It is no surprise that a lot of people will go from the UK to countries like Hungry, which advertise ultra-cheap dental implants.
The saving can seem dramatic, and because the websites look reasonable, it seems that there is no downside to doing this.
As professionals in the UK, we see another side to this.
Almost every day someone will call us to say that they had dental implants abroad, can we take over and put the tooth on?
These days we just say no, and in this article, I will show you why.
The first thing to realise is that patients will judge the success of their treatment on the look of the final result, and if they are going to a “cosmetic focussed” dentist like ourselves, we can assume that the look of the final result is going to be important to the patient.
Here is a situation where this gentleman had one of his front teeth removed and an implant placed. He did this in his home country in Romania, which I think is reasonable, at least he is not going to a country that he has never been to.
The first thing that you notice about this implant is that the gum on the implant is way too high.
In general, we are always looking to have the gum level pretty symmetrical, and level. If anything, this one tooth should have a slightly lower gum line, and this is one reason that the end result is aesthetically average.
Another thing to note is that the gum looks a bit grey around the implant, this gives us an indication that the gum is thin, this is not great for the long term, as thin gums will recede much more quickly.
To understand how this problem came about, let us look at the cross section of this implant.
Diagram 1 shows our current situation, and what it would be like if we put a tooth on the implant.
The red line coming from the implant, with a small red circle signifies the screw channel of this implant. In general, we want the screw channel to be on the inside of the tooth, so it is not visible, and we can have something called a “screw retained” crown, which will let us place and remove the tooth from the implant very easily.
Because the screw channel is coming out from the front of the tooth, we have to use the old fashioned “cement-retained” crown and hope that we never need to remove it in the future.
Diagram 2 shows the ideal position of the implant.
You can see that with better positioning, the top of the tooth will be lower, and the screw channel will be to the back of the tooth.
Diagram 3 shows us what we were trying to achieve by doing a gum graft on the tooth.
Gum Graft?!
We spoke about all of this with our patient, and one option was to remove the implant and start again.
This would not only be very expensive, but it also takes a long time, because we would need to carry out a bone graft, and could take 1-2 years to complete.
So we thought that if we carry out a gum graft (2h process), we might be able to bring down the gum, and improve the thickness of the gum, protecting our dental implant.
Well, this is what it looked like a few weeks after the graft
The implant now has a temporary tooth on it, so at least he can throw away that denture!
The gum level looks a lot better, and a lot thicker.
But the problem is that this is not stable, and after a few more weeks, the gum height problem was back, but at least the gum thickness was better.
This is all because
of the implant placement!
We always knew that there was a risk it would not be as good as we both hoped.
Our “plan B” was to make the crown look as good as possible.
With anything cosmetic, our process is the same, we first make everything in temporary materials first, and then convert that to final porcelain.
So we spent time making the temporary crown look as natural as possible, and we got to a stage where our patient was happy with the appearance, and the gum thickness was good.
From this point on, it is a case of how can the lab replicate this?
Well, actually it is quite hard, the material that I use for the temporaries is very different to the final porcelain, and the porcelain needs a certain thickness to be strong, and look good.
We had a few different try-in appointments, and we finally got to a stage where our patient was happy, and I thought it was as good as I could get it, with the limitation of the bad implant placement.
Even though this is not a perfect result, it has achieved the main goal, which was to improve overall confidence.
The denture that he was wearing was really getting him down, since having a temporary which was fixed in position, he has had the confidence to go on dates, find a partner, and is now expecting a baby!
who knew that a single tooth could change someone’s life so much?!
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