Dental implants are titanium screws or cylinders placed in the jaw bone underneath the gum tissue to support artificial teeth where natural teeth are missing. These screws or cylinders will fuse or bond to your jaw bone. This then allows the foundation to anchor artificial teeth.

Dr. McDonald uses dental implants made by Straumann and Nobel Biocare.

Who needs implants? Anyone who is missing teeth and can benefit from increased chewing efficiency, and improved appearance or speech is a candidate for implants. Implants can be the solution when it has become difficult or impossible to wear a removable denture. You are a candidate for dental implants if ­ -You have enough jaw bone and dense enough bone to secure the implants. -you do not have a severe medical condition It is also possible to graft bone into areas of the jaw that would not allow for placement of an implant. If this is necessary this will be discussed during the consultation visit.

You will first require a consultation visit. During this time an oral examination will be performed to check the available bone. Various radiographs may also be necessary to determine if Implants can be placed. We will work closely with your dentist or prosthodontist to assure the best result possible.

The surgery can be done using either

• Local anesthesia (freezing) only, or
• Local anesthesia with intravenous sedation, or
• General anesthesia.

The method used in this office will be local anesthesia with intravenous sedation. This involves placing an intravenous line in the arm following which selected drugs are used to make you drowsy. Appropriate blood pressure and pulse monitors will be used while you are sedated. When you are very relaxed the local anesthesia is placed in the various sites of the mouth.

The surgery involves opening of the gums and drilling a series of three successive holes. The implant can then be placed. The gums are then sutured over the site. You will receive prescriptions fro pain medication, antibiotics and an anti-swelling pill.

The time of the surgery will vary depending on the number of implants placed. Usually it will be from 15 to 60 minutes. There will be a few follow up visits to monitor the healing afterwards.

Two types of implants can be used.

The type we use is a one-stage procedure. This will involve only one surgery. The implants will be visible in the mouth after the first surgery. The healing time before placing the artificial tooth will be 2 months.

Usual recovery will vary from person to person. It can be as little as 1 day in simple cases to 2 or 3 weeks in more complex cases involving bone grafts. The swelling will be minimized by the anti swelling medication. You will use some pain relieving medication especially the first night. The diet will vary from normal to a soft one.

It is extremely important to keep the mouth clean. This will involve brushing the surgerized gums and using salt water rinses. This will help avoid any infections. The sutures will be self dissolving.

Once the implants are healed You will be sent back to your dentist or prosthodontist to start making your artificial teeth. The risks will be discussed with you during your consultation. These can vary from case to case.

Some dental implant cases require iliac bone grafts to place the implants. Placement of dental implants in your mouth requires that enough bone be present, to support the implant.

Many situations exist that would not enable the placement of dental implants. The most common is not enough bone. The bone needs to be of sufficient quantity to support the implant and withstand the bite forces.

Natural teeth in the opposing jaw create a greater force on the implant. The jaw bone is not always ideal to have implants placed. The jaw bone starts to disappear once the teeth have been extracted. The amount will vary from person to person. This is most commonly a problem in the upper jaw.

The upper jaw bone is a much thinner type of bone as compared to the lower jaw bone. To place implants into jaws with an inadequate amount of bone will require a bone graft to the jaw bone. This will allow the proper number and size of implants to support the chewing forces.

As this is an elective surgical procedure you should be fully aware of the procedure, and complications before treatment is started.

Type of Bone Graft
Bone grafts can be taken from many parts of our bodies. We can also use bone from the bone bank. This type of bone is called "freeze dried bone."

The best results are with your own bone, from the iliac crest of the hip area. A bone graft is taken from the anterior or the posterior area. This choice will depend on the amount of bone that is necessary. The posterior area supplies a larger amount of bone. This will be discussed with you at your consultation visit.

Generally the anterior is used if only one side of the upper jaw is having implants placed. If both sides are to have implants, then a posterior graft will be used.

The bone graft will be placed in the lower part of your maxillary sinuses. Placing the bone graft in this site has a better success rate than placing it on the top or mouth side of the jaw bone.

This does not alter the shape of the upper jaw. It will allow the careful use of your denture during the healing period.

The implants should not be loaded with any pressure during the healing period of 9 to 10 months. This means that the denture should fit comfortably, or it should be adjusted by your Dentist or Prosthodontist.

You will not see the implants after the first surgery as they are placed under the gums.

The success of the implants depends on there being NO PRESSURE on them, for the entire healing period. The best results are when there is no denture present. This is not possible in all cases, which is why a properly fitting denture is allowed for the healing period.

There will be a skin incision over the site where the bone is taken. This usually heals very well. If healing is not ideal, then a scar revision can be performed. This is usually done about 12 months after the surgery once the scar is fully mature.

There will be a varying amount of pain from the bone graft site. This may last for the first 2 to 4 weeks after the surgery. Most patients are able to resume walking on the day after surgery. There will a varying amount of pain with this movement.

You will receive a prescription for "pain relieving medication" on leaving the hospital. There is RISK of developing an infection in the area of the bone graft harvest site. This is a very uncommon problem.

You will be on antibiotics while you are in the hospital and for some time after your surgery.

There is also a RISK of developing some numbness in the skin around the incision. In the anterior area, this will involve the skin over the outer part of the upper leg. In the posterior area, this will involve the skin over the buttock. This is uncommon and can last from a few weeks to a year or more. There is also a possibility that this can remain permanent. This numbness will not affect movement of the leg in any way.

Need for Hospitalization
To perform this type of surgery requires a General Anesthetic, as well as a short stay in the hospital. Most patients will be discharged from the hospital within 1 or 2 days after the day of surgery.

