Implant Dentistry
Implant dentistry, implantology
A dental implant is the optimal solution for anyone who is missing one or more teeth. They can be tailored to different needs so virtually anybody can get teeth that look and function like natural teeth. 

A dental implant is suitable for the replacement of one or more teeth. It is an artificial tooth root made of titanium. The recently popular form of an implant is a screw or a graded post. The material is pure titanium, the surface of which is specially designed to be built into the bone and connected to the gum-tissue. Titanium is the most tissue-friendly material. No allergic reactions to this metal or reactions in the tissue develop.

Dental implants � Dentures consist of 3 parts

  • The first part is the implant itself to be built directly into the jaw-bone.
  • The second part is the abutment, which is placed on the implant after the healing period. This is the connection between the implant and the denture through the mucous membrane.
  • The third part is the denture to be attached to the implant.

Dental implant

Dental implants - pictures

Prior to treatment, a very thorough examination is necessary. Therefore a so-called panoramic X-ray is required. This can also be taken at our dental office. However, it is difficult if not impossible, to advise if the panoramic X-rays sent to us are older than three months.  During treatment, the conditions of jaw-bones and good oral hygiene is critical and important.

To place a dental implant, an outpatient operation is carried out. Depending on the state of dental health, the mucous membrane is cut  open and the surface of bones is cleaned. The operation is performed under local anaesthesia. The implant is embedded by means of a gradual surgical bone-drill. During drilling the area shall be flushed with physiological saline in order to cool and keep it clean. The implant is screwed into the place prepared.
Then the mucous membrane is closed over the implant.
The implant can be totally covered or be visible through the mucous membrane with the help of a healing abutment during the medical treatment. Sutures closing the wound are generally not necessary. If they were, they can be removed after 8-10 days.
The placement of the implant puts less strain on the body than a tooth extraction. In ideal conditions and in the case of an infection-free area it produces a well-closing wound. The operation is not painful and the occurence of pain afterwards is also negligible. The most unpleasant part of the operation is that the liquid used for cooling should not be swallowed and has a salty taste. The operation takes one to two hours if several implants are placed at one sitting. If the bone structure is not highly consistent, iit can be filled in with bone substitution material or autogenic bone to support the implant.
If bone substitution is unnecessary, the operation can be performed only through a 3mm hole without exposure. Following a thorough preparation the operation is much shorter and smaller and the result is even more precise. Sutures are not necessary.

Types of dental implants

Complications, difficulties

Dental implants - pictures
In the case of serious diseases, e.g. blood diseases (leukemia), unset diabetes, permanent aortic stenois, chronic diseases of the immune system, rheumatic diseases, serious liver and kidney disorders, inadequate general physical condition, alcohol, nicotine, drug addiction, and in the case of regular taking of Cortison, Immunesuppressiva and Cytostatica the implantation is not recommended.

As in the case of all surgical interventions, problems may also arise with implantation.
In the lower jaw-bone a nerve being responsible for the movement of lips goes from the middle to Kleimoral . The canal covering this nerve is usually visible in an X-ray photograph.
During operation this situation is taken into consideration. In some rare cases, however, the implant may reach, press or damage this nerve. As a result, the patient may incur deafness, motion or pain during the operation. If deafness persists after the local anaesthetics wear off (after 6-8 hours) or you experience any deficiency in sensory perception or movement, you shall immediately inform your doctor. In this case the implant may have to be removed. Delay in doing so may result in permanent injury!

In the maxilla the opening and reaching the jaw-bone cavity may cause problems. In such a case the course of the operation shall be changed or a jaw cavity operation shall immediately be performed. If neither of them is possible, no implant must be placed. Irreversible complications are fortunately very rare.

The consistency and the condition of the bone may not come up to expectations. Should this be the case, immediate bone augmentation or a change in the treatment plan is required.

Other complications, e.g. serious bleeding, injury of soft tissues can occur but are very rare. After the operation a slight swelling and/or moderate bleeding are normal reactions of tissues.
We must accept the fact that in certain cases the actual treatment may divert from the one drawn up in the treatment plan. Modifications may be necessary due to complications, e.g. instead of the fix denture proposed in the treatment plan a bridge or a magnetic denture will be made. Unfortunately, modifications can also affect the cost of treatment. The preliminary cost estimate is always given on the basis of treatments proposed in the treatment plan and as such disregards last-minute, albeit justified modifications.

Application of the abutment

Dental implants - pictures
The osseointegration of implants takes two to four months in the lower jaw-bone and four to six months in the maxilla. During this period of time, the bone tissue overgrows the implant. If the implant is fixed stable during the operation, the abutment can also be attached immediately, but it can be loaded only gradually until it fully heals. In most cases, though, implants are liberated/exposed after the healing period of 6 weeks or 4 months. Initially,a small incision is  made in the mucous membrane and the implant is liberated. After the removal of the healing abutment the final one is screwed into the implant. In the anterior area of teeth, gums may also need to be shaped.

Making permanent dentures

There are are three different types of dentures: removable, bar-retained (may be removed for cleaning) and fix dentures. For an edentulous jaw a removable, implant-supported denture allows better stabilisation (in the maxilla with at least 4 implants, in the mandible with at least 2 implants).
A fix denture can be anchored to the implant with a screw or be bonded to the implant so that it can be replaced or repaired when necessary.
Natural teeth are prepared according to the treatment plan.

Number of required treatments
  • Appointment, examination, treatment plan
  • planning
  • Implant surgery
  • Removal of sutures after 8-10 days (in most cases sutures are not required)
  • Implant liberation and the shaping or correction of the surrounding soft tissues 6 weeks or 3-4 months after the  implants were placed  
  • Placing the abutment(s), taking an impression,  
  • Fitting
  • New tooth replacements are fitted 
  • Check-up

In an ideal case, the number of appointments  may be reduced to two or three sittings.  If complications develop, further visits may be required.
The list above details the individual steps in the routine. 

Oral hygienie, control
Titanium is naturally not carious but gums around the implants are more sensitive. Therefore, implants should be kept clean more carefully than natural teeth. The area surrounding  the implant is left open so food packs up more easily. You have to remove the food packs regularly and thoroughly.  Specially designed brushes can help clean the implants and the gum tissue around the implants. If food packs are not removed properly it may cause gingivitis. Gingivitis leads to the deterioration of the bone and eventually to the loss of the implant. Tartar is one of the biggest enemies of implants and must be removed immediately after appearance. Once a year a check-up examination is necessary. Cases demanding a special attention and care are observed with the utmost precision. 

Life expectancy
As a rule, an implant is successful if it functions for at least 5 years. Statistics of several million surgically placed implants show a success rate of around 95-98 per cent. In the case of smoking, the risk of complications is much more considerable.  First, it depends on proper oral hygienie whether the implant causes complaints or not. Thorough cleaning, semi-annual or annual check-ups and tartar removal are essential.

 
 
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