Treatment Planning & Timings

The initial evaluation and additional diagnostic material

To plan the most suitable treatment certain information is helpful – for example photographs, x-rays, models of your teeth and jaws. In some circumstances, a more comprehensive three-dimensional x-ray evaluation using a CT Scan may be requested to give greater detail of the shape of your jaws.

What is a CT scan?

The conventional x-ray views most familiar to patients are only 2-dimentional and subject to varying degrees of distortion and inaccuracy. Where important anatomical structures must be avoided, the information they provide may therefore by inadequate. The CT scan in contrast can provide life-sized 3-dimensional information of all regions of the upper and/or lower jaw from which precise measurements can be taken for pre-operative treatment planning. In some cases the CT scan may also be used to evaluate the results of bone-grafting procedures prior to placing Implants.

Having a healthy mouth

Implants survive best in a healthy environment. Any tooth decay or gum problems need to be corrected before Implants are placed to give them the best chance of success.

Sometimes treatment is needed before you are ready for Implants

Gum Health

This may involve the use of special brushing methods, flossing, toothpicks and small “bottle” brushes. Some gum treatment may be necessary.

Removal of Unsavable Teeth

Despite advances in modern dentistry, some teeth may have reached a stage when no treatment can save them. It is often best to remove them at an early stage, particularly if you are thinking of having Implants. Unhealthy teeth act as a reservoir of bacteria risking disease of any possible Implants placed.

Treatment of existing or potential oral infections

Treat or remove all pre-existing oral infection wherever possible

The success of Implant therapy can be seriously affected by infections resulting from failed gum or root canal treatments or untreated gum disease or nerve problems in sites adjacent to Implants. Long-standing infections of the soft-tissues beneath dentures can also adversely affect healing at the various surgical stages. Your treatment may be delayed whilst these areas are resolved.

Although gum infections arising in opposite jaws have no clearly proven link with problems around Implants, there is at least the theoretical risk of bacterial transmission; therefore for the meantime it would be considered prudent to assume that there is a risk. Your mouth should be treated as a whole and not simply as unrelated regions.

How many Implants?

As a general principle, as many Implants as possible should be used. This allows the stresses of biting to be spread over the maximum number of Implants, thus diminishing the load on each particular one.


Some people find it more convenient to proceed in stages

It is sometimes possible to have two or three Implants placed, use them for a while and sometime later, add more Implants to improve the treatment plan. This is not an approach which is feasible in all situations and is probably most suited for treatment of the lower jaw where no teeth are present. An example of this might be the patient with no teeth in the lower jaw who has two or more Implants placed in the first instance. By stabilising their denture using the Implants, it can be held more firmly in place. Later on, if they have sufficient bone, more Implants can be added and eventually fixed-teeth placed on the Implants eliminating the denture altogether.

What is it like having Implants fitted?

Generally speaking, having Implants fitted is not at all painful. For apprehensive patients, sedation can be given.

What is it like after having the Implants placed?

The after-effects of having Implants placed are usually mild and may include slight bruising, dull ache, and swelling, the amount of which will vary dependent upon the number of Implants placed and the difficulty of the surgical procedures. However, the vast majority of patients feel no discomfort at all.

When choosing a date for Implant placement avoid significant social engagements and work commitments for at least a week after. This is just to be on the safe side. Taking time off work is not usually necessary.

Additional procedures before Implant placement

Creating more bone

It is a natural phenomenon that after teeth have been removed the bone that once supported them slowly resorbs away. This occurs faster when prolonged gum problems have been present or poorly fitting dentures are being worn. The result is that there is sometimes not enough bone to support Implants.

When there is not enough bone present, it may be necessary to create new bone to fill in missing areas allowing Implants to be fitted. A variety of techniques are available to do this and these are referred to as ‘Bone-grafting’ and ‘Guided Bone Regeneration’.



Bone-grafting and duration of Implant treatment

Where the clinical conditions indicate that bone-grafting is required to increase the amount of bone into which Implants are placed, it will generally increase the time taken to complete treatment:

  • Under routine circumstances where no bone-grafting is required the Implants are commonly ready to begin function between 6-9 weeks later
  • If the bone-grafting can be undertaken at the same time that Implants are placed, treatment is more likely to take 9-12 weeks.
  • Where Implant placement must be delayed until after maturation of the bone graft, overall treatment may take 9-18 months.

The bone used can be either your own (from a donor site) or from an external source such as Bio-Oss (bovine bone) or Bone Ceramic (fully synthetic).

Guided Bone Regeneration

A technique called ‘Guided Bone Regeneration’ has also shown considerable success where the amount of bone at the intended Implant site is less than ideal.

When a tooth is removed a hole in the gum and bone remains for the first few weeks. Anyone who has lost a tooth or had an extraction knows that this generally heals uneventfully, and eventually you cannot tell where the tooth was.

The purpose of ‘Guided Bone Regeneration’ is to encourage your own bone to form using a biomaterial from an external source to encourage this to happen.

Sinus Augmentations/Lifts

The purpose of Sinus Augmentation/Lifts

It is very common to find that the softer bone in the area above the upper back teeth (molars and sometimes premolars) is very shallow and not suitable for normal Implant procedures. To solve this problem a procedure known as a ‘Sinus Augmentation’ or ‘Sinus Lift’ was developed.

