When a tooth is lost due to infection, gum disease, an accident or injury, a dental implant can be used to replace the missing tooth root and an artificial replacement for the tooth can be secured on to it.

Dental implants are small metal (usually titanium) screw or post, designed to thread into the jaw bone where teeth are missing. The bone in the jaw attaches to the implant which becomes firmly fixed and creates a new artificial root where the missing teeth used to be. Titanium is used due to its excellent compatibility with human biology and it is capable of fusing with bone in a process known as osseontegration.

Dental implants are so natural looking and feeling, you may forget that you ever lost a tooth. Your smile affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don't feel secure or perhaps, you have difficulty chewing. If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is good news - dental implants are teeth that look and feel just like your own. Tens of thousands of implant procedures are now performed every year and long-term studies continue to show improving success rates for implants.

Uses of dental implants

Dental implants can be used for a variety of replacements. The single implant may be used to replace one tooth. This eliminates the need to grind down and alter adjacent teeth as in the case of traditional bridge work.

Two or more implants can be used as anchors to provide support for a fixed bridge that is, two or more false teeth formed together to fill a space where several teeth are missing much like a bridge over a river. Three or more implants can be used to stabilise a complete denture, eliminating unsightly and bothersome moving and clenching associated with the denture. Implants can be used to support existing loose teeth by being splinted with the dental implants.

How is an implant is placed?

Prior to surgery, a panoramic X-ray will be taken using a metal ball of known dimension so that calibrated measurement can be made from the image to accurately place the implant avoiding vital structures such as nerves and critical anatomical features such as mental foramen.

Implant surgery is typically performed on an outpatient with local anaesthesia. A single implant procedure involves an incision and flapping of the gum or gingival that is to expose the jawbone. Then a pilot hole is placed into the recipient bone, taking care to avoid vital structures. The pilot hole is expanded by using progressively wider drills; care is taken not to damage the osteoblast or bone cells by overheating.

The implant screw can be self-tapping and is screwed into place at a precise torque so as not to overload the surrounding bone (overloaded bone can die, a condition called osteonecrosis which may lead to failure of the implant to fully integrate or bond with the jaw bone). Once properly torqued into the bone, a screw cover is placed on the implant, then the gingival or gum is sutured over the site and allowed to heal for several months for osseontegration to occur between the titanium surfaces of the implant and jawbone.

After several months, usually six, the implant is uncovered in another surgical procedure and an abutment and temporary crown is placed on to the implant, this encouraged the gum to grow in the right scalloped shaped to approximate a natural tooth and allow assessment of the final aesthetics of the restored tooth. Once this has occurred, a permanent crown will be fabricated and placed on the implant.

Newer strategies

An increasingly common strategy to preserve bone and reduce treatment time involves the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rate for this procedure are now at acceptable standard. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the implant during the dental implant surgery.

Long-term studies continue to show improving success rates for implants and with diligent patient maintenance, implants can last for a lifetime.

Dr Dennis Jones is a dentist in private practice; email: yourhealth@gleanerjm.com.