Dental Implants - Decision process

[TheGriffter]

Hi All, I am after a bit of assistance regarding dental implants. I have done a fair amount of research, but would like to hear in particular from the resident PH dentists as to my current position and approach.

Background
Back in October I had teeth (5) that were extracted and along with some previous extractions means that now I have some areas that I am considering having implants for.

I now have 4 teeth in a row missing (Upper Left - Canine through to first molar). The recommendation from my dentist is to have a 4 unit bridge, based on 2 implants which seems appropriate, using the Straumann system. There are also a couple of single teeth that I am considering for single implants (one Lower Right, one upper right).

My dental practice does do implant work, but my particular dentist who has been excellent through all the extractions and other work, does not. I have met the implantologist at the practice and he seems very knowledgeable, but openly admits that he hasn’t done hundreds and hundreds of these. I have seen a few examples, pictures and references that he had available (<5). He also does some teaching work in the field of implantology but I don’t know the extent/level of this.

I visited an alternative dentist from a specialist dental implant for a consultation (just a quick exam and assessment, no CT scan). These were found via Google, but they seem to be a reputable and national series of clinics. The implantologist there was more experienced, with specialism in implants and maxillofacial surgery (I had to look it up!) and had literally done thousands of placements.

I have a third appointment with another dentist who was recommended to me by someone who has had implant work done by them.

Questions
So after the waffle and background I am asking:

• The extractions are healing very nicely according to my dentist so is now the right time to get going on this?
• Am I approaching this in a sensible way, is there anything else to consider?
• Straumann were recommended and quoted by my dental practice as “the roll-royce of implants”. What are the experts views on the system, its longevity, ease to work with, benefits v cost etc.?
• Adin and Bio Horizons have also been discussed briefly but I’m unsure if they are of higher or lower grade – thoughts?

I appreciate individual circumstances dictate the most appropriate system, but any feedback, advice or other options (like save the money and buy a M3 instead) will be appreciated either via this thread or PM if preferred.

Cheers, Griff

[StevieBee]

I'm fairly certain I have two Straumann implants.

Knocked out one of my front teeth and badly damaged the other when I was 19 (now 48). I had two pegs drilled into my bone and the crowns then attached. In the time since, only once has one of the crowns come out (fixed with Super Glue!).

Had no problems otherwise and they look like the real thing still. The only slight issue is that the gum on one side has never grown over the root of the crown but you wouldn't notice it.

[Driller]

Hi, I've been placing dental implants for 10 years now, the last 7 of those using Straumann. It is indeed an excellent, if expensive system but you don't want to put any old stuff in your mouth right?

This is not to the exclusion of other systems and there are other good ones out there. The way they are placed including the planning is just as important of course.

TheGriffter said:

Questions
So after the waffle and background I am asking:

• The extractions are healing very nicely according to my dentist so is now the right time to get going on this?

I wait at least 2 months after extractions to give things a chance to heal up and then take some radiographs. Most of the time these radiographs show that things have healed sufficiently to go ahead with the implants.

So if you had your teeth out in October I would expect the bone to be sufficiently healed.

You mention that it's canine to first molar (tooth 23 to 26) so this means it's in the upper jaw so there the maxillary sinus to consider which starts around the second premolar to molar region (this varies obviously). The post extraction radiographs that the dentist took should give an idea if there is enough bone between the sinus floor and the bone crest to place a reasonably long implant (for good enough stability) without ending up in the sinus.

This minimum reasonable length is considered to be 8mm today. 10mm is great, 12mm is utterly bullet proof.

If you have the space all well and good but if you don't then you will have to have a "sinus lift" procedure whilst the implants are being placed. This adds to the cost.

The CT scan or cone beam (obligatory) that they will do before the procedure will show this up in much more detail and allow them to plan things properly.

You say it was suggested to have a 4 unit bridge on 2 implants. I personally think that this is a bit tight. I install 3 unit bridges on 2 implants but 4 is a bit long IMO for a lasting solid result. Cheaper for you though of course. I have placed 4 unit bridges on 2 tooth abutments though and the same on implants can be done.

I would be inclined to place an implant at the canine position and one at the second premolar and a third at the molar position. I would then install a 3 unit bridge between the canine and second premolar and a single unit crown in the molar position. You could also place the bridge between the first premolar and molar with a single unit on the canine, the rationale being that you may have more bone with a wider crest in the molar region allowing you to place a larger, stronger implant.

Often there is a lot of bone in the canine region too making a sort of bulge you can feel.

All of this depending of course on what you have radiographically and clinically and can't be judged on a forum.

TheGriffter said:

* Am I approaching this in a sensible way, is there anything else to consider?

Ask about your periodontal health-you'll want to get any gum disease treated so as not to place implants in a hostile environment. They should have checked this anyway. This may also show up any other teeth which you may lose in the future (I hope not for you!) which could have an impact on the treatment plan.

If the teeth have been missing since October presumably you've either decided you don't need a temporary solution for aesthetics i.e. a partial denture or you already have one.

TheGriffter said:

* Straumann were recommended and quoted by my dental practice as “the roll-royce of implants”. What are the experts views on the system, its longevity, ease to work with, benefits v cost etc.?

Straumann is a great system, very complete with lots of different possibilities for a range of situations. I think it's easily worth the cost and if I was going to have dental implants I would choose this system.

TheGriffter said:

* Adin and Bio Horizons have also been discussed briefly but I’m unsure if they are of higher or lower grade – thoughts?

