HEMPER LANE D E N T A L 58 Hemper Lane Sheffield S8 7FD Tel; 0114 2377275 Information on replacing missing teeth and dental implants

Introduction

The majority of patients keep their teeth for life; however teeth can be lost or sometimes do not develop. This information sheet gives a summary of some of the techniques that can be used to replace missing teeth.

When replacing missing teeth dentists and patients need to consider:- That following tooth loss the bone which supports the teeth shrink – it can also be lost due to gum disease while teeth are still present, lack of bone and supporting tissues makes both conventional treatment with dentures and implant care more difficult and can adversely affect the final result achieved.

• For success the overall status of the remaining teeth needs to be good and there should be no gum disease. Oral care and tooth brushing must be of a high standard.

• In general overall health should be good – conditions that affect patient’s ability to heal and certain medications can adversely affect treatment outcomes.

Methods of replacing missing teeth.

Where a single tooth or small number of teeth are missing Fixed dental bridge Involves grinding down adjacent teeth to support the bridge, good function and aesthetics requires maintaining.

Removable partial denture Made of plastic – or plastic/metal, the adjacent teeth aren’t affected, it is easily and quickly installed and relatively cheap.

Adhesive or Resin-bonded bridge Artificial tooth glued to adjacent teeth, high aesthetic teeth, high aesthetic result no surgery needed. Natural healthy teeth aren’t affected. The glue will eventually fail and it will then have to be reglued or replaced.

Dental implant supported crown The new tooth should fit and function just like a natural tooth requires maintaining.

Where multiple teeth are missing Removable partial denture Made of plastic – or plastic/metal, the adjacent teeth aren’t affected: good aesthetics and may provide good function.

Dental implant supported bridge Can be hard to tell from natural teeth, requires surgery and maintaining.

Where all the teeth are missing Removable full denture A denture that is fitted on top of the

gums, can cause discomfort during eating affect from speech, and cause sore gums from denture movement, it provides good aesthetics.

Implant supported fixed or removable bridge Artificial replacement of natural teeth good function, aesthetics depend upon existing hard/soft tissues, where there has been gum disease bridges often have to have ‘longer teeth to reach the existing gum or artificial pink gum work is placed on the bridge to reproduce the lost gum tissue*. Requires cleaning and maintenance for long term success

Implant retained denture (over denture) A removable denture that is connected to two or more implants. The implants help keep the dentures in place and provide better function and comfort than a conventional denture. Attachments require cleaning and need long term maintenance.

What is a dental implant?

A dental implant consists of a fixture – the part that screws or press fits into the bone on to which different components can be attached to extend the implant through the gum into the mouth so crowns, bridges or dentures can be fitted.

Implants at Hemper Lane Dental Practice

We only accept patients who can look after their general dental needs and participate in the lifelong care that will be required after provision of implant supported restorations.

How long do they last and can implants fail? In a healthy mouth with healthy bone, implant fixtures (the metal part) should last as long as natural teeth – they do need caring for as natural teeth do. The crowns or bridges supported by the implants can last a decade or more but will eventually wear and need replacing. Implants are medical devices placed into bone. As with treatments a small proportion of patients do have failures. Failures are more common when the bone is of poor quality or when infection is present. Some patients are more at risk than others. You will be informed if there is a greater risk for you. Implants and the restorations they support do need maintenance by you (cleaning) and your dentist.

What are the risks? Apart from implant failure, pain bruising, infection and swelling are common to all procedures. This will vary from patient to patient and is dependant upon your procedure. The symptoms can usually be managed with painkillers, antibiotics and cold packs. Damage to nerves or roots of adjacent teeth can occur but are not common.

Is there anything you can do to improve the chance of success? For people who grind their teeth it may be wise to have a plastic guard made to protect the implants/teeth from damage or failure. A good standard of oral cleaning is a prerequisite for treatment and long-term success of your teeth, crowns, bridges and implants. Smoking is a major factor in treatment failure.

