Four Big Questions: Dental Implants
November 9, 2019
QUESTION ONE: ARE IMPLANTS CHEAPER ABROAD?
I have to admit, it’s really tempting, isn’t it? Travel to a sun-kissed, far-flung place and have cheap treatment, a hotel recovery, fly home and all done.
But is it that simple?
Online adverts point out the cost savings but in the long term, is this really going to save you money?
As a national referral centre for dental implants in the UK, we often see the consequences of dental tourism. Patients have been abroad to have cheap dental work carried out, return with problems and ask us for help to sort them out.
As clinicians, we feel very strongly about this. So please listen to us carefully.
We see lovely patients, who have taken their hard-earned money to try and find good value abroad. And we are seeing dental implant placement and restorations that are of a significantly lower quality than we would expect to see placed by experienced surgeons in the UK. Sometimes the placement is so poor that the patient cannot even clean around the implants. And we see restorations of such poor aesthetic finish that the whole treatment, including all the implant fixtures, needs removing and starting from the beginning.
Dentists and laboratories in the UK comply with strict cross-infection and quality controls which don’t apply to some parts of the world.
Any dentist can place implants after just a weekend “implant course.” How do patients know how experienced a foreign surgeon is?
When we plan implants with a patient, often they need hygiene coaching for several weeks or months to achieve great oral hygiene ready for implant placement to be 100% successful. We are hearing of patients turning up at foreign clinics and being given implant surgery regardless of the condition of their oral hygiene. No wonder these implants are failing!
Implant fixtures normally need time to ‘osseointegrate’ before the final restoration is placed on top. Sometimes a temporary restoration can be placed immediately, however, a permanent restoration is normally placed later. Osseointegration takes 2-3 months. Grafted bone takes 3+ months to heal before loading. Immediate loading is not suitable in every case, and if loaded too soon, then failure occurs.
We have seen so many implant tourism disaster stories, that we could cry with the patients who come asking for help.
Patients who truly believed they are getting good value, find themselves in a situation of failure with no follow-up or recourse. It would take multiple foreign trips abroad for their original surgeon to replace the work. However, some foreign surgeons are not giving guarantees and are accepting no responsibility. Their patients have nowhere to appeal for justice. They are left out of pocket, in pain and needing all the work replacing.
Good implant dentistry normally takes many appointments over several weeks and months.
A quick fix can be the quick route to failure.
What about aftercare and supervision? That takes a lifetime. A lifetime of trips abroad? Is that feasible? The cost of returning to a foreign country for follow-up over a life-time is massive.
There are over 130 different dental implant systems worldwide and each has its own unique set of tools and components. Many of the cheaper dental implant systems do not comply with the strict rules of the UK and so are not available here. We have seen failing work carried out abroad that cannot be repaired here because the system that has been used is no longer supported or cannot be sourced in the UK. This leaves the patient unable to have ongoing maintenance for their implant work in the event of problems, leaving them with the choice of returning to the country that the work was originally provided, or having the failing work removed and the procedure started over again.
Still tempted to have a dental procedure done abroad?
Perhaps take a moment to think again. It can work out much more expensive in the long-run.
QUESTION TWO: ARE YOU SUITABLE FOR DENTAL IMPLANTS?
Let’s talk about you.
There are six questions to ask here.
Question 1: Do you have enough bone?
Bone levels are assessed with the 3D CT scanner, where the height and width of the bone can be accurately measured.
Historically, implants were long and wide and needed a lot of bone. The thinking was that the longer and wider, then the stronger the implant would be. However, with more research, new technology and more advanced materials, smaller, new-generation implants have been found to work just as well, if not actually better.
Some of the more cutting-edge implants available now only need 5mm of bone depth. They are tiny and incredibly strong.
So even if you have lost a lot of bone already, then you may still have enough bone already to have implants placed. But what about those people who don’t have enough bone already?
