Association OMS Singapore

DENTAL IMPLANTS/IMPLANTOLOGY

What are implants?

In medicine, implants are used to replace and repair natural structures lost to disease. In dentistry, Dental implants are used to replace teeth.

Generally, dental implants consists of two portions, the portion replacing the root portion of the tooth (the implant fixture) and the portion replacing the crown portion of the tooth (the artificial crown).

Why do I need implants?

Dental implants are good alternatives for the replacement of missing or lost teeth. Being a ??stand alone' structure, it seldom affects or require the neighbouring teeth for support. As such, the surrounding teeth are spared from further treatment in order to replace the missing segment. Should the implant encounter any problems, it is removed on its own without the involvement of the surrounding teeth hence sparing them from further loss.

Am I suitable for dental implants.

The best person to advise a patient on whether or not he or she is suitable to have dental implants is the dentist. This is because there are many factors to consider. The general health of the individual is important. Diabetics must be well controlled if they were to consider implants. As dental implant therapy requires several surgeries, albeit small, any medical conditions which may lead to complications related to the surgery must firstly be treated and put under control. A person's social habit may also jeopardize the implant. If the patient is a smoker, it will affect the implant's lifespan. Local factors like the amount and quality of bone where the implant is to be placed, as well as occlusion (biting position and forces) must be accurately assessed. The oral hygiene of the patient is of utmost importance. Healthy disease free gums are essential for the success of any implant therapy. People with implants must keep them clean and should return regularly to their dentists for checkups so that any problems which may compromise the lifespan of the implant may be corrected early.

What does implant therapy involve?

The standard protocol of implant replacement therapy involves the following steps:

1) Examination and Diagnosis

At this stage, the doctors will assess the patient for suitability for implant therapy. This will include a general examination, some investigations like Xrays or CT Scans. There may also be some moulds taken to assess the positions and number of implants required.

2) Implant placement surgery

If there is inadequate bone around the implant site, the surgeon will decide if there is a need to graft (add) bone to the area. There are many bone grafting materials to choose from. The best bone is autogenous (patient's own) bone. It is usually taken from another site of the jaw or even the hip bone. If there is enough bone, the implant fixture(screw) may be placed directly onto the bone. There is a healing period for the implant to osseointegrate (bond with the bone). This healing period may take up to six months. During this period, there is nothing seen in the mouth and the patient may continue wearing his/her denture over the surgical site.

3) Implant uncovering surgery

At this stage, there will be a minor procedure to expose the implant. After this surgery, there will be metal ??buttons' protruding from the gums. The positions of the buttons will be the spots where the implant tooth will be built upon. After a few weeks of healing, fabrication of the crowns of the implant tooth may begin.

4) Restorative phase

During this period, there will be several visits to the surgeon as there are a few steps involved in the fabrication of the crown portion of the implant. This is also the last stage of the implant therapy. The patient will leave the clinic with a brand new set of ??permanent' teeth.

Variations to the standard protocol

Immediate implants?

Although the standard protocol applies to most cases, there many variations to the protocol. There are immediate implants where the patient may be able to have implant teeth fabricated and issued within a week or even a day. These indications are very specific and the surgeon will be able to advice on the suitability of such cases on an individual basis. This option is gaining popularity as many patients prefer to have their implants restored as early as possible. However, patients must understand that this protocol requires some criteria to be satisfied in order to enjoy good success rates.

Zygomaticus implants?

These implants are very advanced implants and indications are absolutely strict. It involves the placement of long implants which engage the zygomatic bone from within the maxillary antrum/sinus in the upper jaw. These implants are also complemented by up to four normal implants to the front of the maxilla. This procedure requires extreme precision and close coordination between the surgeons and the restorative dentist. Not all patients are suitable for this treatment option.

How long do implants last?

The success of implant therapy depends on many factors. Referring to the selection criteria for suitable patients, it becomes obvious that factors such as diabetes (if poorly controlled) and smoking does decrease the success rate of implant treatment.

Oral hygiene plays a very major role in implant success. A poorly maintained implant will suffer from gradual bone loss and may be loosened and unusable after a few years. Meticulous maintenance of the implants and scheduled visits to the surgeon is essential to spot early problems and remedy them before the problems become untreatable.

The correct usages of the implant tooth/teeth are important. Implant crowns are made of metal and ceramics. They are able to take great compression forces but not shearing or lateral forces. As such, the manner in which the implant is used will determine the lifespan. Patients are usually advised on their diet after implant therapy.

When implants fail, it will manifest as pain, discharge around the implants and looseness of the implant. Failure can happen at different levels. It may be a mechanical failure of the components or a biological failure of osseointegration.

The surgeon will be able to assess the problem and can recommend remedial treatment. Sometimes, this will include removal of the entire implant fixture. However, the same bone site may receive another implant after healing and the entire treatment may be repeated with no harm to the neighbouring teeth

If well maintained, an implant may last for more than twenty years. Success rates can be as high as 99%.

treatments and techniques

Procedures done by Singapore Oral and maxillofacial Surgeons

1.Minor Surgery
- a .Surgical removal of tooth (eg wisdom tooth surgery)
- b. Endodontic(root canal) Surgery
2. Oral and Maxillofacial infections
3. Cysts of the mouth and jaws
4. Benign tumours
5. Disorders of the salivary glands
6. Maxillary Sinus
7. Maxillo-facial Injuries
8. Orthognathic surgery
9. Cleft lip/palate
10. Malignant growth(Cancer) in Head and Neck Region
11. Oral Medicine
12. Control of facial pain / Sedation
13. Dental Radiology / Imaging
14. Care of Surgical Patients
15. Pre-prosthetic surgery
16. Temporomandibular joint(TMJ) Disorders/ Clenching Pain/Surgery
17. Implant surgery
18. Laser Surgery in the Maxillofacial Region
19. Aesthetics procedures around Maxillofacial area, such as fillers, botox etc.
20. Aesthetic surgery (eg. rhinoplasty, blepharoplasty and facelifts)
21. Skeletal recontouring

