Treatment Journey

Implant treatment is often less expensive than the option of tooth extraction and replacement with a bridge or the inconvenience of a removable partial denture. The cost will vary depending on the nature and location of the missing tooth site and whether there is any need for bone augmentation to improve long term success.

An estimate of the cost of your treatment will be provided on the day of your consultation. Payment is expected at the end of each visit.

All fees are correct as of 1^st May 2017

All the common forms of tooth replacement, such as bridges or dentures can be replaced by dental implants. If you are missing just one natural tooth, then one implant is normally all that will be needed to provide a replacement. Larger spaces created by two, three or more missing teeth do not necessarily need one implant per tooth, however the exact number of implants will depend upon the quality and volume of bone at each potential implant site.

Occasionally, it is even possible to join natural teeth to implants with a conventional bridge.

In the upper jaw, bone density is generally poorer than in the lower and if you have no teeth at all, most treatment providers will want to place a minimum of 6 implants to support a complete arch of 10 or more replacement teeth. In the lower jaw, the bone towards the front of the mouth is often very strong and as a direct result, fewer implants may be needed than are required to treat a whole upper jaw. A simple treatment plan to provide 10 or more teeth in the lower jaw might be possible with as few as 4 implants, although it is still more common to use 5 or 6.

When multiple implants are placed, they are routinely joined together in the same way that a bridge supported by natural teeth would be designed.

If enough implants are available, it is often easier and just as effective to make several smaller sections of bridgework each supporting a few teeth. The overall effect in the mouth is the same if you ever need to repair one of the small sections, this can be a lot easier to do.

Again, the bone quality and the number and position of the implants will largely determine which option is most suitable for you. When implant supported teeth are linked together, they are mechanically stronger than the individual parts.

If you have no teeth in the lower jaw, and are not yet ready for multiple implant placements, a conventional lower denture can be considerably improved with 2 implants placed beneath the front section – this is called an 'overdenture'. The same overdenture concept when used to treat the upper jaw, will usually require more implants as the bone is generally softer. Implant supported overdentures, just like conventional dentures, are still removed for daily cleaning. However, once back in the mouth, the implants make them much more stable.

Whilst not suitable for everyone, with proper preparation it is sometimes possible to fit new implant supported teeth on the same day. This fast track treatment can be applied to a number of different situations, however, you do have to balance shorter treatment times against an increased risk of implant failure.

If you have good general health then dental implants will almost certainly work for you. However, habits such as heavy drinking and smoking can increase the number of problems associated with initial healing and thereafter may negatively influence the long term health of gum and bone surrounding each implant. Remaining teeth might also be compromised making treatment planning less certain.

If you have any other complicated medical problems, please speak to Dr Bhat who has considerable experience in handling patients with a complicated medical history. It is rare to have health problems that prevent the use of dental implants.

When you first enquire about dental implants it is often in response to an awareness of ongoing dental problems or the recent loss of teeth. Each of these problems will need to be diagnosed and treated in a logical manner, often placing implants in order to establish healthier conditions.

Although it is tempting to focus on the more glamorous aspects of teeth supported by implants, basic dental health, which includes the treatment of gum disease, repair of decay and the elimination of abscesses will be just as important for the long term success of your treatment.

If you are aware of bad breath, loose teeth, or have noticed excessive bleeding, particularly when your teeth are cleaned professionally, you may have gum problems. Periodontal (gum) disease is a major cause of bone loss and with reduced bone; dental implant treatment can be more complicated.

Whenever the tooth is lost or extracted, a considerable amount of the bone that once surrounded the remaining root portion may disappear. This loss can be particularly rapid during the first few months and is described as 'bone resorption'. Although the rate and amount of bone resorption is highly variable between individuals, it will always occur to some extent, unless specific care is taken to reduce its effects. Sometimes, the simplest measure to minimise bone loss after an extraction is to place the implant immediately or within the first few weeks.

This is one of the most important features of dental implants. Once in place and supporting teeth, everyday functional forces stimulate the surrounding bone which responds by becoming stronger and more dense.

