Implantology: Better Quality of Life with Dental Implants
Titanium
Screw Implant
One of the main focuses of our practice is the placement of dental implants. Dr. Schulte has been treating patients with implants since 1986, and has set more than 2000 implants. As a specialist in oral surgery he always followed the evolution of implantology with active interest.
Until recent times, a patient affected by loss of teeth in many circumstances had to wear a partial or complete denture. These conventional prosthesis were unfortunately associated with aesthetic and functional disadvantages and could lead to psychological problems in younger patients.
Fortunately today, with dental implants it is possible in most cases to insert durable fixed prosthesis which are comparable to natural teeth aesthetically and functionally. New studies show that implants placed by a specialist have long-term success rates of 95%. These results are even better than those obtained with bridges or removable prosthesis.
- What is a Dental Implant?
- How is an Implant Placed? Local Anaesthesia, Conscious Sedation, General Anaesthesia
- Bone Augmentation Procedures, Sinus Lift
- New Surgical Methods: PRP, Piezosurgery
- Single Implants
- Implant Bridges for Partially Toothless (Edentulous) Jaws
- Implants in the Toothless (Edentulous) Jaw
- Immediate Implants, Immediate Load
- Risks and Complications
- Questions and Answers
Implantology has become a large and vast field of dentistry. For this reason we have put together an extensive amount of information for you. You can read or print the entire chapter or chose the section you are interested in by clicking on one of the following titles:
What is a Dental Implant?
Different types of screw implants
An implant is an artificial root made from a biocompatible material that is implanted to replace lost teeth. Standard implants today are screw or cylinder form made from titanium.
Titanium is a unique metal: It can be incorporated in the bone without an intermediate layer. This intimate contact between bone and titanium is called osseointegration. Another advantage of titanium is it does not cause allergic reactions, rejection, nor inflammation of the oral mucosa. Because of its biocompatible qualities, titanium is broadly used for other medical implants, for example hips, knees, etc.
Normally, dental implants have a length of 6-15 mm and a diameter of 3-5 mm. On the market there are numerous companies producing implants, but only few systems are supported by scientific studies and long-term results.
In our practice we use implants of the following companies:
These companies are market leaders with decades of experience and are continuously improving their systems backed by excellent long-term results.
How is an Implant Placed?
Careful planning is the first step preceding an implant operation. With help from x-rays and study models, the amount of bone is measured in length and width, so the ideal position for a suitable implant can be planned.
Bone measurement x-ray
Implantation is a surgical intervention performed under sterile conditions that can take between 45-90 minutes. Implantation can be done without pain using local anaesthesia. Nevertheless, the procedure can be stressful for some patients. For this reason, we offer treatment to be done under conscious sedation, using nitrous oxide (laughing gas) or other sedatives. The advantage is complete relaxation and comfort for the patient.
For larger operations, like bone augmentation, or for dental phobic patients, we can also offer general anaesthesia. An expert team of anaesthesiologists can accompany us within the Clinic St. Anna, or in our private practice.
After the gum tissue is numb, it is carefully opened. With a sequence of calibrated burs, the implant bed is prepared. To prevent overheating of the bone, preparation is done with sterile water cooling. The suitable implant is chosen and placed. The gum tissue is sutured over the implant and a temporary prothesis or bridge is seated.
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Uncovering the Implant
After the implant has integrated into the bone for 6-12 weeks, a small procedure is performed to expose the head of the implant. This procedure is often done by laser because it guarantees proper wound healing and is almost painless for the patient. After the exposure of the implant head, we take an impression and send it to the laboratory where the prosthetic work (bridge, crown or removable denture) is made.
Bone Augmentation
(1)
(2)
(3)
(4)
Narrow bone ridge: Before implantation the bone is built up with
a block transplant (1). Smaller defects are filled during
implantation with bone chips or bone substitutes (2-4).
Frequently the height or width of the jawbone is reduced by bone atrophy, leaving the existing bone volume insufficient to support an implant. In this situation, bone augmentation is necessary. It can be done before or at the same time of implantation. The best material for bone build-up is the patient's own bone (autologous bone) taken for example from the mandible. Only in extreme cases of bony atrophy a bone graft from an extraoral donor site is needed (for example from the hip). The bone graft is taken as a block and fixed with small titanium screws or is ground into granules and covered with a special membrane. After 6 months, the bone is integrated and the implant can be inserted.
For smaller bony defects a bone substitute material (BioOss®) can be used. Within a 6-12 months period, the patient's own bone will absorb and replace the substitute. Advantage: No bone graft procedure is necessary.
