Why has my dentist referred me to a Specialist?

A Specialist is trained to diagnose and manage straightforward to more complex cases, which cannot always be provided in a general dental practice set-up. Only specific forms of dentistry fall into specialist areas and dentists must undertake further training and examinations to become a registered specialist.

There is no such thing as a dental implants specialist.There are, however, specific dental specialists who potentially have higher expertise in placing dental implants successfully because of their further education and experience.

A Specialist Prosthodontist is trained to reconstruct missing teeth with one of many options available like a fixed bridgework, dental implants or a more complex design denture framework. A Specialist Oral Surgeon is trained to perform minor to moderate surgical procedures which is a skill used extensively in implant reconstruction of the mouth for fixed teeth. Dr Joe Bhat at Moor Park Specialist Dental Centre is a Specialist in both these fields and has 16 years experience practicing just Implant Dentistry.

Why should I consider an implant?

A perfect solution to single or multiple tooth loss, dental implants offer secure and predictable results, giving patients complete confidence in their dental restorations. Whether you have lost teeth due to an accident or due to underlying oral health issues, dental implants or an implant borne denture could provide the answer.

In London, dental implants are fast becoming a more popular alternative to dentures and offer a number of advantages over other treatments. Unlike traditional bridgework, dental implants do not require adjacent, often healthy teeth, to be "ground down", thus preserving as many of your natural teeth as possible. In addition, implants also have a positive effect on the jaw bone, helping to maintain its natural shape and fighting gum loss which is so often apparent in the wearers of traditional dentures.

Dental implant treatment is an ideal solution to tooth loss for adults, providing new teeth that look, feel and function like natural teeth to enhance your confidence and give you a great smile.

What can I expect at my first visit?

London dental implant treatment at Moor Park could not be easier. A one hour appointment with Dr Joe Bhat will be arranged to discuss your concerns and needs. This may include x-rays, written reports, a suggested treatment plan and cost estimates. A fee is payable for this appointment, please call the practice to ask for details. The written report will be forwarded to your regular dentist with a copy of the report and fees sent directly to you. Naturally, some cases will be more complex than others and you may require a CT scan in order for Dr Bhat to arrive at a definite diagnosis and plan. Once you have received your proposed treatment plan it is usual for us to contact you to check if you require further information.

A dental implant procedure in London is usually carried out under local anaesthetic. For those of a nervous disposition we offer oral or intravenous sedation or treatment under general anaesthetic as a day patient at Bishop's Wood Hospital.

Thanks to modern materials and techniques, treatment time for dental implants has dramatically reduced to just over 2 months compared to 6 months previously. We may also be able to offer "same day" implants depending on your case.

What are the costs and payment policy?

The cost of implant treatment will vary depending on the nature and location of the missing tooth site and whether there is any need for bone augmentation to improve long term success.

An estimate of the cost of your treatment will be provided on the day of your consultation. Payments will be made at the end of each visit.

Dental Implants Overview

During the last 30 years the use of dental implants has changed dentistry beyond recognition. Implants are no longer considered experimental and it is equally rare to come across situations where they cannot be used at all.

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. Why not see if you are suitable for Teeth in a Day?

What are the alternatives to dental implants?

There are two alternatives for replacing missing teeth, each with its own benefits and disadvantages. Removable dentures are relatively inexpensive and straightforward to provide. The disadvantage is that they need to be removed for daily cleaning and many people also find that they can be bulky, loose and uncomfortable. The advantages of fixed bridges supported by natural teeth is that they are non-removable and there is no need for a surgical procedure. Their main disadvantage, however, is that they usually involve the preparation of the supporting teeth which necessitates the removal of healthy tooth tissue and can cause irritation of the nerves inside the teeth, sometimes leading to death of the tooth and needing root canal treatment.

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 providers will 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 2 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.

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 and 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.

If you have any other complicated medical problems, please speak to Dr Bhat who has considerable experience in handling patients with a complicated medical history. It is rare to have health problems that prevent the use of dental implants. Ask Dr Bhat about Same Day Teeth to see if you are a suitable candidate.

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 the 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.

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.

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. Commonly the failing implant causes no discomfort and if there are enough remaining, it may not be necessary to replace it at all.

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 6 months.

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 if you ever need to repair one of the small sections, this can be a lot 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.

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 and 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.

One stage implant – The implant is placed into a new, healing or healed extraction site and is visible above the gum immediately after placement. The advantage of this method is that a second surgical stage is not necessary to expose the implant. The implant will not normally be ready to support a tooth for several weeks or months.

Two stage implant – The implant is placed into a new, healing or healed extraction site and then covered by a layer of gum so that it cannot be seen – this is the first stage. At the second stage some weeks or months later, the implant is uncovered and components added bringing it above the gum ready to begin placing a new tooth.

Same day implants – This technique is most often used to treat the lower jaw and requires considerable planning before the actual day of surgery. Several implants are installed and a few hours later a complete arch of temporary or permanent teeth can be fixed in place. If temporary teeth are used these will normally be replaced with a permanent bridge after a suitable healing interval. Not all patients are suitable for this style of treatment.

