All on 4 Dental Implant Experience - Edinburgh, Scotland

I have been invited to share my experience of...

I have been invited to share my experience of dental implants which I have done 7 years ago. Unfortunately my story so far has gone from one of joy to despair. I previously had dentures for many years and felt I could afford to do something I had aspired to for many years.

I thought that I was unsuitable but had researched this on the internet and found several implantologists who were promoting dental implants even for the most difficult cases. I chose an implantologist who had a reputation as being an expert in his field for many years and decided to go and have a consultation. From the first meeting I was advised that I should be suitable but would require a full assessment but was very encouraging. I agreed and all the necessary procedures were carried out e.g. x-rays, impressions etc. plus background information re my health and social habits e.g. smoking.

I was given advice on the importance of good hygeine and follow up care following the procedure. I asked pertinent questions about the longevity and any potential problems I may encounter. I was told that the procedure was very successful and as long as I followed protocol I they should last a lifetime. In hindsight I should have asked for more explicit information about any potential problems such as what if the procedure fails, what are potential complications short and long term. I presumed that if there were any problems that this information would have been given to me to enable me to give informed consent or declinel to go ahead.

The procedure was carried out in stages and the implantologist was very competent as far as I was aware and I had every confidence in his abilities. The implant procedure was uneventful and everything was successful. I made a good recovery and was very happy with the outcome. Things started to go wrong about a year following the implant surgery. One of the teeth on the fixed prostheses broke and when i attended the dental surgery it was another dentist who I saw and at that time he noted that I had my own bottom dentition and said that my own teeth had caused excessive force on the bridge and had caused this. He highlighted at that time that my own dentition would cause a lot of pressure on the implants and bridge.

Things went OK for a while until I experienced a crack on the fixed bridge which I had repaired ,only to follow shortly afterwards with a complete break of the bridge when eating a morning roll. All my colleagues at work heard it. It was a real shock. I visited my implantologist again and he asked what I had done. I explained that I was eating normally. It was sent to the technician and repaired at a cost of £570 ($913), Around another year later the bridge cracked then broke again. This time I was angry and said to my implantologist that his should not be happening and again asked how long should this last. He replied 'a lifetime'. He took responsibility and I had another bridge done with reinforced metal (another band of metal placed at the back of the teeth) and was given the repaired bridge.

The new bridge was placed and I visited the implantologist a year later. On examination one of the distal implant screws was found to be loose. This was tightened and the bridge put back on. I was asked to return in 2 years. In another 1 1/2 years (two months ago) the bridge cracked quite severely along one edge. I arranged an emergency appointment with my implantologist and was advised that it would be sent for repair in another two weeks when the technician was contacted to arrange he repair. On removal of the bridge two weeks later I noted that the distal implant around the area of the cracked bridge was loose (the one that had been loose previously). On examination the implantologist found that the screw was fractured. He told the nurse and not directly to me. He placed the spare bridge on the implants and asked me to come back the following week and advised to be very careful because my bridge was sitting on only 3 implants and not fully torqued. The week turned out to be 4 weeks because the dental nurse telephoned me to say that because the implantologist required to hire the screw removal kit my appointment was delayed. I wasn't happy but had no alternative.

On return to the surgery my implantologist asked me if I was aware the screw had fractured and part of it was inside the implant. I said yes and he said that he would try to remove it. He attempted this but after a time said it was stuck and couldn.t remove it. He had given me a local anaesthetic and the procedure was quite traumatic. I felt that the implant must be damaged by the pressure that was exerted. He placed the bridge back on the 3 implants and told me that I would just have to use 3. I asked how realistic this was and he said that as long as I didn't eat things like toffee that would pull the bridge down that it was strong enough to take the forced of eating up and down. I asked if it could be replaced and enquired whether any of the implant system was covered (as I had read on the Nobel biocare and Straumann sites that implants were covered for a minimum of 10 years to a lifetime. He said no and that the reparatory work would be too complicated and would probably necessitate extensive work and the bridge would have to be readjusted or replaced. He said I could have the screw for nothing but that was all. He would not give me any reassurance that he could do anything and said we should just wait and see.

