Indication for an implant
The best possible treatment of tooth gaps is the replacement of the missing tooth without damaging the adjacent teeth. In the case of bridges, for example, the neighboring teeth, which may be healthy, must be ground down to give the bridge a firm hold. A bridge looks like this: a crown is placed on each of two adjacent teeth, while the missing tooth is bridged by the bridge member that is clamped between the two crowns.
It is also possible to make a bridge between an implant and a real tooth. This is always necessary if, for example, the two back molars are lost. Either you decide to have two implants, each of which replaces one tooth, or an implant that carries one crown while a remaining tooth carries the other crown.
The missing teeth are then bridged by a bridge that is placed between the implant and your own tooth. In the anterior region, a bridge cannot provide an optically excellent result because the tooth papilla, i.e. the gums in the spaces between the teeth, cannot be restored. An implant can prevent both healthy teeth from being ground down and missing tooth papillae from being restored to a certain extent.
In edentulous patients, total dentures must be made as dentures. Unfortunately, the hold of the total denture is not always very good and the denture slips when chewing.The taste experience is also considerably impaired when eating, as the palate is completely covered by a plastic plate. If individual implants are placed across the jaw, the prosthesis can be anchored on these implants and the palatal plastic plate is no longer necessary.
In order to be able to anchor such a total prosthesis well, very often implants are placed in the area of the former canines. It is also possible to place several implants distributed over the whole jaw (usually eight), on which a very large bridge is then fixed. This avoids the need to wear a removable prosthesis.
Most patients find a denture firmly anchored in the jaw more comfortable. Implants are most often used to replace individual teeth. Implants are a very good solution, especially in the anterior region.
In order to be able to bill the health insurance company for at least part of the implant treatment, there are four classes of indication when an implant can be placed.
- Class I: Single tooth replacement (The replacement of a single missing tooth, no matter where in the jaw)
- Class II: reduced residual teeth (as mentioned above; if several teeth are missing and these are to be replaced either by several implants or by a bridge from the implant on the patient’s own tooth)
- Class IIa: free-end situation (when a tooth is to be replaced with a bridge from the patient’s own tooth on an implant and the implant is to be placed at the end of the corresponding row of teeth)
- Class III: Toothless jaw (if there are no own teeth left and the implants are to ensure that the prosthesis holds better or if a bridge is to be stretched over the entire jaw, which is only held by implants)
Implants can only be successfully anchored in the jawbone if sufficient bone substance is available. Nowadays, implantology likes to use a three-dimensional x-ray to determine whether sufficient bone is available.
The patient is x-rayed in a special device and the dentist can view the jawbone from all sides on the computer and measure whether there is enough substance for an implant. If this is not the case, there is the possibility of an augmentation. In the course of an augmentation, non-existing bone is replaced with bone replacement materials or with the patient’s own bone taken from elsewhere in the body and specially treated.
This bone thus augmented must then first heal for a certain amount of time and bond firmly to the jawbone. After the healing period the implantologist checks again to ensure that there is sufficient bone substance. If so, the implant can now be planned and inserted.
Sometimes a so-called sinus floor lift must be performed in the upper jaw before the implants are inserted. This is always the case if there is a risk of entering a sinus cavity (usually the maxillary sinus) with the implant. The maxillary sinus is located in the upper jaw very close above the roots of the teeth and should never be opened with the implant.
Therefore, the floor of the maxillary sinus may be raised before placing an implant. In the lower jaw, especially with planned implants in the posterior tooth region, care must be taken to ensure that the nerves that run along here very close to the tooth root are not damaged. At the first appointment the implant screw is placed in the jaw.
This is usually done under local anesthesia. However, a sterile environment should be provided and the drills used should have been sterilized beforehand. The local anesthesia is completely sufficient and is well tolerated by the patients.
Only the surgical drape, under which the head is hidden, causes claustrophobia in some patients. A hole is drilled in the jawbone with a drill that fits exactly to the later implant screw and the screw is screwed in. Then the mucosa over the screw is sutured again.
The screw must now grow together with the bone for about six to eight weeks. Only then is the mucosa cut open again and a sulcus former placed on the screw. The sulcus former is intended to make the gums suitable for the later crown to grow and form a papilla.
After another few weeks, the abutment is then screwed onto the screw instead of the sulcus former. With this abutment, the dental technician will now take an impression of the tooth row.A temporary restoration that looks like a tooth is attached to the abutment. The impression is sent to the laboratory.
Here, the dental technician will fabricate a crown that fits exactly on the abutment and the remaining teeth in the row. When this crown is finished, the patient is given a final appointment at the dental office, where the temporary denture is then replaced with the final crown. It is very important to have the implant checked regularly. Implantology recommends annual X-ray checks, which can be extended to five-year intervals later. The implants should also be checked by the dentist for possible damage during the normal six-monthly check-ups.
