Dental Procedures
Dental Implants
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What is a dental implant? – A dental implant is essentially a substitute for a natural root and commonly it is screw or cylinder shaped. Almost all dental implants are made from titanium although we undertake placement of zirconium ceramic implants “Nobel Pearl’. Implants are placed into carefully prepared sockets at the precise location of the intended tooth. The main aim during placement of any implant is to achieve immediate close contact with the surrounding bone. This creates an initial stability, which over time is steadily enhanced by further growth of bone onto the microscopic roughness on the implant surface. In order to support replacement teeth, dental implants normally have some form of internal screw thread or post space that allows a variety of components to be fitted. Once fitted, these components provide the foundation for long-term support of crowns, bridges or dentures
Can implants always be used to replace missing teeth? – It depends on the condition of the bone in your jaw. Your surgeon will arrange for a number of special tests to find out the amount of bone still there. If there is not enough, or if it isn’t healthy enough, it may not be possible to place implants without grafting bone into the area first.
How long will implants last? – Once the implants and surrounding soft tissues are seen to be healthy and the new teeth comfortable and correctly adjusted, it is the quality of your home care and willingness to present for regular maintenance reviews that will have most influence on how long your implants will last. Well-maintained implants placed into adequate bone can be expected to last for many years. You would expect conventional crowns, bridges and fillings to need occasional repairs or replacements during their lifetime. Implant-supported teeth will have a similar maintenance requirement.
How many teeth can be supported by implants? – If you are missing just one natural tooth, then one implant is normally all that will be needed to provide a replacement. Larger spaces created by two, three or more missing teeth do not necessarily need one implant per tooth, however the exact number of implants will depend upon the quality and volume of bone at each potential implant site.
What happens during the placement of a dental implant? – Treatment is normally divided into two or three stages, each of which may involve several visits.
Pre-operative assessment – Before implants can be placed, X-rays and and on occasions conventional or digital impressions of your mouth will be needed. These allow your surgeon to plan the best way to treat you. We also plan using DTX software a virtual planning programme.
Surgical treatment – The next stage of your treatment is to insert the implants. This is normally done under local anaesthetic (an injection which makes the area where we are working numb) by lifting the gum away from the underlying bone, then gently and carefully preparing the jaw bone. The implant is inserted into the bone and the gum replaced and held together with some stitches. Following insertion, some types of implant will stick out through the gum, whilst other types will be buried underneath the gum. The implants will usually be left for at least three months before they are used to support replacement teeth. Implants buried under the gum will require a second small surgical procedure to expose them before they can be used.
Restorative treatment – You will need a number of appointments to make your crowns, bridges or implant denture. This will include taking (digital) impressions and checking the fit of the parts used to make your replacement teeth. In total, treatment could extend over three to twelve months depending on the case.
What are the risks? – There is a small risk that the implants may not fuse properly with the bone in your mouth and so cannot be used. The risk is higher in certain individuals, particularly those who smoke, and you will be advised if the risk of failure is higher than normal in your case. Implant placement involves surgery in your mouth and so may be followed by some soreness, swelling, bleeding or bruising. Any discomfort is usually controlled with simple painkillers (e.g paracetamol and ibuprofen) and should only last a few days. It is possible for parts of your implants to loosen or wear out with time. This can lead to failure of the implant, or the restoration on the implant, if not treated quickly.
If you do not have enough bone what can be done? – For some people, bone loss after the removal or loss of teeth leaves them without enough to secure an implant. In this case there are a number of options which may be suitable and can be discussed with your implant surgeon.
Sinus Augmentation – In the upper jaw above the back teeth, it is possible to increase the height of bone available by creating new bone in the sinus. This procedure is called a ‘sinus augmentation’. We are one of the few practices in Ireland undertaking sinus augmentation.