On leaving I asked when I should return as my check up appointment should have been May. I was told by the nurse it would be 18 months as normal. I left devastated. I was telephoned at my workplace the next day and the dental nurse asked me how I was and said that the team had been talking when I left and had found another tool in the kit that they could try rather than just leaving it. I was advised not to get my hopes up as it may not work.

Since I have become very depressed and have found that I cannot eat properly as one of the other implant sites is sustaining pressure from my bite and chewing motion and the bridge is moving. I had told the dental nurse this when she had spoken to me and she said that that was fine it was because the screws had not been tightened fully. I am also experiencing a foul taste in my mouth frequently which is coming from the affected implant and worry that there is an infection. I have lost weight and continue to do so because of both my physical and mental state at present and don't see any way of resolution. There are a lot of happy outcome stories about these types of implants and I felt that not enough is known about the adverse consequences of failure of these. I cannot foresee my own outcome and envisage the worse scenario wearing dentures being a nightmare, as the all on 4 procedure entails taking a lot of the bone away to allow room for the bridge to be inserted.

My previous problems with dentures can only be worse. I will continue to publish the my experiences and outcome. The most positive would be the removal of the screw without damage to the implant. However I would always be fearful of it happening again and having to endure these feelings again. I live in Scotland and had the procedure done in Edinburgh

My appointment to allow the implantologist to try...

My appointment to allow the implantologist to try again to remove the fractured screw from the implant was again unsucessful and I have now been advised that the implant itself requires to be removed.

I have now been given 3 choices for further treatment, which is an improvement from my previous visit.

I have been given 3 options. the first being to remain with 3 implants, undergo a new procedure where an implant is placed immediately on removal of the implant with the fractured screw (there are no guarantees of the success of this), or revert back to dentures. He asked me to consider these 3 choices and let him know. There was some conversation around these options and my present situation and cause. This I cannot discuss as I feel at the present time it should remain confidential due to potential outcome of treatment. I will require to make a decision after the holiday period.

I feel at least I have some choices now where previously I felt at a loss with no way to move forward with a resolution. I feel very disappointed that the screw cannot be removed as all the implants are sound and have integrated well within my jaw bone. I feel that the major manufacturers of implant systems should address this potential flaw in their product as it can have devastating consequences to the recipient. They do provide screw removal kits but in my case and probably many others are not effective.
Name not provided

