surgery, take any regular medication (e.g. for blood pressure or for diabetes), unless otherwise instructed.
   If you can use Corsodyl mouthwash up to the day of surgery there is some evidence that this reduces the risk of infection.
4. Clothing
   On the day of surgery, wear comfortable short-sleeved clothing. If you are cold during the procedure, we will provide you with a blanket.
   Do not wear any makeup or face creams, and gentlemen should be clean-shaven if you usually shave. You do not need to shave any permanent beards or moustaches.
5. Care and Maintenance
   The importance of proper aftercare and maintenance cannot be over stressed if you are to have a long-lasting, successful bridge. Implants, like teeth, need to be cleaned properly and checked by your dentist on a regular basis to ensure that everything is healthy. Although implants don’t suffer from gum disease in the same way as teeth, if hygiene is poor inflammation can occur and give rise to bone loss around the implant. In extreme cases the bone loss can be so extensive as to cause the implant to loosen and fall out.
   During the preparation for your new bridge you will have received instruction on new oral hygiene measures designed to secure and maintain healthy bone around your implants. It is important to maintain this high level of hygiene, and regular check-ups with your dentist will allow this to be checked and if found wanting further treatment can be provided.
   Patients with a history of gum disease or those that continue to smoke are at increased risk of early failure of implants, and there are also general conditions, such as diabetes, which can also affect the reaction to plaque and calculus seen with poor levels of hygiene.
   Your dentist can monitor and advise accordingly, and provide early remedial treatment if routine home care is not proving sufficient to keep problems at bay.
6. Bruxism
   Bruxism is the clinical term used to describe grinding of the teeth, which usually happens during sleep and is outside of anyone’s control. Most people grind their teeth some of the time, and this is also true after implant placement and affects All on 4 bridges in particular. A severe grinding habit with natural teeth rubbing against the bridge can cause rapid wear or fracture of the bridge. In these cases your dentist will recommend the use of a night guard to protect the bridge while you are asleep.
   Unfortunately we are unable to offer our usual guarantees against breakages if night guards are recommended and not worn.

ADVANTAGES

Dental implant surgery can offer a number of functional and aesthetic benefits to patients who have severely damaged or missing teeth. Implants can be thought of as replacement tooth roots and can be placed in the upper and/or lower arches of the mouth. Implants provide a solid foundation for either permanent, fixed replacement teeth (individual crowns through to All-on-4™ bridges) or removable teeth (Implant retained dentures).

Implants can look and function just like your own teeth. Most restorations are either made of porcelain or high quality acrylic, which mimics the colour, shade and light-reflecting qualities of natural teeth, so they blend in. Because implants fuse with the bone, they become permanently fixed, and can feel as comfortable as natural teeth, with no discomfort or soreness from, say, slipping dentures.

Implants function in the same way as natural teeth. This means you can eat any type of food you like – with confidence and without pain – including foods that are hard, like apples, or difficult to chew, like crusty bread or steak. Implants also improve your ‘bite’ (i.e. the action of the jaws opening and closing), meaning your new teeth can bite and chew food just like normal teeth.

Implants can benefit you if you’re having difficulty speaking clearly or feel self-conscious when talking as a result of missing teeth or loose-fitting dentures, since they are fixed in place and won’t slip or move.

When a tooth is lost, both the bone tissue and gums can begin to deteriorate due to disuse. Because Implants are integrated into the jaw, this helps to prevent or reduce bone loss and gum recession, since the pressure of chewing stimulates the underlying bone, triggering growth of new bone tissue, thereby strengthening the jaw.

Implants are permanently fixed in place, so you don’t have to remove them for cleaning, take them out at night or worry about them moving, becoming loose or falling out. So, with one or two additional cleaning methods, which you will be shown you can clean your new implant-supported teeth as easily as natural teeth.

Implants are strong and durable and can last for many years, even up to a lifetime, if cared for properly. The bridge may become worn down after 10 to 15 years, but these can be replaced without the need for further surgery or new implants.