Bone grafting – There are many ways in which bone can be added to, however one simple concept is to take a piece of bone from somewhere else and secure it as an ‘onlay graft’ to a deficient area. The new piece of bone will slowly join to the underlying region and when healed and mature, an implant can be placed in a more favourable position. The other method called Guided Bone Generation involves using bovine bone chips and mixing with some of your own bone to replace the missing bone and can take four to six months to become ready for implant placement.
Bone Grafting
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Bone Grafting; Guided Bone Regeneration and Sinus Lift
This documentation has been designed to improve your understanding of these procedures. If you have any other questions that this text does not address, then please ask your specialist oral surgeon.
The Problem
The most likely reason that a bone graft has been suggested is that dental implant placement is planned. Implants require adequate bone to be anchored securely. You may have reduced bone due to early tooth loss, infection, trauma or having large sinuses. (sinuses are the air-filled spaces located in the cheek bones, above the teeth and either sides of the nose.)
Surgical options : Guided bone regeneration
Artificial bone derived from animal or mineral sources can be used to encourage new bone to grow. These materials have been specially prepared to make them safe for use in humans. The materials provide a scaffold for new bone to grow into and will be ready to receive dental implants several months later. The process can take anything from 3 to 12 months to occur. One advantage of this method is that it is not necessary to take bone from another site in the mouth, making surgery more comfortable and quicker.
Autogenous bone graft (own bone)
Bone is usually harvested from inside another part of your mouth. Common donor sites are the lower wisdom tooth region and the chin where small blocks of bone can be collected. Scrapings of bone close to the implant site can also be used along with artificial bone to improve bone regeneration. If large quantities of bone are needed, bone grafts from other areas of your body such as hip can be carried out in a hospital setting. There will be discomfort from the donor site as well as the surgical site, however many people feel that this is worth the additional discomfort as your own bone is normally considered the ‘gold standard’.
Sinus lift procedures
The procedure increases the height of bone between the gum and sinus to allow sufficient bone for an implant to be placed. This can be carried out using artificial bone (guided bone regeneration) or your own bone (autogenous bone graft).
What type of anaesthetic is used?
Depending on the quantity of bone needed, your general health, and anxiety level; bone grafting can be carried out under either local anaesthetic, with or without sedation, or a general anaesthetic. Your surgeon will help you decide which is best for you. The area of surgery will be completely numb during treatment. You can expect to feel pulling and pressure sensations and the vibrations of the drill, but no pain.
What does the surgery involve?
A cut in the gum will be necessary to uncover the proposed implant site. If your own bone is being used, then the gum will
also be cut over the donor site. If artificial bone is used (with or without fragments of your own bone) this will often be held in place with a dissolvable membrane material. Block bone grafting requires drilling and usually needs a small titanium screw to hold the bone in the correct place whilst healing occurs. This can be removed at the time of implant placement but may remain in place permanently. Dissolvable stitches in the gum are often needed to bring the gum back together. However, your surgeon may choose chose to remove them before they dissolve.
If a sinus lift is planned, then a cut in the upper gum at the back of your mouth will be made. A small amount of drilling is carried out. The sinus lining is lifted up. Bone and/or artificial bone is placed into the defect between the sinus lining and the implant site before closing the gum with stitches.
What can I expect after surgery?
It is normal to expect some discomfort and swelling both on the inside and outside of your mouth after bone grafting surgery. This usually settles down after three days but may be sore for up to two weeks. You may find that your jaw is stiff and you have to eat a soft diet for a week or so. It may be necessary to take a few days off work. Painkillers and sometimes antibiotics can be prescribed. Although there can be a little bleeding at the time of the bone graft this usually stops very quickly and is unlikely to be a problem. Should the area bleed again when you get home this can usually be stopped with gentle pressure to the area with a clean cotton handkerchief or surgical swabs. You should avoid rinsing your mouth out on the day of surgery. Carefully cleaning of your mouth and rinsing with warm salt water or Chlorhexidine mouthwash is normally advised after 24 hours to encourage healing.