Do not wish to rate my implantologist as have too many mixed feelings at present

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A lot has happened since my last post. At this point in time I have not had my problem resolved as I opted to have a second opinion from another specialist. I have discovered that the implant with the fractured screw is broken. As I am in the process of identifying the cause of this I am not able to elaborate on this. However I have been told that my problem can be resolved although this will entail either removal of the implant and placement of another, placement of another implant in another position or having a removable prosthesis on 3 implants if I do not wish to opt for the more extensive work. I am now relieved that I have more realistic options and will continue to update my post with my progress.
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Thank you Jess.....I wish to keep informed on your progress. You remind me of a pioneer who is 'blazing a trail' for the rest to follow, based on your realistic and truthful experiences with the implant well as those who administer / apply the techniques. Very interesting times we live in:-) Blessings, Jaymes Washington State, USA (vivere, amere, discere)
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To update on my present position. I continue to have 3 implants and a broken screw within the implant. The specialist who I attend has not been very helpful and contradictory about my options and what he can do and has now advised me that may not be able to place the implant immediately following removal but cannot give a clear explanation of why not or give alternatives to this. He has now admitted that having only three implants would be unstable after saying they would be as strong as four as long as I did not chew toffee. He is essentially lying to me and insulting my intelligence. He is also now requesting to try a third attempt at removing the screw but I have lost all confidence in him due to his attitude. I have told him that I wish a second opinion and he tried to say that other than him there were only another 2 specialists with the experience to give me this in Scotland which is blatantly untrue. He suggested I get this second opinion from one of these specialists who is a colleague of his and would be involved in the removal of the implant. I have no intention of doing this and and seeking a totally independent opinion. I have been in contact with a clinic which has a team of dental specialists, who I hope can give me a full report on the present health of my remaining implants and also the state of the implant with the broken screw. I am hoping that following this I have the option to continue with treatment with this clinic. He has shown himself to be arrogant and intolerant in his behaviour towards me and I have lost all faith in his ability to resolve my problem and fear that he may not be totally honest about any problems that may arise. He does not appear to be concerned about the root cause of the broken implant and has no intention of investigating the cause. He also gave me a routine x-ray to look at the implant and said that there was some bone recession around the end of the implant but that the remainder of it looked OK. He was unable to see the screw. I was not given any reassurance re the recession of the bone or explanation about the possible consequences. He didn't explain why he required the x-ray and I was quite annoyed that he was very matter of fact about not being able to see the screw. When I asked How he intended to proceed if I required removal of the implant and replacement, he would only say if the screw could be removed I wouldn't need to bother about this as the problem would be resolved. In my opinion this would not be resolved as he has not given any reason for it breaking in the first place other than saying 'screws break.' With reference to your question about dental implants in Budapest, even if you had an excellent treatment plan and went ahead with having them done there you would really need to be sure you had a specialist willing to follow up your aftercare as it is very important that you have regular follow-up maintenance appointments and if anything should go wrong you may have difficulty in getting the treatment you need to resolve the situation. There are some specialists within the UK that have arrangements with specialists in some of these countries and you can go and have the implants placed overseas and they will continue with your aftercare. Maybe there are some specialists in your country (if you don't live in the UK) who offer this. I hope you find the answers to your question and get the treatment you need.
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Dear Jess123; Thank you for your review regarding the unfortunate frustrations you have experienced with the implant surgery. I live in the USA and have been contemplating it for 5 teeth, but I will only have 1 at-a-time done if I decide on it. I'm wary about medical / dental personnel and their procedures, so I research as much as I can before getting a consultation. Your review is certainly an eye opening experience, and I applaud you for coming forward with the truthful information. I'm especially proud of you for standing in your integrity and realizing when a medical practitioner is insulting your intelligence! We get that a LOT here in the USA. I would find another implant practitioner who is not associated with the one you are unhappy with. Obviously, they lack some special attention that needs correcting....either inferior material, application, and / or general knowledge. How are your implants at this stage? Do you have any additional follow-up? Blessings, -Jaymes Tenino, Washington State
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Hi Jess, your story has really made me stop and think about having all on four implant denture, I have been advised I will need a sinus lift and bone graft (from the hip) to allow me to live without dentures, but the all on four would avoid this, I'm not keen on this method as major bone shrinkage has affected my profile so bone graft would be a more favourable option, does anyone have a view of what the reputation of dental implants in Budapest is? It's impossible to have only the bone graft procedure done here without committing to the whole treatment plan, but after hearing your difficulties I am more sure than ever that is not the option I will go for. Keep us posted. Thanks good luck.
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Hi Jess, I'm sorry to hear about your troubles. The purpose of placing the two back implants on angles is greatly about instant gratification; avoiding sinus augmentation. I rarely place 4 implants as my treatment is all-inclusive with 5-8 implants. I allow people to choose between 4 implants when it is possible to perform such procedure, but most people opt for more than 4 implants with bone added under the sinuses for implant placement. Chronic sinusitis, previous sinus problems and radiation therapy may affect this surgical option. Your option after dealing with the broken implant piece retained in the bone should include sinus bone augmentation, then a new implant in that location. By adding a new implant, this will require a new set of teeth, as the ones made as the permanents currently were custom fit to the position of the previous four implants. Your bite position may have contributed to the teeth breaking. Multiple implants will help distribute more of your bite stress on the bone and a night guard may also help you from breaking teeth in the future. Keep us posted as we all wish you great outcome.
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thank you for your advice. When I had an initial consultation with the dental specialist I was only given the option of 4 implants and I took his advice as I wasn't aware of any other suitable treatment. I had been wearing dentures for quite a number of years and would have had significant bone loss but the option of bone augmentation was not discussed with me. I think the all on 4 was a new technique for him and he probably saw this as a pioneering treatment. A few other dental specialists have suggested my bite is causing problems. Unfortunately my own dental specialist has not mentioned this and has only suggested in an indirect way that my own bottom dentition was causing pressure on the bridge. I am aware of clicking in my temporomandibular joint which has been a long term issue. I wasn't aware that it caused problems with the position of my bite. I was given some exercises from a physiotherapist who was treating me for whiplash a few years ago and will begin to do these regularly to see if it improves things. The problem with the implant is the screw within the abutment is fractured and not the implant itself which is sound with no fracture to this. My dental specialist cannot remove the screw hence advising that the implant requires removal. He has not given me the option of placing more implants even though I have suggested that 4 may not have been enough. He not longer advertises this system and now recommends that the maxilla should have a minimum of 6 implants. I feel he is reluctant to admit that my problem may be partly or wholly due to too few implants and has only given me options to either try to restore the implant and adjust the bridge, to revert to dentures, or live with 3 implants which will I am sure would end in disastrous consequences quite quickly with even more damage occurring. I really have no other option at this stage but to agree to the removal and immediate placement of another implant. I am very grateful for all the advice I am being given as it is giving me some other options that I may be able to consider in the future. I feel I am a bit restricted at present as I do not believe that any other dental specialist would consider taking on my present problems with the complexities of my present problems.
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That was really nice of you doctor to take the time for this gentleman.
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That sounds great. A broken screw is much better than a broken implant. You have several options. And replacement should take a couple of minutes after getting anesthetized. Be patient, you will get your confident smile back.
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Wow thanks for sharing your story. I am very sorry for all the emotional and physical problems you have had with implants. I will be praying for you from Seattle Washington. You are not alone. I think you will possibly find some relief from this site. God Bless You.
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Jess135 :( To say you have had a rough go is such an incredible understatement. I'm so very sorry for what you have had to endure, especially when you have felt worried about how all of this will end up.

