Everyone has heard of dental implants, but what exactly are they and how does a treatment work?
In Germany alone, the number of implants inserted has risen from 380,000 to 1.3 million in the past 20 years (source: idw-online.de). Today, dental implants are considered the optimal restoration for tooth replacement. But why is that? Before implantology, gaps between teeth or edentulous jaws were rehabilitated with bridges and dentures. These methods continue to be used because they actually work predictably well. However, in terms of individual biology, aesthetics, cleaning and comfort, they are clearly inferior to dental implants.
In addition, the dental implant, as a fixed prosthesis, is most similar to the normal tooth. The only difference is that the normal tooth is fixed in the bone with a fibrous suspension apparatus and the implant is fixed and immobile in the bone. This also results in differences in the transmission of forces to the bone. A dental implant can be easily compared to a dowel for illustration purposes: After it has been tapped into the drilled hole in the wall, a screw can now be turned into this newly created anchorage. The process is very similar for dental implants: the implant is inserted into a drill tunnel in the jawbone that corresponds to the implant geometry. After a healing period (approximately three months), the superstructure for anchoring the crown is screwed or cemented into the implant body.
Most implants are made of titanium dioxide
Standard implants today are two-piece, i.e. they consist of an implant body and a so-called superstructure, which serves to anchor the subsequent dental crown. The implant has a screw-shaped body usually made of titanium dioxide. While there are different implant concepts and shapes depending on the manufacturer and the desired anchorage principle, most implants have a cylindrical or conical outer geometry. The conical shape has better stability, especially in soft jawbone.
An implant must heal in the bone for approximately three months before it can be fitted with a dental crown.
In addition to the actual implant body, further abutments are required in the next treatment steps to attach a new dental crown to the implant. This includes, for example, the so-called implant abutment which is screwed into the internal thread of the implant body (see graphic, source: casa-dentalis.de).
Source: Casa-dentalis.de
The crown can be fastened by means of screwing or bonding. I prefer screwing, as this ensures better interchangeability and prevents the risk of so-called cementitis. This is the inflammatory bone recession in the upper part of the implant, which is caused by adhesive residues that are often very difficult to remove.
The surgical procedure for dental implants is performed under local anesthesia, optional with nitrous oxide
Implants are inserted under local anesthesia, but can also be inserted under outpatient sedation at the patient's request (e.g. nitrous oxide). In preparation, a so-called DVT (three-dimensional X-ray scan) is always performed in order to be able to assess the bone conditions perfectly and to plan the ideal implant position before the operation. The implant must be able to grow into the bone for about two to three months after the operation. This time results from the remodeling processes in the bone (new bone formation and calcification take about two months). Depending on the jawbone, bone augmentation may be necessary before or during implant placement. We love the biology of the body and therefore try to use the body's own materials such as autologous bone, dentin and plasma for this as far as possible. Ideally, however, an implant is placed immediately after tooth extraction (immediate implant). This eliminates the need for another surgical procedure and prevents bone loss in the area of the tooth socket.
Dental implants can be used not only to restore single teeth, but also for bridge constructions or even completely edentulous jaws (all-on-4 or -6 concepts).
Alternative implants are made of zirconium dioxide
Dental implants are now also available in zirconia (white ceramic). Unlike titanium implants, the oral mucosa loves zirconium oxide and adapts excellently to the implant shoulder, so that a very good and natural-looking result can be achieved. However, the study situation for zirconium oxide implants is still somewhat worse than for titanium implants. Provided there is no specific intolerance, I therefore generally recommend titanium implants. However, if the patient is uncertain about this decision (or a restoration with metal is generally rejected), a so-called titanium stimulation test can be performed at any time to rule out a specific intolerance to the metal. The restoration with a ceramic implant is very feasible in such cases. What you need to know: the risk of implant loss is slightly higher than with titanium implants. The decision for one or the other variant should therefore only be made after a detailed consultation.
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