If a sinus lift is carried out you will be advised not to blow your nose, sneeze with pinched nostrils, fly, play woodwind or brass musical instruments, blow up balloons or air mattresses, until healing has taken place.
How long do I need to wait after the bone graft before the implant/s can be placed?
In a few cases the implant can be placed at the same time as the bone grafting or guided bone regeneration. In most cases however a period of 3-6 months healing is necessary before the implant(s) can be placed.
What are the risks?
In some cases, the bone graft fails to take or dissolves away. This can sometimes be the result of infection. In other cases, there is no clear reason why this can happen. If a sinus lift procedure is carried out, there is a small chance that you could develop symptoms of sinusitis after surgery.
In some surgical sites there are nerves that give feeling. Your surgeon will discuss whether any nerves may be bruised as a result of your surgery, which might result in altered sensation of your mouth, lips or tongue. In very rare cases when using artificial bone, incompatibility and allergic reactions have occurred. Although the materials used are rigorously tested for safety there may be some unknown effects on the body that later become clear. If artificial bone is planned, please discuss with your surgeon what type is to be used, as you may have a preference on religious or ethical grounds.
For more information on bone grafting please click on the link to bone grafting from the British Association of Oral Surgeons.
Extractions
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Dental Extraction is a very routine procedure in dental practice. We are specialist at extracting teeth. Most ‘routine’ dental extractions can be undertaken under local anaesthesia. The socket can be packed immediately post extraction with bio-materials, usually a collagen implant with a collagen membrane or platelet rich growth factors to optimise healing facilitating dental implant treatment. After the extraction socket heals there can be vertical and horizontal bone loss and very often there is pre-existing bone loss. The placement of bio-materials mitigates against this normal biological process. We can discuss the range of socket augmentation procedures available to you at the time of extraction to optimise healing.
On occasions a surgical extraction is required. This procedure necessitates a cut in the gum, removing some bone, taking the tooth out in sections and then placing some dissolving stitches. Antibiotics are not necessarily required for a surgical extraction. As bone is removed stronger painkillers maybe prescribed. Some patients prefer to have IV sedation for this procedure. Again platelet rich growth factors can introduced into the socket to aid healing or collagen implants to help bone regeneration. Usually the socket is left heal for three months prior to x-ray examination to assess the site for a dental implant.
With children extractions can again be undertaken under local anaesthesia. There is the option of inhalation sedation ‘laughing gas’ using nitrous oxide and our last resort is a very quick General Anaesthetic. For children with medical insurance who have dental pain and extractions are deemed medically necessary there is some medical insurance cover offered on a case by case basis for General Anaesthesia.
General Anesthetic
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General Anaesthesia is when you are put fast asleep by an anaesthetist to have oral surgery. It is usually a day case procedure and is undertaken at the Blackrock Clinic Dublin. You must fast from midnight and you will be issued with instructions as particular to you regarding what current medications you are to take immediately prior to your admission.
Fortunately the vast majority of oral surgery can be undertaken by an experienced oral surgeon in primary care under IV sedation avoiding the risks of General Anaesthesia.
During the consultation we will assess the presenting clinical picture with x-rays and establish the best method of anaesthesia as particular to you detailing beneficence of surgery high-lighting risks and complications.
If you have medical insurance you will be issued a procedure code at the time of consultation to contact your insurance company and establish that you have the appropriate level of cover on your policy for admission. There maybe an excess payable on the day of admission to Blackrock Clinic with some admissions. Your medical insurance company or Blackrock Clinic will provide you with information.
For more information on admission to Hospital for children please click on the link Oral Surgery for children.
Wisdom Teeth
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Removal of Wisdom Teeth (Third Molars)
Some patients may need to have an operation to take out their wisdom teeth. We briefly explain why this may need to happen, what is involved and the risks and problems.
Wisdom Teeth – Adults normally have 32 teeth. Wisdom teeth (third molars) are the last to come through at the back of the mouth usually around the age of 18 years. Normally, there are four wisdom teeth, one on each side of the upper and lower jaws.
