Mind the gap – how implants and dentures can bring back your smile

Having your teeth fall out of your mouth is a common nightmare and little wonder. Losing a tooth is something most people dread. But simply because we live in fear of it doesn’t stop life, in the form of falls, injuries, or decay, from making this particular anti-wish come true.

By the time you’re staring down the barrel of extraction, you don’t really care about the cause. All you want to know is how to fill it. For most people, the ideal option is an implant.

“Implants are suitable for patients who either present already with missing teeth, or who have a failing tooth which will require replacement, maybe as a result of infection or fracture, or because a conventional crown or restoration procedure won’t work because there’s not enough tooth there to build something back up,” explains Morgan O’Gara of Blackrock Dental.

Each implant is case specific, he says, but in the main they follow the same procedure, with a titanium screw inserted into the bone of your jaw.

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Not everyone’s jaw has enough bone where the implant needs to go.

“The progress of the implant depends on the quality of the bone. There are lots of techniques we can use to help, but in the main, the better the quality of the bone, the better,” he says.

The main factor at play is how long the tooth has been missing. “If the tooth has been missing for years the bone shrinks. With regards to implants, having one tooth that is about to fail is the ideal. So if the person has had dentures for many years and then comes looking for implants, it doesn’t mean it can’t be done but it is more difficult,” he says.

Your dentist will take a three-dimensional X-ray to assess bone quality and volume. Once you get the green light you can plan for the insertion of the screw. “People get nervous about it but it’s actually easier than a tooth extraction,” he says.

It takes three months for the bone to heal and for the screw to be firm enough to start the tooth restoration process. Once the implant is finished, you have a 95 per cent chance of it lasting over 20 years.

You still have to look after the implant. If not, plaque can build up and you run the risk of losing it too, just as you would any other tooth.

“There are two reasons people might consider an implant, function and aesthetics. With back teeth you want to be able to chew properly and you don’t want your other teeth to drift and move. Or, you might have an unsightly tooth at the front that you want to improve,” he says.

Costs vary depending but on average, for a single tooth implant, expect to pay around €2,500.

It is not something you should do too lightly, however. “Ultimately implants are surgical procedures. The big thing now is that people are going abroad to have them done. As human beings with nerves and blood vessels in our mouths and jaws, as with anything surgical, safety has to be number one. If someone hits a nerve you can be left with permanent damage, such as numbness. Any surgical procedure must be planned properly and completely, with safety being the number one consideration,” he says.

Some people go abroad for what is termed “destination dentistry”. Very many such procedures are a huge success at a great price. However, O’Gara views them from the perspective of a dentist who has helped to pick up the pieces when such treatments go wrong.

In some cases people simply don’t get what they bargained for. “A lot of the work people end up getting done is all joined together,” he says. “Over time they can’t clean those teeth properly, plaque builds up, but they won’t know they are all joined up until something goes wrong,” he says.

For some people a denture will be the best option for tooth loss. “It could be that they don’t have enough bone for the implant, or they’ve had implants that failed over time. Osteoporosis can also be a factor, or, where dexterity is a factor, hygiene issues can mean plaque can build up around the implant, just as it would a normal tooth,” says Bevin Mahon of Dentaltech, a denture specialist.

“It may be a young person who has lost a tooth through injury or sport, and who is not yet ready for an implant because they are waiting until they are 21 for the bone to fully develop.”

In such cases a partial denture that just pops in and out is the best solution.

Cost is also a factor. “It’s quite common to have a situation where a person might need a lot of implants, have gaps here and there, but can’t afford the cost of five implants with crowns. Partial upper and lower dentures can fill those gaps and look great,” she explains.

With 3D denture printing technology, which scans the mouth and prints out a denture, a single perfectly fitting tooth replacement can take just a couple of days, and a full top and bottom set two to three weeks.

“Lots of people have dentures. One in three people over 35 are missing one or more teeth, it’s just that people don’t talk about it,” says Mahon. “Even those we’ve taken away the stigma of everything from menopause to mental health, it’s still there in relation to dentures.”