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What is a Dental Implant?
 Almost all dental implants in use today are made from titanium or titanium alloy, materials that have been shown over many years to be well tolerated by bone. The terms 'osseointegrated implants' or 'endosseous implants' are widely used to describe dental implants that can develop and maintain a close union with bone in order to support replacement teeth.
There are many different implant systems available and when competently used they can all deliver a highly reliable form of treatment.
 A dental implant is essentially a substitute for a natural root and commonly it is screw or cylinder shaped. Each implant is placed into a socket carefully drilled at the precise location of the intended tooth. If an implant has a screw-thread on its outer surface it can be screwed into position and if it does not, it is usually tapped into place. The main aim during installation of any implant is to achieve immediate close contact with the surrounding bone. This creates an initial stability, which over time is steadily enhanced by further growth of bone into microscopic roughnesses on the implant surface.
In order to support replacement teeth, dental implants normally have some form of internal screw thread or post space that allows a variety of components to be fitted. Once fitted, these components provide the foundation for long-term support of crowns, bridges or dentures.
How many teeth can be supported by implants?
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 providerswill 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.
What else can be done with dental implants?
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 two 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.
There are many options and every case can be dealt with in a number of ways. You will therefore need to talk to someone who has examined your mouth thoroughly, before having a clear idea as to what is possible.
Dental implants have to obey simple engineering principles, in that they must be placed in strong foundations with enough of them to prevent overloading. In addition each implant must be accessible for daily cleaning so that the biology of the mouth can be used to maintain healthy surrounding bone and gum.
Who is suitable for dental implants?
If you have good general health then dental implants will almost certainly work for you. However, habits such as heavy drinking or 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.
Some dentists will decline to place implants if smoking cannot be reduced or given up altogether.
If you have any other complicated medical problems then speak to someone with relevant experience - it is rare to have health problems that prevent the use of dental implants.
Do you need to have a healthy mouth?
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.
What else causes bone loss?
Whenever a 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.
Dentures - Many patients report that after a while their dentures become progressively looser and do not fit as well as they once did. Initially the increased rate of bone loss following extractions is responsible for the observed deterioration of denture fit. Over the long-term it is the direct effect of chewing forces that causes slow resorption of supporting bone. Most people who have had dentures for many years will have needed a reline procedure to compensate for this bone loss. Therefore the longer dentures are worn, the more the amount of bone available for dental implants may be reduced.
Can dental implants preserve bone?
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. Like all things there are limits to how much work an implant can do. Your treatment provider will be able to discuss this in more detail as it relates to your case.
Bruxism - Patients who have a habit of clenching or grinding (bruxing) their teeth may be at risk of overloading their implants. For most people bruxism occurs during sleep, which is why they are generally not aware of it. Heavily worn or flattened teeth, chipped enamel edges and/or regularly breaking pieces of heavily filled teeth are the most common clinical signs of bruxism. The effects of bruxism need to be considered during treatment planning and can be compensated for by placing additional implants, selecting appropriate restorative materials and providing a night time bite guard to protect the new teeth.
What can you do if an implant does not work?
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 teeth. Commonly the failing implant causes no discomfort and if there are enough remaining, it may not be necessary to replace it at all.
Failures may not always be so easy to deal with and if you embark upon this type of treatment you have to be prepared to deal with this possibility. Most treatment providers will want to achieve failure rates much less than 5%, however in practice this could mean that 1 in 20 of the implants placed might not survive in long-term function. It is a good idea to discuss how your treatment plan might be affected by the loss of an implant.
How long does treatment take?
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 six months.
If there is no reason to shorten the duration of your treatment then be prepared to wait - nobody loses an implant from being patient
Are the new teeth joined together?
 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 and if you ever need to repair one of the small sections, this can be very much 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 and can better resist the forces of normal function which will try and undo the screw components, posts and/or cements that secure the underlying structure to each of the implants.
How do I look after the implants?
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 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.
How long will the implants last?
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 your 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.
How will you know if you are suitable for implants?
When consulting someone to find out more about dental implants 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.
As described earlier, establishing good basic dental health is a key stage in any treatment plan. At this first appointment you should be made aware of which problems are urgent, and what treatment is required to stabilise any gum or tooth related problems. It would be reasonable to expect a verbal outline of how your particular implant treatment might be approached. If you are discussing this type of treatment with a dentist that you have been seeing for many years, much of this information will already be known.
What should you know before you start treatment?
It is accepted practice that you should be given a written summary of your treatment planning discussion(s), highlighting your current dental situation and any alternatives there are to dental implants. This summary should also include an over-view 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.
Do you have enough bone for dental implants?
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.
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