Missing teeth spaces can allow other teeth to drift sideways on downwards into the space; this ca cause occlusal and even joint problems.

Missing teeth can also create aesthetic problems, but the biggest drawback is the inability to enjoy your food. To many people, eating is the culmination of all the senses.

So when you cannot chew your food, or enjoy a hearty meal, then you can always ask us for advice. There are many options.

Replacing these missing teeth by way of bridges fixed over existing teeth is a possibility, but this can be very destructive and reduces the life expectancy of the natural teeth. Sometimes a tooth may need subsequent root canal treatment.

Dentures can be made, but they need replacing, can become loose or even break. They are usually made of acrylic or metal acrylic with metal clasps. Nowadays we can also make flexible dentures that stretch over the teeth and do not need clasps.

By way the best way of replacing teeth is using implants. Implants can support many teeth, maintain bone levels and being fixed are a natural way of replacement.

Implants are made from Titanium alloy, are bio-inert and have been used in dentistry for over 50 years.

In the first of a series of articles we will be discussing numerous case studies.

Patient AB attended with 2 unrestored implants placed at another clinic, unfortunately the clinic had closed down. Lower Right 654 were missing.

We were using the same Nobel active implant system and we were able to help. We assessed the patient, his occlusion and his aspirations.

The patient had the implants placed 6 months ago and had lost his temporary acrylic bridge after it had fractured.

One of the implants had been placed very close to the canine tooth, which could jeopardise the nerve of the canine and also the long term integration of the implant.

We used impression posts attached to the implants and took silicone impressions.

2 weeks later a metal porcelain bridge was attached to the implants by way of integral implant screws. patient was very happy to be able to chew on both sides; now he is considering Invisalign.

Dental implants if paced with care and attention can last a lifetime.

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Implants have been around since 1965 and were originally used in science. Professor Branemark discovered that the Titanium cylinders being used in his experiments were stimulating bone growth around them.

Implants were then used in many medical and dental fields in attaching prostheses or teeth to bone.

The Titanium alloy used is very pure, bio-inert and noncorrosive. However in the mouth it is the bone that fails around implants in certain patients.

As all metals have a rough surfaces they can attract germs. In the healthy patient the implant is placed at the bone level and the healthy gum creates a protective cuff around the post of the implant. This can be seen in the picture above where the gum is pink, firm and stippled (like orange peel), except at one location.

When the cuff is loose, germs can get in and cause local inflammation, this is called mucositis as in the picture above.

The signs are very similar to gum disease in that early signs are redness and or puffiness without bleeding.

Brushing the gums around teeth and implants keeps them healthy and maintains the bone underneath.

Patients that smoke, are diabetics or immunocompromised may have a weakened defence mechanism that allows implant or gum disease to develop.

Routine check ups, visits to the hygienist and also home care/brushing with an electric tooth brush or bottle brushes can help reduce bacterial levels around implants.

If germs are allowed to build up inside the gum cuff then the local body inflammation, in trying to neutralise the germs can also damage the bone, causing bone loss. This is called peri-implantitis.

Continuous presence of the germ biom can lead to the loss of the implant and the superstructure above.

The signs of implant disease can be redness, puffiness, bleeding, white fluid or pus, pain etc. The implant does not become mobile until much later on as the bone contact is very strong, even when there is little coverage.

The implant surfaces need to be uncovered, cleaned, smoothed and or antibiotic substances applied to disinfect them. The gums can then be allowed to heal naturally, but with bone loss, recession can occur and the implant surface may be visible.

Tepe is a brand of sturdy bottle brushes. They can be brushed under bridgework or crowns and keep the gum cuff clean. They can be rinsed and dried and used twice daily for up to 2-3 weeks and then a new one is used.

Mouthwash can also be used once daily to kill off any unwanted germs as well.

Implants need monitoring and maintenance too and can slowly fail without you even realizing it. It is imperative, much like a car MOT that you get them checked regularly.

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