DISADVANTAGES

Implant surgery has a clinical success rate of around 95%, however no surgical procedure is without inherent risks, side effects and possible complications.

A period of healing is needed before the final, permanent restoration can be fitted, up to 6 months in most cases.

Fracture of acrylic or porcelain crowns sometimes used All-on-4 bridges is more prevalent than on natural teeth due to a lack of shock absorbency between the implants and the jawbone.

Implants may work out more expensive than alternative treatments.

Replacement of failed implants

Dental Implant treatment outcomes cannot be guaranteed. We do, however, undertake to replace free-of-charge within the first 2 years after placement any implant fixture we have fitted, in the unlikely event that it fails to integrate in the jawbone. We also undertake to repair free-of-charge any crown or bridge we have fitted to an implant fixture provided by us that fractures within 5 years of being fitted. These are not money-back guarantees and do not cover trauma or neglect.

These undertakings are subject to your compliance with the highest standards of home care and oral hygiene and regular attendance for check-ups, hygiene appointments, wearing of night guards and regular reviews. Failure to do so will render our undertakings void. Please read the notes below.

Significant contributing factors to the failure of Implants are:

Tobacco smoking reduces blood supply to the oral and bone tissues, hence the higher failure rate among heavy smokers. If you are a smoker, you must be aware of this, and you must refrain from smoking for at least 6 weeks before Implant surgery and 28 days after.

Alcohol reduces the resistance of tissues to trauma, causing tissue dehydration and delayed healing. Therefore, you must refrain from drinking alcohol for at least 24 hours before surgery and 3 days after.

Neglected oral hygiene leads to the increased likelihood of failure, as surgery sites can easily become infected with plaque bacteria.

These undertakings do not cover failure due to any of the factors mentioned above and do not include failure due to illness, misuse or trauma.

The most popular type of full arch implant bridge worldwide is an acrylic bridge carrying acrylic teeth. These look and feel good, and offer favourable wear characteristics when opposed to remaining natural teeth.

Although 99% of our patients chose acrylic titanium bridgework for their final materials, we also have ceramic or composite definitive bridgework options available, which are usually only used in the upper jaw.

The ceramic option consists of the same computer designed and manufactured titanium bridge framework but with individually cemented all ceramic crowns placed on top.

We advise you to use the acrylic bridgework in your prototype phase as a test run and decide if you wish the alternative same day smiles ceramic option after the 6-month healing time. Please feel free to ask for more information, but this option does add considerable cost to the restoration.

Additional Procedures

Sometimes additional bone grafting and gum grafting procedures will be necessary before implants can be placed and these will be charged at the appropriate fee. If these are anticipated you will be advised in advance. If the need for these arises at the time of surgery this will be discussed with you at the time.

Removable Bridge (Marius bridge)

In some rare cases we may decide with you that the best result in your case will be a removable bridge (‘Marius bridge’) rather than a fixed one, although this is very unusual. This will be discussed with you before commencement of treatment if it is relevant in your case.

Changes in Sensation

The provision of implants is a surgical technique, which, by necessity, involves some disruption of the soft and hard tissues. Sometimes after surgery you may notice a change in sensation to these tissues. These changes are usually transient and they return to normal in time. This can occur because the surgical site is in the vicinity of the nerves that supply sensation to the lip, gums, tongue and teeth.

Nerve Damage

There is always a very small risk that a nerve will be damaged either temporarily or permanently giving disturbance or loss of sensation to the affected areas.  With detailed assessment, planning and careful surgery this is extremely unusual but you should be aware that it is a possibility that may happen to you.

Swelling, bruising and discomfort

Swelling, bruising, pain and infection are all possible side effects of surgical procedures. You should be aware that implant placement is a surgical procedure and, even when carried out without complications, some post-operative swelling and bruising is to be expected. Swelling and bruising will be worst at 48 hours post-operatively and can take on average 10-14 days to resolve provided there are no further complications such as infection. We will provide you with pre and post-operative medication and instructions to limit the extent of these side effects.

