A dental implant is a real alternative to bridges or loose dentures, because the implant perfectly replaces a missing tooth and fits as tightly as your own teeth. But how does such a treatment at the dentist? Can anyone get dental implants? What are the risks, costs and pain involved? We answer the most important questions.
What is a dental implant?
Dental implants use artificial tooth roots that are attached to the jawbone in a minor surgical procedure to close a gap between teeth. A dental prosthesis can then be attached to such an implant, for example a crown, but also a bridge if more than two teeth are missing, or even a removable dental prosthesis (denture). The artificial tooth roots are made of titanium, a particularly well-tolerated, resistant metal that has long been used in medicine for artificial joints, for example. The implant consists of:
- An implant body, which is anchored in the jawbone like an artificial tooth root and heals there.
- An implant abutment (abutment), which serves as an intermediate piece between the implant body and dental prosthesis and is made of titanium or ceramics
- An implant crown (superstructure), which is screwed onto the implant abutment and represents the artificial tooth. It is usually made of gold, titanium or ceramic.
Structure of a dental implant – iStock.com/adventtr
Advantages of an implant
Dental implants have proven to be a viable alternative to dental bridges, as these require sufficient healthy, stable teeth on both sides of the gap to which the bridge can be attached. However, these “bridge pillars” have to be ground down and crowned in order to attach the bridge, which is why implants are usually considered gentler. Apart from the fact that these third teeth fit absolutely tightly and represent an aesthetic solution to replace lost teeth with a perfect fit, implants have another decisive advantage: they prevent bone loss (atrophy), because bone that is no longer under load forms back. So if one or more teeth are missing and, in addition, with poorly fitting dentures, the bones are no longer loaded at all, then at some point the cheeks and lips are no longer supported by boils. Affected persons then look “sunken”. In addition, implants relieve the remaining teeth, because they can, since they are firmly seated, be loaded like natural teeth.
Dental implant: preparation at the dentist
In advance, the treating dentist or oral surgeon discusses with the patient whether he wants a fixed denture or something removable. Pre-existing conditions and medications taken are also discussed. The patient is examined and X-rays and impressions of the jaws are taken. The dentist can plan the subsequent denture on the corresponding plaster models and with the help of the X-rays. If necessary, a professional tooth cleaning is performed and diseased teeth and gums are treated. If there is too little bone in the implantation area, it must be built up before the implantation.
Procedure of the treatment
Placing a dental implant is a minor procedure that can be done on an outpatient basis, usually under local anesthesia. A small incision is made to open the oral mucosa over the jawbone in the appropriate location. This exposes the jawbone and then a hole is milled into it with the drill using a planning template. The implant is then screwed into the bone and initially capped. The bone substance and the gums grow together and enclose the implant. This healing period can take between six weeks and nine months, with an average of three months. How long the operation itself takes varies greatly. Depending on how many implants are placed and the condition of the jawbone, the surgery can take anywhere from fifteen minutes to several hours. Once the implant body has healed, in this frequent so-called two-phase method, the gum over the implant body is opened again (by laser or a punch) after the healing period. Only then is the prosthesis attached to the implant, usually with screws. In the single-phase method, this is all done in one operation.Implants are used that extend through the gums and to which a temporary denture is attached right at the beginning. In this way, patients have a complete set of teeth right away. However, this increases the risk that the implant will not grow.
Risks: pain and complications
The treatment itself sounds worse than it actually is. Local anesthesia with a syringe is usually sufficient for milling the hole and placing the implant, although the procedure can also be done under sedation or general anesthesia. Discuss the anesthesia in advance with your attending physician. Usually, you do not feel any pain when the implant is inserted, but only feel the vibration of the drill. The affected person usually feels pain only in the oral mucosa, but it heals quickly after a few days. Complications such as severe bleeding or swelling are rare. If the gums are cooled well after the treatment, the swelling usually goes down very quickly. Immediately after the implantation, one should refrain from exertion, as well as alcohol, cigarettes and coffee. However, bacterial infections can occur between the implant and the gums. Therefore, particularly careful oral hygiene is very important. This also applies once the implant has healed and the denture has been fitted. An inflammatory disease in the area of the implant is called peri-implantitis and can lead to the loss of the implant if left untreated. Dental plaque endangers the implanted teeth as well as the patient’s own teeth. A visit to the dentist every six months is therefore a must. Smoking also carries the risk of premature implant loss.
For whom implants are suitable
In principle, any patient can get dental implants, there is no age limit. The experience with dental implants is almost universally positive. The artificial tooth root is especially recommended when the neighboring teeth are still completely healthy and one can avoid grinding them down (as would be necessary for a bridge). Implants are also very helpful in case of large gaps that are difficult to close with a bridge. Also, in the case of a set of front teeth with gaps, a single implanted tooth looks aesthetically better than a bridge made of firmly connected teeth. And for those who have no teeth at all, implants can serve as a fixed anchor for dentures or an extensive bridge.