Routine dental x-rays show large amounts of detail but in only two dimensions. From these views it is generally possible to judge the height of bone available for implant placement, however, more advanced imaging techniques are sometimes needed to determine the equally important bone width, which can otherwise only be estimated from clinical examination.

Dental CT scans - There are now a number of advanced x-ray techniques which allow your jaw bone to be looked at in all three dimensions. The most accurate and widely available is known as the CT (computed tomography) scan. Images obtained by CT scanning will normally be able to show all of the information required about your bone, including quantity and quality but most importantly the presence of anatomical structures that must be avoided.

CT scans are generally the best means for identifying the location of important nerves and allows implants to be placed with considerable confidence. It will therefore require a visit to SD Radiology, a specialist CT Scan Centre for Dental Implantologists at Watford, where the scan is generally completed within a few minutes. Whilst CT scans are more expensive than routine dental xrays, the information they provide is often invaluable for complex treatment planning and knowing where important anatomical structures are located.

So far we have covered the building blocks that are part of routine implant placement. This has included the initial examination and diagnosis, special x-rays such as a CT scan, sedation during surgery and what to expect after the implants have been placed. However, for some people, bone loss after the removal or loss of teeth leaves them without enough to secure an implant.

Sinus augmentation - in the upper jaw above the back teeth, it is possible to increase the height of bone available by creating new bone in the sinus. This procedure is called a 'sinus augmentation'. Dr Bhat can deliver very predictable results in this location and without the general success of this technique many patients would be unable to have implants in a part of the mouth where teeth are so commonly missing.

Bone can be harvested from a number of sources such as the hip, tibia, chin and posterior regions of the lower jaw. When you use your own bone to create new bone in another area of the mouth you will have to contend with the discomfort created by the donor site as well as the surgical site. Many people feel this is well worth any additional discomfort as your own bone is normally considered the 'gold standard'.

Alternatives to your own bone for grafting

For those who would prefer an easier, but slightly slower solution, there are other sources of bone specially prepared to make them safe for use in humans. All of these materials including your own bone simply provide a scaffold into which new bone will grow and consolidate ready to receive dental implants a few months later.

New bone can take anything from 3 to 12 months before it is ready to receive dental implants. Do not be in a hurry to move to the next stage. If you need a large volume of bone it will take longer to mature than a small amount.

Guided tissue regeneration - Each surgeon will have his or her preferred way of creating new bone. Many of them will also use a supplementary technique called 'guided tissue regeneration'. Using this technique slow moving bone cells are given time to fill a space by placing a barrier material between them and the fast moving cells of the soft tissues lining the mouth. When this technique was originally developed the barrier material had to be removed during a separate surgical stage a few months later. Whilst these original materials are still in use, it is now more common to use a 'resorbable barrier' that will disappear naturally a few months after it has done its work.

If you need bone grafting, it will almost invariably increase the length of time your treatment will take, however when successfully applied it will greatly improve the outcome of the implant(s) placed. When used in the front of the mouth it can also allow for creation of much better aesthetics.

Bone grafting requires a considerably higher degree of skill from the operator and is often more complex to perform than the placement of the implant itself.

In certain situations Dr Bhat will recommend combining the implant placement with bone grafting and the placement of a barrier membrane all at the same time. This considerably reduces treatment time and can produce results that are difficult to achieve any other way. However, many surgeons will still prefer to carry out bone grafting as a distinct stage, so that the implants are only placed when the bone grafting has been successful.

Whatever method is chosen to improve the bone quantity the time, effort and expense is generally well worthwhile.

If an implant does not achieve or cannot maintain a rigid fixation with the surrounding bone it will eventually become loose and no longer be able to support replacement. Commonly the failing implant causes no discomfort and if there are enough remaining, it may not be necessary to replace it at all.

Dental implants are routinely placed beside natural teeth and this is generally very safe to do. The only exception to this would be if the natural root was very curved or tilted unfavourably in the proposed path of the implant. This could cause the root to be damaged by the implant; however this can usually be avoided by careful pre-operative planning.

If a tooth is inadvertently damaged by the placement of a nearby implant, any resulting problems can generally be resolved by root canal treatment in which the nerve of the natural tooth is removed.