Bleeding

Bleeding may occur after surgery but this can usually be resolved by applying pressure with a gauze pack or clean handkerchief for 20 minutes. You will be given specific post-operative instructions giving details of who to contact if you have problems.

Everyone is different

As the heading states, everyone is different, and every case has indications for one form of treatment over another. Advances in dental material technology and computer aided design, coupled with our growing experience and understanding of how the body reacts to implants and different treatment approaches, means that we now have a wide range of options available for treatment of the full arch.

Main factors in our decision-making

• Bone quality and volume
  Every implant we place needs bone for it to be retained and successful for a useful period of time. Our diagnosis of the bone quality and volume in strategic positions of the mouth has been greatly enhanced by the use of computer aided x-rays (the CT scan, short for Computerised Tomography) which takes a series of slice images and converts them into 3D images on screen. These can be used to view and plan surgical options, removing much of the experience informed guesswork of the past. We can now approach every case with a high degree of confidence that the intended result is achievable, resulting in high success rates for treatment between 95-100%.
• Bone grafting
  Where bone isn’t available in sufficient volume we have the option to graft bone from elsewhere in the body, or to help the body grow its own new bone with grafting materials. How the body reacts to these techniques is variable, and if we are considering harvesting bone from elsewhere in the body, we have a separate operation site and the associated pros and cons that go along with that procedure to consider.
  The development of new techniques, such as the All-on-4 and Zygomatic implant procedures, removes the need for grafting in cases where bone is less than ideal. We can now plan and deliver these cases with a high level of success thanks to access to CT scans and the technical support we have developed here in the UK.
• Treatment cost
  With every case there will be a range of options available, with the numbers of surgical procedures necessary, the numbers of implants used, or the choice of materials used for the temporary and final restorations all coming together to give a wide range of treatment costs.
  Full arch treatments could comprise of numerous small bridges fitted onto 6-8 implants, managed over a period of time with several surgery appointments necessary to complete the case, or be managed at a single visit, with a bridge fitted immediately onto four implants – same day teeth, as can be found on any internet search.
  The high cost of traditional treatments, involving multiple surgery visits and the construction of numerous small bridge units in titanium or gold with porcelain teeth, has been the main driver for the development of alternative approaches, making the All-on-4 our most popular choice today – treatment carried out on a single day, with a temporary bridge fitted onto four implants, with a very high success rate.
  In many ways the various options for the treatment follows the evolution of those options, from the basic use of full dentures, through to modern concepts and designs such as the All-on-4 bridge. Zygomatic implants extend the All-on-4 concept further still, with advanced techniques necessary to plan and deliver implant fixtures anchored in the cheek bones in cases where no other bone is available.

Full dentures

Full dentures, made of acrylic teeth and gums, held in place by varying degrees of suction made possible by extending the dentures over a wide area including the roof of the mouth, was probably the most common treatment approach up until 30-40 years ago. Extracting all the teeth and fitting full dentures was a very common procedure, but the advent of modern techniques and higher patient expectations have reduced the demand for dentures in the UK.

Improvements in dental health of the “baby boomers” born in the decade or so after the Second World War means that increasing numbers of our aging population have retained their teeth into old age, and for some the prospect of losing teeth and having dentures is not acceptable. Single implants, or bridges supported by 2 or more implants have helped with loss of small numbers of teeth, but for many patients the fact remains that their natural teeth are not going to last a lifetime, and some form of full arch restoration other than dentures will have to be considered.

Implant retained dentures

This is the next logical step up from simple dentures, and is usually achieved with two implants being placed in each jaw onto which are mounted simple press-studs. The receiving component is mounted in the body of the denture, which can then be snapped into place.

The dentures are able to pivot on the implants and are still removed for cleaning, but the retention is improved. Wear and tear on the press-stud components means that these need to be replaced fairly frequently, meaning return trips to the surgery and follow on cost commitments.

Implant over-dentures

These again are the next step in the evolution of the implant retained bridge, where a denture is made to fit over some form of bar or series of copings, which are sitting on a small number of implants. These have a number of names depending on the actual design but the principles remain the same: the dentures can be removed for cleaning in the usual way, and whilst out of the mouth access for cleaning around the implant and fixtures with a toothbrush is simple enough.