Never heard of Adin, Bio Horizons are OK I think, slightly lass "high-end" than Straumann but at this level it's the implantologist which makes the difference.

HTH. Fire away if you have any more questions

Edited by Driller on Thursday 29th January 07:01

[TheGriffter]

Wow, Driller - thanks for taking the time for such a comprehensive response.

Obviously depending on bone density, the single implant/crown at canine and then 2 implants supporting 3 unit bridge really makes sense and gives lower chance of failure later. Whilst obviously a consideration, cost is not my primary decision making factor and I may even do that in addition to, rather than in place of one of the other implants (lower right).

Great to hear that Straumann would be what you would go for if you had to have implants.

I have had the 4 tooth gap for just over 3 months, post extractions, although yesterday I got a partial denture that covers the 4 tooth gap. My original thoughts were that this might actually be a long term solution and implants would not be needed; one day of dribbling, inability to speak and drinking coffee that I couldn't really taste led me to conclude the implants, well planned and placed are definitely the way forward!

I will go and complete the consultations, but feel confident that I will be much better placed to discuss the treatment plans, risks etc.

Thanks again - I will post up progress and probably ask daft questions as I progress.

[MacGee]

Maybe a trip to Paris would be on the cards.

[Driller]

New patients always welcome and (how do they put it on the hifi/home cinema forums?) PH discount guaranteed

Otherwise glad to help, ask as many daft questions as you like

[cringle]

There are over 450 dental implant systems currently on the international market, the main players in this country being Straumann, Dentsply (including Astra), 3i, Nobel and a handful of others. These days most of the systems adopt a "platform switched" approach, and the latest literature suggests there isn't much difference longevity wise between the systems. Suffice to say there isn't more than 10 years or so worth of evidence as this approach has only been widely adopted in the last decade by the majority of implantologists. A lot of the cheaper systems a lot of which are from the far east are decidedly lower grade, and there have been various studies that have demonstrated the lower quality of these with regards to surface imperfections such as carbon deposits left behind during manufacture. If you go to someone offering suspiciously cheap implants, the chances are that they are using a more "economic" system. In my experience as a general dentist who restores implants, the best person to place them is a prosthodontist or restorative dentist and not an oral surgeon as they usually take the final result into consideration to a higher degree. Oral surgeons tend to think in centimetres rather than micrometres. Now before an oral surgeon comes along to fight his or her corner, obviously I'm making a bit of a generalisation here, but if I were to need a dental implant I would most definitely want a prosthodontist or restorative dentist to do the job. So the implant system, so long as it's a major brand, isn't as important as the person who is placing it. Planning planning planning is the key.

[Dammit]

I had two implants, done by Guy's and St Thomas' - consultant with a team of students, which went perfectly.

I have no idea what type they were, but they've been fine.

Not much help I am afraid, but I'd give implants as a procedure a big thumbs up.

[Ellabee]

Hi, I've just come across the above posts about implants - I'm considering them myself to support a whole upper plate. However, I noticed someone mentioned having periodontal treatment before implants placed - I've asked the implantologist if periodontal disease (which I've been told I do have) needs to be sorted beforehand, and he said 'no, this isn't necessary' (I emailed the question, along with many others, and he responded to this in writing). Should I be concerned, as I've read that this can challenge the success of implants, which is why I asked him the question? In addition, he's suggesting implants will be placed (x4), immediately following extractions, on the same day (no immediate load though, this would be 6-8 months later). Like mentioned above, this implantologist seems to be well established and qualified.

If anyone can give me their thoughts, that would be great!

[cringle]

It depends on whether your periodontal disease is active or not. If the implantologist is worth his salt, then he will have checked you periodontal status and advised you accordingly. I wouldn't place an implant on someone with active periodontal disease as the bacterial flora of the mouth needs to be as ideal as possible and this is achieved with thorough scaling usually with a hygienist and home care to match. I also insist my patients commit to minimum twice yearly hygienist visits following implant placement to ensure they last and minimise the risk of implant disease. It's all about predictability and minimising risk!

[Rachie]

You definitely need to know if your disease is active or stable, have you had much treatment for it?

It's my absolute pet hate as a hygienist! Perio health should be in the top of the list not the bottom.

[Legacywr]

What sort of costs are we talking about?

[Driller]

I charge €2000 for the combination of Straumann implant and tooth placed in my dedicated operating theatre, not in a generalist's chair.

With the current rate of exchange this works out as €1432 ( plus a couple of Easyjet flights to Paris).

Just saying

[jimmyjimjim]

Out of interest, does that include bone grafts?

[craig1912]

I had an implant approx15 years ago and it was one of these
https://www.nobelbiocare.com/se/en/home/products-a...

best think I have ever had done

[majordad]

Driller said:

I charge €2000 for the combination of Straumann implant and tooth placed in my dedicated operating theatre, not in a generalist's chair.

With the current rate of exchange this works out as €1432 ( plus a couple of Easyjet flights to Paris).

Just saying

You mean £1432 !!

[Driller]

Yes, thank you!

[Legacywr]

That'll be a lot of money for a mouthful!

[Sheepshanks]

Legacywr said:

That'll be a lot of money for a mouthful!

It's 40% less than I just paid. And I thought everything was dearer in France.

[Legacywr]

Sheepshanks said:

It's 40% less than I just paid. And I thought everything was dearer in France.

What did you have done?

Where did you go?

And, how much did you spend?