No implants in case of severe diseases
Implants are less suitable:
- For patients with lowered immune defenses, for example, during cortisone therapy.
- For severe heart disease
- In advanced osteoporosis or other bone diseases.
- In case of increased bleeding tendency or blood clotting disorders
- In the case of diabetes not controlled by medication
Also in smokers and people with poor oral hygiene, the placement of an implant is associated with increased risks. You should thoroughly consult a specialist before such dental treatment. In the lower jaw, placing an implant is usually unproblematic, because there is usually enough dense bone mass to support an implant. In the upper jaw, the bone is less dense. Thus, it may even be necessary to remove bone from the lower jaw or pelvic area and place it in the desired location in the jaw. Recognize oral diseases – these pictures help!
Durability and care of an implant
If all goes well, a dental implant will last at least ten or 15 years or more, with 90 percent of implants still functioning after ten years. Often, the artificial tooth root lasts longer than the attached denture. Particularly forceful biting, such as occurs during teeth grinding (bruxism), can cause the crowns, bridges and dentures on the implants to need to be repaired or replaced prematurely. Implanted teeth, however, must also be very thoroughly cared for. This is because inflammation always leads to bone loss – and then the artificial tooth root can no longer hold and must be taken out. Unfortunately, titanium, the most commonly used material for implants, particularly attracts plaque. That is why careful cleaning is so important. In addition to a toothbrush, special cleaning agents such as interdental brushes should also be used.
What does a dental implant cost?
A dental implant can be associated with high costs.A distinction is made between the implantological service and the provision of the dental prosthesis on the implants. Depending on how complex the placement of the implant is and which material is used, the price can be less than 1,000 euros or several thousand euros. While the costs of a bridge are reimbursed by the statutory health insurers, the costs of an implant usually have to be borne privately. However, many health insurance companies pay a fixed allowance for the second part of the treatment, i.e. the tooth replacement on the implants, which is based on the standard treatment (standard therapy). Be sure to talk to your dentist about the costs involved before treatment. A treatment and cost plan is important to determine the costs in advance and to arrange reimbursement by the health insurance company later. Sometimes it may be worthwhile to have supplementary dental insurance to reimburse the costs.
How to find the right dentist for implant placement?
A dental implant should always be placed by a dentist or oral surgeon with advanced training as an implantologist and with the appropriate experience. The best recommendation is a satisfied patient. If you want to have an implant placed, you can start by asking around among your friends – perhaps some acquaintances have already had good experiences with a particular dentist when it comes to implants. Which dentist specializes in implants can also be found on the practice sign or on the Internet. Other places to go are:
- The websites of the individual professional societies – such as the German Society for Dental Implantology (DZGI).
- The Federal Association of practicing implant dentists (BDIZ EDI).
- The German Center for Oral Implantology (BDZI)
Who officially states the “Tätigkeitsschwerpunkt Implantologie”, must meet certain criteria for this, which the various medical societies from the field of dental implantology have established. Dentists must have completed continuing education courses and also have placed a specified number of implants – at least 50 per year, at least 200 in total.
Don’t be afraid to ask questions
Don’t be afraid to ask questions to be completely confident in your choice of dentist. Pay particular attention to the following aspects:
- Does the dentist perform conscientious and careful planning? For this purpose, in addition to the clinical examination, an X-ray and planning models of the jaws should be available, with the help of which the dentist can also explain the procedure to the patient. Diagnostics further includes the clarification of other diseases – possibly also in cooperation with other doctors of the patient.
- How many implants has he already placed? An indication of sufficient experience can be, for example, the minimum numbers mentioned above.
- Does the dentist work with a dental master laboratory? The manufacture of implant-supported crowns, bridges and prostheses (superstructures) also requires special knowledge and skills from the dental technician. The master dental technician has the highest qualification in this regard.
- Does the dentist continue his education? Often dentists hang out evidence of their continuing education in the practice. In addition, patients can specifically ask and assess the response of the doctor.
- Does the practice offer comprehensive prophylaxis and professional teeth cleaning? Even after the placement of implants, the dentition should regularly receive such professional dental cleaning to ensure optimal oral hygiene – ideally, implant care and follow-up care should take place in the same practice.
- What exactly is in store for the patient? The dentist should take time, explain all treatment steps and explain about risks.
- What does the implant cost the patient? Because the statutory health insurance companies usually do not cover the costs and private health insurance companies may only cover part of the costs, it should be clarified before treatment what costs will be incurred and what amount the patient must bear. For this purpose, a written treatment and cost plan should be prepared, which the patient can submit to his health insurance company for cost settlement.