Multiple bridges

This represents the first evolutionary stage towards a fixed, permanent restoration for a complete arch, and involves the use of several small bridges and/or single unit restorations making up a complete arch of teeth. This requires multiple episodes of surgery and fitting appointments leading to protracted treatment times. The cost is high due to the reliance on highly technical restorations and expensive materials. Critically, it also requires the presence of bone, which is where the plan can fall down.

Although traditional grafting techniques can be unpredictable, the development of modern synthetic or specially treated bone materials have made grafting a reasonable option in many cases. Sinus grafting, on one or both sides can boost poor bone in the upper arch.  Implants can be placed at the same time or shortly afterwards once the graft material has healed.

All-on-4 treatment

In cases where bone is poor the All-on-4 treatment, which uses the bone most commonly retained in the mouth, comes into its own without the need for grafting. The treatment involves placing 4 implants, with the back two being placed at such an angle that a full arch of 12-14 teeth can usually be fitted without difficulty. The treatment is done at a single surgery visit when any remaining teeth are removed and the implants are placed. After a series of records for the bite and impressions are taken the bridge is then made while you wait, and fitted later the same day.

The bridge fitted initially is a temporary bridge, designed to last through the healing phase before being replaced with a permanent bridge. The final bridge is custom made with a titanium bar running through it for added strength, often allowing for teeth to be added at the back for a greater arch shape, although this isn’t always necessary or desirable.

The use of only four implants and the speed of production of the finished bridge makes this a very cost effective option, so much so that it has become the most popular full arch choice for our patients by far.

The final bridge also presents a choice of option between an acrylic bridge (the most popular) and the more expensive ceramic version, with individual ceramic porcelain crowns fitted onto a titanium/ceramic bridge. More expensive isn’t necessarily better, and there are many good reasons for opting for an acrylic bridge – they are easy and cheap to service or repair, and as a material it is much kinder when opposed to natural teeth.

As the most popular treatment option there now follows a more detailed explanation of the technique for those considering this as an option.

The need to build up the bone in order to place an implant or to support the soft tissue for cosmetic reasons is common, but difficult to predict with absolute certainty. Bone is often lost after tooth extraction or trauma or after tooth disease.  When an implant is placed it is often necessary to build up the bone to support the implant or the soft tissue for cosmetic reasons. Predicting the need for thisis difficult to assess with absolute certainty and often the decision to add to the bone can only be made once your operation has started.

There are numerous materials that are currently available for increasing bone: those taken from the patients themselves, synthetically produced materials, those derived from animals, or human bone from cadavers. 

Each alternative has its merits, but the use of materials such as Bio-Oss, with or without the membrane material, Bio-Gide or Ethoss®, has become the standard choice worldwide.

Bio-Oss is a bone replacement material that is used to increase the body’s own bone. Bio-Oss is composed of the hard, mineral portion of natural bone and has a structure very similar to that of human bone. It is therefore well accepted by human bone tissue and serves as scaffolding for new bone to grow.

The starting material is carefully inspected bovine bone that has undergone treatment with patented processes for purification and sterilisation. Included amongst these processes is the treatment of Bio-Oss at high temperature for more than 15 hours, after which it is highly purified and finally sterilized.

Bio-Oss is a solid scaffold, which serves as a guide to encourage new bone to grow. This scaffolding material enables and facilitates bone formation in the area where the operation is performed. It is inserted into the operation area in the form of granules or small blocks. Your own bone slowly grows into the Bio-Oss material, which at a later time is gradually broken down by the body.

As an alternative to Bio-Oss, one can use the body’s own bone, which is taken from a different location, for example the chin or hip, or scavenged from the drilling process. Once the bone sample is removed from its original site it is then inserted into the operation area. In this procedure, the following must be considered:

• There may now be a second area of operation, which may be associated with additional pain or loss of sensitivity, and
• It is possible that the amount of the newly gathered bone will not be adequate for the intended purposes.
• These alternative procedures add significantly to the costs of treatment, and are normally unnecessary with the use of modern biomaterials.

