Everything you need to know about implants
Are you thinking about implant placement or have you already decided on an implant?
This text should provide you with general considerations regarding implants and implants. In dental practice, implants are increasingly used in patients after tooth loss. Implant placement treatment has proven to be a stable, functional good and long-term successful measure while providing high comfort for patients.
Therapy is based on an initial assessment that applies to each patient individually and varies greatly. For this reason, detailed information regarding treatment methods, implant materials and systems can only be clarified through a personal interview with the implant physician. , oral surgeon, maxillofacial surgeon).
Implants can replace individual teeth or a larger number of missing teeth. In addition, they can form a fixation system for extensive fixed dental restorations (bridges) or removable dental restorations (dentures), in case some teeth are missing in a satisfactory number.
The structure of the implant consists of the following components:
The body of the implant that is implanted in the bone
Upgrade parts (column, abutment) for fixing the tooth crown to the implant body
Crowns or structures for fixing dentures
There is a difference between a system of two-part and one-part implants. In the case of two-part implants, the body of the implant and the part for the upgrade are separated. When it comes to one-piece implants, the connecting element for dental restoration is made in one piece with the body of the implant.
Two-part dental implants are often used, for the reason that in this case it is ensured that the implant is not loaded during the healing phase.
IMPLANT MATERIALS AND SYSTEMS
Highly purified titanium is mainly used as the basic material for dental implants. This material is particularly suitable in relation to tissue (biocompatible) and forms a secure bond with bone (osseointegration). From the biological aspect, it behaves neutrally and does not cause any allergic or foreign body reactions.
There are a large number of different implant systems in the world for dental practice. Cylindrical, ie screw-shaped implants, proved to be particularly good. The cavity in the jaw bones in which the implant is placed should be made with a rotating instrument (drill). Compared to other systems, this surgical procedure is faster and simpler, burdens the patient less than other implantation techniques and rarely leads to complications in wound healing and implant growth.
Screw-shaped implants have the advantage of being firmly fixed to the bone immediately due to their threads (primary stability). This shortens the growth time because only a small amount of bone has to form around the implant.
INICTIONS AND PREREQUISITES FOR DENTAL IMPLANT INSTALLATION
Dental implants are used to make up for missing teeth. In doing so, it is theoretically possible to replace each lost tooth with an implant. With the loss of individual teeth, this is certainly expedient, while in the case of complete edentulousness, it is not necessary. When it comes to fixed bridges, as a rule, (4-) 6-8 implants per jaw are enough. Functional improvement by applying a large number of dental implants is generally not possible.
A typical reason for performing implantation with approximately 10-20%, in all cases, is the restoration of individual teeth. In this case, individual teeth that were lost due to injury, periodontitis, caries or after unsuccessful endodontic treatment, ie resection of the root tip, are compensated by installing implants with a crown.
Care of individual teeth through implants is a fixed dental restoration, which means that there is no connection between the implant and the upgraded crown that can be separated (by the patient). One of the possibilities is also the fixation of artificial crowns for the implant by means of a screw (or implant upgrade). The screw opening is closed with synthetic material or ceramic if it is in a visible place. Gluing or cementing is often used. The standardized or individually adjusted upgrade is firmly connected to the implant with a screw and the crown is cemented to that stump.
Indications for implantation
Single tooth implant
Closure of larger edentulous regions
End of dentition. Replacement of non-existent molars
Significant reduction in the number of remaining teeth
Total compensation; complete toothlessness
Prerequisites for performing implantation
Sufficient bone volume to anchor the implant
Enough space for prosthetic augmentation (crown)
Good oral hygiene
Jaw development completed
Taking into account contraindications
(The method of care depends on the situation of the tooth and is determined by the attending physician when planning the implant placement.)
Medical reasons that are not in favor of implantation (contraindications) are circumstances that make such a procedure either impossible (absolute contraindication), or lead to the possibility of special dangers (relative contraindications)
General medical contraindications:
Drugs that affect bone metabolism, for example, bisphosphonates
Untreated or insufficiently controlled diabetes mellitus
Decreased immune defense of the organism due to either disease or drugs (for example, cortisone therapy, use of cytostatics ...)
