Dental Implants

Before you can proceed with implants, all remaining teeth, the gums and the jawbones have to be restored to a healthy state. There is no point in inserting an expensive dental implant next to an old and defective amalgam filling or if the gums are inflamed and thus endanger the healing process. This means that the costs of the preceding remedial treatment have to be added to the costs of the implant and its superstructure in form of a crown or a bridge.

In some people, the bone is simply too narrow and/or shallow to provide a stable foundation for an implant. The problems or insufficiencies in the underlying bone structure do not automatically eliminate you as a candidate for dental implants. With modern bone grafting (bone augmentation) techniques, you can still benefit from the superior qualities of dental implants over dentures or removable bridges.

A bone graft is a way of building up your existing bone so that it can provide a suitable base for implants. The bone in your jaw can be stimulated to grow either through natural or synthetic means. Your dentist will be able to help you determine the best method of bone grafting for your specific case. One or more of the following might be appropriate:

The goal in each of these cases is to help the patient grow new and healthy bone tissue that will support the dental implant procedure. Depending on the type and extent of bone grafting, the healing period can be three to four months. In some cases where the scope is less, bone grafting and setting of the implant can be done in one session.

This stage involves boring one or more holes into the recipient bone and inserting or screwing in the implant(s). The surgeon stitches the gums over the implants. The procedure is done under local anaesthesia – or rarely general anaesthesia or sedation. Light pain, swelling and/or haematoma can be expected immediately after the surgery. As with all other surgeries, the recovery depends on a number of individual factors, such as the general health of the patient, complexity and extent of surgery. Dental surgeons say that removal of a wisdom tooth is more unpleasant. Some patients are incapacitated for a week and others, especially after immediate placement, as it is called, go to work the next day without any noteworthy problems. On average, patients qualify the pain as a 3 on a scale of 1 to 10.

Whether all the above treatment steps are carried out in a sequence with longer intervals in between them or in one single surgery depends on the case in question. The implant, mostly made of titanium alloy, grows together with the bone in a process called bone integration (osseointegration). The time required for an implant to become bone integrated is two to three months for the lower and five to six months for the upper jawbone. After this period the implants are loaded with the planed restoration and the treatment completed.

Implant surgery can fail when the implant does not integrate with the bone or the tissues surrounding the implant become inflamed (peri-implantitis). This can occur as a result of sub-optimal bone preparation procedures, residual bone inflammation, premature loading or overloading of the implant.

Patients who smoke and patients with insufficient oral hygiene have a considerably higher risk of failure. The failure does not increase proportionally with the number of implants or the length of the surgical procedure.

An edentulous jaw is nowadays a routine case for dental implantology. Studies of such cases show a success rate of 97–99%. More difficulties are encountered with implants placed in visible areas of the upper jaw, especially if the teeth have been lost due either to trauma or inflammatory processes. The loss of bone substance in the upper jaw is usually much higher than in the lower, thus making remedial and reconstructive implant treatment more difficult.

Some implant manufacturers offer a guarantee period of up to ten years. This means that if the dental surgeon and the manufacturer agree, the patient can have new implants free of charge. Natural teeth always have natural movement. This is not the case with implants, which are rigidly anchored in the jaw. A loose implant means insufficient bone integration, which may necessitate its removal.

As a rule, implants do not fail – as with some other transplanted organs – because of the rejection by the immune system, but because of localised inflammation of the surrounding tissues. Such inflammatory processes are often induced by parodontitis or deficient oral hygiene. Bacteria can access the tissues at the gum line of the implant and cause an inflammation (peri-implantitis).

Most failures resulting in implant loss occur during the bone integration period or in the first 18 months after the loading.

Immediate placement implants are placed into a tooth extraction site either immediately or just a few days after the tooth extraction. Immediate placement means in no way immediate loading of an implant. The loading of the implant with restoration is possible only after the bone integration interval, as required for standard implant procedures. An immediate placement can be carried out when the implant is placed in a single-root tooth site (usually), with well preserved, healthy bone and mucosa around it. The advantages of immediate implant placement are:

This treatment is well documented, but should be carried out by a specialist in dental implantology.

Dental implants have long been approved as best practice treatment. The probability that an implant will still be fully functional after five years is 85–95% for the lower jaw and 80–90% for the upper jaw.