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10 things to consider before having dental implants

12 June 2013 / by / 21 comments

10 things to consider before having dental implants

Den­tal implants can be a heaven-​sent for those with miss­ing teeth, how­ever, there are some points to take note.

BY: Dr Ang Chee Wan

For those with miss­ing teeth, den­tal implants can bring back the joy of sim­ple activ­i­ties such as eat­ing and chew­ing food with ease and com­fort. It also pro­tects against dam­age to adja­cent teeth.

The treat­ment process begins with an exam­i­na­tion and treat­ment plan­ning to deter­mine if the foun­da­tion is suit­able to receive an implant. There­after is the implant place­ment, where a titanium-​alloy implant is inserted with­out load for a heal­ing period of two to three months. The final stage involves the place­ment of the crown over the implant, which is made to match to the neigh­bour­ing teeth as close as pos­si­ble to achieve a good aes­thetic outcome.

So before you con­sider hav­ing such a pro­ce­dure, here are 10 things to keep in mind:

1. Don’t rush into implant treat­ment – Implant treat­ment requires care­ful plan­ning and thor­ough dis­cus­sion between the patient and spe­cial­ist, which requires time. Dur­ing the dis­cus­sion, find out if there are other options that don’t require implants.

2. Dis­cuss if tech­nol­ogy will be used to ensure the safety of implant treat­ment – There are many tech­no­log­i­cal advances that can be applied to ensure that the implant treat­ment is safe. These include low-​dose, in-​office 3D CT scan to avoid place­ment of implants into nerves and other impor­tant struc­tures.
• Low-​dose radi­a­tion is also impor­tant and the lat­est dig­i­tal X-​ray machines pro­duce lower dose of radi­a­tion com­pared to older machines.
• Com­puter plan­ning soft­ware can be used to bet­ter pre­dict the final out­come of the implant treat­ment even before the surgery.
• Lasers can be used for cer­tain pro­ce­dures to reduce post-​op dis­com­fort.
• Micro­scope and fine instru­ments can also be help­ful in reduc­ing post-​op discomfort.

3. Dis­cuss the implant brand and type of crown mate­r­ial to be used – Rep­utable implant man­u­fac­tur­ers pro­duce com­po­nents that have been tested in research and have been func­tion­ing for decades. Hence, patients should always choose implant com­po­nents from rep­utable implant man­u­fac­tur­ers that have a long his­tory because these com­po­nents have stood the test of time. Also keep in mind that some mate­ri­als used for the crown are stronger and should be used in the back teeth. How­ever, some mate­ri­als are more aes­thet­i­cally appeal­ing and should be used in the front teeth.

4. Take time to dis­cuss if the bone, gum and other teeth are healthy enough for implants to be placed – The spe­cial­ist should check if the bone, gum and other teeth are healthy enough before implant treat­ment. If the bone and gum at the implant site are not healthy or suf­fi­cient, addi­tion of bone and gum may be required. Only by doing that, can the implants be safely placed to ensure their longevity. The patient’s other teeth and gums should not be infected. If decay and gum infec­tions are not treated first, the infec­tion can spread to the implants.

5. Find out if the den­tist has rel­e­vant post-​graduate qual­i­fi­ca­tions – Implant train­ing is not done in most under­grad­u­ate pro­grammes. Some struc­tured post-​graduate train­ing in implant den­tistry is nec­es­sary. Reg­u­lar atten­dance of lec­tures and hands-​on course is also impor­tant for con­stant upgrad­ing of the specialist’s skills and knowledge.

6. Ask to see before and after pho­tos of work per­formed by the den­tist – These pho­tos will pro­vide an idea of the pos­si­ble final out­come and can be used to gauge the dentist’s expe­ri­ence in the spe­cific clin­i­cal situation.

7. Dis­cuss the cost of treat­ment after you have thor­oughly under­stood the var­i­ous treat­ment options – After a com­pre­hen­sive exam­i­na­tion and dis­cus­sion of the var­i­ous treat­ment options, find out the rea­son for the high– or low-​cost of treat­ment. Dif­fer­ence in implant brands, mate­ri­als used and the specialist’s skills and expe­ri­ence will account for the dif­fer­ence in treat­ment fees.

8. Be aware of poten­tial fail­ure of implants – As with all pro­ce­dures in med­i­cine and den­tistry, not all implant pro­ce­dures will be fail-​proof. In gen­eral, the suc­cess rate of implants is about 90 per­cent to 95 percent.

