What are the risks associated with implant placement?
There are some general risks similar to those of taking a tooth out. These include bleeding, damage to surrounding structures and post operative infection. Bleeding is controllable at the time of surgery but after the anaesthetic has worn off the wound may leak a little. The surrounding structure which are most important not to damage are nerves and blood vessels. When placing implants into the molar area of the lower jaw care is taken to avoid damaging the dental nerve which runs under the roots of the lower teeth. X rays which allow accurate assessment of the proximity of this nerve are an important part of the planning to avoid this complication. X rays also are useful in planning the placement of implants in the molar area of the upper jaw. In this case it is the sinuses on either side of the nose which must be avoided. Finally care must be taken to avoid infections around the implant site. The mouth has a very substantial population of bacteria, many of which could cause post operative infection. We also want to avoid any foreign bacteria getting onto the would site. For these reasons the patient is asked to use an antibacterial mouthwash for a week before and a week after the procedure. The normal precautions to prevent cross infection in the surgery are stepped up and sterile gowns and drapes are used. In spite of these precautions a very small percentage, less than 5% of implants may develop infection either immediately after placement or some months after. This complication may require the removal of the implant, letting the site heal and trying again a few weeks later.

How long will my implants last?
As the technology of implants improves the expected levels of success keep rising. Most surveys suggest between 95% and 98% success rates over 5 years. Which means that for every 100 implants that are placed, we can expect 95 of them still to be in place 5 years later. Research indicates that once implants survive 5 years they remain in place for the rest of the patient's life. As success rates of dental restorations go this exceeds the success rates we can expect from crowns, bridges and root canal treatment. There is no consensus amongst experts as to the main cause of implant failure. There are relatively so few failures that surveys of these small numbers are not very revealing. We can however be fairly certain that age is not a risk factor; hence there is no upper age limit for patients to have implants. It does not seem that existing or previous gum disease in other parts of the mouth is a risk. We would expect general illnesses like diabetes and those medical conditions which leave the patient at risk to infections would be risk factors and for this reason these conditions are amongst the few which exclude such patients from having implants. It is possible that excessive or early bite forces may be a problem. There is no proven association between smoking and implant failure. We assume that oral hygiene might be a factor though like smoking, this is no proven association with implant failure. This does not mean that poor oral hygiene or smoking are advisable.

Will I have enough bone to allow implants to be placed?
In the planning stage the dentist will take routine X rays including the panoramic ones to assess the amount of bone in the area an implant is being considered. If the routine X rays do not provide enough information, the dentist may require a computer assisted scan (CAT) which gives three dimensional images on which accurate measurements can be made. Where the amount of bone is marginal, the scan can be used to make an accurate template which the dentist can use at the time of implant placement to make sure the implant goes just where planned. If there is insufficient bone for the implants it may be possible to augment the bone with a graft of bone from elsewhere. The most simple augmentation is done using powdered cow bones treated to remove all the living material. However this powder cannot build up a large bulk of bone. A block of bone may be needed and this has to come from the patient! There may be sites in the mouth nearby where bone can be harvested or if large quantities are required the hip provides an ample supply.

Who is qualified to place implants?
Traditionally implant placement has been restricted to dentist who have specialised in Oral Surgery or trained to become Maxillo-Facial Surgeons. During the last 20 or so years general practitioners with a special interest in implants have taken courses and become proficient in implant placement. At present more implants are placed by trained general practitioners than specialists. However this training can be quite varied as there have been no guidelines which might indicate some minimum training requirements. Recently the Association of Dental Implantology has prepared some guidelines and it is expected that dentists who want to start placing implants will find it useful to compare their training to these suggested minimal requirements.
The training required for placing implants does depend on the level of complexity of the procedure. Those procedures which require block bone grafts or sinus augmentation require greater skill and training than those, for example, which involve placing two implants in the front of the lower jaw to support a denture.
Some idea of the risk associated with the placement of implants can be assessed by the criteria used by legal liability insurers to assess the premiums of dentists placing implants. There is no increase in premiums for general practitioners who may be placing implants as part of their every-day routine, provided the procedures they use are not complex. Complex procedures may be defined as those involving sinus augmentation and block bone grafts, and dentists or oral surgeons doing this more complex work are required to pay higher insurance premiums.

What will my implants cost?
The cost of implant placement depends on the degree and extent of the treatment. The full cost can therefore only be estimated after a full examination including x rays and a provisional treatment plan has been worked out according to each individuals needs. Even so costs do vary from practice to practice so it is worthwhile shopping around.

This patient had a post retained crown. After some years the root fractured leaving no other option but to extract it. For a while he wore a plastic denture to replace the single missing tooth but was not happy with it.	An implant was placed where the root had been. It was left in place for 8 weeks to attach firmly to the bone. During this waiting period he wore his plastic denture.
After 8 weeks the crown was attached to the implant and the patient was able to discard the plastic denture.	He now bites into apples and is unaware of any foreign object in this mouth.

This diagram shows the positions of two retaining studs attached to implants in the lower jaw. The denture attaches to these studs but can be removed for cleaining	The two implants in the lower jaw with the studs attached are all that is necessary to keep the lower denture in place.