Bio-Gide is a membrane made of collagen that is generally used to cover the bone replacement material.

It has been proven that better healing rates are achieved when the Bio-Oss® particles are covered with a membrane (Bio-Gide). The tissues of the gum grow more rapidly than the new bone and the membrane protects the Bio-Oss particles from this faster growing connective tissue. This ensures that the underlying bone can heal in an undisturbed fashion.

Bio-Gide is composed of highly purified natural collagen obtained from pigs.

No. The collagen membrane becomes completely broken down by the body; hence a further operation to remove it is unnecessary.

The manufacturing processes of Bio-Oss and Bio-Gide are subject to a Quality Assurance System based on international guidelines (ISO9001 / EN 46001). These processes are checked once every year by acknowledged, independent testing institutes and international authorities. Bio-Oss andBio-Gide are medical devices that satisfy the safety standards and conditions required by European Union (CE – Certification) and the US Food and Drug Administration (FDA).

As with almost all natural and artificial materials incompatibility and allergic reactions are possible and can never be fully excluded. However because of the high degree of product purity such reactions have been limited to a few mild individual cases. If you experience any reactions please feed this information back to us immediately. 

Ethoss is a material that is used to increase the volume of the body’s own bone in order to help the placement or aesthetic result of a dental implant. Ethoss is synthetic and is completely free from any animal or human tissues. It is made from a ß-Tricalcium Phoshate and Calcium Sulphate. These materials are known to be well accepted by the human body and serve as scaffolding for new bone to grow. The product is produced in a sterile cleanroom.

Ethoss encourages new bone to grow in the area where the operation is performed. It is placed into the area in the form of granular paste that sets.

Gum tissues grow more quickly than the new bone. The Calcium Sulphate acts as a membrane that prevents this faster growing tissue from getting into the area where new bone is required. This helps to ensure that the new bone can grow in an undisturbed fashion. The ß-Tricalcium Phoshate acts as a scaffold for new bone to grow. Your body completely absorbs the Calcium Sulphate and ß-Tricalcium Phoshate over a period of months and it is replaced with your own new bone.

There are several alternatives to a synthetic graft material. Some materials are produced from animal bone including cows, pigs and horses. Other materials are produced from human donor cadavers. Bone can also be taken from a different location in the patient’s body. This is normally the chin or hip, or it may be collected during the implant drilling process. Once the bone is removed from its original site it is then inserted at the operation area. If your own bone is used, the following must be considered:

• the amount of bone gathered may not be enough.
• a second operation area may be associated with additional pain or loss of sensitivity in the area,and
• there may be additional costs for the treatment.

Yes. The manufacturing processes of Ethoss are subject to a Quality Assurance System based on international guidelines (ISO 9001 and ISO 13485 and the standards of Risk Management System based on ISO 14971). Acknowledged, independent testing institutes and international authorities regularly check these processes. Ethoss is a regulated medical device that caries CE-Certification (certified by the European Medical Device Directive 93/42/EEC.). This means that it satisfies the safety standards and conditions required by European Union.

As with almost all animal, human or synthetic materials in compatibility and allergic reactions are a possibility and so can never befully excluded. However no such reactions to ethoss have been reported to date.If you do experience any reactions to ethoss please contact us immediately.

A dental cone beam CT scanner uses x-rays and a computer to produce 3D cross sectional images of the jaws and teeth. It is a compact, faster and safer version of the regular CT scanner. Through the use of a cone shaped x-ray beam, the size of the scanner, radiation dosage and time needed for scanning are all much reduced. 

The machine moves around your head in a circular motion in a similar way to the panoramic dental radiography unit, which is commonly used in dental surgeries and hospitals, and which you may have already experienced. 

You will be seated in the CBCT machine. Your head will be carefully positioned and you will be asked to keep absolutely still while the scan is taken. The positioning takes a few minutes, but each scan takes only a minute or so. You may need more than one scan depending on the reason for your examination. The whole procedure should not take more than 30 minutes. 

