Your dentist may have referred you to Scott Clinic for a consultation to discuss having a dental implant to replace a missing tooth.

A dental implant is a fixture that is inserted into the jaw bone, to which a single artificial tooth can be attached (a crown) or in some instances a row of teeth on a bridge. Implants are made of materials that are compatible with your natural jaw bone; at Scott Clinic we use titanium implants from two companies, Nobel Biocare and Neoss.

An important part of dental implant treatment is ensuring you have enough bone for the implant to ‘osseointegrate’ or grow into your bone tissue, and in some cases, it may be necessary to have a preparatory bone graft done prior to placement of a dental implant.

As well as helping to replace missing teeth, dental implants can also help to minimise the natural bone loss that occurs at the site of a missing tooth and also maintain the structure of your face, which can alter over time with missing teeth.

Consultation and Cone Beam CT Scan

You will need to attend the clinic for a comprehensive consultation with one of our Oral Surgeons to assess your suitability for a dental implant. This will involve a review of your medical and dental history, a clinical examination of your mouth and a Cone Beam CT Scan of your jaw. The scan is valuable for assessing your jaw bone and where the surgeon will place the dental implant.

Dental Implant Surgery

At Scott Clinic we offer three ways of having dental implant surgery; local anaesthesia only, local anaesthesia and intravenous sedation and general anaesthesia.

• Local anaesthesia: the surgeon will numb the area in your mouth where the implant is to be placed with a small needle, just like you may have experienced at the Dentist.

• Local anaesthesia with intravenous sedation: as well as the injection to numb your mouth, the Surgeon will put a small needle into a vein in your arm or hand, and give you a small amount of intravenous medication to help you feel a little more relaxed.

• General anaesthesia: you will be completely asleep for the procedure. This will be done at Royston Hospital.

There are two stages to dental implant surgery:

Stage One. If your tooth is already missing, this stage involves making an incision in your gum where the implant will be placed and then using special surgical instruments, a hole is made in your jaw bone and the implant placed into the hole. If you still have a tooth that needs replacing, this will be removed, prior to preparing the area for the implant.

The implant is covered with your gum, which is gently stitched back into place and left to grow into your bone for 3 – 4 months. You will probably need to wear a partial denture during this time.

Stage Two. At this appointment a few months after your implant placement, a small x-ray will be taken to check that the implant has successfully settled into the bone and then an abutment will be placed. This is a very simple procedure done under local anaesthesia only. The abutment forms the support for the final crown (artificial tooth) that your dentist will make for you and you will need to make an appointment with them, about 3 -4 weeks after the abutment surgery.

The dental implant treatment can take up to 9 months before you have your new tooth, and if you require a preparatory bone graft to replace your jaw bone this makes the dental implant journey a three-stage procedure and may take an additional 3 – 6 months.

Are there any risks associated with dental implant surgery?

Any surgical procedure carries some risk and the specific potential complications will be discussed thoroughly with you before going forward for surgery. General risks of the surgery can include: pain, swelling and bleeding postoperatively, inflammation of the gums around the implant, infection, injury to the nerves in your jaw, overgrowth of tissue surrounding the implant, loose implant or abutment and very rarely, fracture of the jaw bone.

What do I do after the surgery?

You will be given very specific post-operative instructions related to your surgery by the nurses at the clinic.

How successful are dental implants?

It can be difficult to predict how well a dental implant works for each person, and the long term success depends on a few things; health of the mouth and jaw prior to implant placement, smoking status, oral hygiene and care of the implant and how many implants have been placed.

There is an approximately 95% overall success rate with dental implant treatment and most people can expect to have a fully functioning implant in place for 10 years or more.

How do you look after your dental implant?

Good oral hygiene is critical in maintaining the life and health of your dental implant. You must clean your teeth and gums, including your implant and crown, every day to keep them free of plaque and there are special oral hygiene products specifically for dental implants to help you with this.