Impacted wisdom teeth – Some jaws are too small to accommodate all the teeth. There may not be enough space for the wisdom teeth to come through completely. They are said to have become impacted (stuck). This is often painful.
Reasons for the removal of wisdom teeth
• the most common reason is repeated infections (pericoronitis) of the gum overlying a wisdom tooth
• decay in the wisdom tooth, which your dentist cannot fill
• decay in the tooth in front of the wisdom tooth. The dentist can’t fill this tooth properly until the wisdom tooth is removed
• infection (abscess) at the bottom of the wisdom tooth root
• when the molar tooth next to the wisdom tooth is affected by gum (periodontal) disease
• a cyst (fluid filled sac) forming around the wisdom tooth
• as part of other operations on the jaw where the wisdom tooth is “in the way”
• there may be other less common reasons that your surgeon will discuss with you which are too unusual to go into detail about here
Your surgeon should only recommend removal of your wisdom teeth when the benefits of taking the tooth out are greater than the risks of leaving the tooth where it is.
Nerve shadow
Decay (black shadow) in an impacted lower wisdom tooth
The removal of wisdom teeth – Some wisdom teeth are harder to take out than others. It can involve a cut in the gum close to the tooth. Sometimes some bone around the tooth is taken away with a drill and the tooth may be cut into smaller pieces. This makes removing the tooth and root easier. Stitches will be placed in the area and these dissolve usually by themselves in one to two weeks. The procedure can be carried out with just an injection in the gum to numb the area (local anaesthetic), with or without sedation, or general anaesthetic may be suggested if the extractions are difficult. This may also be the case if you are very anxious or frightened. There may also be medical or personal reasons why sedation or general anaesthetic are necessary.
What can be expected after the operation?
The amount of pain after the operation varies. It depends largely on how difficult the tooth was to take out. The usual recovery time is 3 to 7 days. Pain is usually managed by taking painkillers e.g. ibuprofen and paracetamol. These are same medicines you usually take for headaches and general aches and pains. Swelling is common and tends peak on the second and third day after surgery. It gradually disappears over about a week. You may have difficulty opening your mouth (trismus) and this is likely to last for a few days. You will have to eat soft foods that don’t need much chewing. You may see some bruising on your face and neck. You will not normally be given antibiotics. Do not plan to have your tooth out just before going on holiday, especially if you are going abroad. Also avoid timing surgery around important social events. It is also likely that you will need to be away from work for a few days afterwards. Further information may be given to you when your surgery is finished.
What can go wrong?
Having wisdom teeth taken out is a safe and common operation. However, as with any procedure there are some risks and problems that can occur. Most bleeding will stop within 30 minutes after the operation finishes. You may notice your saliva is blood stained for a day or two afterwards. If you bleed a lot you should bite down hard, for 20 minutes, on any swab/gauze you were given. A rolled up clean handkerchief (not tissue) could also be used. If you cannot stop the bleeding, you should contact your dentist or surgeon. Dry socket is a condition which is more common after removal of wisdom teeth in the lower jaw. If you have pain which seems to be getting worse rather than better, 3-10 days after the extraction, together with a bad taste and/or bad breath then you should contact your dentist or surgeon. The socket may need washing out and a dressing to be placed. Antibiotics are not usually necessary. You may develop an infection. This may show as a fever, feeling generally unwell; tender glands under your jaw line; the skin over your jaw or upper neck becoming hot, hard, reddened and tender to touch. You should contact your dentist or surgeon. Although you usually won’t have been given antibiotics at the time you had your tooth out you may need to take them now.
As has been said before It is also not uncommon for there to be a restriction in the amount that you can open your mouth afterwards (trismus). If this doesn’t improve in the days immediately after surgery it can also be a sign of infection.
When the tooth next to the wisdom tooth has a large filling or crown it is possible that this can be damaged or knocked out during surgery. This will need repairing or replacing when the extraction socket has healed up enough.