The scan will give us detailed information that cannot be obtained from more conventional x-ray equipment. For example, if you are being considered for dental implants orother special procedures it enables us to assess the exact shape of the bone. 

CBCT scans are low dose examinations and give an x-ray dose to the patient that is considerably less than a medical CT scan. 

A medical CT scan of the upper jaw gives a radiation dose equivalent to approximately 179-578 days of background radiation (the radiation constantly present in the environment). A CBCT scan of the whole jaw would be comparable to approximately 12-30 days of normal background radiation. 

As with any x-ray examination, please inform the radiographer if you might be pregnant. 

No. Without this examination it may not be possible using traditional dental x-ray pictures to assess the bone accurately enough to allow your treatment to be performed safely. 

Before your CBCT you will be asked to remove glasses, dentures, hearing aids, earrings, tongue studs, necklaces, hair clips and any other metal accessories that may affect the scan. This is not an examination that requires any injections or special preparations beforehand. 

If you are having the scan for dental implant planning, you may be asked by your dentist to bring a localisation stent with you. This is a special ‘plate’ that you will wear rather like a denture, containing markers to guide our x-ray examination. You will only need to wear this during the scan. 

If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you. 

Remember, it is your decision. If you change your mind at any time, please let staff know immediately. Your wishes will be respected at all times. 

This procedure is not painful, but you will need to remain still for the duration of the scan. If you are claustrophobic please mention this to the radiographer so that they can offer you appropriate support and advice. 

After the examination you will be able to go home straight away. 

The CBCT will be reported by our consultants and the report will be sent through tothe dentist who has referred you for the examination. 

No special aftercare is necessary, you will be able to eat and drink and carry on all your normal activities. 

In the unlikely event that you experience any problems following your CT scan please contact the dental surgery from Monday to Friday between 9am – 5pm.

If you are considering tooth extraction as part of your treatment plan it is important for you to be fully informed about the procedure, its pros and cons and possible risks, in order that you can give full consent to the procedure.

Although tooth extraction is a very common procedure it is important to recognise that, as with all surgical procedures, there is a risk of complications that commonly are beyond the control of the dentist.

You will have considered the alternatives to the extraction of teeth, from doing nothing through to attempting to save and restore the teeth concerned. Your extraction(s) may form part of a treatment plan involving implant placement,and it is important to realise that complications following the extraction can lead to difficulties with planned implant work. These difficulties range from a simple delay in treatment, say after infection at the extraction site, through to the planned implant work having to be reviewed or abandoned altogether.

Normal complications that can occur as a result of the extraction(s) include but are not limited to:

• Allergic reaction to medications or anaesthetics used in the extraction process 
• Pain, swelling, infection, bruising, post-operative bleeding
• Stiffness of the adjoining or nearby muscles 
• Numbness – There is the possibility of injury to the nerves of the face or tissues of the oral cavity during the administration of anaesthetics or during the extraction, which may cause a numbness of the lips, tongue, tissues of the mouth and/or facial tissues. This numbness is usually temporary but may in rare cases prove permanent. 
• Fracture of the root tips, which may also result in the root tips being left in place or displacement of the root tip into the sinuses and/or spaces nearby 
• Dry sockets, inhalation and/or swallowing of foreign objects
• Damage to adjacent teeth and/or restorations 
• Damage to bone necessary for implant placement, requiring further surgery and bone augmentation before implants can be attempted.

Although the vast majority of cases proceed without complications, surgical procedures of any kind, including extractions, can never be guaranteed. However, you can rest assured that every effort will be made to avoid complications and that you will be kept fully informed throughout the process if we have concerns about how the treatment is progressing. 

Conscious sedation is a commonly used, safe procedure which is defined as a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely

Conscious sedation can be provided by tablets or intravenous injection, the main difference being the level of sedation achieved. The intention in providing sedation is to allow a patient to undergo more difficult procedures in comfort, without the worry normally associated with those treatments. It is a safe and effective procedure in common use for dentistry and dental surgery in particular.