Your dentist may have referred you to Scott Clinic to have your wisdom teeth removed. This is a very common procedure for the team at Scott Clinic.

Wisdom teeth (also called ‘third molars’) are usually the last teeth to come through, and whilst most people have four, some people don’t have any.

Wisdom teeth can become problematic for some people as often there isn’t enough room in the jaw for the teeth to come through the gums and the teeth may become ‘impacted’.

Impacted wisdom teeth can cause pain, infection, inflammation, crowding and pressure on the teeth in front of them and occasionally a cyst can form around the impacted tooth, which can over time cause damage to the tooth, gum and teeth around it.

Consultation and Cone Beam CT Scan

You will need to attend the clinic for a comprehensive consultation with one of our Oral Surgeons to assess your wisdom teeth. This will involve a review of your medical and dental history, a clinical examination of your mouth and a Cone Beam CT Scan of your jaw. The scan is valuable for assessing exactly where your wisdom teeth are and how close they are to the important nerves in your jaw bone.

Wisdom Teeth Extraction Surgery

At Scott Clinic we offer three ways of having your wisdom teeth extracted; local anaesthesia only, local anaesthesia and intravenous sedation and general anaesthesia.

• Local anaesthesia: the surgeon will numb the area in your mouth where the teeth are to be removed, with a small needle, just like you may have experienced at the Dentist.

• Local anaesthesia with intravenous sedation: as well as the injection to numb your mouth, the Surgeon will put a small needle into a vein in your arm or hand, and give you a small amount of intravenous medication to help you feel a little more relaxed.

• General anaesthesia: you will be completely asleep for the procedure. This will be done at Royston Hospital.

Are there any risks associated with wisdom teeth extraction?

Any surgical procedure carries some risk and the specific potential complications will be discussed thoroughly with you before going forward for surgery. General risks of the surgery can include: pain, swelling and bleeding postoperatively, inflammation of the gums, infection, injury to the nerves in your jaw, difficulty opening your mouth for a few days, and dry socket (when the blood clot dissolves too early).

What do I do after the surgery?

You will be given very specific post-operative instructions related to your surgery by the nurses at the clinic.

It is recommended that you take one week off work or school after having your wisdom teeth extracted.

Dentoalveolar surgery is a term that covers a variety of problems that can occur in your mouth or jaws. This can include removing cysts or lesions in the mouth, assessing abnormal tissue in the mouth, apicectomy (removal of the tip of a root) and extraction of a tooth or retained tooth root. You may have been referred to Scott Clinic for the treatment of one of the following conditions ;

Cysts

Fluid-filled sacs or cysts can sometimes form around the tooth root in your jaw. Cysts can cause pain, swelling and infection and if not treated, may cause problems with the normal development of the teeth. Cysts can be removed by one of the Surgeons and may be done under local anaesthetic at the clinic or general anaesthetic at Royston Hospital.

Oral Lesions

Tissues in the mouth can occasionally look a bit abnormal. A biopsy ( removal of a small piece of tissue) may be required to send to the Laboratory for identification of the lesion. Once the Doctor knows what the lesion or abnormal tissue is they can then recommend the most appropriate form of treatment. Biopsy of abnormal tissue is done under local anaesthetic at the clinic.

Apicectomy

Often performed in conjunction with a root canal treatment (done by your Dentist), an apicoectomy is the surgical removal of the tooth root tip and sealing the gap to clear the persistent infection and help to save the tooth. An apicoectomy is usually done under local anaesthetic at the clinic.

Extraction of tooth or tooth root

Every effort is usually made to save your natural teeth but occasionally, extracting a tooth may be the best option. If you have very decayed or broken down teeth, extensive gum disease that may have damaged the bone or tissues around your teeth, non-functional teeth, cracks in a tooth root, extra or impacted teeth, you may require extraction.