If the teeth being replaced by dental implants are in a clearly visible part of your mouth it is most likely that you will want to have some teeth present whilst the treatment is underway.

There are a number of ways that this can be done, ranging from simple plastic dentures to removable bridges. If replacement teeth are used during treatment stages it is important that they do not apply uncontrolled pressure to the underlying implants.

Most patients will be very familiar with the dental anaesthetics used for routine dentistry and will know how effective they are. Implants are placed using the same anaesthesia. Depending upon the complexity of your case, the operation might take anything from 15 minutes for a single implant, to several hours for complex bone grafting and multiple implant placements.

Since the surgery normally involves exposing the bone in the area where the implant and/or bone graft is to be placed, you can expect some minor swelling and occasionally bruising afterwards.

For most patients, any of the simple painkillers you might take for a headache will be all that is needed for a few days. If you experience more discomfort than this, do not hesitate to contact Dr Bhat who can prescribe stronger medication.

Healing is generally uneventful and any stitches are removed a week to 10 days later. During the first few days you should report any unexpected levels of pain or swelling so that it can be assessed. If in doubt always ask for advice, as early detection of a problem will often lead to a simpler solution. You may also be asked to take a course of antibiotics and to follow some simple procedures such as rinsing with salt water or an antiseptic mouth rinse. It is important that you carry out these instructions.

During your consultation appointment with Dr Bhat you will be expected to answer detailed questions concerning your medical history and there will be a complete examination of your mouth and remaining teeth to discover the nature and extent of any current dental problems. If you do not have up to date x-rays of your remaining teeth you may also be required to have new ones taken. Sometimes models and photos will also be needed so that these can be examined after your visit.

It is accepted practice that you should be given a written summary of your treatment planning discussions, highlighting your current dental situation and any alternatives there are to dental implants. This summary should also include an overview of the anticipated treatment stages and give you some idea of how long treatment is likely to take, how many implants are required and what the fees are expected to be. There may well be other issues specific to your case and these would be dealt with accordingly.

Although it is quite straightforward to provide good pain control during surgery, most people will be quite anxious for all but the most simple of implant cases. There is no need to suffer in silence as there are several very effective means by which you can achieve a relaxed state.

Oral sedation - A simple way to aid relaxation is to be given a dose of a short acting medication such as Temezapam (normally used to help with sleep difficulties). This will reduce anxiety for most patients and provides a very good effect for uncomplicated surgical stages taking less than an hour.

Conscious sedation - For treatment of greater complexity it may be suggested that you have a more controlled way of keeping relaxed and comfortable during the surgical stages. This is known as a 'conscious sedation' and is distinctly different from a general anaesthetic, because you remain alert enough to respond to simple instructions which may be helpful to the surgeon - however you will remember almost nothing about the treatment stage. For a routine 'conscious sedation' a carefully controlled amount of sedative is delivered through a vein in your arm or hand for as long as the treatment takes.

For procedures involving oral or conscious sedation you will need to arrange for an adult to take you home. You will also be advised not to operate any machinery for at least 24/36 hours afterwards.

General anaesthesia (GA)

General anaesthetics require a hospital admission and are mainly, but are not exclusively used for complex cases such as where bone is being grafted from the hip to the mouth, or where large numbers of implants are being placed at the same time.

Dr Bhat has operating rights under GA at BishopsWood Hospital, private wing of Mount Vernon Hospital, where GA can be provided by a consulting anaesthetist as a day stay procedure. One is normally fit for discharge 2-3 hours after the GA has been provided.

For routine cases, from the time of implant placement to the time of placing the first teeth, treatment times can vary between 6 weeks and 6 months. The availability of better bone can be used to decrease treatment time, whilst more time and care must be taken with poorer bone, which can therefore extend treatment times beyond 6 months.

Immediate Dental Implants – This technique is most often used to treat the lower jaw and requires several appointments to take impressions of the teeth before the actual day of surgery. Several implants are installed and a few hours later a complete arch of temporary or permanent teeth can be fixed in place. If temporary teeth are used these will normally be replaced with a permanent bridge after a suitable healing interval. Your suitability for this type of treatment will be assessed by Dr Bhat at the consultation.