Immediate implant – For this technique a tooth is removed and an implant placed immediately into the extraction site. Depending upon the local bone and soft tissue conditions, the implant surgery may be a one or two stage procedure. Not all patients are suitable for this approach.

Onlay grafting – There are many ways in which bone can be added to; however, one simple concept is to take a piece of bone from somewhere else and secure it as an 'onlay graft' to a deficient area. The new piece of bone will slowly join to the underlying region and when healed and mature, an implant can be placed in a more favourable position.

Where can you get extra bone from?

Bone can be harvested from a number of sources such as the hip, tibia, chin and posterior regions of the lower jaw. When you use your own bone to create new bone in another area of the mouth you will have to contend with the discomfort created by the donor site as well as the surgical site. Many people feel this is well worth any additional discomfort as your own bone is normally considered the 'gold standard'.

Alternatives to your own bone for grafting

For those who would prefer an easier, but slightly slower solution, there are other sources of bone specially prepared to make them safe for use in humans. All of these materials, including your own bone, simply provide a scaffold into which new bone will grow and consolidate ready to receive dental implants a few months later.

New bone can take anything from 3 to 12 months before it is ready to receive dental implants. Do not be in a hurry to move to the next stage. If you need a large volume of bone it will take longer to mature than a small amount.

Guided tissue regeneration - Each surgeon will have his or her preferred way of creating new bone. Many of them will also use a supplementary technique called 'guided tissue regeneration'. Using this technique slow moving bone cells are given time to fill a space by placing a barrier material between them and the fast moving cells of the soft tissues lining the mouth. When this technique was originally developed the barrier material had to be removed during a separate surgical stage a few months later. Whilst these original materials are still in use, it is now more common to use a 'resorbable barrier' that will disappear naturally a few months after it has done its work.

Does bone grafting affect the length of treatment?

If you need bone grafting, it will almost invariably increase the length of time your treatment will take, however when successfully applied it will greatly improve the outcome of the implant(s) placed. When used in the front of the mouth it can also allow for creation of much better aesthetics.

Bone grafting requires a considerably higher degree of skill from the operator and is often more complex to perform than the placement of the implant itself. In certain situations Dr Bhat will recommend combining the implant placement with bone grafting and the placement of a barrier membrane all at the same time. This considerably reduces treatment time and can produce results that are difficult to achieve any other way. However, many surgeons will still prefer to carry out bone grafting as a distinct stage, so that the implants are only placed when the bone grafting has been successful.

Whatever method is chosen to improve the bone quantity, the time, effort and expense is generally well worthwhile.

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.

Implants in their current form have only been available for twenty years so long term data is limited however, the latest research shows very good results. Over a ten year period, for non-smokers without untreated gum disease, success rates of dental implants of 95% can be expected. 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?

During your consultation appointment 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.

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 overview 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.

CT scans are generally the best means for identifying the location of important nerves and allows implants to be placed with considerable confidence. We are one of the few dental practices with their own CT scanner on the premises, and this procedure takes no more than a couple of minutes to complete. Whilst CT scans are more expensive than routine dental xrays, the information they provide is often invaluable for complex treatment planning and knowing where important anatomical structures are located.

Can dental implants be placed next to natural teeth?

Dental implants are routinely placed beside natural teeth and this is generally very safe to do. The only exception to this would be if the natural root was very curved or tilted unfavourably in the proposed path of the implant. This could cause the root to be damaged by the implant; however this can usually be avoided by careful pre-operative planning.

If a tooth is inadvertently damaged by the placement of a nearby implant, any resulting problems can generally be resolved by root canal treatment in which the nerve of the natural tooth is removed.

Can you wear false teeth during the course of implant treatment?

If the teeth being replaced by dental implants are in a clearly visible part of your mouth it is most likely that you will want to have some teeth present whilst the treatment is underway.

There are a number of ways that this can be done, ranging from simple plastic dentures to removable bridges. If replacement teeth are used during treatment stages it is important that they do not apply uncontrolled pressure to the underlying implants.

Is it uncomfortable when the implants are placed?

Most patients will be very familiar with the dental anaesthetics used for routine dentistry and will know how effective they are. Implants are placed using the same anaesthesia. Depending upon the complexity of your case, the operation might take anything from 15 minutes for a single implant, to several hours for complex bone grafting and multiple implant placements.

Since the surgery normally involves exposing the bone in the area where the implant and/or bone graft is to be placed, you can expect some minor swelling and occasionally bruising afterwards.

For most patients, any of the simple painkillers you might take for a headache will be all that is needed for a few days. If you experience more discomfort than this, do not hesitate to contact your dentist who can prescribe stronger medication.
Healing is generally uneventful and any stitches are removed a week to 10 days later. During the first few days you should report any unexpected levels of pain or swelling so that it can be assessed. If in doubt always ask for advice, as early detection of a problem will often lead to a simpler solution. You may also be asked to take a course of antibiotics and to follow some simple procedures such as rinsing with salt water or an antiseptic mouth rinse. It is important that you carry out these instructions.