How long will my treatment take? Dental implant treatment is complex and often prolonged, it involves multiple visits to the practice and it is not possible to give an accurate time over which can be completed. The minimum treatment time is usually a few months and for many patients a year or more is not uncommon.

Will I be able to wear my existing denture during the treatment? You should be able to wear your existing denture straight away with appropriate adjustments, however following bone grafting procedures you may have to go without your denture; denture wear can also be difficult until any bruising settles.

Stages in dental implant care

1. Planning • Initial consultation appointment to assess for suitability. • Further consultation and the obtaining of special x-ray pictures and study casts of the

teeth may be required. • Review with the results of any tests and discussion regarding care.

2. Treatment to prepare the mouth for care. • Care by your dentist and yourself to bring the teeth/gums to a healthy state. • Repair of any missing bone or soft tissues may be required using bone grafts. • Healing period and review.

3. Surgery to place implants. • Implants are usually placed using local anaesthetic, the procedure taking one or two

hours depending on the number of implants to be placed. • If possible implants are placed using a single stage surgical technique, this is not

always possible and a more conservative two stage technique may have to be used. In the two stage technique the implants are left to heal covered by the gums. At the end of a healing period (3 to 6 months) surgery to uncover the implants and reshape the soft tissues is then needed before restoration of the missing teeth can be undertaken. If a single stage technique is used this second surgical procedures is missed out but during the healing period it is important to carefully clean the exposed temporary tops placed on the implants which are visible on the gum.

• For some patients it may be possible to place temporary crown or bridge when the implant(s) is placed. This will need careful cleaning and it is important to limit the amount of biting force placed on the crown.

4. Further visits to check healing and any sutures.

5. Restorations of the missing teeth. • This part of care usually requires multiple visits over several months, there are many

stages as each restoration is individually crafted and the technical / laboratory stages can take considerable time to complete.

Patient information following Dental Implant surgery

Q. Will there be any pain after surgery? A. Discomfort can be expected following surgery and there is often some swelling bruising of the tissues. Simple pain relieving tablets may be needed for the first few days after surgery; we recommend Paracetamol or tablets you normally take for headaches please follow the directions on the packet.

Q. What if the anaesthetic does not wear off and my lip stays numb? A. Sometimes after an implant in the lower jaw, numbness or reduced feeling in the lip persists after the anaesthetic wears off, if this happens you should ring the practice and arrange to come back for review the next working day so we can check the area, you should not wait for your normal review.

Q. What do I do if it bleeds? A. Bleeding may occur in the first few days especially when brushing your teeth, if the bleeding is persistent you should rinse your mouth carefully with hot water and then apply pressure to the site by biting on a clean rolled up handkerchief or cloth. You should apply pressure for 10 minutes and then avoid further mouth rinsing for 12 hours.

Q. How do I clean my teeth? A. For the first week pay special attention to carefully brushing your teeth/implants twice a day and if needed after meals – a soft toothbrush and toothpaste for sensitive teeth is helpful immediately after surgery. Careful brushing of the area where the implant is will encourage healing. The use of an antiseptic dental mouthwash is also helpful (‘Corsodyl Daily’ mouthwash is good but other types are fine) or use a warm salt mouthwash (half a level teaspoon of salt in a mug of hot water use twice a day). Q. Can I wear my denture? A. If you have a denture it will have been adjusted by the surgeon, who will advise you if you can wear it. Denture wear is usually fine as long as you do not place a lot of force on the implants as this can affect whether they bond to the bone. Dentures should always be left out at night. Q. What can I eat? A. You should avoid very hot foods and drinks for the first 24hrs (allow drinks to cool) as hot liquids can cause the wound to bleed. A soft diet should be taken for the first few days.

Q. When do I come back to the clinic? A. An appointment will have been made for review. Stitches will dissolve and fall out but healing is often improved if they are removed at a week to ten days.

Q. How can I access further advice is case of difficulty? A. Please ring Hemper Lane dental practice on 0114-2377275