CONSIDERATIONS BEFORE HAVING A DENTAL IMPLANT
What Is A Dental Implant?
A dental implant is a titanium screw that is fused into the jawbone.
Dental implants are used to replace teeth when they are lost. Dental implants can be considered to be replacement of your tooth roots. They can then be used to anchor with a single crown, bridge (multiple teeth i.e. two or more) or used to secure a denture in place.
Dental implants are comprised of 2 main components: the dental implant and the abutment which acts like an intermediate connector to the crown, bridge or denture (please see below).
Dental Implant Component
A dental implant is a partially hollow metallic screw (usually titanium or a titanium alloy, newer versions include ceramics) that is surgically inserted into a patient's jawbone.
Dental implants are installed during surgery, either by a dental specialist (Periodontist or an Oral Maxillofacial Surgeon) or by a General Dentist who has implant surgery experience.
After the implant is installed, it is typically left for approximately 8-16 weeks to heal and to fuse with the bone (duration can vary due to addition of bone grafting). During the healing time, a cover screw (two stage surgery) or healing cap (single stage surgery) will be attached to prevent bacteria or food entering the dental implant and causing damage to the implant or surrounding gum and bone.
Dental Abutment Component (Crown, Bridge, Denture)
A dental abutment is foundation for your future crown, bridge or denture which screws into the dental implant.
Insertion of your abutment/s and crown, bridge or denture can be carried out again either by a specialist (Prosthodontist) or by a General Dentist.
The healing cap (see videos above for more information) is removed and a mould of the implant is taken and sent to a Dental Laboratory. A Dental Technician from the Laboratory typically constructs the crown, bridge or denture and in other instances, it can also be milled in the dental office.
Once the crown, bridge or denture is ready, your treating dentist will insert it into your mouth. This can either be screwed, glued or clipped (for a denture) into place.
Dental Implant - Complete
Once both components have been installed, the dental implant is complete. Dental implants are meant to last many years, but complications can arise, as with any implantable device.
How Long Do Implants Last?
Dental implants generally last for many years. However, dental researchers and clinicians do not know (at this time) if they last for a lifetime.
There isn't enough long-term research (+40-50 year studies) to indicate that implants will last for a patient's lifetime. As with all medical devices, dental implants have the potential to develop complications and/or fail (i.e. not all implants will last forever, all the time!).
There are two types of implant failures:
The first one is early failure, which can occur within 12 months of implant placement.
The second is late failure, which can occur after 5-10 years.
What does "many years" mean? The answer to this is in the dental research.
What research definitely tells us is the following:
Only a few research papers with solid evidence and properly structured research exist for a handful of dental implant manufacturers
What this research tells us is that after 20 years, 89.5% of implants were still present in patients mouths (that means that nearly 11%, or 1 in 10, of implants failed and were removed after 20 years (Chappuis 2013)
In a more recent study (in 2015) assessing patients in Sweden, it was found that 7.6% of patients had lost at least 1 implant after 9 years. It also identified patients who smoked and had a history of periodontal (gum) disease had a higher chance of implant loss. It identified implants shorter than 10 mm and certain brands (lower priced market brands) also showed higher rates for early implant loss. Conversely, the top three manufacturers in the world (STRAUMANN, ASTRA/DENTSPLY, NOBEL BIOCARE) showed the lowest rates in terms of implant loss
So, the short answer is that research tells us, that between 10-20 years, 9 in 10 patients will keep their implants. Great news!
However, there is currently no research to indicate rates of implant survival beyond 30+ years, although it will come with time. Having said that, there are case reports of patients keeping their implants for +40 years.
What Is A Bone Graft
And Why Are They Used?
Occasionally, it is necessary to add to the amount of bone in your jaw after you have had a tooth extracted. This is often done at the time of extraction (see video below) to prevent future bone loss. If a tooth is removed and the tooth socket is not grafted immediately, it is very likely that bone (and sometimes gum) will resorb (recede), meaning a bone graft is required either before or at the time of implant placement.
Bone-grafting can be a complicated process. For extensive cases, where large changes must be made to the shape and size of the area for the dental implant, separate surgery must be done before the implant can be placed (usually several months later).
Before surgery, it is standard practice to have a 3D radiograph taken of your jaw. This will produce a 3D digital image of your jaw and teeth helping your surgeon plan for your surgery.
