Implantation is a type of dental prosthetics where the entire missing tooth/teeth is/are restored. Both roots and crowns are restored. That is, the tooth or all teeth are restored by means of implants when they are missing and other types of prostheses cannot be used.
How are lost teeth restored?
When all teeth or part of them are lost, four solutions are possible.
- Missing teeth can be restored by means of removable dentures (dentures with metal framework, full plastic dentures, partial plastic dentures). This option is most reasonably priced; dentures of this type are fabricated very fast, yet they are most inconvenient to use in every sense because the longest period of adaptation is required (see Prosthetic Dentistry).
- Missing teeth can be restored by means of bridge dentures (see Prosthetic Dentistry). This option is fast and convenient to use, however, adjacent teeth located next to the cavity need to be polished and dentures have to be made for them. Where adjacent teeth are badly damaged, dentures will reinforce them. However, if these teeth are healthy or nearly healthy, polishing reduces their lifespan. Besides, by harming the teeth which are healthy we as though violate the principle of doctoral ethics: first, do no harm (in Latin “Primum non nocere”. This principle has been formulated based on the works of the famous Hippocrates).
- Missing teeth can be restored by means of implants: adjacent teeth will not be damaged, and there will be no need to take dentures out.
- Lost teeth may be unrestored at all. Technically, it is possible to restore teeth nearly any time, however, it depends a lot on the client’s financial situation. Nowadays, there is no reliable scientific data that it is necessary to have thirty two or twenty eight teeth throughout the entire life. How many teeth do humans need? It is very individual... Therefore, patients should be asked first, how many teeth exactly they need to chew food properly, pronounce sounds clearly and look good. Responses vary greatly, indeed. Our needs are very different, yet there are certain regularities. Normally, they depend on age. Older patients say that a row of twenty teeth facing each other without any cavities is sufficient for them (ten in each jaw). What is interesting that children have twenty deciduous teeth and do not complain lacking them. However, let’s analyse what it implies to have twenty teeth, no molars, just incisors and pre-molars. They are certainly sufficient for chewing food and producing clear sounds (quite a large number of older patients say that even fewer than twenty teeth are sufficient for them), however, not all of them will like the fact that when speaking and smiling the end of the dental row will be visible, i.e. dark gaps at the corners of lips. Consequently, at least one molar in each jaw is required for aesthetical purposes. So, the majority would agree that a minimum number of teeth meeting the needs of chewing, sound production and aesthetics is twenty four (teeth are present on each side of the jaw till the first molar inclusively).
What is a dental implant?
One of the most modern and successful methods of restoring lost teeth is a dental implant. It is not a completely new method of treatment. It was used even by ancient civilisations. In 1965, the first modern treatment of this type was performed in Sweden. Over recent decades, dental implantology has become a daily routine in practical dentistry due to rapid development of implantology science.
A dental implant is an artificial root shaped as a screw which is screwed into the bone and a crown is attached to it.
How are implants secured in the bone?
An implant has a macro- and micro-rough surface. As an implant is made of material which is not rejected by the body, an implant simply fuses to the bone and is as though locked inside. This is called osseointegration. The ability of titanium to osseointegrate was discovered in Sweden in 1957.
What are dental implants made of?
Most commonly, dental implants are made of titanium (Ti). This metal is widely used in medicine because of its excellent biocompatibility with own tissues. The body does not reject titanium. Allergy to titanium affects 0.6 % of human population.
Dental implants made of other materials (e.g. zirconium oxide ceramics) have not proven to be reliable in practice.
Where are dental implants manufactured?
Currently, there are hundreds of dental implant manufacturers. A manufacturer is selected by the doctor based on the reliability criteria of both the doctor and the patient. Very often, a decisive factor is the price or marketing tricks used. However, long-term prospects of dental implant use are sometimes overlooked. These “gadgets” are placed in the body.
When choosing an implant system, the following questions have to be clearly answered:
- Is the working culture of people manufacturing implants and taking care of their quality high?
- If an implant is rejected by the body, will there be any doubts that this might have happened due to the manufacturer’s fault?
- How the bone will respond to these implants in the long run?
- Do these specific implants have any scientific grounds in general?
- Is the quality of this manufacturer’s production constantly monitored by independent experts or are long-term clinical trials performed?
