DENTAL IMPLANTS/GRAFTING
SIMPLE TOOTH IMPLANTS
An implant is a titanium screw which is implanted into the jaw bone in a site where a tooth is missing and needs to be replaced.
Depending on your bone quality the implant may be placed in a single stage, or need to be carried out in two stages. Dr Allan will discuss this with you at your consultation.
You will need a CT or Cone Beam scan taken prior to surgery. Your referring Doctor will also need to provide Dr Allan with a surgical guide to assist with implant placement. If you wear a temporary ‘suck down denture’ this will need to be adjusted by your referring Doctor following surgery.
Smoking significantly interferes with implant success rates.
This procedure is usually done as a day surgery case under IV sedation or general anaesthesia.
SINUS LIFTING
The maxillary air sinuses are responsible for the production of mucous and secretions which pass through the nose picking up dust particles, bacteria and air pollutants. They are located in the upper jaw near the premolar/molar teeth.
Once a tooth is missing near the maxillary air sinuses for a period of time this can cause the sinus to drop down eliminating any space for placement of a dental implant. If this occurs a sinus lifting procedure is required. This will be determined at the time of your consultation by Dr Allan.
There are two types of sinus lifting procedures:
For significant defects a Conventional sinus lift is required. This is where a small window is created along the side of the affected sinus and then a special instrument is used to elevate the sinus. A bone substitute and membrane is then packed into the area to increase the bone height + width for a dental implant to be placed.
For minor sinus defects a Osteotome sinus lift is required. This is where an instrument is used through the implant preparation to gently tap up the sinus membrane to create enough room for a dental implant to be placed. In some instances, the bone substitute and membrane is also required.
Most sinus lifting cases are done as a day surgery case and under IV sedation or General anaesthesia.
FULL IMPLANT SUPPORTED CASES
For patients who are wearing full upper and/or lower dentures and are not satisfied with the functionality of these then there is the option of All-on-4 implant surgery. In cases where the bone levels are suitable, four conventional implants can be placed in the upper or lower arch. Impressions can be taken at the time of surgery and an implant supported bridge can be placed immediately after surgery. This is a fixed prosthesis which cannot be removed and is the next best thing to having your own natural teeth. It is important to maintain a soft diet for at least 4 months following surgery and ongoing dental hygiene and maintenance appointments are paramount.
This procedure is done at Saint John of God Hospital with an overnight stay under General anaesthesia.
IMPLANT SURGERY
Implants – Implants are titanium screws that when placed into bone will biologically integrate to provide a replacement for missing teeth. It takes between three to four months for the bone to heal sufficiently before you can use the implants to bite.
Once the implants have integrated, your referring dentist will fabricate the final crown or bridgework.
Pre Operatively – You may be required to have additional radiographic records taken prior to surgery.
Your referring dentist must provide a surgical guide prior to implant placement. It is essential that the surgical guide and any additional radiographs arrive at Dr Allan’s office at least one week prior to surgery.
A healthy mouth will assist post operative healing and regular professional cleaning is recommended. Smoking interferes with healing of the mucosa and bone. Dr Allan will not carry out surgical procedures if you smoke.
Post Operatively – The sites where the implants have been placed will be tender and most likely will have sutures present. These will be removed approximately ten days after surgery. You should rest and not attend work during this period.
You will be prescribed antibiotics, analgesics and anti-inflamatories following your surgery. You will be required to follow a soft diet and to rinse several times each day with a “Savacol” or salt water solution until your sutures are removed.
Dr Allan recommends that you visit your referring dentist to have your temporary prosthesis adjusted and fitted following each stage of implant surgery.
It is important that the surgical site is cared for properly to avoid infection and possible failure of your implants.
Stage I – Implant Surgery
The implants will be covered and will require between three to four months
to heal and integrate with the bone, before being uncovered at stage II
implant surgery.
Stage II – Implant Surgery
The abutment is screwed onto the implant that will have been placed at least three months earlier.
When the gums have healed around the abutment, your dentist can begin the prosthetic restoration
of this region
Single Stage – Implant Surgery
During this surgical procedure, both the implant and the abutment will be
surgically placed. You will be required to wait three to four months before
your dentist can prosthetically restore the implants
BONE GRAFTING
Bone Grafting – Bone grafting/augmentation is required if there is insufficient bone width and height in the space where an implant needs to be placed. If there is minimal bone loss, a bone substitute derived from bovine can be used. This is placed as a scaffold in the defect site and your own bone will grow through this.
If there is a significant bone defect you will require a ‘block harvest’ from the mandible (lower jaw). This is where a block of bone is taken from the mandible and placed into the defect site and secured in place with mini-screws, in conjunction with the use of the bone substitute material. Sometimes it is possible to place the dental implant at the same time.
Significant bone grafting cases are usually done at Saint John of God Hospital with an overnight stay under General Anaesthesia.
