The replacement of missing teeth by means of implants

First step

What shall I do if I wish to have a dental implant done?

Having made up your mind on having your missing teeth replaced with implants you are advised to book an appointment for consultation. In the free medical consultation you will discuss the available options with the treatment specialist. The treatment plan and quote printed during the consultation will be handed over to you.

What shall I bring along to the consultation appointment?

You are advised to bring along all available dental panoramic radiographs, any documentation pertaining to chronic diseases, and if you take any medications, the names of such medications, etc.
You are encouraged to report for this consultation with a 3D CT scan on hand in (DICOM format). These scans can be done in special imaging centres (such as VIP Dental,

On the basis of the CT scan the following important factors can be examined:

  • the quantity and quality of remaining bone
  • bone thickness and height
  • the individual morphology of the mandibles and maxillae (shape and pattern)
  • the presence of chronic lesions (inflamed and infected bones, pus pocket, broken root canals, etc.)
  • polyps forming in the maxillary sinus and the presence of other inflammations
  • other dental foci (inappropriately treated root canal of tooth adjacent to the area to be implanted)

These important details are invisible to the naked eye with a small mirror in the clinical examination, only a CT scan can furnish the information required to draw up an appropriate treatment plan and decide on the following:

  • Is there an “ordinary implant surgery” at issue?
  • how many implants can be installed?
  • where are the implants advised to be installed?
  • is bone graft, sinus lift or other bone implantation required?
  • If bone graft is required, what is the method to opt for? Can implant surgery and sinus lift be performed in a single session or they require separate sessions?
  • How much will the aforesaid implant surgery and bone graft cost?

A panoramic radiograph is only 2 dimensional, displaying barely half of the information visible on a 3 dimensional CT scan. If you bring no CT scan along to the first appointment you may only expect some „dentist’s speculations”, a „rough” treatment plan and a „ball-park” quote and, with reasonable likelihood, you will have to report again for an examination with a CT scan on hand…

By way of illustrating the above below is an everyday situation with a car mechanic:

Requesting a treatment plan without a panoramic radiograph (or no radiograph at all) for an implant operation asking

„How much will an implant cost?” can be best likened to pulling up in front of a garage and calling out from the car to the mechanic „How much will the repair of my car cost?”

Showing up for the examination with a CT scan is like driving into the garage, having the car connected to the computer and lifted and the chassis inspected, then having the engine hood opened and the engine examined, etc., before being told what needs to be done to your car and at what price…

I hope this clarifies the difference between a “ball-park quote” and a quote based on appropriate examination.

Believe me you can save a lot a money by making the right choice.

What follows when I have accepted the treatment plan?

At the next appointment on having evaluated the CT scan and planned the surgery we are good to proceed with the implant surgery in the course of which the treatment specialist places the dental implant into the jawbone.

On the day of the implant surgery recovery time can also be established, and date for preparation of the permanent tooth replacement (crown, bridge, denture) can be assigned. The timing of the preparation of the tooth replacement depends on how firmly the implant has been fixed. Bone can be of different qualities, densities, etc., much in the same as wood. It makes a difference whether a screw is drilled into acacia wood, pinewood or oakwood. The firmer the screw sits in the wood the sooner it can be loaded and the more loadable it is. The same applies to implants: if we manage to drill the screw firmly into the bone, the implant can be loaded within 2 to 3 months of being installed, whereas with a bone graft, artificial bone graft or sinus lift performed it may take 6 to 8 months before the implant can be loaded and osseointegration is complete!

Is the implant visible in the mouth after being installed?

The implant itself is invisible as it is drilled into the bone, which is covered by the gum. If the implant displays inadequate stability it is is covered with a cover screw and the gum above is completely sealed with sutures by the dentist. With adequate stability witnessed the gum is sewn in place and a gingiva former is screwed on top of the implant with a small metal „cap” jutting out of the gum being visible. It is supremely important to thoroughly clean this small screw, treating it as if it were a small tooth. There is no need to be afraid of cleaning the cap with a soft brush.

Why is it good if the gingiva former can be screwed in simultaneously with the implant surgery?

There is no reason to be upset about the gingiva former as it is of great service in preventing further surgery by allowing the gum around it to heal beautifully and moulding the gum into a shape suitable for a subsequent abutment and crown.

If the gum needs to be sealed with a cover screw, shall I receive a gingiva former subsequently?

Yes. A minor surgical intervention is required under local anaesthesia, ideally a couple of weeks prior to preparing the permanent replacement. Following anaesthesia the gum will be exposed with a small incision and the flat cover screw inside the implant underneath will be replaced with a tall gingiva former sticking out of the gum. When the gum around the gingiva former has healed completely (3 to 6 weeks’ time) the permanent implant borne crown is ready to be prepared.

On completion of the surgery what further action needs to be taken?

Following the installation of the implant a follow-up panoramic radiograph is prepared without delay and the treatment specialist prescribes the necessary medicines and instructs you on things to do at home. Suture removal is due 7 to 10 days following surgery.