A Dental Student's Guide to... NHS-funded implants

This month, Hannah Hook breaks down everything you need to know about NHS-funded implants, including priority patient groups, contraindications, maintenance and the discharge process.

Dental implants are screw retained prosthesis which are surgically inserted into the bone under a strict criterion to enable ‘osseointegration’.

The prosthesis retained by the screw portion can be a single tooth, multiple teeth, or dentures.

While dental implants are becoming increasingly common in private practice, there are certain situations in which they may be provided for patients with funding provided by the NHS.

The provision of NHS-funded dental implants is largely based in hospital settings following local protocols. It involves eligibility in line with acceptance criteria from the guidelines established by the Royal College of Surgeons of England (RCSEng).

Information included below has been extracted from ‘Guidance on the standards of care for NHS-funded dental implant treatment’, published in 2019 by the RCSEng.

Priority patient groups

1. Tooth loss due to congenital or inherited conditions

Hypodontia
Cleft lip and palate
Dentinogenesis imperfecta
Amelogenesis imperfecta
Dens invaginatus (type II and III)
Early tooth loss due to severe periodontal disease.

2. Tooth loss due to trauma

Traumatic tooth loss at any age associated with loss of supporting bone and gingivae
Conventional tooth replacement options (dentures/bridges) should be considered first.

3. Tooth loss due to surgical interventions

Patients who have lost teeth due to the removal of head and neck cancers or non-malignant pathology and require oral rehabilitation to help improve speech and function.

4. Tooth loss due to acquired or congenital conditions with extra-oral defects

For example, patients who may require eye or ear prosthesis.

5. Edentulous patients with repeated unsuccessful dentures

Those with severely atrophied ridges where the wearing of conventional dentures is very difficult
These patients require an assessment by a specialist prosthodontist or restorative dentist to confirm that conventional options for dentures have been exhausted.

6. Patients with severe oral mucosal disorders

Denture-bearing tissues may be compromised due to the condition of the mucosa in patients with severe xerostomia or mucosal disorders
Before implants are considered for these patients, they should be assessed by an oral surgery or oral medicine consultant to try and optimise the mucosal condition before.

Contraindications

Poor dental health

Periodontal disease: those with a history of chronic periodontal disease should be treated and their disease stabilised for at least six months before implant treatment. Increased failure rates and risk of peri-implant disease is associated with periodontal disease
Caries/apical pathology: any active disease should be treated and stabilised before implant treatment is started
Bruxism: parafunctional habits can result in a higher risk of complications such as occlusal overload and consequently fracture of the implant, therefore the placement of dental implants in these patients should be carefully considered
Compliance: poor compliance and lack of motivation is a contraindication for the placement of dental implants.

Smoking

Higher complication and failure rates have been associated with tobacco smoking due the effects of nicotine on wound healing
Patients who smoke tobacco or e-cigarettes should give up smoking for at least three months before being considered for dental implants.

Poorly controlled diabetes

Patients who have a HBA1c greater than eight are at a higher risk of complications and increased failure of dental implants
Therefore, dental implants should be avoided in these patients until their diabetes is under control.

Bisphosphonates

Patients who have received intravenous bisphosphonate treatment are at a higher risk of osteonecrosis and therefore are not usually considered for implant treatment
Those taking short-term oral bisphosphonates are at a lower risk of bone necrosis. However, they should still be made aware of the potential risk of it occurring.

Psychiatric/mental health

Careful consideration should be given as to whether dental implants are the correct choice of treatment for patients with mental health issues.

Other conditions

A detailed assessment of patients with blood or bone disorders, immunodeficiency, epilepsy, drug and alcohol abuse is also required
This is to ensure that dental implants will not be affected by the conditions.

Maintenance

NHS-funding covers the active course of treatment. But it does not extend to the post-treatment costs associated with the maintenance of the implants or future treatment should it be required
If a patient is accepted for NHS funded dental implants, they should be made aware that future costs associated with the implant will not be covered by the NHS
Further to this, there is no guarantee that future treatment or replacement costs associated with the implant will be covered by the NHS.

Discharge

Following their course of treatment, patients will be discharged back to their general dentist
Also, the provider (who placed the implant) must provide the patient and general dentist with information about the type of implant used, if grafting was undertaken and any periodontal charts or radiographs that were carried out.

Key points:

Dental implants are available on the NHS, but this is only for eligible patients under a strict criteria
There are multiple contraindications to the placement of dental implants, and these should be considered
Whilst the NHS will fund the implant treatment for eligible patients it is unable to provide funding for maintenance costs
Following completion of implant treatment patients will be discharged back to their general dentist.

Contact [email protected] for references.

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