Dental implants are a replacement for tooth roots and carry either single crowns as replacement for missing teeth or bridges with several crowns and bridge segments to replace multiple teeth on several implants. The most extended construction would be to replace all teeth in one jaw on implants. This sometimes can be achieved with only 4 implants. A special technique for a full arch restauration on that basis is called “all on 4” and gives a fixed restauration within a day or two depending on the details of the restauration.
All these are fixed restaurations with the prosthesis (visible part of the teeth) fixed to the implant(s). The other indication for implants is to use them with special attachments, that give anchorage and retention for a removable denture, which is called overdenture. That can be removed for cleaning and will otherwise usually all ways stay in the patients mouth. This can be done with at least 2 implants in one jaw. If more anchorage is required 4 or even 6 implants may be used.
The essential requirement for implant placement is sufficient bone supply, to allow for placement of implants surrounded by bone all around. In order to assess the available bone supply, every single patient gets a cone beam scan done. This is a 3 dimensional scan giving excellent information of 3 dimensional configuration of the jaw bone. This examination gives similar information to a cat scan, however with much less radiation. Therefore the scan is justified for planning of implants, as this is the only examination, that really gives a three dimensional picture and measurement of the bone supply. We then can clearly see if and how much additional bone built up is necessary for implant placement.
In case of need for limited bone built up, this can be done as simultaneous augmentation with implant placement. As material we usually can use mineral etracts from bovine bone or synthetic bone substrate. The need for a bone graft taken from the patient is only given, if there is need for major bone built up. In those cases there may sometimes be the need for a 2 step procedure with grafting first and later implant placement 4-6 months later.
The implant procedure itself can be single stage or in 2 steps as well. In a single stage procedure the implant is placed with abutment that exceeds the gum level and is reaching into the oral cavity with 1 or 2 mm. The other option are one piece implants, that reach into the oral cavity like a tooth stump. They may exceed the gum level at 3 or 4 mm. After completed healing and integration of the implant into the bone structure usually after 3 – 4 months the prosthetic treatment can be performed with placement of the prosthesis as crown or bridge. This can be screw retained or cemented like a crown an a tooth stump depending on the specific situation and implant type. We exclusively look at the surgical treatment, the prosthetic treatment with crown placement on the implant is done by your dentist or a specialised prosthodontist.
In case of a staged implant procedure the implant is placed with a cover screw not exceeding the bone level, so that the mucosa – the internal skin – can be closed over the implant (figure 1 and 2). There may be additional bone built up performed at the same time as implant placement. Reasons for a staged procedure would be need for fairly extensive augmentation and limited stability of the implant after placement. In both cases the covered healing will reduce complications of the healing process. After 3 – 4 months then the second stage surgery can be performed with placement of a healing abutment, that is reaching through the gums (figure 3). The soft tissue healing has to be waited for. The prosthetic treatment ususall can be performed after 4 to 6 weeks (figure 4). Again the prosthetic treatment is done by your dentist.
The operation itself can be carried out under local or general anesthesia, depending on the extent of needed surgery and your personal preference. Usually with multiple implants or need for augmentation or grafting there would be the indication for operation under sedation or general anaesthesia. With less extensive treatment there would be the possibility for surgery under local anesthesia.
The specific postoperative instructions on top of the usual post-operative recommendations would be, that the implants and possible augmented surrounding tissue should not carry any load for the first 6 weeks. That means, that you should have rather soft food for this time, and in case of dentures, they additionally would have to be ground out on the base covering the implant area.
The specific long term requirements for implants are firstly meticulous oral hygiene, as implants can as well develop periimplantitis, which is the inflammation of the surrounding tissues of the implants. That is the correlation to the periodontitis around teeth. This can finally lead to resorption of bone and mobility of implants, that then would have to be removed, similar to teeth that become mobile with progressive periodontal disease. If you are able to keep the implants free of peri-implant infection, implants are a real long term solution. There are implant restaurations, that have been in place for more than 40 years.
The following is a list of our most frequently asked questions about dental implants.
Is this something new or is it established?
The first dental implant has been placed in 1965 in Sweden. Since then there has been a long experience and ongoing development in dental implant treatment. Dental implantology is now an integral part of dentistry with established routine procedures for different situations. It is a very safe treatment with longlasting results.
Is my situation suitable for implant treatment?
The clinical situation will give a first indication, if implants could be the right treatment. If this would be the case, we always perform a cone beam scan, in order to exactly see the available bone supply. A cone beam scan is a special type of CT scan, which gives a very precise three dimensional reconstruction of the jaw, showing exactly the available bone supply at the site, where an implant would be planned.
What if there is not enough bone?
