Introduction
The implantation of exogenous material, be it as a hip joint replacement or artificial knee, is almost a routine operation today, especially due to the ever-increasing proportion of older people, in whom signs of wear and tear of the joints naturally occur more often. More and more, implants made of metal or ceramic are also being used in the oral cavity as tooth root replacements/dental prostheses and fastening elements for prosthetic treatment. Today they are therefore an integral part of dental therapy.
If you have decided to have a dental prosthesis with dental implants, you should definitely consult an implantology specialist to benefit from his experience. He will then suggest the most suitable implant system for your individual needs. Before starting a prosthetic restoration with implants, the treatment is planned, in which the wishes of the patient and the possibilities, advantages and disadvantages of such a restoration of a residual dentition or an edentulous jaw are discussed, and what alternatives are available.
The financial question also plays a not inconsiderable role, because to this day, the statutory health insurance companies do not subsidize implant treatment, but only the crown or bridge or prosthesis that sits on it. For a dental implant to be placed at all, certain conditions must be met. There must be enough solid bone so that the dentist can insert the implant deep enough.
The lower jaw bone is more stable than the upper jaw bone and therefore does not pose a risk for an implant. The x-ray image shows whether the bone conditions are sufficient. If this is not the case, an implant must be dispensed with, or the bone must be strengthened by implanting the body’s own bone.
In the upper jaw, the maxillary sinus represents another complication. It can have different dimensions and therefore leave no room for the placement of an implant. An important aspect is the oral hygiene of the patient.
The durability of an implant depends largely on the patient’s ability and willingness to practice careful oral hygiene. This is not always easy, especially with fixed restorations. Patients in whom this is not to be expected should not receive implants.
Once the preparatory measures have been completed, dental implantation can begin. The surgical procedure is usually performed under local anesthesia. The procedure is more complex if bone augmentation is necessary.
If there are several implants to be placed and the patient is very anxious, it is also possible to work under general anesthesia. First, the mucous membrane is cut through with a small incision and then the site for the implant is prepared with a drill adapted to the dental implant used. This is inserted and the mucosa is closed again.
Afterwards, pain may occur, but this can be eliminated with painkillers. Swelling can be avoided by cooling immediately after the operation. Afterwards, the bone must be allowed to heal, which can take 3 to 6 months.
An interim prosthesis bridges the time. Once the implant has healed, the preparation of the final restoration can begin: Either with a fixed bridge construction or crown or with a removable prosthesis anchored to the implants with retaining elements. For the durability of implants it is very important that the prosthesis sitting on them is statically sound, so that uneven loading is avoided.
Otherwise the dental implant may loosen. Therefore, dentist and dental technician must work closely together in such a treatment. You should not suffer any pain during the operation.
For this purpose there are locomotor anaesthetics or stronger narcotics. Since the procedure is more invasive than smaller dental operations, pain may occur postoperatively when the anesthesia wears off. The incision alone, which is made in the mucous membrane and the gums, is already painful because the soft tissue has to be cut through to the bone.
Since bone is not dead tissue, it is possible to cause pain in the bone afterwards. After all, a screw is drilled into the bone where there may have been nothing but bone for years. Just because of the operation itself, the grinding on the bone and the cold water cooling, hypersensitivity can occur.
If these persist for a longer period of time, it is important to discuss this with your dentist.The so-called immediate implant is only suitable for the replacement of teeth that are not root-inflamed or acutely periodontally inflamed. With immediate implants, the implant is placed immediately after the tooth has been extracted. However, the crown must be designed in such a way that there is no contact with the opposing teeth, so that bone healing can take place at rest.
The dental implant can only be loaded after about 6 weeks. When extracting the tooth, it is important to ensure that the bone is not damaged and that enough bone is left in which the dental implant can be inserted. Teeth with two or three roots are rather less suitable for this type of dental implant, but not completely unsuitable.
The advantage of the immediate implant is shorter treatment time. The most common is the conventional procedure, where the healing of the bone is completed. However, the disadvantage is that the patient has to wait several months before the final treatment can begin.
But with an interim prosthesis, this waiting period can be easily bridged. Another question is whether the dental implant can be loaded immediately after implantation. Today there are implant systems that promise immediate loading.
The dentist must decide whether the jaw conditions are suitable for this. Here too, the safest method of ensuring an intimate connection between implant and bone is osseointegration over several months. However, medical studies show that there are no significant differences in the durability of immediate implants or conventionally placed dental implants.
Excellent oral hygiene of the patient is essential for the preservation of the dental implant. The patient must be very careful to keep the implants free of bacterial plaque, otherwise there is a risk that bacteria will penetrate between the mucosa and the dental implant and cause so-called periimplantitis (inflammatory disease of the periodontium, similar to periodontitis). If left untreated, this can ultimately lead to loosening and loss of the implant.
In addition, the patient should come to the dentist for regular check-ups so that complications can be detected and treated early. If you ask a dentist, he or she would probably say “Never”. Nicotine is a cell poison that can destroy all cells and inhibits wound healing.
Since a large wound is placed in the mouth during implantation, the nicotine would destroy the cells that are important for healing and thus interfere with wound healing. In the case of a simple wound after tooth extraction, one says at least 2 weeks cigarette break. The wound of an implant is much more invasive.
Therefore the cigarette break is correspondingly longer: no smoking for 6 weeks. It could be argued to start smoking again as soon as the wound has healed, but after the wound has healed, it starts to grow into the bone, which involves bone cells that must not be destroyed. In addition, cigarette smoke and nicotine disturb the oral flora to such an extent that the implant is not sufficiently protected from inflammation, and thus there is a risk of loss.