For most implant-supported teeth you will be able to clean around each supporting implant by brushing and flossing in just the same way that you would around natural teeth and tooth-supported bridges. In some areas special floss, interdental toothbrushes and other cleaning aids may be needed to maintain good oral hygiene. Cleaning is not at all difficult, provided that you do not have impaired use of your hands.

It is reasonable to expect some of the daily hygiene procedures to be a little more complex than around your original teeth - equally expect to spend more time than you may have done in the past if you wish to maintain optimum implant health.

For the first few months the implants are in function and your dentist may ask that you are seen more frequently. However, once they are satisfied your treatment is performing as planned, ongoing care will be similar to any patient with natural teeth.

One stage implant - The implant is placed into a new, healing or healed extraction site and is visible above the gum immediately after placement. The advantage of this method is that a second surgical stage is not necessary to expose the implant. The implant will not normally be ready to support a tooth for several weeks or months.

Two stage implant - The implant is placed into a new, healing or healed extraction site and then covered by a layer of gum so that it cannot be seen – this is the first stage. At the second stage some weeks or months later, the implant is uncovered and components added bringing it above the gum ready to begin placing a new tooth.

Immediate Dental Implants - This technique is most often used to treat the lower jaw and requires considerable planning before the actual day of surgery. Several implants are installed and a few hours later a complete arch of temporary or permanent teeth can be fixed in place. If temporary teeth are used these will normally be replaced with a permanent bridge after a suitable healing interval. Not all patients are suitable for this style of treatment.

Immediate implant - For this technique a tooth is removed and an implant placed immediately into the extraction site. Depending upon the local bone and soft tissue conditions, the implant surgery may be a one or two stage procedure. Not all patients are suitable for this approach.

Summary of stages for routine dental implants

• Diagnosis and treatment planning after which it may be necessary to carry out repairs or treatment to any remaining teeth.
• Implant placement is usually followed by a period of healing lasting from 6 weeks to 6 months. Often the implants are completely hidden beneath the gum; however one stage procedures where the implant is visible from the time of placement are also commonplace. Stitches are normally removed 7 to 10 days after the implant placement.
• Several visits may be needed over the next few weeks to adjust temporary teeth or dentures and to monitor healing.
• Once the implants have healed uneventfully for the required time, they are uncovered if necessary and made ready to connect the teeth. Sometimes the time allowed for implants to integrate may be increased or decreased to suit the local bone conditions and the overall quality of healing.
• In some cases the first teeth fitted to your implants are not the final ones, but replicas of the intended design. This stage can be used to assess the implants, control early loading and in areas where aesthetics are more critical, also gives the gums time to mature around each implant before the final teeth are fitted
• Final teeth are commonly fitted between 3 and 9 months after the implants were first placed. The way that the teeth fit together is carefully adjusted so that they do not interfere with each other.
• Regular examination and hygiene appointments are then all that is required to maintain the health of the mouth, teeth and implants.

Onlay grafting – There are many ways in which bone can be added to; however, one simple concept is to take a piece of bone from somewhere else and secure it as an 'onlay graft' to a deficient area. The new piece of bone will slowly join to the underlying region and when healed and mature, an implant can be placed in a more favourable position.

During the period after the new teeth are fitted, the success of each treatment stage will be the main factor determining how the implants are performing. Once the implants and surrounding soft tissues are seen to be healthy and the new teeth comfortable and correctly adjusted, it is the quality of your home care and willingness to present for regular maintenance reviews that will have most influence on how long they will last.

When poorly cared for, implants will develop a covering of hard and soft deposits (calculus and plaque) which is very similar to that found on neglected natural teeth. Untreated, these deposits can lead to gum infection, bleeding, soreness and general discomfort, just as can occur around natural teeth. It could probably be said that implants much like teeth will last for as long as you can keep them clean.

Well maintained implants placed into adequate bone can be expected to last for many years and probably for our lifetime. However, just as you would expect conventional crowns, bridges and fillings to need occasional repairs or replacements during their lifetime, your implant supported teeth may also have similar maintenance requirements over theirs.