Our dental implant team is led by Jonathon Pugh BDS MSc. Jon was born and educated in Birmingham, graduating from the University of Birmingham in 1987 with honours and a distinction in clinical dentistry. His MSc in implant dentistry was completed at Warwick University, again with distinction, and he has been placing and restoring dental implants for over 27 years.
All aspects of treatment are undertaken from single tooth replacement to full arch rehabilitation but Jon's main area of interest is in helping patients through the process of tooth loss to rehabilitation with implant borne prosthesis. This process involves the placement of multiple Straumann implants with or without immediate loading. Followed by the construction of either implant retained over-dentures or fixed crown and bridgework.
Jon is also experienced in all aspects of Guided bone regeneration including sinus augmentation. These techniques are routinely used to facilitate the placement of dental implants in sites with inadequate bone volume.
We've listed some FAQs below, but if you have any other questions, please do not hesitate to contact the team on 01902 420654.
What are dental implants?
Dental implants are small but strong screws made of biocompatible metals, or ceramics, which are inserted into jaw bone in place of missing or failing teeth. You can think of an implant as a false root and they can be used as a base for fixing individual crowns, multi-tooth bridges, retaining over-dentures or supporting full arch fixed bridges.
Why choose dental implants?
Dental implants bring back the benefits and sense of security that comes with having strong healthy teeth. You can speak, smile and bite with confidence. We will also make bespoke replacement teeth to meet the most exacting aesthetic requirements so you can have an attractive natural smile.
In a healthy mouth, a tooth root transmits chewing forces to the jaw bone. This force is necessary to preserve the bone and prevent bone from being resorbed. Spaces left by missing teeth also allow neighbouring teeth to move.
Implant therapy is a well-proven, state-of-the-art medical dental technique, which has been significantly tested and used over the last four decades by qualified dentists and surgeons worldwide. Today, it offers the possibility to treat almost every indication caused by tooth loss.
Who manufactures the implants we use?
The world leading Straumann Group manufacture the implants we use. Their products are manufactured in line with internationally accepted quality standards, with high precision and documented clinical research.
It may surprise you to know that only a few systems in the ever expanding implant market have been scientifically tested. The Straumann® Dental Implant System is one of the best documented, with more than 700 scientific publications.
The assessment, what is involved?
The condition of the jaws will be assessed for suitability and the treatment planned using X-ray views, photographs and models of the teeth where appropriate. It may be necessary to take a CBCT Scan (cone beam computerised tomography) which is a three dimensional X-ray to check the amount and position of the available bone. The final decision whether or not to proceed with implant placement will be made at the time of surgery and will be determined by the quality and quantity of the jaw bone.
What are the associated risks?
An important nerve runs in the lower jaw that supplies sensation to the lower lip and skin of the chin. The X-ray assessment is important in determining the position of this nerve avoiding the slight possibility of injury which could result in altered sensation and neuropathic pain which can be acutely debilitating.
In the upper jaw it is important to ascertain the size and position of the sinuses and nasal cavities prior to implant insertion. Occasionally the implants may have to be placed slightly into the sinus but not the nasal cavity. It is also important to identify blood vessels that pass through the bone to reduce the risk of bleeding during surgery.
If the implants are being placed between existing teeth then there is always the slight risk that the tooth, its roots or supporting bone may be damaged during the placement procedure. This is more likely to occur if the teeth are very close together or their roots angled, reducing the amount of space required to accommodate the implant. If this is the case it will have been identified during your assessment and discussed with you prior to implant treatment. Orthodontic tooth movement is rarely required prior to implant placement.
The most serious complication following implant placement results from bleeding into the floor of the mouth following implant placement in the lower jaw. This can result in the floor of the mouth swelling which makes swallowing and eventually breathing difficult. Though this is a serious complication it is very unusual. I have personally placed thousands of implants for over the last 25 years and have never seen this happen.
When are dental implants placed?
Immediate placement means the implant is placed directly into a tooth extraction socket. Immediate placement will reduce overall treatment times but is reserved for cases with sufficient healthy bone to achieve initial implant stability.
If the bone is not healthy or requires augmenting then the implant placement is usually delayed for eight to twelve weeks after tooth extraction.
When are my new teeth fitted?
As a general rule we do not fit provisional crowns, bridges or over-dentures to implants on the day they are placed. The definitive restorations are usually fitted 10 to 26 weeks after implant placement. The notable exception to this is the Pro Arch technique where all the teeth are extracted, multiple implants placed and a provisional full arch immediate function bridge is fitted all on the same day.