The temporomandibular joint (TMJ) is located in front of your ear on both sides of your head, where the lower jaw attaches to your skull. This complex joint moves up and down allowing your mouth to open and close, and side to side. There is also a disc between the jaw bone and the skull that is a bit like a shock absorber in that it moves with the jaw, protecting the bones as you open and close your mouth. There are a number of muscles attached to the TMJ which control the position of the joint & jaw joint movements when you eat or talk.

Problems can occur in both the joints and muscles and can cause jaw pain, neck pain, headaches, earache, difficulty with mouth opening and painful joint noises such as clicking, popping or a grating sensation.

How do I know if I have a TMJ disorder?

If you have been referred to Scott Clinic for assessment for a possible TMJ disorder, you will be booked for a consultation and Cone Beam CT Scan. The CBCT will help the Doctor to identify any abnormalities in the bony jaw joints and discs. The Doctor will also take a full medical and dental history and physically examine your teeth, mouth, jaw joints and muscles. You might have some blood tests taken or be referred for an MRI scan if the Doctor thinks this would be helpful to diagnose the cause of your symptoms.

How is a TMJ disorder treated?

Identifying the cause of your TMJ disorder can influence the type of treatment recommended to you. Simple measures such as a soft diet, local heat and massage are often all that is required. Occasionally a bite splint, rather like a mouth guard, may be constructed to help relieve pressure on your jaw joints and allow your jaw muscles to relax. You may be given some muscle exercises to do.

For some specific jaw joint disc problems which do not settle with simple treatment, surgery may sometimes be beneficial. This might be a jaw-joint washout procedure called arthrocentesis, or for jaw joints showing extreme arthritis, jaw joint replacements may be offered.

As the cause of TMJ disorders can be multifactorial, a range of health professionals, all specialising in various aspects of jaw joint problems, such as oral medicine specialists, physiotherapists and pain specialists may be asked to be involved in your treatment.

At Scott Clinic we are fortunate to have our own Cone Beam CT Scanner, which takes both simple jaw x-rays and very specific CT scans of your jaw.

What is a cone beam CT scan and why do I need one?

CT stands for computed tomography which means using x-rays to take multiple detailed images from different angles, to produce 3D or ‘cross sectional’ pictures of specific areas, in this case, the jaw.

In a cone beam CT scanner the x-ray beam is in the shape of a cone and is moved around the patient to produce a large number of images.

You may be required to have a CBCT to assess damage to the jaws or teeth, identify the position of teeth and nerves prior to extracting the teeth, evaluate the sinus and nasal passages, and it is an integral part of planning for dental implant surgery.

Are there any risks from radiation if I have a CBCT?

Cone beam CT has the advantage of lower radiation exposure compared to conventional CT and this is because of the unique cone-shaped way the radiation beam is generated. No radiation remains in a patient’s body after a cone beam CT examination.

What are the benefits for my treatment to having a CBCT?

• The focused x-ray beam reduces scatter radiation, resulting in better image quality.

• A single scan produces a wide variety of views and angles that can be manipulated to provide a more complete evaluation.

• Cone beam CT scans provide more information than conventional dental x-ray, allowing for more precise treatment planning.

• CT scanning is painless, non-invasive and accurate.

• A major advantage of CT is its ability to image bone and soft tissue at the same time.

What do I need to do for a CBCT?

A cone-beam CT examination requires no special preparation and we take the scan at the time of your consultation.

You will be asked to remove anything that may interfere with the imaging, including metal objects, such as jewellery, glasses, hair clips and hearing aids. You will also need to remove any dentures, partial plates or tongue piercings.

Females will be asked if there is any possibility of pregnancy and it is very important to advise the nursing staff or Surgeon if this applies to you as it may not be safe to take the CBCT if you are pregnant.

You will be placed in a seated position in the CT Scanner and the clinician will position you according to the area that they want to scan. The gantry which houses the x-ray source and site detector will move around your head in a 360 circle, and you will be asked to close your eyes and stay very still for the duration of the scan which is approximately 25 – 30 seconds. The scanner is not enclosed and you will be monitored by the clinician throughout the scan.

