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FAQ - General Can the body reject an implant? Is the placement of an implant painful? I've heard that dental implants are experimental – is that true? How have dentists grouped themselves in the acceptance and provision of implants? What is the down side of implants?
Can the body reject an implant? Kidney, heart or organs transplanted are sometimes rejected due to a cascade of many complex reasons associated with the body’s acceptance or rejection of foreign protein and cellular components. Titanium implants are different because bone thinks that titanium is self and that bone grows up to and into the metal’s microstructure without any space or defensive boundary. The successful implant surface has bone cells lying in happy cohabitation right up against the metal. No chrome nickel hip implant or nose ring has such a tranquil environment at a microscopic level. The body’s defense mechanism, called inflammation (heat, swelling and discomfort) is similar to a nations army – when there is danger of invasion, troops are sent to the border. So too, with implanted materials other than titanium – and interestingly, sapphire – warrior cells called lymphocytes can be seen surrounding the material, ready to defend. These cells are NOT present around a successful titanium implant suggesting a healthy symbiotic harmonious environment of mutual acceptance. The failure of an implant to integrate into bone - what we call osseo-integration - is due to many factors, some of which we don’t even yet know about; we don’t really know why 90% work, let alone why one in 10% don’t succeed. Factors such as the pre-treatment bone health, nicotine (via smoking or perhaps nicotine chewing gum) might alter blood flow through bone. Patient selection, oral hygiene and patient adherence to the prescribed medicines and mouthwashes may also influence success. Regular follow-up care, assessment of the gums and bite are small investments towards success. Is the placement of an implant painful?
Bone is often taken from the lower wisdom tooth area, the amount being about the size of a jellybean. If that bone is then placed in the site of a front tooth, the lip can swell slightly or discolour like a bruise, but just for a few days. I like to use Marcaine rather than Lignocaine as a local anaesthetic because the area can be made numb for 6-8 hours, sparing the patient any initial symptoms. If the implants are placed whilst the patient is asleep in hospital, I also routinely use Marcaine to spare them any challenges for many hours post-operatively. Interestingly, it seems that the use of Marcaine at the beginning of a procedure on a sleeping patient aids their recovery. A more peaceful anaesthetic because of the numbness. I've heard that dental implants are experimental – is that true? Absolutely not! Thirty years ago, they were, but not now. Nobel Implants are the most thoroughly researched procedure in the history of dentistry and, while no procedure is 100% successful, the current technology has resulted in very high success rates in the hands of well-trained and experienced clinicians. Dental implants are carefully regulated by the FDA and the American Dental Association has approved a number of implant systems. Newer brands have less research and whilst many may succeed at the bone interface, the superstructure designs have varying interlocking options, varying engineering advantages and complexities that can manifest over time. Best to stick with the benchmark brand even if it costs a little extra. Of course, because the soft tissue healing time is only some days during which you can rest up and then travel while the bone does its job of surrounding the implant. The site is about as big as a jellybean and there will be minimal awareness .. if at all! You will be smiling and eating ok wearing a modified denture/temporary bridge or best of all, just with the same space you had before the implant. The little silk sutures are removed after 5 days and you can go straight to the airport. The major implant companies have contact dentists across the world in most major cities, so if you had any concern, you just phone us and we can provide you with the dentist contacts via the supplier implant company’s office network. How have dentists grouped themselves in the acceptance and provision of implants? Some general dentists don’t want to be involved, preferring to either refer patients or to just offer bridges without seriously mentioning implants or by dismissing them as too expensive or "you don’t have enough bone". If you haven’t got enough bone, we can just fetch a bit. Easy! No argument for a bridge, at least without an assessment, costing and insurance rebate inquiry arranged by an implant dentist. There is not a specialty recognised for implants, nor is such a registration desirable, however the initial launching of implant treatment protocols involved a 2 member team approach using a surgical and restorative dentist. Now, the major training centres have extended their programs to allow general dentists with a prerequisite background to carry out both phases. In Perth, 4 general dentists have been trained in the surgical stage, including myself. The advantage of a multi-skilled sole operator is simply simplicity. No complexities of travelling from one office to another, no glitches, no areas of interpretable responsibility…. and faster and less expensive. Many other manufacturers provide implants that have different design approaches with lower product costs. The most expensive and longest researched is Nobel Biocare which I choose to use, in spite of its higher cost because I know it is better in my hands and that cost should be secondary to outcome. My investment in training and inventory would be in excess of $100,000, my inventory includes one or more of every implant and component in every available diameter and length. The instrument setup for Nobel surgical is about $13,000 including a cunning electrotorque device which allows accurate tightening of component screws to 10,20,32 and 45 Ncm. Competitor manufacturers charge $700 for an abbreviated startup instrument array which do not include a variable tightening device. Why would someone recommend and use only one system, one other than Nobel when that system has been researched scientifically and exhaustively for 30 years? The great lesson in life is that you do get what you pay for! Grasp the wisdom of John Ruskin 1819-1900 British Author, Artist, Essayist and Critic: A Thought to Ponder…. "It is unwise to pay too much, Some Oral Surgeons and Periodontists often do provide implants, yet for the former, the size and scale of oral surgical interventions is often grander that the delicate postage stamp size of an implant site whilst for the Periodontist, who traditionally never extracted teeth themselves, the increasing frequency placement of immediate implants at the time of extraction means that a general dentist would have had more extraction experience than the gum specialist who would have just recently purchased forceps! Break a denture or a temporary bridge at either locations and they might not, understandably have the equipment or experience to fix it. That’s a cancelled dinner or a trip through peak hour traffic to another office, the office of the general dentist! An entire arch of implant supported crowns i.e. non-removable teeth, would look and feel strong and normal. In fact the biting power of an implant crown is greater than for a natural tooth, which is suspended in a fibrous sling within the bone, which is connected by nerves to mission control (the brain) which, when overstimulated, send a message "stop biting soooo hard". Dental implant science was born to solve a problem, the edentulous patient with functional, emotional, aesthetic and social handicaps, devoid of options and with nowhere to go. Until now.