FreQuently asked Questions

Q1. When do we need to remove our wisdom teeth and how do we decide if it is an extraction or if it is surgery

A1. Our wisdom teeth can sometimes be the cause of gum infection or tooth decay depending on the manner in which it is erupted. If the symptoms are persistent, it is usually indicated for excision. The decision to either extract or to perform surgery is dependant on the type and depth of impaction of the tooth. It is also dependant on the size and shape of the roots. If the tooth is fully erupted with no bony obstruction, then an extraction will usually be successful. In most cases, however, a minor surgical procedure is required.

Q2. What is the difference between local and general anaesthesia.

A2. Local anaesthesia is when a small injection is given to achieve numbness to the surgical site. The procedure is then carried out with the patient's cooperation. General anaesthesia is always performed in an operating theatre. The service of an anaesthetist is required. The surgery is performed after the patient is anaesthetized (sleeping). There is a need for the patient to recover in a ward after the procedure. It is common for healthy patients who undergo general anaesthesia for wisdom tooth surgery to be discharged on the same day. This is known as a day surgery procedure.

Q3. I heard about sedation, what is sedation?

A3. Sedation is when the patient is put into a half sleep state for the surgery to be carried out. Local anaesthesia is also given but this is usually done after the patient is sedated. There are different forms of sedation. Some methods will utilize medical inhalational gases for the sedation. Other methods will an intra-venous line to be inserted through a vein on the hand/arm. The intra-venous method is further divided into a single dose sedation technique and a continuous infusion technique. The latter method will require the full attendance of an anaesthetist. Do discuss with your Oral & Maxillofacial Surgeon with regards to the best technique for your case.

Q4. I heard about excessive bleeding if extractions are done at midday, is that true?

A4. Although this fact has been repeated many times over especially from the older generation, there are no scientific studies to verify this fact. With modern medications and techniques, any form of bleeding in a healthy individual should be easily managed by your OMS Surgeon.

Q5. What are the signs and symptoms of oral cancer?

A5. Most oral cancers start off as a non-healing ulcer in the mouth. The ulcer tends to grow with time and bleeds occasionally. It may or may not be painful. If there is an unusual growth noted in the mouth, the OMS surgeon will usually perform a biopsy during which a small sample of the soft tissue is removed and sent to the histopathology lab for analysis. The results will be known within a week. If you have a history of smoking or betel nut chewing ("Serei") or if you are an alcoholic, then your chances of developing oral cancer increases. Please see an OMS surgeon quickly. Early treatment saves lives.

Q6. I heard about dental implants. Is it safe to have metal in our body and will it set off alarms at the airports?

A6. Dental implants are made of titanium. Titanium has been shown to osseo-integrate or "bond" with bone. It is unlike steel which is usually encapsulated with soft tissue growing and wrapping around it. So, unlike, old steel orthopedic plates which will require removal after a period of time, titanium implants do the opposite and bond with the bone. Many modern orthopedic implants are made of or are at least coated with a layer of titanium due to its osseo-integration properties. Titanium does not set off alarms at the airport. If you travel a lot, you may ask your OMS surgeon to write a letter to certify that you have dental implants in your jaws. Your OMS surgeon will be happy to oblige.

Q7. How long can dental implants last?

A7. The science of Dental implantology has been around since the nineteen sixties. It was discovered quite by accident by a Prof Branemark while he was studying blood flow in rabbit's ears. Since then, dental implants have come along way in terms of clinical research and materials. The modern dental implant is very predictable in terms of success rates and if all conditions are ideal and the dental implants are well maintained in the mouth, it should last for more than twenty years or even a lifetime! The OMS surgeon and the restorative specialist will play their part in the treatment, but the patient plays the more important part of careful use and care of the dental implant retained prosthesis.

Q8. It is true that removal of the upper front teeth can cause mental and eye problems?

A8. Again, this rumour has been heard many times over. The nerves supplying the upper front teeth are sensory nerves. It is not involved in the mental processes and functions of the brain. It is theoretically not possible that extraction of the upper front teeth can directly cause mental problems. Although toothache to the upper posterior teeth can sometimes radiate to the eye on the same side, it is not related directly to the nerves supplying the eye.

Q9. My lower jaw is very long and I really wish to have it surgically corrected, it the procedure safe? What are the long term problems if I undergo the surgery?

A9. The procedure for surgery to the lower jaw is known as orthognathic surgery. Specifically, it will be a Bilateral Saggital Split Osteotomy or a Vertical SubSigmoid Osteotomy. Each procedure has its advantages and disadvantages as well as risks. It will be best that you seek advice with your OMS surgeon as it is too long to be covered here. However, it is a relatively safe procedure which is performed on a regular basis in our local hospitals. It is likely that you will have to undergo braces therapy in preparation for the surgery as well as after the surgery. The long problems are few and are unique for different techniques used. Please see your OMS surgeon for further advice.

Q10. My son fell down and lost his two front teeth when he was 9 years of age. When is the best time for him to have dental implants placed?

A10. The best time to have dental implants placed is when the patient is fully grown. In Singapore, it is usually at the age of 18 to 20 years for boys, and 16 to 18 years for girls. There are variations to this range. If the implant is placed too early, it will remain behind as the rest of the dentition and jaw grows. This will lead to a "submerged" tooth situation and will be difficult to remedy.