If so much bone volume has been lost, that even one of these small implants are too large, then there are modern techniques of bone grafting available, as discussed earlier.
Remember: it is simpler and cheaper to have dental implants immediately after tooth extraction when there is maximum bone, however, if you have already lost a lot of bone, then there are amazing techniques available.
However, there are a few – very few – cases, where it is impossible to reconstruct the jaw as there has been devastating bone loss in the jaw. There simply is not enough bone to provide grafting, or not enough volume of gum over the bone to leave room to place grafting and close the surgical site. Approximately 1% of patients in our experience fall into this group.
This is why there is a clock ticking after tooth extraction. Time is important.
So, don’t accept a quick diagnosis of “there’s not enough bone for dental implants” until you have had a consultation with a leading dental implant surgeon who is highly experienced in complex grafting procedures. To them, your case could be simple. Chances are you are one of the 99% of patients who are suitable for dental implants.
Question 2: Are you well enough?
For success, dental implants need to be accepted by the body, so that osseointegration can take place. There are a few medical conditions that affect our immune system and affect the ability of our body to ‘accept’ a foreign body and therefore affect implant surgery.
Some of these conditions only temporarily affect the immune system, so implants can be placed after these existing circumstances have changed, for example:
- Smoking, alcoholism and drug addiction. Wait until dependency has stopped.
- Pregnancy. Wait until after childbirth
- Growing children. Wait until after the growing stage is complete, so normally after the age of 18-21.
- Uncontrolled diabetes increases the risk of infection and has a longer healing time. Wait until the diabetes is controlled well.
- Illness requiring anticoagulants (blood thinners). Liaison with the medical doctor is necessary to see if they can be stopped or changed before and during surgery.
- Autoimmune diseases (e.g.: lupus, rheumatoid arthritis, etc.) lead to longer healing time. Wait until in remission.
- Untreated psychiatric or psychological problems. This can compromise the security of the team or the patient during the procedure, the patient may have dissatisfaction with the final result because of unrealistic expectations and be unable to care for the final implants.
- Other diseases, for example, severe sinusitis, septicaemia. Wait until resolved.
Some conditions permanently subdue the immune system, so implants will never be suitable, these include:
- osteoporosis and other bone diseases
- cardiovascular disease (e.g. recent myocardial infarction, valvular disease, heart failure)
- long-term treatment with anti-rejection drugs that suppress or slow down the immune system
- cancer that is not in remission, has been treated with bisphosphonates or required radiotherapy treatments in the jaw area
- HIV or AIDS
Question 3: Are you too old?
Guess how old the oldest implant patient is that we know of in the UK?
“We just put an implant in a 101-year-old, last week. He found it absolutely fine. Wished he’d done it years ago.”
Kate Keating, Straumann.
Question 4: Is your mouth healthy enough?
Any existing infections in the mouth need to be treated. Gum disease needs treating and any tooth infections near the site of the implant need treating before surgery. If they were not treated, then these infections would affect the implant and its success.
Question 5: Do you smoke?
Smoking reduces your ability to heal, so you need to stop smoking. Forever. If not, then your implant will probably fail.
Smoking has a dramatic effect on the health of your mouth as well as any dental implant work that may be planned. Apart from the overall risks of cancer within the mouth, throat and lungs, healing from any surgery is reduced. Smoking means that your blood is able to carry less oxygen and this means that healing tissues don’t repair as quickly or as well. The effect on dental implants in the extreme can be a total failure of the implants to bond to the bone.
Even in light smokers, 5-15 per day, the success rate of implants reduces from around 98% to around 90%.
In heavy smokers, 15+ per day, the success rate reduces to below 80%.
In patients smoking over 30 cigarettes per day, implants are totally contra-indicated as the failure rate is unacceptably high.
Smoking also contributes to bone loss around both natural teeth and implants.
Smoking is strongly associated with a condition called ‘peri-implantitis’ where the bone is lost around dental implants.