What are the alternatives to implants?
Missing teeth can be managed in a number of ways. These can be summaries as follows:
Accept the space, which is obviously unacceptable for front teeth and not advised for back teeth.
Replace the missing tooth or teeth with a denture which is patient removable. Dentures can replace some of the teeth (partial denture) or all the teeth (full denture). A partial denture is often used as a provisional prosthesis as it can be made prior to tooth extraction and be fitted at the time the teeth are extracted. If you find wearing a partial denture is satisfactory then no other treatment may be required.
Replace the missing tooth or teeth with a bridge which is fixed to either natural teeth or dental implants and is not patient removable. Bridges fall into two categories. The first are adhesive bridges that bond to the back of an adjacent tooth. They require little tooth preparation and can provide long term solutions to missing teeth. If they have a drawback it is that they can de-bond unexpectedly. The second type of bridge cements over a natural tooth. This type of tooth borne bridge requires extensive tooth reduction that can lead to a tooth dying or fracturing. Both types of bridges require reasonably healthy teeth to attach to. If a supporting tooth is lost then the bridge is lost.
What are over-dentures?
Dentures over implants that are secured by retentive abutments but are patient removable. This allows us to provide you with very stable but removable replacement teeth. The key features of over-dentures are:
What is Pro-Arch?
is a treatment concept utilises dental implants to support a full arch of teeth
in the form of a fixed bridge. The bridge is screwed into the implants via
screw retention abutment and is not patient removable. Pro-Arch can be used to
replace a full arch of missing or failing teeth in one day! The initial
immediate function bridge is a provisional which replaced after six months or
so with a definitive bridge.
The key features of the Pro-Arch treatment concept are:
· A cost effective solution. Your new replacement teeth require as few as four implants in each jaw
· Faster treatment and healing time. Your replacement teeth can be attached to your implants immediately after insertion. There is no waiting time for healing between implant surgery and tooth replacement unlike conventional implant protocols
· Greater accessibility. Tilting implants has allowed us to treat far more patients than previously without extensive bone grafts
· Scientifically proven and documented to show consistent good clinical outcomes.
What happens if implants fail?
Fortunately this occurs rarely and the success rate for dental implants is very high. However, failures are still a possibility and an understanding of this is a prerequisite for proceeding with your treatment.
We completed a study recently where we looked at 311 consecutively placed implants over a six month period. All implants were placed by Mr Pugh. The implants were placed in all categories of patients who had varying risk factors or who had undergone guided bone regeneration. This showed a success rate of 98.4%. This means less than 2 out of 100 implants placed failed to integrate. The reason for the failure to integrate is not well understood but could be linked to infection at the implant site, trauma to bone at implant placement or micro-movement of the implants immediately after placement. Any potential problems specific to an individual’s implant treatment will be discussed before treatment starts. Should an implant fail to take then it is often possible to replace it with a second implant after an appropriate healing period. It will of course be necessary to wait a further six weeks to three months while the second new implant attaches to the bone.
What are risk factors for implant failure?
is generally accepted that implants do have a very good success rate. However
certain habits and medical conditions do increase the risk of complications and
possible implant failure. These include:
Of these habits and medical conditions only large doses of radiation to the head and neck prevent implant placement being considered but you should be aware that they can influence whether your implants integrate then survive in function. It is also true that these habits and conditions can be accumulative. For example a diabetic patient with a history of periodontitis and who smokes is at a higher risk of implant complications. An increased risk of post-operative complications or failure in function will affect the guarantees we can offer you and will also guide us in your maintenance programme.
Do the restorations suffer from complications?
The risk of complications with the provisional and definitive restorations is generally accepted to be in the region of 10% per annum. Which means that we will occasionally have to repair the crowns, bridges or over-dentures we fit. Generally these complications are very minor and easily resolved especially if the replacement teeth are either patient removable or have been screwed into the implants rather than permanently cemented.
After care, what's involved?
Implants are not "Fit and Forget” they need the same care and attention as natural teeth. On completion of treatment it will be necessary to attend recall appointment to check the condition of the implants and the replacement teeth they support or retain.
After this, regular reviews are recommended to monitor the condition of the implants and any remaining natural teeth. Also regular hygiene maintenance appointments are essential, as a build of plaque will cause inflammation and possible bone loss from around your implants, resulting in their eventual loss. This condition is called peri-implantitis and is very similar to gum disease around natural teeth.
