Dental implants

An implant is a small titanium screw placed into the jawbone where the tooth root used to be. Its purpose is to support a crown, a bridge or a denture. It's placed under local anaesthetic, and the bone then grows onto its surface over roughly three to six months — that's the part that can't be rushed. Once it's stable, we take a scan and fit the tooth on top.

Some cases need a bone graft first, or at the same time, where there isn't enough bone to hold the implant securely.

How the appointments run. An initial consultation and intraoral scan (about 20 minutes), a CT scan arranged through a radiology practice, a guide try-in (about 10 minutes), then implant surgery about two weeks later (about 60 minutes), and finally the scan and placement of your crown, bridge or denture once the implant has integrated. Review appointments are at no cost.

• A bridge — quicker and without surgery, but it involves cutting down the teeth either side.
• A denture — removable, and the least expensive option.
• Leaving the gap.
• Referral to a specialist where the case is complex or the aesthetic demand is high.

If nothing is done, any of the following can follow over time: loss of bone where the tooth was, gum inflammation, infection, sensitivity, and neighbouring teeth drifting or loosening — sometimes ending in further extractions. Jaw joint problems, headaches, referred pain into the back of the neck and the facial muscles, and sore muscles when chewing are also possible as the bite changes.

• Discomfort and swelling after surgery.
• Prolonged or heavy bleeding.
• Damage to adjacent teeth or their roots.
• Infection after the procedure.
• Stretching of the corners of the mouth.
• Restricted mouth opening for several days — sometimes from swelling and muscle soreness, sometimes from stress on the jaw joints.
• Fracture of the jaw or of a thin bony plate.
• Allergic reaction to an antibiotic or anaesthetic.
• Gum recession or a visible metal edge, and a shape that doesn't perfectly match the neighbouring tooth. Aesthetics at the front are the hardest part of implant work.
• Medication affecting bone — some osteoporosis and cancer treatments raise the risk of poor healing in the jaw, so tell us about them even if you stopped years ago.

Nerves near the lower teeth

A large number of nerves serve the teeth and tissues of the mouth. Two matter most for lower implants. The inferior alveolar nerve supplies feeling to the lower teeth, lip and chin. The lingual nerve supplies taste and feeling to the side of the tongue.

These nerves vary in position from person to person. During any jaw surgery there is a small chance of damaging them, which could lead to temporary or, rarely, permanent changes in sensation or taste in that area. Planning the surgery with MGUIDE helps minimise this risk, but it cannot remove it entirely.

There are two main ways an implant can fail to fuse to the bone in the first place.

• Infection. A strict sterile technique is used, but the mouth carries a high bacterial load, so a small risk of infection after surgery remains. Following your post-operative instructions and taking the medications we recommend is what keeps that risk down. If the implant becomes involved in an infection, it has to be removed. Smoking increases the risk of infection five to eight fold.
• Fibrous tissue entrapment. Fibrous connective tissue can grow between the implant and the bone, preventing true bone-to-implant contact. The implant isn't painful, but the join isn't strong enough to carry a tooth.

Late failure

Late failure means an implant failing months or even years after the procedure. It can be caused by excessive stress on the implant (grinding, clenching or trauma), insufficient bone support (failing to keep the soft tissue healthy, or smoking), infection, or systemic health issues such as diabetes.

Signs include pain, swelling, the implant loosening, or a change in the appearance of the gum around it. If it happens, we assess it thoroughly to work out the cause. Treatment may involve removing the failed implant, bone grafting to rebuild adequate support, and placing a new implant once the site has healed.

Once the implant has integrated with the bone, the prosthetic phase begins. That may be a single crown, a fixed bridge, a fixed full arch, or an implant-supported removable denture.

Only genuine, high-end componentry is used, with well-known and reputable laboratories. Every component used is identified and recorded in your patient record, and you can have a copy whenever you want one. Prostheses are designed to be retrievable — they can come off — so the implant and the tooth on top can be maintained properly.

Complications can arise in the prosthesis, sometimes within a few months. They include, but aren't limited to, chipping or breaking of the ceramic, open contacts developing between the implant and the natural teeth beside it, and screw loosening. Further work to repair or replace the prosthesis or its components may be needed.

The success of a dental implant depends to a great extent on your own maintenance and meticulous hygiene throughout your mouth, and especially around the implant post where it comes through the gum. Smoking and poor dietary habits affect gum and bone healing and will limit how well the implant does.

• Follow the home care and dietary instructions we give you.
• Return at 6-monthly intervals for us to check your mouth and clean around the implant, and to have any dental treatment needed to keep your mouth healthy.
• Expect this to be regular, long-term follow-up care for the life of the implant.

Our 6-monthly active maintenance visits are capped at $220.

Implant treatment is $5,000, paid in two halves:

• $2,500 when we send your case away for the surgical guide.
• $2,500 at implant surgery.

Your initial consultation and intraoral scan are included, and review appointments are at no cost. The CT scan is arranged through a radiology practice and billed by them. You'll be given a written quote for your own case before anything begins.

Warranty

Most practices offer no warranty at all on an implant failing to integrate, because there's no way to predict your body's healing accurately. We do.

• Before the tooth goes on. If the implant fails to integrate, we repeat the procedure free of charge. In some cases a different option turns out to be the better answer, and a credit is applied instead. If a second implant also fails to integrate, we refund $1,000 per implant.
• After the tooth goes on. If the implant fails within two years of placement, we repeat the procedure free of charge, or where an alternative is the better answer, apply a credit of 50% of the total paid.
• Prosthetic complications of the kind described above are covered by a two-year warranty from the date the implant is placed.

A warranty is not a guarantee that treatment will succeed. It covers the complications set out here. It doesn't change the fact that no dental treatment can be guaranteed, and it depends on you keeping up the maintenance described above.