Dental implants

Replacing a missing tooth is one of the more common reasons people come to see us, and one of the more considered decisions they make. This page covers how we approach it and what to expect from your first appointment.

What it involves

A dental implant is a titanium screw placed directly into the bone of the jaw, which is then used to support a new tooth or teeth.

That might be a single tooth, or sometimes two joined together. Implants can also be spread further apart to support a longer set of teeth, including a full set in either the upper or lower jaw, or both at the same time.

Whether it's right for you

For the vast majority of cases a dental implant is the preferred way to replace a missing tooth. It gives you back a fixed tooth that does not need to be taken out, and it is not detrimental to the health of the teeth next to it.

That is in contrast to a fixed bridge, which often requires cutting down the teeth either side and can damage them in the long term; or a removable denture, which is a much larger, bulkier appliance that tends to trap food and can affect speech and taste.

So most patients are good candidates. In rarer cases a significant lack of bone, or certain medications such as bisphosphonates, make treatment considerably more risky, and on balance an alternative approach may be the better one.

How the treatment runs

How many appointments you need, and over what period, depends on the treatment involved.

For a single implant crown: a consultation with a thorough assessment, normally including 3D x-rays to measure the bone available; placement of the implant; a review appointment; impressions or 3D scans so the new tooth can be made; and a final appointment to fit it. From placing the implant to fitting the crown is normally 10 to 12 weeks.

A full set of teeth works differently. We start with a full consultation, clinical photographs and 3D x-rays to plan the case. Sometimes there is an additional appointment to try in some teeth first, checking the colour, bite and appearance before moving on to surgery. At surgery we can remove any failing teeth, place as many implants as are needed, and fit an immediate fixed temporary set of teeth the same day.

For a case that size we review you one to two weeks later, and again another two weeks after that, to make sure healing is as hoped. Around eight to ten weeks later we begin making the definitive set of teeth, which takes a further three to four appointments depending on complexity. Start to finish, a full upper and/or lower set is usually about five to six months.

The day itself

This depends very much on the case, but a single implant can be a quick and straightforward process.

We ask you to arrive about ten minutes before your appointment to go through the final consent form. We normally give pre-operative antibiotics to reduce the chance of infection, and an antiseptic mouthwash to clean the mouth before we start.

The gums are numbed with local anaesthetic, a precision hole is created, the implant is placed, and a few stitches close the gum tissue back over the top. For a single straightforward implant with no bone grafting, that can be as quick as 20 to 30 minutes in total.

An x-ray is normally taken at the end to confirm the result and to use for monitoring in future. You go home with post-operative instructions and an aftercare pack, and we ring you a day or two later to see how you are getting on.

What people expect, and what actually happens

People often arrive with a preconceived idea of what this is going to be like. On the face of it, having an implant placed into the bone of the jaw can sound quite daunting.

In the vast majority of cases, though, patients walk out pleasantly surprised at how easy the process was. We make sure you are completely numb before we start, and you are able to take breaks along the way where possible. For a simple implant the procedure might take 20 minutes, which is often a good deal shorter than something like a root canal.

Recovery

This varies completely depending on the procedure and what was needed on the day.

For a single straightforward implant with no bone grafting, I would anticipate a very small amount of discomfort on the day itself, improving rapidly over the next few days. If teeth are being removed at the same time, or there is bone grafting to do, the discomfort and swelling can be greater and last a few days longer. That is where the aftercare pack matters: ice packs to keep the area cold, antiseptic mouthwash, anti-inflammatory medication, and advice on how to manage the area.

For more complex treatment such as All-on-4, which sounds far more drastic, recovery is often very straightforward. Swelling and discomfort tend to be worst around day two to three, but because the teeth are fixed and there is no movement in the mouth, there tends to be relatively little discomfort in the gums themselves.

Where we fit immediate fixed teeth on the same day, we want to avoid putting any stress on the implant while it heals. Observing a soft diet for the first four to six weeks is really important.

What can go wrong

This varies with complexity, but implant treatment tends to be very predictable. Minor swelling or bruising can be expected occasionally afterwards. Infection is possible, though relatively rare. With close monitoring and a good oral hygiene routine at home following the procedure, complications are normally minimal.

How long it lasts, and looking after it

There are two sides to this question, and the second matters more.

The first is the mechanical longevity of the components we use, meaning the implant itself and the tooth on top. We use strong, adequately sized implants and a strong crown material, with an excellent connection between the two, to reduce complications.

The second is your own biology, and the health of the bone and gums in the long term. Biological problems usually revolve around long-term gum disease, uncontrolled diabetes and smoking, so it matters a great deal that those are under control both before and after implant treatment.

Choosing between your options

It is important that you are fully informed about the options available and the pros and cons of each. It is just as important that you understand how you want the final teeth to behave, both in terms of whether they are fixed or removable, and how they will feel and affect the other teeth in your mouth.

A single implant is often the best way to replace a single missing tooth. Where there are already crowns on the teeth either side of the gap, a bridge becomes a very viable option. An implant-retained denture is really reserved for people missing multiple teeth, or more likely a full set in one jaw. It is a lower-cost option than a full set of fixed teeth such as All-on-4, but it keeps the drawbacks of being bulky, removable and more likely to trap food.

What happens at your consultation

The first appointment is a conversation, not a sales pitch. We listen to what's bothering you, examine thoroughly, and explain what your options actually are — the pros and cons of each — including the option of doing nothing for now.

After that assessment you get a total cost for the treatment, in writing. Clear pricing up front matters to us: you should know what is involved and what it costs before you decide anything, and it is very rare for that figure to change once treatment is underway.

Then take it away and think about it. There is no deadline and nobody will chase you.

Who you'll be seeing

The same surgeon, the whole way through. Dr Brad carries out your consultation, your treatment and every review afterwards — you won't be handed between clinicians, and you won't have to explain your history twice.

Every treatment plan is built around the individual patient rather than pulled off a shelf, and that runs across the whole team — before, during and after treatment.

Dr Brad qualified at University of Birmingham in 2005, has placed implants since 2007, and holds an MSc in Restorative & Aesthetic Dentistry (2015). He is registered with the General Dental Council, number 85988.

If you've been putting this off

Most people who come to us have been thinking about it for a long time — sometimes years. That is normal here, and nobody will make you feel awkward about it.

It starts before you even get here. When you ring, you will speak to our reception team or to Dr Brad's treatment coordinator, all of whom know the implant process well. They will take the time to understand where you are up to and how you are feeling about it, rather than just putting a date in a diary.

If nerves are the thing holding you back, sedation is worth asking about. The options range from simple oral sedation — a tablet taken beforehand, purely to calm you — through to IV sedation, carried out by a dedicated medical doctor who comes in to assist. For longer and more complex cases Dr Brad will recommend it as a matter of course. With IV sedation you would need someone to bring you in, take you home afterwards and stay with you for a few hours.

Take the appointments at your pace. Ask the same question twice if you want to. If you would rather just find out what is possible and go away and think, that is a perfectly good reason to come in.

What it costs

You are given a total cost for your treatment after your consultation, set out in writing, so you know the full figure rather than a starting price that grows.

Payment is normally spread across the appointments involved, and you will get a breakdown of those appointments, the intervals between them and the cost of each. Longer-term finance through an external provider is also available — we can talk that through at your consultation.