Severe cardiovascular disease
Generalized connective tissue or bone diseases (e.g., rheumatic diseases)
Certain psychiatric illnesses
In smokers, it must be borne in mind that the short-term success of the implant (osseointegration) is lower and that the rate of implant loss can be increased to a factor of 4.
In these patients, long-term success is lower. For this reason, it should be understood that the prescribing dentist and implantologist cannot provide smokers with any guarantees regarding the success of the implantation.
Locally conditioned contraindications (and appropriate measures):
Insufficient volume of existing bone: bone augmentation (augmentation)
Poor bone quality: proper implantation technique, a procedure that makes the bone thicker
Endangerment of important structures (nerve branches, maxillary sinus or roots of adjacent teeth): appropriate implantation technique and use of imaging procedure and, if necessary, application of computer technique
Diseases of the jawbone, oral mucosa or dental support apparatus: treatment of the underlying disease
Unclear painful conditions at the level of the jaws: conducting diagnostics, treating the underlying disease
Unfavorable bite ratios (for example, too little space for the crown): if necessary, the use of methods from jaw orthopedics or surgery
Creaking of bruises (bruxism): therapeutic use of rails
Incomplete jaw development: wait for the end of development
A range of local, biological-anatomical or functional circumstances can jeopardize the success of implant treatment, both in the short and long term. Such circumstances generally do not preclude the performance of implantation, but often require appropriate application. Therefore, careful examination and determination of the condition before treatment is one of the prerequisites.
ADVANTAGE OF IMPLANTS
Prophylaxis of bone loss (maintenance of bones that break down without mechanical load)
Spare healthy teeth
Increased number of bone beams (provides a solid support for dental restoration)
Very good therapy for tooth loss due to gingival inflammation (implants for periodontitis)
Routine procedure mostly risk-free
Good to very good prognosis, economical therapy due to mostly long lifespan
RISKS IN IMPLANTATION
Deciding for or against implants is certainly often accompanied by the concern that complications (for example, loss of implants) may occur within the therapeutic use of implants. Taken as a whole, implant therapy is one of the procedures that are characterized by low risks.
The risk of premature implant loss in uncomplicated conditions is below 5%. The individual risk for the patient can be well assessed after a thorough examination by the attending physician. Thus, problems arising from specific anatomical circumstances can be largely avoided (for example, injuries to nerves, adjacent teeth, opening of nasal or jaw cavities).
(Your doctor will provide you with detailed information in this regard.)
In order to avoid the occurrence of postoperative complications (disturbances in the healing process), you as a patient can be of significant help to minimize the risks. In the text that follows, you will receive important notes in this regard.
Late complications are rare and mainly related to chronic infections. However, the frequency is increased in patients with certain general diseases (see contraindications in smokers as well).
periimplantitis due to poor hygiene
Periimplantitis is a disease that can occur in patients with implants. It is similar to periodontitis of natural teeth.
As is the case with natural teeth, implants and implants that carry dental restorations create plaque. If these deposits are not thoroughly eliminated, the gingiva becomes inflamed first (gingivitis). Periimplant gingivitis is repaired after the removal of the deposits that caused it, as a rule without complications.
If the deposits are not carefully removed, the inflammation further affects the bone.
This causes the bone around the implant to break down due to so-called periimplantitis. The implant begins to loosen. Failure to take timely treatment can result in implant loss. Precisely in order to prevent the occurrence of periimplantitis, great attention should be paid to maintaining optimal oral hygiene.
Periimplantitis is more difficult to treat than natural teeth. The release of plaque biofilm from the surface of the implant made of synthetic material (mechanical cleaning) by the attending dentist is more problematic, due to the fact that during cleaning, the surface of the implant structure can sometimes be damaged. Therefore, sometimes the initial condition cannot be re-established, which may be the cause of the subsequent failure of the therapeutic measure.
In addition to mechanical cleaning of the implant, it may be necessary to target the pathogenic bacteria present.