Your plight is common, so researchers have been busy trying to find ways of moving or making bone and luckily, sound tested methods are now available. Moving bone is easy. You end up with bone where you need it and the site that surrended its bone just regrows! These donor sites can be anywhere where bone exists; head, hip, wisdom tooth area or perhaps in the near future, a gelatin sponge will be soaked with a bone stimulating hormone and presto, bone! The research on recombinant human bone morphogenic protein II by Genetics Institute is most promising in doing just that task as might be the possibility of taking a teaspoon of your blood, growing some of those cells in the laboratory and then re-implanting them where you need bone. So, a person with inadequate bone that cannot have implants or bone augmentation is rare. The procedures have % success outcomes, so explanations of the matter can assist decisions. Remember "if you cannot make up your mind – you don’t have sufficient information". Bone grafting can be done in the chair in the dental office or sleeping in
hospital and importantly, most of my patients would state that the procedure and recovery
was easier than an extraction, which, lets face it, has a certain amount of necessary
force, the worry of "will something break?" or even "will it come
out". Implanting bone or titanium implants is a gentle sequence of gentle processes. What is the down side of implants? Gum height If bone loss has been allowed to progress, the vertical disparity is unpredictable and can be difficult to "bulk out". Gum shape between teeth With bone loss between teeth and a future implant site, the gum support is often lost, so that a compromised result will require either wider shapes as the "tooth" emerges from the gum or some fancy patch work rotations of the gum or an acceptance of wee spaces between the implant supported teeth. The use of an oral irrigator is most beneficial… for all intra-oral structures! Lip support Because the lip is basically a circular muscle hanging like a curtain from the bone under the nose - bone which encases the teeth - any bone loss causes the lip to drop back into the face, flopping back under the nose. Neglected bone loss then requires either bone grafting or a hybrid denture like restoration upon the implants, so that some pink bulk can be given to the lip. Evidence this loss of lip support by the number of persons who over-apply lipstick thus faking the fleshiness of the lip, or could this be the reason why collagen injections are becoming so frequent? Bone erosion of the sensuous lips’ support? Failure = redo Because we have experienced 9 of 10 implants work, implicitly, 1 of 10 will ‘fail’. So, if you have multiple implants, you might experience multiple redo’s due to factors we don’t know about. If you are not prepared to accept the emotional, financial and logistical disruption of having a replacement implant(s) then dentures are your best option. Don’t have implants if you cannot accept your body’s rejection of the titanium. Most implant practitioners would reduce their fee for replacement dramatically. Remember a ‘failed’ implant is a misnomer: its problem is merely that it is not firm, its mobility being unsuitable to support a dynamic moving high pressure shredder! It just sits there happily, moving a bit, not sore unless highly pressured. I have never had a replacement implant fail a second time! It is as if the dormant bone is more accepting the second time. This implant modality is not for litigants and the faint hearted but for the brave and gracious in ‘defeat’. Numbness Lip numbness is usually a predictable rare complication so that during the implant planning stage, radiographs can display the closeness to the bone conduit holding the delicate "string" enervating the lower lip. Most implant surgeons would then be able to estimate the chance of this complication so that the patient could decide if they want to run the risk of what is a minor inconvenience. I have lived with a numb lip, my girlfriend’s: she had some implants placed by a colleague knowing that, because she had very little bone following surgery - as a toddler- for the removal of a tumor, implants would impinge on what was left of the nerve. She now has 4 very functional implants (she eats and enjoys her food lots and lots) with the only drawback being that if she has sneaked some chocolate ice-cream, the telltale chocolate might have left a smudge on her unsuspecting lip. I never comment! Cost Once you have come to terms with value as an enduring concept, distinguishing the waste of money involved on the many things we ostensibly strive for, such as wonderful dinners, trips and clothes, borrowing or saving money to enhance one’s body is less daunting, given that it will improve the ability to enjoy those foods and laughter and that a smile and teeth are present during eating, sleeping, walking and making love, 24 hours a day. The teeth, that is! People are happy to spend their money on the things they want, not the things they need. |
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