My advice to any smoker is to give up completely. After 3 months of not smoking, the blood oxygen levels will be back to that of a non-smoker and healing will be normal. If smoking is avoided long-term, the success rate of implants will continue to be as high as someone who has never smoked. You may wish to discuss smoking cessation clinics with your local doctor.
Question 6: Are you motivated for the aftercare?
Implants need caring for just like natural teeth. Every day, the gum around the implant fixture needs cleaning with interdental brushes and floss.
Every single day.
Twice a day.
No exceptions or your gorgeous new implants will probably fail.
This may be a serious turnaround for you. The reason your natural teeth may have failed could have been from lack of dental care of your natural teeth. If you don’t care for implants, then they too may fail.
QUESTION THREE: HOW SAFE ARE DENTAL IMPLANTS?
When provided by an experienced surgeon, dental implants are one of the safest surgical procedures with one of the highest success rates.
However as with any surgery, in the wrong hands, the risks are high. Remember ‘cheap’ rarely means ‘quality.’
A highly trained and experienced clinician will make a correct diagnosis from the beginning, plans the treatment with precision and is skilled in executing the treatment.
An ethical clinician puts you as the patient first before anything else.
It is estimated that 98% of implant treatments are successful. Success means no long-lasting complications and the implant remains healthy and functional.
So, let’s take a look at that 2 % of cases that fail. What can go wrong and why?
The implant fixture may not osseointegrate, meaning that the bone does not bond to the fixture.
This is rare. However, it does happen. There is rarely any pain, just that the implant becomes loose and eventually falls out. To re-treat this case, then the failed implant would need removing, if still in position, then the site left to heal. The causes for failure would need to be identified and addressed, then another implant would normally be placed.
So, let’s look at the three main causes of failure.
1. Planning Failure
Your surgeon will assess the quality of the bone, looking at how dense it is, and the volume. This is done through 3D CT scanning. Then the surgeon will plan how the implant will be placed, whether additional bone is needed, and how soon the implant can be loaded, meaning how fast can you start really biting on it.
If the surgeon overloads an implant too soon before healing is complete, or places too few implants in a situation when they will get overloaded, then the implants may fail.
With good mentoring of training-surgeons and digital scanning technology, this should be rare.
2. Patient Failure
You, the patient, have to understand what your responsibility is.
You must do what your surgeon asks, clean around the implant religiously, have implant checks every year, visit your hygienist as regularly as recommended.
You must not lie! Don’t lie about your medical condition or say you don’t smoke if you do. There’s no point. Your implants could fail simply because of you.
3. Surgical Failure
The 3D CBCT scan (CT x-ray) shows where the nerves and blood vessels are so that the surgeon can plan where to place the implant. The surgeon can guide the implant into place in exactly the right position to the nearest millimetre.
Before 3D CBCT scanning, there was an increased risk that the surgeon could place an implant in the wrong place, into a nerve for example, and numbness of the tongue and lip could occur, which could be permanent. With a 3D CBCT scan and good planning, this should never happen nowadays.
Remember the rule, if the surgeon doesn’t do a CBCT scan at the planning stage, then walk away. There is no excuse for poor surgical planning.
Implants are one of the safest surgical procedures that you can have, yet why is there still a nation of people who are struggling with loose dentures and missing teeth?
QUESTION FOUR: WHY ARE MORE PEOPLE NOT HAVING DENTAL IMPLANTS?
Now this is a very interesting question. We have spent a lot of time trying to understand this.
We see such life-changing results at our clinic, that we find it incomprehensible that more people are not having dental implants.
If more people knew all the information surrounding missing teeth, with the subsequent bone loss, the problems of dentures and dental bridges, and more importantly the loss of biting ability leading to reduced nutrition and the reduction in self-confidence, then I think that more people would choose to have dental implants.
So, let’s look at these issues more closely.
Until quite recently, dental implants have been a big mystery both to patients and older-generation dentists.