Bone Substitute – More commonly it is possible to carry out bone grafting using a bone substitute derived from Australian Cattle. This bone is grafted where is a defect and covered with a membrane to aid in bone regeneration. The use of this bone substitute allows for augmentation without harvest of bone from elsewhere in the jaw.
The onlay grafting procedure – Bone is harvested from the side of the mandible (lower jaw) through an incision inside the mouth. This bone will be shaped and secured in the area deficient in bone with mini screws. This is left to heal for a period of five months. These mini screws will be removed during future implant surgery. The mucosa (gum) is then stretched over this site and sutured.
You will have two healing sites in the mouth.
Lower Jaw – The site where bone is harvested from will be sutured with resorbable stiches which will fall out after approximately ten days. There might be some temporary altered sensation in the lower lip area, and the side of the mandible may be tender for several weeks. It is important to continue with a soft diet to avoid the risk of damage to the mucosa.
Graft Site – The graft site will also have sutures which will be removed ten days following your surgery. The mucosa is very delicate in this area due to the increased bulk and the stretching of the mucosa over the new bone. You might experience some temporary altered sensation in the lips and cheek area adjacent to the graft.
Bone grafting at the time of Implant surgery
In some cases, it is possible for an implant to be placed at the same time as onlay grafting.
Post Operatively.
It is important that the surgical site is cared for properly to avoid infection.
You will be prescribed antibiotics, analgesics and anti-inflammatories.
Frequent rinsing (numerous times each day for ten days) with a warm salt water or “Savacol” solution will assist your healing.
The surgical sites will be swollen, tender and have sutures present. These will be removed approximately ten days after surgery. It is important to keep your tongue away from the sutures to avoid the sutures falling out too early. It is recommended that you rest and not attend work during this period and eat only soft food.
You will not be able to wear your denture immediately following surgery as this may cause the graft to fail. It is recommended that you visit your referring dentist following suture removal to have your denture adjusted and fitted. In extensive grafting cases, a longer delay before wearing a denture will be required.
Smoking interferes with healing of the mucosa and bone. Dr Allan will not carry out grafting procedures if you smoke.
CONVENTIONAL SINUS LIFT
The maxillary sinuses are air-filled cavities above your back teeth in the upper jaw. Following tooth loss and subsequent bone loss in that area, there is often insufficient bone height in the back of the upper jaw to place dental implants. This procedure involves elevating or “lifting” the lining of the sinus cavity and placing the bone graft onto the sinus floor. This increases the amount of bone in the back of your upper jaw, allowing implants to be placed.
A window is made in the maxilla (top jaw) to allow the careful elevation of the floor of the sinus. Bone chips are packed into the sinus space then bone is onlay grafted being secured with mini screws.
Bone Substitute – More commonly it is possible to carry out bone grafting using a bone substitute derived from Australian Cattle. This bone is grafted where is a defect and covered with a membrane to aid in bone regeneration. The use of this bone substitute allows for augmentation without harvest of bone from elsewhere in the jaw.
The onlay grafting procedure – Bone is harvested from the side of the mandible (lower jaw) through an incision inside the mouth. This bone will be shaped and secured to the side of the upper jaw with mini screws. This is left to heal for a period of five months. These mini screws will be removed during future implant surgery. The mucosa (gum) is then stretched over this site and sutured.
You will have two healing sites in the mouth.
Lower Jaw – The site where bone is harvested from will be sutured with resorbable stiches which will fall out after approximately ten days. There might be some temporary altered sensation in the lower lip area, and the side of the mandible may be tender for several weeks. It is important to continue with a soft diet to avoid the risk of damage to the mucosa.
Upper Jaw – The graft site will also have sutures which will be removed ten days following your surgery. The mucosa is very delicate in this area due to the increased bulk and the stretching of the mucosa over the new bone. You might experience some temporary altered sensation in the region under the eye and near the nose, lips and cheeks.
Post Operatively – It is important that the surgical site is cared for properly to avoid infection.
You will be prescribed antibiotics and analgesics, a nasal spray and anti-inflammatories.
It is important to sleep in an elevated position and to refrain from nose blowing for two weeks.
Frequent rinsing (numerous times each day for ten days) with a warm salt water or “Savacol” solution will assist this healing.
The surgical sites will be swollen, tender and have sutures present. These will be removed approximately ten days after surgery. It is important to keep your tongue away from the sutures to avoid the sutures falling out too early. It is recommended that you rest and not attend work during this period and eat only soft food.
You will not be able to wear your denture immediately following surgery as this may cause the graft to fail. It is recommended that you visit your referring dentist following suture removal to have your denture adjusted and fitted. In extensive grafting cases, a longer delay before wearing a denture will be required.
Smoking interferes with healing of the mucosa and bone. Dr Allan will not carry out grafting procedures if you smoke.