What if I don’t want to have the CBCT?

Your choice not to have a CBCT will be completely respected, and the Surgeon you are seeing will take the time to explain your options for treatment without the scan. In some instances, it may be decided that it is not safe or feasible to proceed with treatment without a scan, but that decision will be made in full consultation with you.

You may have elected to have your treatment under intravenous sedation to help you relax and remain calm. The sedative, called Midazolam, is given through a small needle in the back of your hand or your arm. Once you feel drowsy and relaxed, your mouth will be numbed with local anaesthetic and treatment started. During the procedure, you should feel peaceful and often unaware of what is going on. Many patients do not remember part, or all, of their procedure.

One of our Registered Nurses will monitor you carefully during the surgery and after the procedure, you will be allowed to recover until you are fit enough to be discharged with your escort.

Before the appointment

• On the day of your appointment, you may be able to eat and drink up to two hours before your appointment, but any meal should be light, e.g. tea, toast, juice. Diabetic patients need to consider their regimes accordingly and advise the Surgeon. Sometimes you will be asked not to eat or drink anything, but you will be given specific instructions by your Surgeon at your first consultation.
• Remove any nail varnish.
• Do not consume alcohol for at least 8 hours before your procedure.
• You must be accompanied by a responsible adult (over 18 years old) who is able to wait with you, escort you home and stay with you for the rest of the day. If this is not organized we cannot perform your procedure.
• Please make your own arrangements for transport home following your procedure. This should either be by car or taxi. Do not drive or use public transport.
• All routine medication should be taken as usual. If you are taking anti-coagulant medications this should have been brought to the attention of the surgeon prior to your surgery date but please remind the Dr that you are on these medicines when you attend your procedure.
• Please inform us if you may be pregnant.
• Any illness occurring before the appointment should be reported immediately as it may affect the treatment.
• If you have any questions about the procedure please ask before the sedation and treatment starts.

Following treatment

Although you think you have recovered quite quickly, the effects of your sedation may not have worn off completely until the next day. For the first 24 hours after the procedure, it is important that you:

• Do not consume any alcohol
• Go home with your escort and rest quietly for the rest of the day
• Do not drive a vehicle or operate machinery
• Do not go out alone
• Do not make important decisions such as purchasing expensive items or signing important documents.
• Do not worry if you have difficulty remembering what has happened. This is called amnesia and is very common after sedation.
• Please take any medication you have been prescribed as directed, remember to always read the instruction label.

The maxillary labial frenum attaches the upper lip to the gums just above the upper two front teeth.

A prominent maxillary labial frenum can cause a large gap to occur between the upper two front teeth.

Removal of the abnormally long or dense tissue (frenectomy) may be required for functional reasons i.e impacting on the ability to open the mouth adequately for teeth cleaning, mal-alignment of teeth or gum recession, or have to be done as part of orthodontic treatment.

Frenectomy may be done under local anaesthesia at the clinic but usually under a short general anaesthetic at Royston Hospital.

In order to be useful and functional, teeth need to ‘erupt’ into the correct position in the mouth, but occasionally teeth can become impacted and unable to move into the appropriate place in the jaw.

This is usually seen in children and the upper canines are the most common teeth to have this problem it may be suggested that your child has a procedure to help the teeth move into position.

This is called the exposure of a tooth and may include bonding a bracket (tiny gold chain) onto the ‘lost’ tooth which your orthodontist will use to ease the tooth into a good functional and aesthetic position.

This surgery may be done under local anaesthesia at the clinic, but if the teeth that need exposure are in a very difficult position, the Surgeon may recommend a short general anaesthetic

As the local anaesthetic wears off you may experience some bleeding. If the bleeding is bright red (more than dilute pink) then bite firmly on a piece of gauze over the extraction site for 20 minutes – it is this prolonged pressure which stops the bleeding. If you continue to spit out clots or bright blood, then please call 027 234 3472.