There will be a wait to obtain a hospital date. This is due to the limited amount of hospital time available. This will vary between 6 and 14 months.

Should you decide to proceed with the surgery, please let us know as soon as possible. You will then be placed on the hospital waiting list. Usually you will receive 2 months or more notice of a hospital date.

Occasionally there are hospital cancellations, or extra time available. This is short notice, but if it is possible for you to come on short notice, please let us know. This may speed up the timing of your surgery.

It may also be possible to perform this type of surgery in private clinics in the near future. This would also speed up the timing of the surgery.

Recovery From the Surgery
Usually 2 weeks off work is recommended after this surgery. The recovery will most certainly vary from patient to patient. Your recovery may also be shorter or longer than the average time.

A positive attitude towards the surgery, as well as, adequate foods and fluids after your surgery, will certainly help.

Swelling
You will receive an anti-swelling medication ( Dexamethasone ) to help reduce the amount of swelling. This will also help reduce the length of your recovery time. This is given while you are in the hospital and for 3 to 4 days after you leave the hospital.

This medication has not seemed to cause many problems over the years. It can cause an upset stomach. Either taking an Antacid (Gelusil or others) or PeptoBismol will usually help relieve it. It also can cause the cheeks to appear RED. This is an uncommon side effect and will disappear when the drug is stopped.

IF EITHER OF THESE HAPPEN, THEN YOU SHOULD CONTACT DR. McDONALD IMMEDIATELY.

Infections
These can occur at either the bone graft site or in your mouth. You will be on antibiotics while you are in the hospital and for 10 to 14 days after you leave. This will be a strong antibiotic due to the nature of this surgery.

It is recommended that you eat 3 to 4 small containers of plain Yogurt daily, while on the antibiotic. There should NOT be any fruit in the yogurt, as this kills the friendly bacteria in the yogurt. This will help prevent any stomach problems while on this medication.

You should keep the hip area dry for the first week after the surgery. This will help prevent an infection in this site.

In the mouth, rinsing and brushing will help prevent an infection. The mouth is full of bacteria that cause infections, and thus it is MANDATORY that you keep the mouth, as clean as possible. You can either use salt water rinses or diluted mouthwash.

Infection of the Sinus
This is a potential risk with this type of surgery. We are working in the lower part of your sinus, to place the bone graft and implants.

This is certainly very uncommon, but can mean COMPLETE LOSS of the bone graft and implants.

Stages of Surgery
The implants are placed and exposed in the mouth at the initial surgery.

The healing period is four months before fabrication of your new teeth.

Numbness in the Facial Skin
Uncommonly, there can be some numbness over the upper lip, cheek, and nose areas. There is a nerve that comes out below the eyes, on either side of the face. This can get stretched occasionally with this type of surgery. It can last anywhere up to a year after the surgery. It will not cause any problems with movement of the lips or cheeks.

Loss of the Bone Graft and Implants
This can happen most commonly due to an infection. This will result in another surgery to remove the bone graft and implants. It may lead to chronic or long term sinus problems. This will be discussed with you at your consultation visit. You should make sure that in your case the benefits from this type of surgery outweigh any of the potential risks.

This surgery is often the last resort to try and provide a stable base to support a denture, due to the amount of bone loss in your jaws. It is a difficult surgery but seems to have at this time, few long term risks, and a good success rate.

Scars on the Skin
As mentioned above there will be a scar over the hip area where the bone graft is taken. The surgery for the implants is performed entirely through the mouth. This will leave no scars on the face.

Very, very rarely one of the surgical instruments can cause a small abrasion on the skin of the face. This happens as we are working through the mouth opening, which can be limiting at times. If this happens there may be a small scar around the mouth opening. It will usually heal well.

If the scar remains prominent, then it may require a surgical revision. It will usually take 6 to 12 months for the scar to fully mature, before a decision is made to revise it.

Ability to Complete the Surgery as Planned
There is no way of predicting what type of bone will be present in your jaw before the surgery. This will only be noticed at the time of surgery. If the bone is very thin then occasionally we may not be able to place the implants at this time.

The bone graft will be placed allowing a healing period of 6 months . This time is necessary to allow the bone graft to fully mature. The dental implants will then be placed after this 6 months. This will be done in my office under local anesthesia or sedation. It may also be performed at the anesthetic clinic under a general anesthetic.

A healing period of 6 months will be needed for the implants, before they are exposed into the mouth. This healing period should not be shortened as it may jeopardize the success of the implants.

Cost of the Surgery
The hospitalization and the bone graft surgery are covered by the medical services plan of B.C. ( care card ).

The cost of the implants and teeth will NOT be covered by the medical plan.

You will receive an estimate of the implant cost at the time of your consultation.

The cost of the teeth would be obtained from your Dentist or Prosthodontist.

If you have dental insurance, this will usually NOT cover any of the implant costs.

Summary
As you can see from the above discussion, a bone graft is the last route possible to place implants in difficult cases. This is due to the lack of bone available in your jaw. The bone has undergone resorption after your teeth were extracted.

The results are certainly good, with minimal risks to this date. You will need to go over the risks and benefits and decide whether this surgery fits your needs. Make sure you understand the procedure, surgery, and potential complications before you proceed.

If you would like to talk to patients that have undergone this type of treatment, please inform my office. We will provide a list of names for you to contact.

You should also understand the type of denture or teeth you will receive after the implants are complete. This will need to be discussed with your Dentist or Prosthodontist.

Please read our Dental Implant Policy.

If you have any questions regarding your proposed treatment, please contact the office at 604-873-0303.