If I'm understanding correctly you went back to the same place/office that you originally had your implants placed and a different doctor was there, is that correct? Remember, there is never anything wrong with going for a second, or even third opinion. Each doctor will have their own technique and skill level, so it might be worth trying to find a doctor who can work with this tough case.

Sending you a hug and hoping there is a good, long term, solution available for you.

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I have been treated with the same implant specialist from the outset. The only occasion I saw another dentist was at a time when my own specialist was not available within the same practice. This was the occasion when one of the teeth broke. I intend to try to get a second opinion following my next visit to my implantologist when he will be trying to remove the screw. I require some frank explanations about why he is avoiding this and unwilling to clarify the alternatives to my living with 3 unstable implants. Even if the screw is removed I feel that the implant system remains at risk of further failure and need answers about why these problems have arisen. I feel he is placing the blame squarely at my door because he has no solution to the failure of the implant system and his reputation is at stake. I will pursue another opinion but I am sceptical about getting this any time soon, as I feel that other dental specialists are reluctant to either give an opinion on another potential colleagues work or may be reluctant to take any responsibility for a situation where there could potentially be an impending complaint. This type of treatment is being so widely marketed that I think it will be difficult to get an unbiased opinion from those implant specialists who perform the procedure whilst others who do not carry it out may not wish to make comment. Failing this I will see my regular dentist to see how I can have this situation resolved as it is affecting my health. In the UK fortunately we have the NHS and my health is compromised there is an obligation to treat me. As all UK citizens are entitled to free health care although dental care is income related and is not free dependent on earnings. However I should be able to get support to access a second opinion should I not be able to access this privately. There is also an organization in the UK the dental complaints service who are funded by the general dental council. This agency assist with trying to resolve disputes between dental professionals and patients. I hope I have the resilience to defend my position against a very powerful and elite profession.
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Thanks for your kind words or comfort.
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