- Is it an old and reliable manufacturer treasuring its reputation?
- Won’t the manufacturer disappear one day and spare parts will be required for the maintenance of implants in the future?
- Is the manufacturer well-known among specialists of implantology and is it possible to repair dentures in different countries?
Dental implants with a different price tag, yet produced by reliable manufacturers only, are used in our Clinic taking into account our patients’ needs, for instance, Swedish Astra Tech implants manufactured by Dentsply Implants (see www.implantsforlife.com , www.dentsplyimplants.com).
This long-standing manufacturer with high business culture is justly considered one of the major inventors of the ‘wheel of Implantology.’ Namely the scientists who created Astra Tech implants came up with a number of inventions without which modern dental implants are unimaginable: they were among the first ones to start using a high-precision, conical abutment for attaching the dental crown to the implant and the concept of different platforms, they were also the first ones to start roughening surfaces of implants and using microthreads for the dental neck. Therefore, the system of Astra Tech implants is famous around the world for being the best scientifically-founded system of dental implants ensuring the best protection of the jaw in the long run.
When dental implants are used?
Generally, dental implants are used for restoring lost teeth or supporting removable dentures.
An implant when one tooth is missing and polishing of adjacent teeth is undesirable
An implant when several adjacent teeth are missing
Implants when all teeth have been lost, fixed dentures on implants
An upper denture on an implant, a lowe denture on an implant
When a removable denture is not stable in the mouth, it can be secured to implants by means of special attachments.
How conventional dental implantation is performed?
1. During the first appointment, the condition of patients’ remaining teeth, gums, jaw bones is examined and the therapeutic plan is developed. Therefore, a panoramic X-ray picture has to be made where both jaw bones with remaining teeth are visible. In case of unclarities, the doctor may recommend an additional examination of jaw bones by a computer tomograph.
2. A dental implant has to be secured in the bone in the same way as a natural root. Therefore, upon sufficient anaesthesia, a small incision is made in the gums where a tooth is missing to expose the bone. An opening is made in the bone by means of special sterile drills where an artificial dental tooth is screwed. If the implant is well secured and it is coated by bone on all sides, a higher cover is screwed immediately which sticks a little from the gums as a small metal tablet. Where an artificial root is weakly secured in the bone or the bone grafting procedure has been performed (see Jaw Bone Grafting), a low cover is screwed and the implant is completely sutured under the gums.
3. In a week, the patient is invited for examination, sutures are removed.
4. In 3–6 months after implantation, depending on the initial condition of the bone, the production of a dental crown of individual shape and colours starts. A tooth may be attached to the implant by special cement or screwed. In our Clinic, the most common method of securing is screws so that a denture could be taken out and repaired easily when required.
Is dental implantation painful?
Implantation is performed with local anaesthesia; therefore, patients do not feel any pain during the surgery. After the surgery, pain killers are prescribed just in case the patient starts feeling a nagging pain. In case of a wide-scope implantation or bone grafting, a more severe pain, swollenness or a bruise are possible during the first week. However, the healing period (from 3 to 6 months) is by no means painful.
After any surgery performed in our Clinic, all patients are provided with the Guidelines: how to take care of the oral cavity, what to eat, what phenomena are normal after the treatment, and in what cases the patient should see the doctor without any delay.
Is incision-free dental implantation possible?
Incision-free implantation (a.k.a. no-flap implantation) is a fast procedure causing only minor post-surgical discomfort to the patient. A dental implant is placed after making only a small opening in the gums. As the top of the implant fills in the gap, there is no need for suturing the wound.
In our Clinic, this methodology is applied when the jaw bone where a tooth is missing is wide enough, i.e. the bone and fixed gums are sufficient (see Jaw Bone Grafting and Gingival Grafting). High quality incision-free implantation can be performed only by a very experienced doctor; otherwise the lifespan of the implant reduces considerably.
Can dental implantation be performed immediately after extraction of a bad tooth?
The topic of immediate implantation (performed immediately after extraction of a tooth) is often widely escalated for marketing purposes. It sounds really attractive: a patient comes to the clinic with bad teeth and leaves it with the new ones. To describe this treatment nicely-phrased expressions, such as “Teeth in an hour”, are sometimes used. One might think that it is a state-of-the-art and cutting-edge method of implantation used by most advanced professionals in all cases of dental implantation since not all of us start wondering “Isn’t it too good to be an absolute truth“ while reading such statements. The major benefit of both incision-free implantation (no-flap implantation) and immediate implantation is rapidness; however, a well-reasoned decision should be taken. Otherwise, an ancient truth of life stating that something has to be sacrificed for the sake of rapidness will be faced. The sacrifice might be aesthetics, precision and lifespan of the denture.