Implant loss is a rare but disappointing outcome. The resulting defect in the bone can be closed again with the newly formed bone, so that if possible, the implantation can be repeated. Also, in the case of implant loss, there is no limitation in terms of care using ordinary dental restorations (for example, care using bridges).
PROCEDURE - IMPLANTATION
Before implantation, it is necessary to ensure optimal oral hygiene and, if possible, stop smoking. Gingivitis (gingivitis), as well as diabetes, must be further treated. Caries treatment should be completed. Insufficient bone volume in the jaw, among other things, is the reason for the next necessary preparation procedure, in which bone mass is added.
If there is not enough bone mass, either implantation is abandoned, or the bone must be upgraded so that the criteria for prognostically favorable implantation are met. This procedure is called augmentation.
In this case, the desired bone, the material that replaces the bone or both elements together is applied to the desired place, where after that, little by little, there is a physiological remodeling of the bone in the jaw bones that can be loaded.
In this case, prophylactic use of antibiotics is often recommended, in order to prevent bacterial inflammation.
PREPARATION FOR DENTAL SURGERY
Before the dental procedure, the oral cavity is disinfected with an antiseptic solution (for example, chlorhexidine). Prophylactic use of antibiotics during implantation is recommended before and if necessary during the procedure, which prevents inflammation that can lead to implant loss, as well as the appearance of bacteremia (transient presence of bacteria in the blood).
DENTAL SURGERY (IMPLANTATION)
Implants, as a kind of "artificial tooth root", are implanted in the jawbone, mainly with the use of local anesthesia. It is a single-bone implant. At the planned place, the mucosa is cut and placed laterally, and the implant bed is gradually processed according to the individually determined length of the implant and its diameter. The preparation is performed using a rotating instrument (drill) at low speed with constant cooling with saline in order to avoid excessive heating of the bone.
After implant placement, a gingival suture is placed. Wound healing, under normal conditions, is completed after 10 days.
The length of the bone healing phase without load depends on the quality of the bone itself. In accordance with the acquired experience, during the period of healing, a (provisional) dental replacement is placed on the implant. In the healing phase, the jawbone usually takes several weeks to reach a stable connection between the bone and the implant. This phase, when it comes to the upper jaw, depending on the condition, lasts on average 3-6 months, and when it comes to the lower jaw, on average 2-3 months. In some cases, so-called "immediate (immediate) loading" is possible.
After healing, which is "invisible" to the patient in most implant systems and takes place under the mucosa, another operation is performed during which the implant is released. At that moment, or a few days later, the shaping and completion, that is, the merging of the dental restoration elements, may follow.
During further treatment, a supraconstruction is placed (dental restoration that is visible in the oral cavity). For that purpose, with two-part implants, an upgrade (supporting column, abutment) is inserted into the artificial root of the tooth, and then the planned dental restoration is carried out in several phases.
SUBSEQUENT TREATMENT AND MAINTENANCE OF IMPLANTS
Immediately after the implant care, the place of the operation should not be burdened. Excessive cleaning procedures (eg with a hard toothbrush) directly at the level of the suture should also be avoided, and the remaining part of the teeth must be cleaned very carefully.
Prophylaxis of infection in the first hours after surgery plays a key role. Antiseptic mouthwashes are available as additional prophylaxis.
And later, dental implants must be checked regularly because of the danger of inflammation. Timely detected infections are significantly easier and more efficient to treat than advanced ones, which have already led to the breakdown of the jawbone.
For that reason, it is necessary for the attending physician to monitor the condition of dental implants every 3-6 months. In addition to the usually good oral hygiene necessary for the good condition of the oral cavity, it is necessary, in accordance with the method of care, in addition to normal toothbrushes, to additionally apply special additional means and techniques for cleaning dental implants. To this end, the implants should be cleaned with a special dental floss with a soft cleaning segment or with special toothbrushes for interdental brushes.
Careful maintenance of oral hygiene
Dental floss and / or interdental brushes
Supplementary: antiseptic mouthwashes (eg chlorhexidine)
Adherence to the terms of regular dental check-ups