The cone beam scan gives a three dimensional reconstruction of the jaw. With additional software there can be a virtual implant placement done on this three dimensional jaw reconstruction. This shows exactly, which implant could be placed and where bone might be missing. If there is not a big defect, the bone usually can be build up simultaneously with implant placement. This is called augmentation and utilises either synthetic bone replacement materials or bone derivates usually taken from bovine bone. Those derivates are very safe and give a good bone substrate without any known risk for transfer of diseases. The material is safe and allows you even to give blood, if you had an operation with placement of this augmentation material.
What if the bone defect is larger, not allowing for sufficient implant size?
If the bone defect is larger, there may be the need for a bone graft in order to establish sufficient dimensions of the jaw, which would allow to place an implant of the right size for a specific situation. This can sometimes be done still simultaneously with implant placement as bone ring graft. In that case a bone ring is taken usually from the lower jaw in the back or chin area. This is don internally without any external wound. The bone ring is then attached to the jaw with the dental implant as fixation screw. In these cases the wound is usually closed completely, allowing for protected environment and covered healing. At the end of this opeartion you can’t see the implant in your oral cavity, it is covered.
Sometimes it is necessary, to do the bone graft first without implant. This type of bone graft is usually taken from the back of the lower jaw as well from an intraoral access with no external wound. After sufficient healing of the graft the implant will then be placed in a second operation, which is usually 6 months later.
In the upper jaw there may be the need for a sinuslift procedure if the bone height in the area of the maxillary sinus is only low. There may be only 3 – 6 mm height of bone in the area of the back teeth, which would not allow for placement of a sufficient long implant, to carry the necessary load. In that case there is need to push up the maxillary sinus membrane and get some internal bone build up, to allow for placement of a sufficient long implant (usually 13 mm is a very good length for an implant there). This can be done in most cases simultaneously with implant placement. The implant mostly would be placed on bone level with covered healing. A second stage surgery would therefore be necessary. This however is only a minor procedure, which could be done under local anaesthesia.
What is a single stage procedure compared to a staged procedure?
A single stage procedure is to place the dental implant with a healing abutment on top. This abutment is just sticking through the gums. This allows for integration of the implant and healing of the soft tissues at the same time and only requires one operation. After sufficient healing time of usually 3 months you are referred back to your dentist to get the implant crown placed – the visible „tooth“.
With a staged procedure the implant is placed on bone level with placement of a flat cover screw. The soft tissues are then closed over the implant, so that this is not visible at the end of the operation. This gives protection through covered healing and is necessary in case of larger augmentations or limited implant stability. After sufficient healing – usually after 3-5 months the second stage surgery is performed with placement of a healing abutment, that is sticking through the gums. The healing time then is another 4-8 weeks, before you are referred back to the dentist for placement of the implant crown.
How long does it take until I have got my tooth back?
If an unrestorable tooth has to be removed first, we usually wait 2 months, before we take the cone beam scan. This shows us the available bone supply and treatment needs in your particular situation. In most case the surgery can be perfomed within the next month.
Depending on the necessary procedure the treatment may be done as single stage procedure, which means usually another 3 months healing, before the prosthetic treatment with placement of the implant crown or bridge can be performed.
In case of a staged procedure the implant placement and necessary augmentation or grafting is performed first with covered healing. After completed healing the second stage surgery can be done about 4-6months later with placement of a healing abutment. After another 4-8 weeks the prostehtic treatment can be performed by your dentist.
In summary it usually takes about 6 – 7 months for a single stage procedure and about 10 – 11 months for a staged procedure, before the tooth is back.
How much does that all cost and what is covered?
A rule of thumb says that an implant tooth is about $5,000 – 6,000 dollars. This is depending on the necessary work and if the procedure is done under local anaesthesia or general anaesthesia and additionally depending on your health fund cover. Is the surgery done as single stage procedure or in more steps. What additional work is necessary. All those factors have to be taken into account, to get an idea of the total cost. We allways will give you an estimate for the surgical treatment with itemised quote, so that you can check with your health fund, what your cover is.
The quote will only include the surgical treatment. Regarding the prosthetic treatment with placement of the implant crown or bridge you would have to check with your dentist or prosthodontist, what the cost would be for this final treatment.
Is the implant placed under local or general anaesthesia?
The treatment can be done both ways. It is depending on the amount of work, if we would rather recommend a procedure under sedation or general anaesthesia in the day surgery or not. If there is major augmentation, sinus lift or grafting involved, we always would do the surgery under general anaesthesia. This usually can be done in the day surgery. If medical conditions require a hospital stay we could do that as well with or without overnight stay.
