Bionic teeth

This article is for the benefit of anyone who has had a tooth or teeth extracted and is considering implants as a preferable alternative to dentures; I will describe in detail the process of my recent two implants so that you know what to expect. If you are squeamish about this sort of thing you may not care to read on.

I had a missing tooth in my lower jaw for many years - the third from the back (not counting the missing wisdom tooth) on the right hand side. This hadn’t been a problem (apart from the occasional hazel nut getting stuck in it), but a year or so back it became apparent that the tooth behind it had decayed below the gum line and needed to be removed. This was done, leaving me with two missing teeth and just the very back one (a gold crown).

I have a dental bridge elsewhere but it didn’t seem suitable for a large gap, and also has the disadvantage of requiring otherwise unnecessary filing of an otherwise healthy tooth. The obvious solution was a plate (dentures) but I was very anxious to avoid this. I’d had a temporary plate in the past prior to bridgework, and it was a real nuisance - for one thing it kept falling out - and though permanent dentures are rather better they are still a nuisance.

So implants seemed the way to go, though it’s a very expensive option - around £2000 per tooth. The idea of having holes drilled into your jaw is a bit alarming at first, but as I shall describe it’s not nearly the problem it appears to be at first sight.

It’s quite a long process. The extraction was done in June 2014. It was then necessary to allow plenty of time for the jaw to heal and fill in the hole in the bone. (I was advised to eat plenty of cheese and take vitamin supplements in order to get a good calcium intake to aid the healing). After three months, in September 2014, I went for a CT scan at an address just off Harley Street in central London. This is a sort of 3-D x-ray, allowing the dentist to assess whether the bone is suitable for the implants and to measure the space available so as to decide the diameter and length of the implants.

We had a consultation about it, then the actual implants were fitted in October. It’s important to avoid infection, so I had to take a large dose of an antibiotic a couple of hours before the procedure, and a week’s dose at normal levels of the antibiotic. No alcohol allowed for a fortnight after the procedure, and salt mouthwashes three times a day for the same period.

There are always risks with any invasive procedure, but they are minimal. I was warned that there is a nerve running along the lower jaw just below where the implants would be and there was a tiny risk of this being upset, leading to possible tingling or even a loss of feeling for a time. In very rare cases this might be permanent. In the event I had no such problem.

The actual procedure is not of course painful, with a local anaesthetic. In fact the worst problem I had was the strain on my neck being in position for over an hour and a half. I asked for a prop to be used to keep my mouth open since I’d had problems with jaw-ache in the past after having to hold my mouth open for a long time.

The gum has to be cut back to allow access to the bone. The holes are made starting with a very narrow drill and working slowly up in tiny fractions of a millimetre. This is a slow business, taking about 45 minutes for each implant. The implants are externally and internally threaded, and are screwed slowly into the holes using what is in effect a ratchet Allen key. When this is done an ‘abutment’ may be fitted - this is a collar on top of the implant with a threaded rod beneath it which is screwed into the threaded hole inside the implant. Sometimes this can be done immediately, as was the case with one of my implants, sometimes it’s left until rather later. I don’t know what the reason was for not doing my second implant.

x-ray
This X-ray shows the implants in place, with the abutment on the rear tooth (left-hand in the image). The implant without the abutment is below the gum line (the gum doesn’t show in the X-ray), the top of the abutment on the other implant is just level with the gum. The gum was then sewn back over the implants, leaving stitching visible. Again, this isn’t as alarming as it sounds - the gum heals very quickly and I had very little pain with it once the anaesthetic had worn off.

I then had to wait another five months for the bone to heal round the implants. In the meantime the gum was a bit tender if something hard got into it, so I had to be careful about chewing, but it rapidly settled down and I had very little discomfort.

In March 2015 the second abutment was screwed into place, and an impression taken so that the laboratory could construct the crowns. I could have had the crowns fitted a fortnight later, but because I had other things going on I waited until April.

The abutments were unscrewed and discarded, and a small tube with an internal screw was fitted on top of each implant, with the internal screw being screwed down into the implants so that the tubes protruded above the implants for a few millimeters. The actual crowns were then glued onto the tube. As with ordinary crowns, the glue is strong enough to withstand normal eating, but the dentist can remove the crowns if necessary for any reason. However I was warned not to use dental floss, unless I pulled it through from one side - never to pull it upwards as this might place too much strain on the crown.

implants
The photo shows the two crowns, indicated by the arrows, in front of the existing gold crown. I can treat the teeth entirely as normal. It took a little getting used to, as there had been a large gap there for almost a year. At first I kept biting my tongue as it strayed into what had been the space, but this settled down after a week or so. Because the gum beneath the teeth has receded, the teeth seem to stick out slightly and the inner lip feels as if there was something stuck to them - you get used to this. It does rather tend to trap food, so that careful cleaning is necessary. There is a slightly odd effect on the texture of some foods as the lower teeth obviously have no feeling - it’s not very strong, many people don’t notice it, and of course it doesn’t affect the actual taste.

If you want to avoid dentures, and can afford the considerable expense, I can recommend this procedure. It’s well established, and as long as your dentist is competent you are unlikely to have any problems. There is some inconvenience involved (not least no alcohol for at least two weeks - a month in my case) but the inconvenience of dentures is permanent.