Implant systems and evidence

There are about 500 different implant systems currently in use around the world today. Less than ten of these have any substantial refereed evidence in the literature, let alone long-term follow up evidence.

We prefer the Straumann Dental Implant System® and Astra Dental implant systems With more than 20 years of clinical research that have resulted in over 3,000 independent scientific publications, we feel that they offer the most extensively documented, clinically validated and practice-proven implant system on the market.

We are constantly told by technicians, and by dentists who perform their own restorative treatment on implants we place for them, that using this system is easier than providing dentistry on teeth.

Of course, the implants have to be properly placed in exactly the right position!

Mini-Implants

See “Transitional restoration”

Success rates

The most common variable, quoted in many studies, in the success of any surgical therapy is the experience of the operator. Our clinicians are all accredited and registered experts in their field, with years of experience and an up-to-date appreciation of the current state of contemporary therapy.

They are actively involved in teaching and training new surgeons and in performing research to advance the knowledge that we have in the fields of implantology, periodontology and regenerative therapy.

Our implant survival rates average 98 – 99% over a 15 year period.

Implant therapy

Implant therapy is best carried out in defined treatment phases which require a systematic approach to treatment planning and the surgical and prosthetic phases of treatment.

The protocols we use are as laid down by the ITI and are founded on years of ongoing clinical research and follow up, which is one of the reasons for our high success rates.

At the initial consultation we will take into account the patient’s expectations and wishes. There is an interactive discussion regarding the nature, advantages and limitations of implants, materials used in augmentation procedures and other alternative treatments that may suit the patient. We will perform a detailed examination that will enable us to give the patient an outline idea of the costs and timescale of different treatment options that may be suitable.

If the patient wishes to proceed further, they will then return for further investigations according to their treatment need, e.g. mounted study casts etc., following which we will be able to provide a detailed written report, proposed treatment plan and estimate detailing the timescale and cost of treatment.

When to refer

The best time to refer is as soon as possible! It is not necessary to wait months after tooth removal before referring. Whilst immediate implant placement (placement of an implant at the same time as extraction) is rarely the best treatment, we often time extractions according to planned implant placement in order to achieve an optimal result for the patient.

When to extract

Usually, we will take this decision. For the referring practitioner, the basic rule is: If the tooth is causing bone loss (e.g. fractured root, chronic infection, suppuration), remove it! If the tooth is not causing bone loss, seal the canal and refer.

Grafting

Most aesthetic placement will require some bone augmentation, although this is generally simple and simultaneous with implant placement. We have extensive experience in intermediate and complex grafting procedures, with exceptionally high success rates.

Block augmentation using intra-oral donor sites is most often provided on an out-patient basis, with intravenous sedation as required. We have in-patient facilities at a nearby private hospital for more advanced procedures, for example using iliac crest donor bone from the hip.

Healing times

Immediate load can sometimes be an option, but because the indications for such a procedure are more limited, appropriate case selection is an important factor.

The standard healing time for SLA implants by Straumann is 6 weeks; using SLActive, this can be as little as 3 weeks, without taking the risk of a compromised result that can be present with immediate load.

We prefer procedures that are safe, simple and proven by clinical evidence!

Transitional restoration

A transitional restoration is worn during the healing phases after bone grafting or implant placement. We prefer to avoid the use of transitional dentures where possible, to avoid the risk of premature / adverse load on a healing graft or implant, which is a known risk for failure. Other options are always investigated.

One option is to place temporary mini implants that are immediately loaded with a transitional bridge. These mini implants are then easily removed when the “proper” implants are loaded.

Our opinion on mini-implants is that this is their only use – Although mini implants are available in a bewildering array of sizes from 1.8mm to 2.9 mm diameter, FDA approval is for 3.0mm only to be used as a “permanent” solution for overdenture stabilisation; otherwise they are only cleared for “transitional” use. There is little published evidence on their uses and limited prosthetic options for restoration.

There are orthodontic mini-implants available, which we use to achieve superb anchorage, and this is a well-documented treatment modality.

Provisional restorations

A provisional restoration is an initial, temporary restoration on the implants.

Whilst “progressive load” on implants is now known not to be necessary, provisional restorations are used:

• To help with refining occlusion in complex reconstructions.
• To prove aesthetics and phonetics in complex reconstructions.
• To model soft tissues and allow these tissues to mature and stabilise in aesthetic sites.

Flapless Surgery

Flapless surgery should only be performed by an appropriately experience surgeon using some form of guided navigation and / or a computer generated template with appropriate 3d imaging. We have considerable experience in this field, and a 3d scanner available on-site in our dedicated radiography suite.

Peri-implant disease

Please refer also to the information given in the periodontal sections of this website.

There remain several unknowns about peri-implant disease, often referred to as “peri-implantitis”. The facts at present are:

• Bacterial colonisation of the implant surface may cause peri-implantitis

• (Berglundh 1992; Ericsson 1992; Pontoriero 1994; Abrahamsson 1998; Zitzmann 2001)

• Transmission of microflora from periodontal pockets to implants is possible (Leonhardt 1993; Mombelli 1995; Papaioannou 1996; Quirynen 1996; Lee 1999; Sbordone 1999)

• Adequate presurgical periodontal stabilisation and ongoing SPT (Supportive Periodontal Therapy) is essential (Newman & Flemmig 1988; Bragger 1990)

We provide a comprehensive service in these matters.