For the simpler procedures, local anaesthetic is used to carry out your surgery. For more complex procedures, your surgeon may elect to carry out surgery in a Day Surgery setting under Intravenous Sedation or General Anaesthetic.
The grafted bone usually takes around six months to fuse with the existing bone. Bone grafting has a very high success rate but in rare instances they have to be repeated, or more bone added at the time of implant placement, as some of the bone graft can resorb over time.
Bone graft sources can include your own bone (typically taken from the area of implant placement) or from the wisdom tooth areas in your jaw. Larger bone grafts can require the addition of bone graft material that are sourced from companies (sources of bone grafting material include animal, synthetic or donor bone - aka human bone). In rare instances, a small percentage of patients may require bone to be taken from their leg or hip bones.
Another form of bone grafting, when carrying out dental implants in the upper jaw, is Sinus bone grafting. Some patients have very large maxillary sinuses (air spaces) in the premolar and molar tooth sites. This means there is limited bone for implant placement.
The way to assist in insertion of implants in this area is the placement of a bone graft into the sinus either before or at the time of implant surgery (please see video below).
Blood Donation After A Bone Graft:
Are you a blood donor, or do you still want the ability to donate blood after having a dental implant? Did you know, depending on what bone grafting material is used, this may affect your ability to donate blood, either for a specified amount of time, or even forever?
Before Proceeding With Dental Implant Treatment, What Should You Ask Or Know?
We have put together a checklist of questions that Patients should ask of their Dental Professional prior to treatment.
Make sure to download or print this checklist off before visiting your Dentist.
Problems With Poor Quality Dental Implant Components
As with most mechanical products in the world, there are High Quality and Poor Quality parts that can be used to repair or construct a working part, like a car engine or a tool. The same goes for dental implants.
There are now many companies in the world that make Poor Quality copy parts for dental implants (the abutment components). This was not always the case, as the manufacturers who make the dental implant components also make the adjoining abutments as a complete set. These are engineered to fit perfectly together and perform perfectly in the mouth.
Switching out a High Quality dental abutment for a Poor Quality copy dental abutment is not the same as switching out a High Quality part for a Poor Quality copy part in a car! Firstly, dental implants are inserted into the human body. Therefore, there is a mechanical component (the abutment) and the medical device (the dental implant) that come in close contact with the human body. This means that if the copy parts are not made to a specific standard (high quality and rigorous testing) and do not fit as well as the genuine components, a space develops between the implant and the abutment, which can lead to bacterial infections, corrosion of the metallic components and ultimately infection of the dental implant.
Why Do Dental Laboratories Who Make The Crowns, Bridges Or Dentures Use Non-Genuine Components?
Initially, one would think that cost would be the primary reason (i.e. making the cost of treatment cheaper). Ideally, the dental laboratory could pass the cost saving on to the dentist who could then pass this on to the patient. If everyone involved in the process was aware of the parts used and the costs involved, it would be a transparent and fair way to carry out treatment.
In some instances, laboratories that outsource components (particularly from overseas) may not be aware that the components are Non-Genuine or if they are of a poorer quality, which leads to the dentist and the patient also being unaware of their origin. This means sometimes there is a significant lack of transparency across the whole process in implant dentistry.
There are Australian companies that manufacture Non-Genuine components, however, some of these utilise excellent production facilities, materials and manufacturing processes to achieve high quality components.
What are the reasons why you might receive a Non-Genuine dental implant part?
You require a custom-made abutment due to the complexity of your case. Sometimes, the pre-made abutment simply won't fit in the tooth location, so a dental laboratory is tasked with creating a Non-Genuine part to fit better.
Your dentist will request a Non-Genuine part as a way to save on the total cost of your implant treatment. Your dentist should inform you of this.
Please note, Non-Genuine parts are not worse than Genuine parts. Sometimes they even perform better. What you should be aware of is Non-Genuine POOR QUALITY parts as these have a much higher chance of causing complications. The Dental Implant Registry will be working with dental researchers to determine which parts work the best in the future to ensure patients will eventually receive well researched dental implant parts.
By registering your dental implant components on the Dental Implant Registry, you are made aware of what parts are being used in your procedures.