It is as well depending on your personal preference. Some patients prefer to be awake, others don’t want to know about it. In case of more straightforward procedures we certainly could do this under local anaesthesia. This may be done just in the chair or sometimes as well in the day surgery with advanced monitoring and more surgical equipment available.
Will there be a gap after placement of the implant?
If you have a partial denture for replacement of the missing tooth / teeth, this can be worn after implant placement as well. The area of the implant will be ground out on the denture, so that it can be placed immediately after the operation. Usually the denture in position helps to reduce the local swelling. The denture should be worn all the time and only taken out for cleaning for the first few days.
What are implants made of?
Most of the dental implants are made of titanium with some surface modification, to increase the attachment of the bone. There are numerous different brands. We only use some of the market leading dental implants. The systems we regularly use are Astra, Noble Biocare, Straumann and MIS.
We cooperate with your dentist, to find the system, which suits your situation best and that your dentist can use for the prosthetic treatment.
Could I be allergic to dental implants?
In principle it is possible, that an allergy to titanium may exist. However this is extremely rare and is nothing, that would have to be expected. If an implant does not heal sufficiently, this is usually caused by a local healing propblem. In that case the implant has to be removed. After completed healing about 2 months later a new implant can be placed at the same spot, which usually heals without problems.
What about smoking?
Smoking is one of the few factors, that definitely have a negativ impacte on the Implant prognosis. Smoking affects the healing process adversely as well as the long term results with higher risk of implant failure.
This hopefully will give you another incentive to stop smoking. This definitely will increase the long term prognosis for dental implants.
What is the postoperative situation?
There are instructions for postoperative handling after oral surgery procedures, that apply to implant operations as well.
Additionally it is recommended, that for 6 weeks after the operation there should not be any load on the implant site, to have best conditions for healing. After this time the implant stability is usually strong enough, that limited local load would not cause healing problems. This means to have soft food or clearly stay away from the implant site with stronger biting or chewing forces.
What are possible complications?
There is the possibility of impaired healing after implant placement. This is usually indicated through some discomfort or ongoing pain after surgery. Usually the implant surgery only causes very little pain. There may be some discomfort from augmentation procedures for some weeks. That however settles after a few weeks.
If an implant does not heal sufficiently, this is usually caused by a local healing problem. In that case the implant has to be removed. After completed healing about 2 months later a new implant can be placed at the same spot, which usually heals without problems.
What are possible long term complications?
Once the implant is integrated successfully and following prosthetic treatment with placement of the implant crown there is the possibility of long term periimplant gum infection with bone loss around the implant. This is similar to gum infection around teeth and can lead to increasing bone loss around implants.
Meticulous oral hygiene is the best way to prevent this complication. You should see your dentist for regular followup visits including professional cleaning to reduce the risk for this complication.
We usually would see you for a clinical followup after 3 months and a final check including x-ray after one year to see if any bone loss around the implant is happening.
Another complication from the prosthetic site is loosening of abutment screws that keep the implant restauration in place. This then shows as beginning crown movement of the implant tooth. In that case the crown would have to be removed, checked and put back in place with sufficient tightening of the screw.
Sometimes the screw loosening may indicate overloading of the implant restauration through clenching or grinding of teeth. In that case you should get a splint provided for wearing overnight, to reduce any increased loading of teeth and implants.
How long does the implant last?
If you are able to maintain good oral hygiene, implants have a very good long term prognosis. They easily can last 10, 20 or 30 years and longer. Sometimes the prosthetic restauration – the implant crown may show signs of wear and deterioration. The dental ceramics are very good and getting better all the time. Still they have not yet the durability of healthy tooth substance.
There may be the need for replacement of the implant prostheses. This can however be done with the implant still in place, as the primary connection of the implant prosthesis is always screw retained. It can be unscrewed and removed and replaced if necessary at a later stage.
There is a normal slow bone loss of the jaws, that happens around teeth and implants. This can lead to the situation that teeth appear to get longer. They are actually not growing or getting longer, they are being more exposed. This as well would happen around implant teeth. Usually the implants are placed deeper, so that they won’t be exposed for a long time with normal minimal bone loss.
Is the implant tooth different, or like a normal tooth?
Teeth are anchored to the bone via periodontal fibres and have a normal slight mobility. The implant tooth is different to a natural tooth in the way, that the implant is directly integrated into the bone without any movement. Some patients do feel this difference and describe it as similar to biting on concrete with the implant tooth with no movement at all. This is however no problem for biting or chewing and all patients are feeling very comfortable with their implant teeth.
In case of grinding or clenching teeth there would be the indication for a splint to protect teeth and implants from damage through overload.