It is normal to spit out dilute blood over the next 2 or 3 days as the saliva dissolves the clot

An ice pack applied to the side of your face helps reduce this. Cover the icepack with a cloth before applying to your face. The swelling is often at its worst at day 2-3 after surgery and may cause discomfort with mouth opening and eating.

Please take your pain relief as required and as prescribed

The day after your surgery, start gentle warm salt water mouth soaks (1/4 tsp table salt in a tumbler of warm water) after every meal and just before bed. You may notice a little bad breath a day or so post-operatively—the mouth soaks will help with this (but not too vigorously which may upset the wound) and try to brush your teeth as normally as possible. Continue the mouth rinses until your sutures have dissolved and longer if you wish until the extraction sites have completely healed (this can take up to 6 weeks).

You may have been prescribed a course of antibiotics to take following the surgery. Please stop taking the medication if you feel you are having a bad reaction to it and call us.

You may or may not have dissolving sutures. If not, these will be removed in 10 -14 days. Dissolving sutures take between 1-3 weeks to disappear.

It’s normal to feel quite tired after surgery and if you have had some form of sedation, this may last for 2 or 3 days. It is very important you do not attempt to drive home yourself, operate heavy machinery or make any important decisions for the first day. We strongly advise you to arrange someone to take you home and remain with you until you are fully recovered. Avoid alcohol for 24 hours post-surgery.

After implant placement or bone grafting, it is important NOT to place direct pressure onto the implant or bone grafting site. If any bleeding occurs we recommend gentle pressure with gauze for approximately 15 minutes or sooner if the bleeding settles. If this does not stop the bleeding please contact Scott Clinic.

If you have any concerns at any time, please do not hesitate to call us. One of our team will be in touch either the evening after surgery or the next day.

Soft diet only for 5 days. Avoid hot fluids for 24 hours.

Do not drink from a straw until sutures dissolve 2-3 weeks as the suction can disturb the healing site. Gentle sips from a cup are fine.

cool fluids and soft cool food only

• Yoghurt, smoothies, ice-cream, jelly, mashed banana, stewed apples, milkshakes.

• Water and any other cool fluids, except alcohol.

It is ok to have warm/hot drinks & food.

• Yoghurt, smoothies, ice-cream, jelly, mashed banana, stewed apples, milkshakes.

• Tea, coffee, hot chocolate.

• Soup.

• Scrambled eggs, soft fish, soft mince type consistency food.

• Mashed potato, pumpkin, kumara.

• Porridge, weetbix.

• Soft pasta & noodles (avoid rice).

• Soft breads (no toast for a few days).

A splint may be required to reduce the wear on your teeth if you tend to clench or grind your teeth and change the way your teeth bite together..

A bite splint can also decrease the pressure in the jaw joints or TMJ. By reducing the load on these joints a bite splint can help minimise pain from the jaw joints and muscles.

If it has been recommended you wear a bite splint please read the following information:

- Please wear your splint every night and as much as you can during the day for two weeks.

- After two weeks, wear your splint at night only for four weeks.

Your splint will feel a little unusual in your mouth to begin with and it can take a week or so for you to notice a difference in your symptoms.

After 6 weeks you will be booked for a review consultation with Mr Goodisson. Please bring your splint with you to this appointment.

- Keep your splint in a container with a little bit of cold water. This stops it from drying out. Do not use hot water as this can soften and bend the splint.

- Before and after you use your splint, please clean it with a soft toothbrush.

- Once a week you can soak your splint in ½ strength Milton solution if you wish, to prevent it from becoming stained.

Your splint should last up to 5 years before becoming too worn or breaking. If your metal clips become loose that can usually be tightened.

Please do not hesitate to contact Scott Clinic with any questions about your splint.