For more information on Genuine and Non-Genuine parts, please see this article here.
Important Things To Know About Dental Implant Treatment
How Experienced Is My Dentist?
Every dentist who carries out implant treatment should have formal training and sound foundational knowledge of implant dentistry.
Dental specialists who are Prosthodontists, Periodontists and Oral Maxillofacial Surgeons undergo training in implantology as part of their speciality training.
General dentists can also undergo training through universities and private training facilities in implantology.
You should ask your dentist about their experience in the procedure they are proposing to carry out.
A combination of excellent surgical and/or prosthetic (crown, bridge or dentures making) skills, when combined with products with a proven track record, will ensure you achieve the best results possible.
Are My Implant Components Safe?
Dental implants inserted into patients in Australia should be registered with the TGA (regulator of medical and dental devices).
You can search the TGA website to see if your implant and crown components are registered on the Australian Register of Therapeutic Goods.
The abutment component, which supports your crown or bridge, should ideally be a Genuine component and registered with the TGA. However, in some instances, Non-Genuine/Custom parts are used. If that occurs, your dentist should explain why they are using them versus the Genuine components.
Some of these Non-Genuine parts can be sourced from overseas (Thailand, China, Vietnam and Cambodia) and the metals used to make them, and the processes used to construct the crown, bridge or denture, can in some cases mean a poorer quality device is installed into your mouth. Cheaper does not always mean better! Evidence is emerging that patients are at a much higher risk of developing complications when these poor-quality copy parts are used!
The TGA does not have a register for the Custom (Non-Genuine) dental abutment parts (as exceptions apply) as these devices are deemed a "low risk". However, dental clinicians and the DIR believe that dental implant complications are serious as these can mean patients can experience infections, pain and suffering, psychological distress/anxiety about their appearance and ability to socialise (especially with anterior tooth replacements).
Currently there are no mechanisms in the Australian/NZ market to conduct a product recall (contacting patients who may have received a dental device deemed as dangerous). The only way to protect your dental health in these instances is to request that your implant details are registered on the DIR by your treating dentist.
Below is a series of images from the same patient. A Genuine dental implant was installed, but a Poor Quality Non-Genuine abutment was attached. The left photo shows the infection that occurred due to the Poor Quality Non-Genuine abutment. The middle image was taken 8 weeks after the Non-Genuine abutment was replaced with a High Quality Genuine component. The final image shows the recovery, without any surgery, that the patient had within a year with the Genuine component. Unfortunately, cases like this are becoming more and more common, as more Poor Quality Non-Genuine components are finding their way into the dental marketplace.
Are There Complications?
Dental Implants have an extremely good track record for success.
However, a small percentage of patients can experience biologic infections (bleeding of the gum and bone loss around their implants) in the order of 2-8% depending on the study, and technical or mechanical complications (porcelain fractures, loosening of implant crowns or bridges, or fractures of the implant or abutments/foundation that support the crown or bridge) in the order of 15-30%.
Some of these complications can lead to loss of the dental implant, abutment and/or implant crown. It is very important for your dentist to know what components make up your implant. If you are travelling or change dentist, you should have this information.
The below images show what potential complications patients may incur. The left image shows gum recession around the implants, which can mean a poor aesthetic result for patients. The middle picture shows severe bone loss around the implant after an infection. The picture on the right shows what a dental infection can look like.
How Do I Ensure Long Term Success?
Once your implant/s have been inserted and restored (insertion of the dental implant crown or bridge) you should keep it/them as clean as possible. This should include excellent home care (brushing, flossing, interdental brushes) and regular reviews with your dentist and hygienist. Some patients who have full bridges may require removal of and cleaning under the bridge and supporting implants once or twice a year.
Home care is routinely done using a number of cleaning devices including conventional products like tooth brushes, floss, superfloss and interdental brushes are mandatory. Some patients also require the use of Waterpiks (see below images).
Please note that patients who smoke, have a history of periodontal (gum) disease and diabetes are at higher risk of developing implant infections. They will very likely require more frequent visits to the hygienist or dentist (3-4 times per year).
If you have any questions, please contact the DIR Team using the contact form below.
We can help answer your dental implant questions and help put you in touch with a DIR Registered Dentist near you who can provide you with the best possible implant outcomes.