9. Dis­cuss the post-​treatment main­te­nance régime – After the com­ple­tion of the implant treat­ment, there should be a plan for the main­te­nance of the implant and the teeth. Implants func­tion just like nat­ural teeth, and like nat­ural teeth, infec­tions can occur around the implants if they are not reg­u­larly checked and cleaned.

10. Seek a sec­ond– or third-​opinion if in doubt – Always seek a sec­ond– or third-​opinion because dif­fer­ent spe­cial­ists may be able to pro­vide dif­fer­ent options for consideration.

Dr Ang Chee Wan is a den­tal spe­cial­ist in peri­odon­tics. He is a clin­i­cal direc­tor at T32 Den­tal Cen­tre and a vis­it­ing fac­ulty at the National Uni­ver­sity of Sin­ga­pore. This arti­cle first appeared on T32 Den­tal Centre’s web­site and it has been updated with permission.

(** PHOTO CREDIT: T32 Den­tal Centre)



Dental implants can be a heaven-sent for those with missing teeth, however, there are some points to take note.

 

BY: Dr Ang Chee Wan

 

For those with missing teeth, dental implants can bring back the joy of simple activities such as eating and chewing food with ease and comfort. It also protects against damage to adjacent teeth.

The treatment process begins with an examination and treatment planning to determine if the foundation is suitable to receive an implant. Thereafter is the implant placement, where a titanium-alloy implant is inserted without load for a healing period of two to three months. The final stage involves the placement of the crown over the implant, which is made to match to the neighbouring teeth as close as possible to achieve a good aesthetic outcome.

So before you consider having such a procedure, here are 10 things to keep in mind:

 

1. Don’t rush into implant treatment – Implant treatment requires careful planning and thorough discussion between the patient and specialist, which requires time. During the discussion, find out if there are other options that don’t require implants.

 

2. Discuss if technology will be used to ensure the safety of implant treatment – There are many technological advances that can be applied to ensure that the implant treatment is safe. These include low-dose, in-office 3D CT scan to avoid placement of implants into nerves and other important structures.
• Low-dose radiation is also important and the latest digital X-ray machines produce lower dose of radiation compared to older machines.
• Computer planning software can be used to better predict the final outcome of the implant treatment even before the surgery.
• Lasers can be used for certain procedures to reduce post-op discomfort.
• Microscope and fine instruments can also be helpful in reducing post-op discomfort.

 

3. Discuss the implant brand and type of crown material to be used – Reputable implant manufacturers produce components that have been tested in research and have been functioning for decades. Hence, patients should always choose implant components from reputable implant manufacturers that have a long history because these components have stood the test of time. Also keep in mind that some materials used for the crown are stronger and should be used in the back teeth. However, some materials are more aesthetically appealing and should be used in the front teeth.

 

4. Take time to discuss if the bone, gum and other teeth are healthy enough for implants to be placed – The specialist should check if the bone, gum and other teeth are healthy enough before implant treatment. If the bone and gum at the implant site are not healthy or sufficient, addition of bone and gum may be required. Only by doing that, can the implants be safely placed to ensure their longevity. The patient’s other teeth and gums should not be infected. If decay and gum infections are not treated first, the infection can spread to the implants.

 

5. Find out if the dentist has relevant post-graduate qualifications – Implant training is not done in most undergraduate programmes. Some structured post-graduate training in implant dentistry is necessary. Regular attendance of lectures and hands-on course is also important for constant upgrading of the specialist’s skills and knowledge.

 

6. Ask to see before and after photos of work performed by the dentist – These photos will provide an idea of the possible final outcome and can be used to gauge the dentist’s experience in the specific clinical situation.

 

7. Discuss the cost of treatment after you have thoroughly understood the various treatment options – After a comprehensive examination and discussion of the various treatment options, find out the reason for the high- or low-cost of treatment. Difference in implant brands, materials used and the specialist’s skills and experience will account for the difference in treatment fees.

 

8. Be aware of potential failure of implants – As with all procedures in medicine and dentistry, not all implant procedures will be fail-proof. In general, the success rate of implants is about 90 percent to 95 percent.

 

9. Discuss the post-treatment maintenance regime – After the completion of the implant treatment, there should be a plan for the maintenance of the implant and the teeth. Implants function just like natural teeth, and like natural teeth, infections can occur around the implants if they are not regularly checked and cleaned.

 

10. Seek a second- or third-opinion if in doubt – Always seek a second- or third-opinion because different specialists may be able to provide different options for consideration.

