Services - Dental Implants

Dental Implants

Wisdom Teeth

Bone Grafting

Facial Injury

Facial Pain

Obstructive Sleep Apnoea

Oral Pathology

What are dental implants?

Dental implants are root-like structures made of titanium, a material which our body easily accepts. They come in all shapes and sizes.

They can be used to replace as few as one tooth. or all the teeth in the mouth. Other applications include replacing missing eyes, ears, noses. and fingers.

How do dental implants work?

Implants are artificial roots which are inserted into the bone to replace the natural roots you have lost. A strong bond is formed between the implants and the bone over several weeks or months. The implants provide a stable foundation for crowns, bridges or dentures which are placed over them. An abutment is the interface that connects the new tooth to the implant.

Due to the extreme stability of the implants, the new teeth are very firm and make eating and chewing feel as natural and comfortable as your original teeth. They can also be made to look very real too. Implants also slow down bone loss.



Diagram (left) showing the similarities between an implant-supported crown and a natural tooth.	Such a crown (above) does not require the adjacent teeth to be ground down unlike conventional fixed bridges.

What are the advantages of dental implant therapy?

It is an advanced treatment that most closely mimics natural teeth in look, feel and function such as speech and chewing.
Implant-supported teeth will not move during function unlike non-implant-supported dentures.
It minimizes bone loss.
It minimizes changes to adjacent healthy teeth.
It preserves facial contours and appearance.

Case Study 1
Case Study 2
Case Study 3
Case Study 4
Case Study 5
Case Study 6

:: Case Study 1

A 28-year old Caucasian lady fractured her front tooth during sports (Figure 1). The tooth had to be extracted and an implant was placed immediately (Figure 2). It was initially covered by a temporary plastic crown. Six months later, the final crown was made to match the adjacent teeth (Figure 3).



Figure 1	Figure 2	Figure 3
This lady had her broken tooth extracted (Figure 1), implant inserted (Figure 2) and a temporary crown placed all within the span of two hours. This protocol enabled her to have a replacement tooth on the same day she lost her natural one. The final crown (Figure 3) was made six months later after the wound had healed completely.

:: Case Study 2

A 50-year old expatriate banker did not like the look of his 3-unit bridge which was only ten years old (Figure 4). The gums had receded and exposed the unsightly margins. Decay had also set in. He realized that when one part of a bridge failed, the entire bridge had to be replaced thereby making the long term cost rather high. He opted to separate the three teeth by having an implant inserted in the middle (Figure 6). Highly aesthetic all-porcelain crowns were then made over the teeth and implant (Figure 7). He also opted for a screw-retained implant crown which allows it to be unscrewed for maintenance and repair. This means that he is unlikely to need to replace that crown ever again.


		An implant was placed in the middle and three new individual crowns replaced the aging three-unit bridge.
Figure 4	Figure 5

Figure 6	Figure 7

:: Case Study 3

A 16-yr old Caucasian girl had a congenitally missing upper left lateral incisor (Figure 8). This means she was never born with it. Braces were used to realign her other teeth and create a space for a normal replacement tooth. An implant was inserted into the space and an all-ceramic crown was made over it (Figure 9). Her self-confidence has never been better ever since (Figure 10).



Figure 8	Figure 9	Figure 10
This teenage girl no longer had to be self-conscious about her missing tooth after an implant was inserted.

:: Case Study 4

A 48-yr old Caucasian lady had a 3-unit bridge on the lower right side (Figure 11). After several years, it started to get loose at one end. It was impossible to remove the entire bridge without damaging it. As she preferred to reuse the bridge, time was allowed to pass with the hope that the other side would eventually loosen. Unfortunately, the underlying teeth became so badly decayed that they had to be extracted. Two implants (Figure 12) were inserted with much difficulty as there was hardly any bone left. Eventually, a new 3-unit implant-supported bridge was made (Figure 13).



Figure 11	Figure 12	Figure 13
Implants are normally placed parallel to each other in order to accommodate a bridge but the lack of bone in this case resulted in the implants being placed otherwise. Special components had to be used before the new bridge could be seated.

:: Case Study 5

A 46-yr old German gentleman lost all his upper and some of his lower teeth. He had been wearing dentures for many years and found them uncomfortable. His oral surgeon in Germany placed eight implants in the upper jaw (Figure 14). As he was on a round-theworld tour, he decided to have his upper teeth made in Singapore. Full-arch fixed implant-supported prostheses were fabricated and secured onto the implants by screws (Figure 15). He is now planning to do the same for the lower jaw (Figure 17).


