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What are dental implants? A dental implant is a medical grade titanium screw that can be placed directly into your jaw bone, to replace a missing tooth. The dental implant/implants can be used to support a prosthesis such as a crown, bridge or dentures. Dental implants are available with different design characteristics, shape and sizes. The choice of implant which is best suited for your clinical scenario, will be discussed with you by your periodontist. How do I know if I am a suitable candidate for a dental implant? Numerous factors affect whether a patient is a suitable candidate for a dental implant. During your consultation visit, the periodontist will do a full examination of your mouth and your 3D CBCT scan of your jaw. The periodontist will determine whether you have sufficient bone height, bone width, soft tissue and prosthodontic space for an implant to be placed. A clear plan of action will be discussed with you and a treatment estimate of the costs involved will be provided. What are all the parts of a dental implant? A dental implant comprises three basic components: 1. The implant body: this is the physical dental implant (titanium screw which is placed in your jaw). 2. The abutment: There are two abutments that will be used. The healing abutment is used by the periodontist to shape the gum prior to construction of the crown. The crown abutment is the connection between the implant and the crown. 3. The crown: The crown is the final phase of the treatment process. This is the component that will be designed and placed by your dentist and is the part that is visible in your mouth. What are the steps involved in the placement of a dental implant? The following is a basic outline of the steps to having a dental implant placed: 1. Consultation. The periodontist will thoroughly examine your mouth. A 3D CBCT scan needs to be taken on which the assessment of the bone where the implant is to be placed is performed. The position, size and type of implant is also planned on this scan. This 3D CBCT scan will also provide crucial information whether bone augmentation (grafting) procedures are required. A treatment estimate will then be provided. 2. In some cases patients may first require a specific tooth to be removed prior to implant placement. Some patients may require bone grafting additional to the implant placement. This bone grafting may be required prior to implant placement or can occur at the implant placement appointment. This will all depend on the clinical situation. 3. The implant surgery can now proceed. To place the dental implant a small soft tissue flap is created in your gum. The site where the implant is to be placed is prepared with special implant drills. The implant is then placed intoyour jaw, with either a cover screw or healing abutment (dependent on the clinical situation). 4. Healing period. A period of healing is required before the dentist can place the crown on the dental implant. The duration of this healing period is determined by many factors - such as quality of your bone, whether bone grafting was performed etc. 5. Assessment whether the implant is ready for the implant crown. The periodontist will make an assessment to determine whether the bone has matured sufficiently around your implant. Those implants that were placed with a cover screw, will require an appointment called “implant uncovery”. Here a small flap is raised and a healing abutment (which shapes the gum is placed). 6. Dental implant crown. Once the implant has been assessed and determined to be ready for restoration by the periodontist, the dentist can proceed to construct and place the implant crown. Do I need to have my dental implant checked after it is completed? A dental implant (just like your natural tooth) needs to be assessed by your periodontist on regular intervals. At these assessment appointments (implant maintenance visits) the health of the bone and soft tissue (gum) around the implant will be checked. This is an essential part of looking after your implants. Implants (just like teeth) can also develop infections – which can lead to serious complications, such as the loss of your implant. Your periodontist will explain to you how to look after your implants, as well as how frequently you need to have your implants checked. Do my implants last forever? Just like a tooth may develop infections or need additional treatment over time, a dental implant may also develop complications. This is the reason why regular check-ups (implant maintenance visits) are very important. Implant companies do provide a warranty on the implant (for different periods of time depending on the company) and will cover the cost of the physical implant body if failures do occur that can be proven are not related to poor patient care of the implant. A treatment estimate for the surgical costs to replace the implant will be provided in these scenarios.

What is Periodontitis? Periodontitis is a condition of inflammation resulting in the destruction of the bone and gum tissue that surround a tooth. When left untreated – periodontitis will result in tooth loss. How do I know that I have periodontitis? Most patients usually present complaining of bleeding gums and swelling of the gums. Many patients also express that it seems that their teeth have moved and changed position. Others symptom include recession of the gum tissue, teeth that are sensitive and discomfort on chewing. The diagnosis of periodontitis can be confirmed upon examination by a periodontist. Are there any factors that put me at greater risk for periodontal disease? Poor oral hygiene and plaque control are one of the leading causes of periodontitis. Habits such as smoking place patients at a higher risk for the development of periodontitis. Smokers also demonstrate a faster progression of tissue destruction, as well as a poorer response to treatment. Systemic diseases, such as uncontrolled diabetes, also increase the risk of a patient developing periodontitis. Why do I need to be routinely examined to assess the health of my gums? Periodontitis is a slow, progressing chronic disease. Unfortunately many patients only present for examination once significant damage to the bone and gum tissue have already occurred. This then results in scenarios where the teeth can no longer be saved. It is thus of utmost importance that patients have regular assessment of their gum health, to ensure that conditions such as periodontitis can be identified in the early stages and tooth loss can hopefully be prevented. The periodontist will use an instrument (the periodontal probe) to take multiple measurements around your teeth and gums. Interestingly, untreated periodontitis has been shown to increase the risk for the development of other systemic diseases, such as coronary heart disease, stroke, diabetes and adverse pregnancy outcomes. How is periodontitis treated? The treatment plan for a patient with periodontitis will vary depending on the clinical scenario. Management of periodontitis involves: •improving oral hygiene •improving the control of systemic diseases if present (such as diabetes). •deep cleaning of the tooth and root surfaces (known as root planing) Those patients not fully responding to root planing, may require more intensive surgical procedures, which will be fully explained by the treating periodontist. Is the treatment of my periodontitis a once-off procedure? Once a patient has been diagnosed with periodontitis, they need to be monitored on a regular basis. Follow-up examinations and treatment is required – referred to as supportive periodontal therapy. The frequency of these visits will be determined by your periodontist. Without these regular supportive periodontal therapy visits, periodontitis can develop and progress again.

What is Oral Medicine? A periodontist specializes in three fields, namely Oral Medicine, Periodontology and Implantology. Oral medicine is a field of dentistry focusing on disorders of the orofacial region. Periodontists in South Africa have specialized training in diagnosing and managing oral mucosal abnormalities. Oral mucosal abnormalities include growths, ulcers, oral allergic reactions, auto-immune disorders, malignancies (cancer), infections, salivary gland disorders and the presence of pain or discomfort in the oral cavity. Interestingly, many systemic diseases can present with specific lesions in the oral cavity. The oral cavity is often the first part of the body where some systemic diseases may present with signs and symptoms. What does an oral medicine consultation involve and should I have one? The periodontist will do a thorough examination first of your head and neck area – this involves palpating your lymph nodes and looking for any abnormalities or signs of disease. Then the oral cavity is examined step by step, checking for any lesions, abnormalities or signs of systemic disease. This thorough examination is important for all patients, as very often lesions may be present, however they are asymptomatic and you are not aware of it. Screening for oral cancer is also a very important aspect of this examination. Unfortunately in many patients oral cancers are only diagnosed in the late stages, because these lesions often only become symptomatic (sore) once the cancer has progressed and spread. What will the periodontist do if they find a lesion or abnormality? If a lesion or abnormality is identified in your mouth, the periodontist will perform special tests to diagnose what the lesion is and identify the cause. Examples of such tests include a soft tissue biopsy or blood tests. Many patients often present complaining of recurrent ulcers or a burning sensation in the oral cavity (especially the tongue). The periodontist can perform specific blood tests to try and identify the cause, which is often a nutritional deficiency the patient may have. Once the biopsy or blood results are available, the necessary treatment or referrals will be prescribed by your periodontist.