Bone may be successfully grown in the sinus spaces above your upper back teeth allowing Implants to be placed. Either your own bone, or a biomaterial, or a combination of both can be used to increase the volume of bone available for future Implant placement. Over a period of time this is replaced by new bone thus providing a bed into which Implants can be fixed.


Case Study showing Delayed Implant Placement following Sinus Augmentation/Lift

Case Study showing Delayed Implant Placement following Sinus Augmentation/Lift


Case Study showing Simultaneous Implant Placement and Sinus Augmentation/Lift

Case Study showing Simultaneous Implant Placement and Sinus Augmentation/Lift


Implant placement and Bone Grafting

If the amount of bone overlying the sinus is adequate, some surgeons prefer to place the Implants at the same time as the grafting procedures. Whatever type of bone is added to the sinus it must be left to mature before Implants are placed or brought into function. If the Implants are placed as a secondary procedure, (depending on the amount of bone being grown and nature of the graft material used), they can be inserted after 3-9 months, although occasionally it may be necessary to wait longer.

As with other bone grafting procedures, the Implants are left to become firmly attached to the bone. Commonly a slightly extended healing period is chosen with an average of 3-9 months before a Denture or Crown or Bridgework is fitted. However, all Bone Grafting is unique to each individual and this information is for guidance only.

During Treatment Fees may vary due to:

  • Alternative procedures required due to changes in the Treatment Plan
  • New treatments becoming available in the course of your treatment
  • Treatment extended over a longer period of time than expected.

After Implant placement

Sometimes bone may be lost around an Implant. There are techniques available to treat these problems if the cause can be identified. In some situations however, progressive bone loss might result in the loss of the Implant. The risk of this can be reduced by routinely seeing a Dental Hygienist.

New advances

Implantology is a rapidly advancing science. We may take advantage of the new procedures or materials as they become available if they promise to significantly improve the outcome. Alterations to your original plan may therefore be made during your treatment, however any changes in cost would be fully explained before being accrued.

How long does the treatment take to complete?

This depends on the complexity of the treatment. Initially there is a treatment planning stage which may last a month or so. Then there may be some time spent on such preparatory procedures as improving gum health, removing any unsavable teeth and growing bone. This may take anything from a few weeks to many months.

After the Implants are placed they are left to settle in place from 6-12 weeks. The final fitting of Crowns or Bridges or the attaching of Dentures to the Implants takes a couple of weeks typically.

The time depends on your individual situation. In some cases the Implants are suitable for immediate function with either transitional or permanent teeth fitted at or soon after the placement.

Sometimes special medication will be prescribed for you to help healing and produce minimal discomfort. To gain the most benefit, please follow the instructions given.

Do not rush your treatment

It is important that neither the patient nor the Implant provider attempt to rush the treatment or try to advance the various stages faster than the time required for complete healing and maturation of bone and soft-tissues. Even treatment that is well-planned and executed can fail as a result of moving too quickly from stage to stage.

Precautions for denture wearers

Denture wearers may require their Dentures to be modified or be asked to leave them out for a period of time to prevent them resting on newly placed Implants.

Reporting problems and queries

If anything arises that you are concerned about, telephone immediately. Usually there is nothing to worry about, but no matter how apparently trivial, it is always better to check.

The finished teeth – Aftercare

Unlike teeth, Implants cannot get tooth decay. However, like teeth, they can suffer from gum problems. Teeth with untreated gum problems can become loose and be lost. This is also true of Implants.

Thorough daily cleaning is as important with Implants as it is with teeth.

Follow-up Appointments and Regular Check-ups

To ensure that any problems are detected early, regular maintenance check-ups are advisable. Problems are more easily treated if detected early. Check-ups may be recommended 3, 4 or 6 monthly. In most cases review appointments will be more frequent during the first year that the Implants are in function.

Regular check-ups are every bit as important as they are with natural teeth, if not more so!

Some examples of problems that can arise – When to contact your Dentist

Porcelain Crowns attached to Implants may chip or break as they can when attached to natural teeth. However, removal of Crowns from Implants for repair is usually easier than from natural teeth. Implant-supporting Bridges that become loose should be re-tightened immediately to reduce the likelihood of further unnecessary damage.

Should it be discovered during a routine maintenance visit that an Implant has failed, or is failing, appropriate remedial action will be planned accordingly. Implants that become loose will not re-tighten and should be removed at the earliest opportunity. Should you notice any areas of soreness, discharge or pain on chewing near any Implant or tooth you must immediately report this to the Dentist responsible for your maintenance.

Successful treatment

Success depends on your body’s reaction to Implants and your personal care of them. Implants can fail due to gum disease just as teeth do. Success is constantly improving due to improved techniques. Natural teeth last longer today as awareness of the need to look after them becomes more accepted. However, there would not be a need for Implants if teeth were totally successful.

“Success rates for Implants now compare very favourably with all other forms of Dentistry.”

Smoking and Alcohol Consumption

Both smoking and heavy alcohol consumption reduce the survival of Implants (and teeth) and cause a higher risk of Implant failure.