Sinus Lift (Sinus Floor Elevation)
A special kind of bone augmentation is the sinus lift. In the molar region of the upper teeth, the large sinus cavity provides less bone volume, which can make implantation impossible. Here the sinus lift procedure can help: Through an operative access from the mouth, the sinus floor is exposed and the covering mucosa membrane is carefully lifted. The new formed cavity is then filled with bone chips or synthetic bone material. In case of sufficient height of the alveolar bone, the implants can be immediately placed. If the bone volume is insufficient for a stable anchorage of the implant, the bone is first built up and implants are placed after six months into the reconstructed bone.
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Smaller defects are filled during implantation
with bone chips or bone substitutes | |
PRP: Growth Factors from Own Blood
New strategies aim to shorten the healing period that can be uncomfortable for the patient. This can be performed by adding factors that stimulate the bone growth and accelerate the integration of the implant. In this context, a decisive role is played by thrombocyte concentrates from the patient's own blood (PRP= Platelet Rich Plasma). A part from blood platelets, it contains multiple growth factors in high concentration. This leads to a faster bone regeneration and wound healing even for high-risk patients (diabetics, smokers). In our practice we use the automatic PCCS system from the 3i company to produce PRP. With only 60 ml of blood it makes sterile PRP concentrates of the highest quality.
Piezosergury: A New Surgical Device
Piezosurgery is a new method of bone surgery, developed by Prof. Tomaso Vercellotti that opens promising perspectives for dental implantology. Delicate hard metal scalpels that utilize microvibrations at an ultrasonic frequency, allow bone to be cut in an extremely gentle and atraumatic way. But the biggest advantage of piezosurgery is its selective cut: That means, hard tissue (bone) is easily cut while soft tissue (nerves, blood vessels, oral mucosa) remains unharmed even if it gets in direct contact with the instrument tip. Another benefit of piezosurgery is it avoids intraoperative bleeding, it doesn't traumatize the bone, therefore, wound healing is much better.
We utilize this innovative technique mainly for bone transplants, sinus lift procedures, and for all operations involving nerve tissue.
More Information about Piezosurgery.
Indications for implants:
There are three main indications for dental implants:
- Single implants, when only one tooth is lost
- Implants for the partially edentulous jaw
- Implants when all teeth are lost (Edentulous jaw)
Single Tooth Implants
Standard treatment of the past:
A missing front tooth
is replaced with a bridge
after the preparation of
the neighbouring teeth
In the past, when a single tooth was missing, the standard solution was to place a bridge after preparation of the healthy neighbouring teeth. The consequence of this treatment in some cases was damage of the nerve (pulp) which then needed root canal treatment. The crown margins can also provoke gum recession with compromised aesthetic results.
A singular implant can be placed in the exact position of a lost root. During the healing phase of a few weeks, the implant stays covered by gum tissue. In this time the patient wears a temporary which can be fixed or removable. After the uncovering of the implant and the impression, the crown is made in the laboratory and then placed onto the implant.
A missing incisor is replaced by an implant.
Left: X-ray with implant and temporary adhesive bridge.
Middle: An impression post is screwed on the implant.
Right: The completed implant crown,
leaving the neighbouring teeth healthy and intact.
Implants for Larger Gaps
Fixed implant supported bridge:
Before only removable
partials were a possibility
If several teeth are missing, it is considered a partially edentulous jaw. In the past, when a bridge wasn't possible, a removable partial was the only option. With implants, the gap can be closed with a fixed implant bridge, without a removable prosthesis and without damaging healthy neighbouring teeth.
Prosthetics yesterday and today:
Yesterday: Removable partial denture with clasps
Today: Bilateral replacement of the missing lower molars with fixed,
naturally looking bridges and crowns on implants
Edentulous (Toothless) Jaws
Two implants in the edentulous
mandible are connected with a
bar.
An attachment is integrated in
the denture and provides
a stable hold.
Until now, the loss of all teeth meant wearing a full denture with the possibility of the following consequences: Poor fitting denture, especially in the lower jaw, limited chewing function, reduced sense of taste, sometimes involuntary gag reflex or distorted pronunciation (phonics).
The denture exerts continuous pressure on the jaw bone. This can provoke further bone loss and poor fitting of the denture. Removable dentures are an insufficient support for the facial tissue. This can result in premature wrinkles and aging appearance.
With dental implants, it is now possible to break this vicious circle. With 2-4 implants and mounted attachments, the prosthesis gains a stable fit.
With more sophisticated constructions (6-8 implants per jaw) it is possible to place a fixed implant bridge. Implants have a bone maintaining effect: Bone atrophy doesn't occur even under chewing pressure. The good lip support provides a harmonic facial profile and taut skin.
6 implants in the edentulous mandible and fixed immediate bridge (immediate load)
An edentulous patient before and after treatment with implants: Improved support for the facial tissue and therefore a younger appearance.