For hundreds of years, dentures were the acceptable solution for the replacement for missing teeth. Dentists are still taught in dental school that dentures are the mainstream method of replacing missing teeth. However, also taught at dental school are the compounding issues that dentures have on the remaining teeth and dental health. Yet dentures are still being churned out in their millions each year. Why is this?
Interestingly, the UK population is lagging behind many developed countries in dental implant treatment. Presently, only approx. 0.3% of the UK adults have implants, whereas other countries have much higher density. Over 6% of the adults in South Korea and Israel have implants, and almost 3% of adults in Spain and Italy have implants.
One reason that the statistics in the UK are so low could be our NHS mindset.
However necessary dental implants are, the NHS is simply unable to afford the cost of dental implants for the whole of the UK population with so many missing teeth. A rough estimate is that there are 300 million missing teeth in adults in England and Wales alone, as statistics show that on average, each adult has 6 missing teeth. The NHS is simply unable to afford to offer dental implants as a mainstream treatment. (Note that the NHS offers implants in extreme cases, such as post-jaw resection following cancer treatment.)
However, times have changed. Our mindset is changing.
People are living longer and longer.
The modern savvy consumer easily expects to live into their 80s and 90s with good health and nutrition. We are demanding an increased standard in the quality of living.
We are not content with old-fashioned, antiquated solutions such as dentures. We are more aware of modern procedures, and now implant treatment is now on the rise. Even in the UK.
The Issue of Fear
Many people are fearful of the dentist. They had difficult experiences. If a patient has many missing teeth, then that means that they have endured many extractions. This memory can be overwhelming and difficult to move beyond.
However modern dentistry is different. There are dental teams who are lovely, welcoming and adore their patients.
There are ways to make every treatment gentle. There is the magically relaxing sedation.
I’ve said this before, and I will say it one more time. Keep looking until you find a dental team that you enjoy being with and who you trust. Find a team that offers sedation. We think it makes all the difference.
Lack of Knowledge
We consider this to be another key reason that more people don’t have dental implants. Simply people don’t understand fully about them. They don’t know about the long-term benefits. They don’t understand how devastating missing teeth, dentures and dental bridges can be. They don’t understand that initially dental implants are the most expensive, yet in the long-term, they are the best value by miles.
Learn more about gum disease and dental implants.
To arrange a FREE consultation, call us on 01904 639667.
"The Essential Guide to Dental Implants- Learn Insider Secrets and Avoid Costly Mistakes," by Dr Andrea Ubhi and Dr Adam Glassford is now available to purchase on Amazon.
About the Authors
Dr Andrea Ubhi BChD founded her practice to focus patient care on dental implants and cosmetic dentistry in the heart of historic York. Graduating in dentistry in 1991, Andrea was a pioneer in cosmetic dentistry in the UK from the late 90s.
She was the youngest and first female to be named Dentist of the Year in 2005 at the Dental Awards, and she was named Employer of the Year in 2016 (Private Dentistry Awards). Her team was awarded National Team of the Year in 2018, 2017 & 2016 (the Dental Awards).
She is a co-founder of Inspiring Women in Dentistry. Andrea is also chair of the charity, Asha Nepal, to which all profits from this book are donated, supporting survivors of trafficking and abuse. www.asha-nepal.org
Adam Glassford BChD Dip Con Sed(Ncle) Dip Imp Dent (RCS)(Eng.)(Adv cert) is the lead Dental Implant Surgeon at Andrea Ubhi Dentistry.
Dentists refer their patients to Adam for Dental Implants, Sedation & Cosmetic Dentistry from across the UK. Adam qualified in Dentistry in 1996 from Leeds University and holds the Advanced Implant Diploma from the Royal College of Surgeons of England and also the Diploma in Conscious Sedation.
Adam is one of the leading dental implant providers of Swiss Straumann implants, the global manufacturer. Adam has placed over 6000 dental implants over the past 16 years and provides complex, advanced and simple implant treatments, including complex grafting procedures.