Differently from conventional implantation performed in several stages and in several months after extraction of a tooth, when performing immediate implant placement it must be guessed how the bone will rearrange after extraction of a tooth, i.e. whether an implant will remain covered in bone, whether gums will not sink, whether we will look nice. One of the benefits of immediate implantation speculated a lot in popular pieces of writing is that implantation prevents bone recession which starts after extraction of a tooth. Unfortunately, scientific research reveals that it is far from truth. Immediately after extraction of a tooth a thin bone layer which used to support dental ligaments is lost. This always happens irrespective of the use of implants or bone substitutes. It is a great a pity that no artificial materials have been developed yet which would radically change natural biological rearrangement processes in the bone. The primary bone recession lasts from one and a half to two months after extraction of a tooth. The bone heals for several other months. After that, the secondary bone recession starts because this part of the jaw bone is no longer loaded. If the bone is not stimulated, it deteriorates. Namely dental implants prevent from the secondary bone recession because they form a load for the jaw bone and make it reinforce in a similar way as dental roots.
Consequently, based on scientific research the best time for implantation with a minimum risk is several months after extraction of a tooth when the primary inevitable rearrangement of the bone is over and the bone recession caused by inactivity has not started yet. Moreover, if an implant is placed after the completion of the primary bone recession, it is clearly visible how much of the bone is missing and how much of it needs to be grafted (see Bone Grafting, Gingival Grafting).
Thus, implant placement immediately after extraction of a tooth is not a suitable method in all cases. Immediate implantation is one of possible ways of implantation. If predictable and long-term results are desired, it can be used when a tooth used to be covered by a thick layer of bone and gums and when the procedure is performed by a highly experienced professional.
Do dental implants always integrate?
Merely several percent of screwed implants do not integrate. This usually happens during the first month after implantation. The major symptom is a loose implant. The patient usually does not even feel that. An implant which failed to integrate is easily removed and after several months a new one is screwed. In our Clinic, implants are replaced free of charge.
Can dental implants be placed for all patients?
Generally, dental implant placement cannot be performed for patients for whom a tooth cannot be extracted due to their overall health condition. Most importantly, existing diseases (high blood pressure, diabetes, etc.) should be under control. Elderly age neither is a decisive factor. Namely older people usually start lacking teeth, therefore, the majority of dental implants is placed for them.
When is bone grafting performed?
In the same way as natural dental roots, implants must be covered in bone. Therefore, in cases when the jaw bone in the place of the missing tooth is insufficient for a firm hold of an artificial root, prior to implant placement or simultaneously bone grafting is performed (see Jaw Bone Grafting).
How are dentures on implants maintained?
No exceptional maintenance is normally required. Implants in the same way as natural teeth are cleaned with conventional products. In cases when all natural teeth are lost and dentures are secured only on implants, the use of toothpaste which is free of fluorine compounds is recommended (see Prevention of Diseases in Oral Cavity, Natural Preventive Measures). Provided the doctor has not prescribed otherwise, an appointment with the oral hygienist should take place twice a year to have professional mouth cleaning performed and to check whether implants and the remaining teeth are in good condition. High-quality and regular cleaning is prerequisite for long use of implants to prevent from the inflammation of gums and bone.
Are dental implants long-term?
Restoration of lost teeth by means of implants is one of the most long-lasting and most advanced methods of implantation. Teeth are usually adversely affected by decay but implant dentures certainly no. One should remember that we are speaking about dentures and not natural teeth. A dental implant is a very good substitute for a bad tooth; however, it is not the same as healthy, natural teeth. Porcelain finish splinters from dentures on implants more often than from dentures attached to teeth. Yet, it can be repaired. Generally, a long lifespan of implants is determined by the following factors:
- Initial condition of the bone and gums and the patient’s ability to maintain good oral health;
- Doctor’s competence;
- Selection of a good implant manufacturer (see above Where dental implants are manufactured?)
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