Immediate Implants
Immediate implant placement is the seating of an implant at the same time as the tooth is removed. Today this procedure is considered standard and allows the surgical treatment to be completed in one intervention. Only in special cases, for example acute infection, it is better to first remove the infected tooth and allow healing before the implant is placed.
Immediate Load of Dental Implants
A traditional implant treatment consisted hitherto of several phases:
- Tooth extraction
- Implantation (if immediate implant, at the same time as extraction)
- Unloaded healing phase (6 weeks - 6 month)
- Uncovering of implants
- Prosthetic phase
The long waiting time from the beginning to the end of treatment was a problem for the patient, especially if sufficient temporaries could not be placed. Sometimes, when all teeth were replaced by implants, the patient had to wear a full denture until the complete bony integration of the implants.
In such cases, immediate load of dental implants can be an advantage. In one appointment, also under general anaesthesia, all teeth are removed, the implants are seated, and a temporary bridge is connected to the implants. This new technique offers the patient much more comfort and less chair time.
Though it must be mentioned that immediate load of implants is only possible if volume and quantity of bone are sufficient to guarantee a strong anchorage of the implants. Otherwise it is safer to proceed according to the conventional method, leaving the implants uncharged until the healing phase is complete.
Risks and Complications
In the meantime, the high success rate of implants is well documented. In routine cases, 10 years after implantation, over 90% of implants placed by a professional surgeon, are still in function. These are encouraging numbers that not all medical fields can offer. Nevertheless, with careful planning and execution, failures sometimes occur:
Implants or bone build-ups can be lost by bacterial infection or overload. Rarely, sensory nerves or neighbouring teeth can also be affected.
Risk factors for implant loss are:
- Bad oral hygiene
- Heavy smoking
- Pronounced osteoporosis
- Poorly regulated diabetes
Questions and Answers on Dental Implants
- How long do implants last?
The durability of implants has been studied for about 30 years. The results prove that with good oral hygiene and regular check-ups, implants set by an expert surgeon can last a lifetime.
- Are implants an option for all patients?
Generally speaking, yes, except for some rare case. The patient's age does not play a role. Implants in older patients have the same good prognosis as in young patients, if they are maintained with good oral hygiene.
- What are Pros and Cons of implants?
- With implants, it is possible to make an aesthetic fixed prosthesis even in cases where earlier a removable partial or full denture was the only possibility. Another advantage is there is no preparation of the healthy neighbouring teeth. Implants can prevent bone loss and give a stable fit to full dentures.
- Surgical intervention can be perceived as a disadvantage, as can the healing time for the implant. In same cases implant treatments may be more expensive than conventional prosthesis or bridges.
The advantages and disadvantages of an implant treatment must be considered for each individual case.
- Is implantation painful? What can I expect after the operation?
With local anaesthesia the operation is absolutely painless. Upon request it can be done under conscious sedation or general anaesthesia. After the treatment it is normal to feel soreness for a few days. This can easily be controlled with the pain medication. Some visible swelling is normal for 3-5 days, sometimes bruising occurs but will fade rapidly.
- How long is the healing period and can I wear a temporary prosthesis during this time?
The healing time required for an implant before the crown/prosthesis is placed, depends on the bone quality and the number, length and diameter of the implants: In ideal cases when several implants are involved the prosthesis can be immediately placed. Otherwise it takes normally 6-12 weeks until the implants can be uncovered and loaded. If a bone augmentation is necessary, it lengthens the healing period up to ca. 6 months.
We make a fixed or removable temporary prosthesis at the time of implantation so after the treatment the patient is not without teeth.
- Is smoking bad for implants?
Today it's known that heavy smokers (more than 10 cigarettes/day) have a higher risk to loose implants than non-smokers. The major risk for smokers is complications involving bone augmentation.
- Is the quality of all implants equal?
There are many implant-producing companies on the market, but only few have long-term studies to support their products. We use implants from Straumann (CH) and 3i (USA) that have a complete scientific documentation. Furthermore, these market leaders guarantee the component supply even after many years. This is extremely important when, for example, after ten years a connecting screw must be replaced.
- What is your opinion of "Fixed teeth in one day"?
Promises made in advertising are not always reality. The immediate load of implants, meaning, the immediate connection of a fixed prosthesis on freshly placed implants, brings the patient a relevant advantage of time and comfort. However, in every individual case these advantages must be weighed against the potential risks, which are not inconsiderable. It is important that the surgeon has a solid experience of this new technique. We perform immediate load procedures only if the advantage for the patient clearly prevails.
- How must I clean my implants?
The rules for implants are the same as for natural teeth. Good oral hygiene is recommended and beneficial. The use of interdental brushes is helpful to keep clean between implants. Our dental hygienists can give you instruction for a correct cleaning technique.