 

Dr Ang Chee Wan is a dental specialist in periodontics. He is a clinical director at T32 Dental Centre and a visiting faculty at the National University of Singapore. This article first appeared on T32 Dental Centre’s website and it has been updated with permission.

 

(** PHOTO CREDIT: T32 Dental Centre)


 

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21 Comments

  1. Stephen Teng says:

    Any difference/advantage btw mini & normal implants, other than the costs?

  2. Dr Ang Chee Wan says:

    Hi Stephen,
    Thank you for your question. Mini-implants are US Food & Drug Administration (FDA) approved to retain lower full dentures and to replace lower front teeth. They have smaller diameters compared to conventional implants. Hence, their strength is lower compared to conventional implants and may not be able to support molars and premolars. Also, with smaller diameters, they have food trap when used to replace bigger teeth such as molars.

  3. Yeun Tay says:

    I am thinking of extracting my lower left 2nd premolar and 1st molar which had done Root canal treatment (1 is completed, 1 half done) many years ago, replacing them with implants (or mini implants). Is mini implants getting more better/reliable since year 2013?

    Please advise which is a best option (or any other feasible options for long term?), the cost for implants (or mini implants), and much can be deducted through my Medisave? Thank you very much.

  4. You have described good points on dental implants. Everyone should consider these guidelines before choosing dental implant treatment.

  5. Susie Chia says:

    Dear Dr Ang,
    Thank you for the valuable pointers with regard to tooth implants. The cost can vary from $3K-$6K; which may be attributable to the different implant materials used. As a layman, we would not have any knowledge as to who the reputable implant manufacturers are as mentioned in your write-up. Would appreciate if you list out a few implant manufacturers for both the implants and the crowning materials so that we would be able to make a fair comparison.
    Also, what is your take on allowing post-graduate students to perform the tooth implant. Fully appreciated that they will be guided by a specialist, are there any risks and benefits that we have to consider? Thank you.

    • agelessadmin agelessadmin says:

      Thanks, Susie for your comment. I have queried the centre and waiting for a response. When I get it, I will e-mail you directly.

    • agelessadmin agelessadmin says:

      Sorry Susie for the late reply. Here is the response from Dr Ang: “Thank you for your enquiries. There are some reputable manufacturers who have been around for more than 30 years. Your dentist will be able to provide some recommendations during your consultation visit. There are many materials available for fabrication of crowns. Newer materials like zirconia are strong and is metal-free. These materials cost more and hence the total cost for implant treatment will be higher as a result. Even for metal-based materials, there are gold containing materials (which cost more) and there are also non-gold containing materials (lower cost). Gold containing materials produce crowns that have a better fit compared to non-gold containing materials. Hence, it is better to use zirconia or gold containing materials for fabrication of crowns.

      Having implants done by post-graduate students in NUS is a safe option. The procedures will be supervised by specialists. The implants used in NUS are from reputable implant manufacturers and the materials used for fabrication of crowns are either zirconia or gold-containing materials.

      I hope the information provided will be useful in helping you decide on the treatment of choice.”

  6. hani yunos says:

    I want to have implant coz few of my tooth has drop of need to asked few more question tks

  7. Belle says:

    Hi good day what is the cost of implant per tooth in upper front area. Thanks

  8. Jing says:

    Hi, thank you for the very informative checklist. I just had my lower molar tooth tooth extracted because the endodontist suspected that there is a hairline crack on the tooth (probably due to grinding of teeth at night) and he won’t attempt root canal.

    Could you share how the habit of teeth grinding affects the choices a tooth implant? Also are there other signs to look out for to know for sure whether I do grind or clench my teeth at night? My husband says he doesn’t hear my grinding my teeth while asleep.

    Are Korean brand implants cheaper? If yes, are they included in the reputable brands?

    Thank you.

    • agelessadmin agelessadmin says:

      Thanks Jing for your comment, I have e-mailed the dental centre on this and waiting for a response back.

  9. Steven Ang says:

    Where is Dr. Ang’s clinic?
    Pls provide address

  10. Jewel says:

    Hi,
    I think some private dentists just make use of patients ignorance and just do whatever they feel like. I want Dr Ang’s address too for my Friend who got her root canal done and then she was supposed to get her crown done and her gums started to bleed and now her two minuscule root canal tooth which was scraped shorter got chipped off . Some dentists want to make good money in Singapore huh !

    But they forget their karma is also time bound lah !

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