Replacing what was lost
Replacing what periodontal disease took away
An implant is a titanium root replacing the one that is gone. When periodontal disease has taken the bone, that has to be rebuilt first: without bone to anchor into, an implant will not hold.
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What an implant is and what it is not
A dental implant is a titanium screw that acts as a root. It is placed in the bone and, over the following weeks, bone grows onto it and bonds: that process is osseointegration, and it is what allows the implant to bear biting forces afterwards. An abutment is screwed on top and, finally, the crown you can see.
It helps to understand that an implant is not a tooth. It has no periodontal ligament, so it does not cushion loads or warn you with pain when something is wrong. It cannot decay either. But it can lose the bone around it if infection sets in, and then the problem arrives without prior symptoms.
It is equally important to know what it does not solve. An implant replaces a lost tooth but does not treat whatever caused the loss. If that cause was active periodontitis, placing implants without stabilising it first means building on ground that is still moving.
When bone is missing: bone grafts and sinus lifts
When a tooth is lost, the bone that held it stops being loaded and begins to resorb. Within months the ridge loses width, and over the years it loses height too. That is why when the tooth was lost has such an influence on the treatment plan.
In the upper jaw there is an added factor: the maxillary sinus, an air-filled cavity that tends to expand downwards once molar roots disappear. If only a few millimetres remain between the ridge and the sinus floor, a sinus lift is needed: carefully raising the membrane lining it and placing graft material underneath to create the missing bone height.
When width is what is missing, guided bone regeneration is used: graft material plus a membrane that stops soft tissue invading the space while bone forms. Depending on the case, the implant can go in at the same time or you may need to wait some months for the graft to mature.
Why it is planned with 3D CBCT and guided surgery
A conventional X-ray is a flat image: it shows height but says nothing about ridge width or exactly where the nerve runs. Cone beam CT gives a volume, and with it the available bone can be measured in three dimensions and structures that must be respected, such as the inferior dental nerve or the maxillary sinus, can be located.
On that volume the position of each implant is planned virtually, thinking not only about where there is bone but about where the crown needs to sit for the bite and the aesthetics to work. That planning produces a custom-printed surgical guide that controls the drill's angle and depth.
The practical benefit is twofold: greater precision and, often, less invasive surgery, because in many cases it allows working without raising as much tissue, which translates into an easier recovery.
When it needs treating
- You have lost one or more teeth and want a fixed solution
- You wear a removable denture that never quite holds
- You have been told you do not have enough bone for implants
- You need a tooth removed and want to know what comes next
- You want to avoid cutting down neighbouring teeth for a bridge
How we do it
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1
3D scan and planning
With cone beam CT we measure the available bone and locate the nerve and maxillary sinus before touching anything.
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2
Regeneration, if needed
Bone graft or sinus lift to build the bed the implant will sit in. Sometimes done at the same time as placement.
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3
Guided placement
With a custom surgical guide, the implant goes exactly where it was planned on screen.
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4
Crown and maintenance
Once osseointegration is complete the crown goes on. From then on the implant joins the maintenance programme.
Frequently asked questions
How long does it take?
It depends whether bone has to be regenerated. A straightforward case can be done in a few months; with a graft it takes longer, because bone needs time.
Does placing an implant hurt?
Surgery is done under local anaesthetic and you feel no pain. Recovery is usually milder than people expect.
Can I have implants if I have periodontitis?
The disease has to be stabilised first. An implant placed in a mouth with active periodontitis is far more likely to fail.
Do implants last a lifetime?
They can last decades, but they are not immune: without maintenance they can lose bone just as a tooth does.
Can the implant go in the same day as the extraction?
Sometimes, yes: that is called an immediate implant. It depends on there being no active infection, enough bone remaining around the socket and sufficient initial stability. That is decided from the CT scan, not by eye.
What is the success rate?
In patients without risk factors, published ten-year figures are very high. What lowers that percentage most is smoking, uncontrolled periodontitis and the absence of maintenance.
Does it feel different when eating?
At first, yes, because an implant lacks the proprioceptive sensitivity of a natural root. Most patients adapt within a few weeks and end up chewing normally.
Can the body reject titanium?
Titanium does not cause immunological rejection the way a transplanted organ can. What may happen is that osseointegration does not take place, in which case the implant is removed and can be attempted again later.
Shall we talk?
Tell us what is going on and we will say whether this is your case or not. The first visit is about naming it.