There are two nerves that lie very close to the roots of the lower wisdom teeth. One of these nerves supplies feeling to your lower lip, chin and lower teeth. The other supplies feeling to your tongue and helps with taste. Sometimes these nerves may be bruised when a wisdom tooth is taken out. This can cause tingling or numbness in your lip, chin or tongue, or more rarely affect your taste. In most case this doesn’t last, but in a small number of people recovery may not be complete. Very rarely, permanent painful sensations may be felt in the damaged nerves (burning sensations, stabbing, shooting pains.) Between 2 and 20% of people will have some tingling or numbness that can last several weeks, between 0.5 and 2% will have permanent problems as per the literature. This is not our experience and this is why it is best to have your wisdom teeth removed by an experienced oral surgeon here at the Castle Clinic Dalkey or on our General Anaesthesia list at the Blackrock Clinic as a day case. If you experience any of the symptoms that suggest nerves have been damaged as described above you must contact your Dentist or surgeon as soon as possible.
Upper wisdom teeth generally cause less problems and are simpler and quicker to remove. As with lower wisdom teeth crowns or fillings in the teeth nearby can be damaged. There are no nerves close by that can be damaged, however there is a small risk of breaking the bone behind the wisdom tooth (tuberosity) which can cause bleeding and/or create a passageway between the mouth and the sinus (the air-filled spaces that lie either side of the nose and beneath your cheeks). If this happens it may need a surgical operation to repair it either at the time of your wisdom tooth removal or at a later date.
Your dentist or surgeon may inform you of other problems and risks that only apply to removing your particular tooth.
Your dentist or surgeon may advise you of ways of changing the way of removing your tooth to reduce the risk of complications particularly if your surgery is high risk. One such modification is called a Coronectomy. Please click on the link ‘patient information on coronectomy’ published by the British Association of Oral Surgeons for further information.
Soft Tissue Surgery / Cancer Screening
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Mouth Cancer
Introduction
Mouth cancer can develop in any part of the mouth – this includes the tongue, gums, tonsils, lining of the cheeks, lips and the upper part of the throat. Early signs of mouth cancer can often be seen. If mouth cancer is detected early, there is a better chance of surviving it.
What should I look out for?
Look out for the following changes and see your dentist or doctor if they last longer than three weeks.
• an ulcer or sore in your mouth or on your tongue • persistent discomfort or pain in the mouth • a red or white patch in your mouth • an unexplained lump in your neck • a sore or painful throat • a croaky voice or difficulty swallowing
Mouth ulcers and swellings are very common and usually get better on their own. Changes that last longer than three weeks could be serious and you should see your dentist, oral surgeon or doctor as soon as possible.
You should check your mouth regularly in front of the mirror. Your dentist is specially trained to look for signs of mouth cancer and can check the areas that aren’t easy for you to see. A mouth cancer check is part of every dental check up. You should attend regularly – depending on your oral health this could be every 3 months or up to 24 months for adults.
If your dentist notices anything unusual they will refer you to the Castle Clinic for further tests. Once a month we run a dysplasia clinic for long term follow up of areas in the mouth that are considered ‘at risk’ of changing into a cancer.
How is mouth cancer diagnosed?
Mouth cancer testing is normally done by specialists. It is common to carry out a test called a biopsy. This is where a small piece of tissue is removed and examined under a microscope to see if there are any cancerous cells present. The biopsy is normally done with a local anaesthetic (numbing injection) into the area around the suspicious area.
How is mouth cancer treated?
This depends on how early the cancer is found, what type of cancer it is and where it is in the mouth. Treatment usually involves surgery, chemotherapy, radiotherapy or a combination of all three.
How can I reduce my risk of mouth cancer?
Be a non-smoker • Smoking cigarettes, cigars or pipes all increase the risk of mouth cancer. Smokers are more than three times more likely to develop mouth cancer than non-smokers. Although e-cigarettes may be safer than tobacco, we still don’t know that regular use is completely safe.