		The implants were placed in Germany and the new upper bridge incorporating thirteen teeth were made in Singapore. The seamlessness in treatment over wide geographic distances facilitates patients’ mobility without compromising the standard of care during and after treatment.
Figure 14	Figure 15

Figure 16	Figure 17

:: Case Study 6

A 59-yr old Chinese lady constantly had problems with the many sets of upper dentures made for her. The pain and discomfort she experienced was due to trauma and bone loss arising from the bite of her lower natural teeth against her gums through the upper denture. Three implants were placed to support a special bar and denture attachment (Figure 18). The use of the bar significantly improved the retention of her new upper denture and prevented trauma to her gums. She is finally able to enjoy all the food that she likes (Figure 19).



Figure 18	Figure 19
A horizontal metal bar (left) connects all the three implants in the upper jaw. An overdenture (right) has an internal attachment that allows it to grip the bar for greater retention and stability. The overdenture can be removed for daily cleaning.

How serious is an impacted tooth?

An impacted tooth may cause problems such as swelling, pain and infection of the surrounding gum tissue. It can also cause permanent damage to adjacent teeth, gums and the supporting bone structure. Rarely, an impacted tooth can lead to the formation of cysts or tumours that can destroy large portions of the jaw.

The tooth has not caused me any problems yet - must it be extracted?

Many times, problems with wisdom teeth occur with few or no apparent symptoms. No one con tell you when your impacted tooth will cause trouble, but it is possible that trouble will arise at some point in time. Waiting until it does cause trouble may result in more pain than necessary and may require more complicated treatment.

When should I have my impacted tooth removed?

An X-ray of the mouth is useful to help predict potential problems. Your dentist or an oral maxillofacial surgeon con frequently, from such X-rays, be able to predict if the wisdom teeth are going to cause trouble, either in the near future or later in life. If so, he is likely to recommend the removal of the wisdom tooth rather than wait for it to cause problems.

Specialists nowadays recommend that impacted wisdom teeth be removed between the ages of 14 and 22 years if they are likely to cause problems. Surgery is technically easier and patients recover much more quickly when they are younger. The risk of complications increases with age, and the healing process tends to be slower.

What does wisdom tooth removal entail?

The procedure usually takes about half an hour, although this varies according to each case. You may choose to have the wisdom tooth removed under local anaesthesia, with or without intravenous sedation, or under general anaesthesia in a hospital setting. Your dentist or the oral maxillofacial surgeon will assist you in selecting the method of pain relief that is most suitable for your case. Most patients can resume normal activities within a few days, depending on the degree of impaction and the number of teeth removed.

How will I feel after the procedure?

You may experience some swelling and discomfort. However, your dentist or the oral maxillofacial surgeon is able to reduce the possible discomfort with medication and provide postoperative instructions which will aid healing.

What are common complications and risks associated with removing wisdom teeth?

Some patients develop a "dry socket" after wisdom tooth removal. The typical dry socket produces a dull pain that doesn't appear until three or four days after the tooth has been extracted. Dry sockets are found to occur more often in women (even more so in those taking oral contraceptives), persons over the age of 30, and smokers. A dry socket needs to be treated by your dentist, who will usually place a medicated dressing in the dry socket to soothe the pain until it subsides.

A less frequently occurring complication associated with the removal of wisdom teeth is numbness of the tongue, lip or chin. This numbness happens very rarely and when it does it is usually temporary.

Bone Grafting

Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. We now have the ability to grow bone where needed. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth.

Facial Injury

Cuts and lacerations on the face require careful stitching for a proper cosmetic result. For a fractured jaw, metal braces may be attached to the teeth and wires used to hold the jaws in place and allow the bones to heal. Severe fractures may require surgery to wire together the broken bones or secure them with metal plates.

Facial Pain

A common cause of facial pain and headaches is the disfunction of the temporomandibular joint (TMJ). Symptoms may include earache, headache and limitation of jaw opening. Patients may also complain of clicking sounds in the joint or pain on opening and closing the mouth. The oral maxillofacial surgeon can work with you to determine the most appropriate treatment.

Snoring/Obstructive Sleep Apnoea

Obstructive breathing patterns during sleep can range from snoring to periods of true apnoea. This can lead to fatigue, daytime sleepiness, poor work performance and even cardiovascular disorders. Oral maxillofacial surgeons work together with other medical specialists to provide treatment for obstructive sleep apnoea.

Oral Pathology (Cancer)

Indications of the possible beginning of a pathology or cancer include reddish or whitish patches in the mouth, a sore that fails to heal or bleeds easily, or lump or thickening on the skin lining the inside of the mouth, chronic sore throat or hoarseness and difficulty chewing or swallowing. Any facial or oral pain without an obvious cause should be investigated. Do not ignore any suspicious lumps or sores. If you have any questions or concerns, you may wish to consult with Dr Andrew Robinson, who runs an Oral Medicine clinic at our practice once a week.