Sedation is not sleep, but a drug induced state that reduces awareness and your ability to respond. The procedure still requires local anaesthetic and this will be given once your chosen method of sedation has been achieved. IV sedation has a strong amnesic effect, and it is unlikely that you will remember much at all about the surgery.

Sedation by tablets, usually Temazepam, is described as anxiolytic. It reduces anxiety, but is less profound than intravenous sedation, with the normal drug for the IV route being midazolam. The usual protocol for sedation by tablets is to take some the evening before the procedure to assist with sleeping, and a repeat dose an hour before the surgery. Recovery after oral sedation is slower than for IV sedation, and the normal precautions, such as avoiding driving or operating heavy machinery for 24 hours will need to be observed.

Conscious or intravenous (IV) sedation involves the administration of a sedative drug through a fine plastic tube (cannula) into a vein, usually in the back of your hand or arm. You will become drowsy and may not remember any of your dental treatment. It is vital that you can still cooperate with your dentist so you will remain conscious though relaxed. You will be monitored continuously throughout your treatment and the sedation can be topped up at any time.

As with any procedure there can be complications from sedation, which may include a reaction to the drug itself, which may require emergency medical attention and/or hospitalization, such as altered mental states, physical reactions, allergic reactions, and other sicknesses. These complications are very rare and sedation is now considered a routine procedure to support the delivery of dental implant treatments.

Sedation also reduces your ability to discuss treatment options with the dentist should circumstances discovered during the operation require a change in the treatment plan. If, during the procedure a change in treatment is required, the dentist and the operative team will need to make whatever change they deem in their professional judgment to be necessary and in your best interest.  As part of your consent to have sedation you will nominate the dentist who you wish to take responsibility for decisions if the need arises.

You will need to notify the dentist if you are pregnant or breastfeeding, or if you have sensitivity to any medication. You should also advise the dentist if you have recently consumed alcohol, or are presently taking psychiatric mood altering drugs or other prescription medications. You can eat and drink as normal but it is not a good idea to eat a heavy meal before sedation.

 You must have someone with you to take you home after the procedure, and should not be alone during the evening and overnight of the day of surgery. You are also advised against taking sole responsibility for children for 24 hours after having sedation.

You will remain conscious during this kind of sedation. 

You may experience a temporary loss of memory during the time that you are sedated. Many patients have no memory of the procedure at all. You may feel unsteady on your feet for some hours after the procedure. Your ability to think clearly and make judgements may be affected for the next 24 hours. You may experience some forgetfulness. 

Once you are sedated, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment. 

Any injections that you may need can be given through this numbed area to reduce the chance ofany discomfort. 

You will spend sometime in the recovery area following your treatment. You will be checked by the dentist or the person giving you the sedation before you can go home. 

You must be accompanied by an able-bodied adult who can take responsibility for you following your treatment. This person must be able to stay with you overnight. If arrangements have not been made for someone to accompany you after treatment, you will not be able to have the sedation. 

If you have any questions or are unclear about having your sedation, then do not hesitate toask the dentist. 

Your judgement may be affected by the drugs. This is similar to the effects of consuming alcohol. You should not drive a car, ride a bicycle or operate machinery until the following day. In some cases, this may be for as long as 24 hours. 

You should also not take responsibility for the care of others, use sharp implements or cook.It would be unwise to make any irreversible decisions for 24 hours following your treatment. Owing to the effects of the drugs used, care should be taken when using the internet for personal communication. 

Before you are discharged, the dentist or dental nurse will give you and the adult accompanying you (escort) important information about your care. You will begiven information relating to any local analgesia and the treatment you have received. The dentist will also provide details of pain relief as well as how and when to take other prescription medicines. 

You will be given a telephone number of who to contact if you have any problems as a result of your treatment. 

Due to the specific nature of the sedation treatment you are asked to confirm, by signature, that you have read and understand the advice set out to you, and that you consent to having sedation treatment as prescribed by your dentist. You will be asked to re-confirm this consent on the day of treatment.