Avoid chewing tobacco or betel nut • People who chew tobacco or betel nut (areca nut found in gutkha, betel quid or paan) are at higher risk of developing mouth cancer. If you smoke or chew tobacco or betel nut, the best thing is to stop completely. Help is available from your doctor.
Cut down on alcohol • The more you cut down on alcohol, the more you reduce the risk of mouth cancer. People who drink alcohol and use tobacco have the highest risk of mouth cancer.
If you’d like some help on cutting down your drinking, see your doctor.
Eat a healthy diet and 5-a-day • Eating plenty of fruit and vegetables may help to reduce the risk of mouth cancer. Try to eat a least five portions every day.
An increasing number of oral cancers are caused by certain strains of the Human Papilloma Virus (HPV). There is now a vaccine for HPV for boys and girls at the age of around 13.
What else affects my risk?
Mouth cancer is almost twice as common in men as in women. It’s rare in people under 40, but HPV-associated cancers are becoming more common in younger people.
For more information on mouth cancer please click on the ‘Statement On Mouth Cancer Diagnosis and Prevention’ from the British Society of Oral Medicine and Cancer Research (U.K.)
Sedation
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Why do we use sedation?
Many people are anxious about the prospect of having surgery in the mouth, and think that the only alternative to just having treatment with a local anaesthetic (numbing injection in the gum) is to have a general anaesthetic. Not only does that mean a visit to hospital; but general anaesthetic is not completely safe. Conscious sedation is a good alternative to this and can be used to help deliver most oral surgery treatments. This allows the majority of patients to relax enough to undergo treatment they feel wouldn’t be possible without it. Sedation is safer and patients have a quicker recovery.
What types of sedation are there?
There are three generally available types of sedation: oral (OS), inhalational (IS) and intravenous (IV) and in some specialist centres intra-nasal (via the nose) (IN). Your referring dentist or surgeon may ask you to complete a simple questionnaire which will help assess your anxiety and guide the choice of the most appropriate sedation for you and the procedure that you need to have.
Oral sedation (OS)
This can be an effective way of managing patient anxiety. The prescribed drugs are usually benzodiazepine (‘Valium’) types. The pre and post op instructions that are given for intravenous sedation apply. Oral sedation is less predictable. It is difficult to know how successful a particular dose will be and precisely what time it will “kick in” i.e. be at its most effective. For this reason inhalational or intravenous sedation are most commonly used as their effects are more predictable. Oral sedation may be used the night before appointments in very anxious patients who would otherwise be unable to sleep, with other sedation being used on the day of treatment.
Inhalational sedation (IS)
This involves breathing a mixture of nitrous oxide and oxygen (also known as ‘laughing gas’) throughout the procedure, via a mask, that fits over the nose. It is very safe and is suitable for co-operative children and adults alike. It is particularly good at reducing the fear and anxiety associated with having injections, and eliminating the tendency to gag/retch when dental instruments are used in the mouth. The sedative has no painkilling effect so a local anaesthetic (a numbing injection into your gums) is still necessary so that the treatment can be carried out. When inhalation sedation is effective patients will describe “being aware” that they were having treatment, “but not caring.” The effects wear off very quickly; allowing a swift return to feeling normal and an escort is not always necessary. However, it is not as widely available as other forms of sedation as it requires specialised, expensive equipment to administer it.
Intravenous sedation (IV)
This is used to help relax patients during minor surgical procedures. The sedative (usually a benzodiazepine “Valium” drug) is given by injection into a vein (intravenous) in the arm or the back of a hand. People remain conscious at all times and are able to talk and respond to instructions, but usually remain unaware of the procedure they are having. The sedative has no painkilling effect so a local anaesthetic (a numbing injection into the gum) is still necessary so that the treatment can be carried out.
Intranasal sedation (IN)
This uses the same benzodiazepine type drug that is used routinely in intravenous sedation except it is squirted into the nostril. This is used for extremely needle phobic patients and special care patients where co-operation or understanding is limited. Once effective, sedation is maintained by further intravenous injections if required.
