Dental implants: replacing a missing tooth

Why replace a missing tooth

A missing tooth leaves more than a gap. The neighbouring teeth tilt into the space, the opposing tooth drifts up or down for want of contact, and the bite gradually distorts.

The jawbone, meanwhile, is no longer stimulated by chewing at that spot, so it resorbs. That bone loss is progressive and makes placing an implant more complex as time goes on. It is the reason a replacement should not be put off.

The stages of placement

• Prior assessment: clinical examination, X-rays and 3D imaging to measure the volume and density of available bone
• Digital planning of the implant’s position, angle and diameter
• Placing the implant under local anaesthetic, usually a short procedure
• Osseointegration: three to six months during which bone grows onto the titanium surface
• Digital impression, then fitting of the abutment and the final crown

A temporary prosthesis can be fitted during the healing phase when the site is visible.

The conditions that have to be met

An implant is not placed in a mouth that has not been made healthy first. Three conditions are checked before any decision:

• Enough bone volume. Where it is lacking, a bone graft or augmentation may be considered beforehand.
• Healthy gums. Active periodontitis has to be treated and stabilised before placement: the same bacteria attack bone around an implant as around a tooth.
• Compatible general health. Uncontrolled diabetes, bisphosphonate treatment, radiotherapy to the mouth area and heavy smoking all change the decision and must be disclosed.

From a single tooth to full rehabilitation

One implant replaces one tooth. Several implants, well distributed, can carry a bridge and restore a whole section — without relying on the remaining teeth.

Where an arch is edentulous, a complete denture can be stabilised on a few implants instead of resting on the gum. The gain is felt first in chewing and in stability: a denture that no longer moves is worn quite differently.

• One missing tooth: one implant, one crown
• Several adjacent teeth: an implant-supported bridge
• A full arch: a fixed or removable prosthesis stabilised on implants

The number of implants is not decided in advance: it follows from the bone volume available, measured on 3D imaging, and from how the chewing forces are distributed.

Living with an implant

Once the crown is fitted, you brush an implant like a tooth. It cannot decay, but the tissue around it can become inflamed and the bone can resorb: that is peri-implantitis, the equivalent of periodontitis around an implant.

Follow-up is therefore not optional. A yearly review with an X-ray and regular professional cleaning are what determine how long the whole arrangement lasts.