If you have teeth and implants mixed together it is also very important to maintain the health of the natural teeth. Should the natural teeth become infected or are lost for any reason the remaining implants may be damaged by the extra pressure caused by the additional work load.
We generally ask your dentist to carry out implant maintenance for straight forward cases where only one or two dental implants have been placed. If you have one or more potential risk factors for implant complications or we have placed multiple implants we generally take care of the maintenance program. This service is carried out by our hygienists and isn’t included in the initial cost of implant treatment.
Failure to follow a maintenance programme significantly increases the risk of complications and will invalidate any guarantees we have given you.
Whilst I wish I could report that all the implants placed in our clinic integrate without complications and never fail in function, I can’t. The reality is that very occasionally implants are lost. Thankfully this is a rare event and can be minimised by an accurate risk assessment, adhering to recognised protocols and appropriate maintenance.
All the implants we place come with manufactures guarantees against mechanical failure. In my experience they don’t break, but the manufacture will replace the implant if this should happen.
If an implant fails to integrate the clinic will remove the implant and offer you a replacement free of charge. This is regardless of any complicating habits or medical conditions. We cannot give life-long guarantees once the implants have successfully integrated and have been restored.
What is Cerabone?
Cerabone is a bone replacement material that is used to increase the body’s own bone. Cerabone is composed of the hard, mineral portion of natural bone and has a structure similar to that of human bone. It is therefore well accepted by human bone tissue and serves as a scaffold for new bone growth.
The starting material is carefully inspected bovine bone that has undergone treatment with patented processes for purification and sterilisation. Included amongst these processes is the treatment of Cerabone at a very high temperature (1100 degrees Celsius) after which it is highly purified and finally sterilized.
What is guided bone regeneration?
Guided bone regeneration is indicated to increase bone volume to ensure long term stability of the hard and soft tissues, ensure long term implant survival and create an aesthetically pleasing tooth dimension. We use biomaterials for a variety of guided bone regeneration techniques which include socket preservation, ridge augmentation and sinus augmentation.
The below sections describes the material characteristics of Cerabone and Collprotect Membranes.
What are the reasons for using Cerabone?
When you do not have enough bone of your own available to accommodate a dental implant, Cerabone will be used to increase your own bone, thus providing an adequate amount for the procedure you require.
What is the function of Cerabone?
Cerabone is a scaffold which serves as a guide-rail to allow new bone to grow. This scaffolding material enables and facilitates bone formation in the area where the operation is performed. It is inserted into the operation area in the form of granules. Your own bone slowly grows into the Cerabone material, which at a later time is gradually broken down by the body.
Are there any alternatives to Cerabone?
As an alternative to Cerabone, one can use the body’s own bone, which is taken from a different location, for example the chin of hip. However this procedure requires additional anaesthesia. Once the bone sample is removed from its original site it is then inserted into the operation area. In this procedure, the following must be considered:
Synthetic materials are also available but have limited applications.
What is Collprotect?
Collprotect is a membrane made of collagen that is generally used to cover the bone replacement material Cerabone.
What is Collprotect made from?
Collprotect is composed of highly purified natural collagen obtained from pigs.
What is the function of Collprotect?
It has been proven that better healing rates are achieved when the Cerabone particles are covered with a membrane (Collprotect). This is because the tissues of the gum grow more rapidly than the new bone, the membrane protects the Cerabone particles from this faster growing connective tissue. This ensures that the underlying bone can heal in an undisturbed fashion.
Does the Collprotect membrane have to be removed in a second procedure?
No. The collagen membrane becomes completely broken down by the body hence a further operation to remove it is unnecessary.
What is periodontitis?
Periodontal disease affects your gums, bone and other supporting tissues of the teeth. This group of specialised tissues are collectively known as the periodontium and gum diseases which affects these tissues are called periodontitis. Although most people suffer gum inflammation or gingivitis from time to time, around 10% of the population appear to suffer from the more severe forms of the disease which cause loss of bone that supports the teeth. This group appears to be at greatest risk of losing teeth through periodontitis. Sadly periodontitis susceptible individuals are also at a higher risk of developing implant complication.
If you have an increased susceptibility to periodontitis which is a risk factor for adverse incidents or implant complications and future tooth loss this needs to be considered and managed prior implant treatment. Periodontitis susceptibility does not preclude implants being placed but undiagnosed, untreated active periodontitis does.