Dr Gerald Tan

Yes, it's a similar kind of recovery process. I wouldn't say that it is vastly different. With an immediate implant or conventional delayed implant, typically the immediate recovery from the surgery can be 1 to 2 weeks. Then we wait a typical 3-6 months or sometimes 8 months for the bone to fully regenerate. So, it's not too different.

The duration of the surgical procedure really depends on the number of implants being placed. If one implant is placed, removing one tooth, a typical procedure like that could be an hour long. But if you have 2 or 3 immediate implants, that could take up to 2 to 3 hours, sometimes even 4 hours. Sometimes, when we put immediate implants, we also do simultaneous procedures like a bone graft. Sometimes we do immediate implants with a simultaneous gum graft. So we can do a few simultaneous procedures with the implant which could lengthen the duration of the procedure.

No, I don’t have a supply of these individual teeth. And the reason why is because we can manufacture it differently. Everyone's teeth are different. For example, your teeth could be big, mine could be small, some people's teeth can be long, or broad. Everyone's teeth are different, so the beauty of computer-guided planning and CADCAM technology is that through all these scans and software we can actually make immediate temporary crowns that will be in the exact same shape to blend in with the rest of the teeth.

For example, if you have an emergency which involves the loss of an upper front tooth. You know that if you lose the upper front tooth or several upper front teeth, it can be quite distressing. If you have all these upper front teeth removed due to trauma or an accident, you can't smile, you can't go out and engage in any kinds of social situations. In those cases, of course, bearing in mind the contraindications factors I've mentioned, I typically plan for immediate implants in those situations where we extract the upper front teeth and replace them with implants.

That would be a straightforward way of removing all the damaged teeth that are hopeless. If a bone graft needs to be done, we will do the bone graft, if the gum graft needs to be done, we will do the gum graft, and then we will suture and close up the surgery there and the patient will not be getting an implant. The patient will be getting some kind of a denture so that at least when they smile they have teeth.

Yes, of course. So after the immediate implants are placed, we typically follow very closely with reviews. Some of these reviews can be as frequent as ones in a month or two months, just to check that the healing is uneventful and there is no infection and the soft tissues and gums grow over the implants nicely. We will take x rays along the way to ensure that the bone is regenerating well.

I've done 8 on top and below and that will be enough to support a full set of teeth on the upper jaw and lower jaw. I wouldn't go more than 8 implants on top or below. Sometimes, based on the case, you can even get away with 4 implants or maybe even 2 implants on the bottom.

Don't smoke, not even a single stick. Secondly, keep meticulous oral hygiene. But having said that, don't over brush the area because if you overbrush the surgical site, it can destroy or disturb the wound. When you have a wound, you want to be very gentle when brushing around the area of the surgery but still you need to brush to keep good oral hygiene. Thirdly, take all of your medication religiously: all the antibiotics, antiseptic mouth rinse, sometimes even prescribed probiotics. All these will help and aid healing. Lastly, please do not bite the implant.

No, if the surgery is planned out properly and major structures are avoided like major nerve branches are avoided then there should not be any issues whatsoever. Again, treatment planning is crucial. For me when a case is dicey, computer-guided planning is critical so that the level of accuracy and predictability increases in such a case, so I know nothing can go wrong. I know that there will be no injury to the nerve or numbness, this kind of things.

I will be laying out two scenarios. So for example, let's say you are involved in a road traffic accident, or maybe a sports accident or injury, and you lose your upper front four teeth. Let's say it's very traumatic; your upper front four teeth are damaged and cracked beyond repair and you have to get them extracted. So, when we plan to extract the teeth, at the same time we will replace those four missing teeth with implants immediately with four plastic teeth. So if you are sedated and you wake up, at least you have four teeth and you can smile and look normal.

In my hands, from doing so many implants and dental surgeries in my life, I will say the most common reason for osseointegration failure is smoking. I repeat, in my experience, smoking is the most common and important reason for osseointegration failure. After the implant is placed, the patient is normally very happy without much pain or swelling. They think they are out of the woods and they start smoking again.

The risk for immediate implants is higher than for one placed in a delayed fashion. The risk is, of course, delayed osseointegration of the immediate implant. Osseointegration is a concept where the implants and the bone fuse together and this concept of Osseointegration is relevant not only for dental implants but also for hip implants or any kind of implants placed in the body. I'm sure you have heard of people going for surgery for knee or hip replacements with metal implants.

Getting immediate implants sometimes is more costly because it involves computer-guided surgical planning. It involves more procedures done in one visit, more bone grafting, and immediate implants. So it's those few implants on that build. If you are going to get sedated that's an extra item on the bill because the anaesthetist will have to come into sedate the patient for the surgery. There are basically more items on the bills and the immediate implants are more costly compared to delayed implants. But for the delayed surgery, it may still be the same.

Well, if there is osseointegration failure, typically how it presents itself is that the implant is loose, no longer firm in the gum or bone. Otherwise, the implant is wobbly and it happens sometimes due to an infection. So we always look out for swelling, pus, or abscess, anything that could indicate an infection in that area. If the surgical site is infected and osseointegration occurs then I'm afraid the immediate implant has to be removed and we have to start all over again. We remove the immediate implant, maybe put a bone graft in, and then we transfer the case to a delayed implant.

That's a good question. We can actually do implants in an emergency situation, but we also do immediate implants in a non-emergency situation. The advantage of non-emergencies is that there is time to slowly plan and make the temporary crowns in the lab. But in the real emergency scenario where there is no time for the lab to fabricate the crowns then the dentist will have to fabricate the temporary crowns in the clinic on the day of surgery.