Guidance that must be followed to keep you safe
There are strict rules, which must be adhered to for patient safety as the sedation can remain in the body for anything up to 24 hours afterwards. There maybe some variation between clinics, surgeries and hospitals especially around time without food before having sedation. The following instructions are intended as a guide only. Please follow the specific instructions that your surgeon and their team give you precisely.
If a responsible adult escort (friend or relative) is required they must stay in the clinic waiting room during your treatment and drive/escort you home afterwards; if not, you cannot have sedation.
Before your treatment, remember, to tell your oral surgeon of any changes in your medical history, your prescribed medicines and if you have any allergies. Unless specifically told otherwise by your surgeon, you must continue to take, the normal doses, at the usual times, of all your regular prescribed medicines.
On the day of your treatment under oral, intravenous or intranasal sedation
• you can have a light meal up to 2 hours before your treatment
• you can drink fluids right up to the time of treatment unless you have been instructed otherwise
• do not drink any alcohol the day before or on the day of treatment
• treatment and recovery time is usually 1-2 hours
• a responsible adult must bring you, drive you home and stay with you for the rest of the day to your appointment
• you cannot bring small children with you to your appointment- your escort must be responsible for you alone
On the day of your treatment under inhalational sedation
• you can eat and drink as normal before the procedure
• it is advisable not to have too heavy a meal if your appointment is close after breakfast or lunch, otherwise you may feel bloated and nauseous
• it is advisable to have a responsible adult bring you to your appointment and accompany you home
After your treatment under oral, intravenous or intranasal Sedation
Afterwards patients generally have little or no memory of the procedure.
• you must not travel home by public transport such as a bus
• you should stay at home resting quietly for 24 hours
• do not drive a car or ride a bicycle, drink alcohol, operate machinery, or use a kettle or stove. Do not do any work or make important decisions for 24 hours, to allow the effects of the sedation to wear off. Your balance, co-ordination and ability to think clearly will all have been affected by the sedative
• you can eat and drink normally as soon as you feel like it once the numbness in your mouth has worn off
• if you have any pain do not hesitate to take the painkillers as advised by your surgeon
After your treatment under inhalational sedation
Patients generally do remember the procedure. Even though the sedative effects pass off very quickly, you are still advised to rest quietly for the remainder of the day. You can travel home by public transport and do most of the activities prohibited after other types of sedation, but driving a car or riding a bike is best left to the following day.
Sinus Lift
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Sinus lift procedures
The procedure increases the height of bone between the gum and sinus to allow sufficient vertical bone height for an implant to be placed. This can be carried out using artificial bone (guided bone regeneration) or your own bone (autogenous bone graft).
There are two types of sinus lifts. A direct sinus lift and an indirect sinus lift.
Indirect sinus lift
This procedure is undertaken at the time of placing the implant and is usually done when there is 4-5mm of residual dental bone. It involves tapping up the bone and placing the graft material and then the dental implant. It then is left for four-six months to ossify (convert to bone) and thereafter a digital scan is undertaken and a new screw retained implant crown made.
Direct Sinus Lift
We at Castle Clinic undertake this procedure routinely. This involves grafting the floor of the sinus when there is less than 4mm of residual dental bone. A window is made into the sinus and the delicate membrane is lifted up and then the graft is placed with collagen membranes and platelet rich growth factors. The graft is left for nine months and then the implant is placed and left for four months. The complication that can occur is that the sometimes the thin and friable sinus membrane can tear and the procedure is abandoned. It is important that there is no nose blowing after surgery for several weeks as the graft settles and the surgical wounds heal. The direct sinus lift is usually done under IV sedation and one side at a time. If General Anaesthesia is undertaken bilateral sinus grafts can be undertaken.
For more information on bone grafting and sinus lifts please click on the Bone Grafting module that has patient information published by the British Association of Oral Surgeons.
