IMPLANTOLOGY AND DENTAL IMPLANTS
Missing teeth can even make biting an ordeal, not to mention its aesthetic downsides. Today there are several means of replacing missing teeth. We are able to perfectly restore masticatory function and enhance your natural smile.
Missing teeth can be substituted by implanting “artificial roots”, drilling down intact teeth enamel (with bridges fixed on neighbour teeth) or by means of removable dentures. Implantation is the cutting-edge tooth replacement method allowing for the substitution of several teeth by fixing artificial teeth onto the implants, without the necessity of drilling down healthy (adjacent) teeth. At our clinic Straumann and Dio implants are used.
IMPLANT, CROWN, SUPERSTRUCTURE
Dental implant fixture is a titanium screw which, fastened into the lower or upper jawbone, functions as a new tooth root. Following a healing time of 3 to 6 months, the implant integrates into the bone (osseointegration) and becomes a safe securing means for the crown, fixed bridge, or a removable denture, for that matter.
The replacement of a missing tooth consists of 3 phases:
- implant fixture (tooth implantation, the surgical phase)
- implant suprastructure (a titanium abutment or retention bar, implant bar screwed into the implant onto which the crown, bridge or denture is placed by the dentist)
- implant-retained crown or bridge (the crown or bridge is placed on the abutment)
Who is eligible for an implant?
Any healthy individual with one or several missing teeth is eligible for an implant. Excluding criteria include severe uncontrolled diabetes, advanced osteoporosis, patients under bisphosphonate treatment or heavy smoking and inadequate oral hygiene. Implantology ensures the replacement of missing teeth and makes the patient feel at ease to smile, talk and eat again.
How long does the surgery take and when do I receive my permanent crown?
At our clinic, we prefer to apply the two-phase implantology method in order to minimize risks, preferably implanting only into fully healed bones and gums. In the first phase, the implant is fixed into the lower or upper jawbone. 3 to 6 months later, the implant is complemented with an abutment onto which a life-like crown or bridge is fixed. Occurring under local anaesthesia, the implantation of a tooth usually requires 10 to 20 minutes. Patients with dental fear may also avail themselves of conscious sedation, in other words, dentophobia will be no impediment to the treatment. Healing time is 3 to 6 months, during which the implant osseointegrates into the bone. If bone replacement is required, healing time may take 6 to 9 months on average.
Is there a contingency of the implant getting expelled from the body?
Yes, this may occur, but it can usually be attributed to bad oral hygiene, wearing the provisional removable denture too much (the denture may crack the gum, the blood supply of the bone may decrease and the gum around the neck of the implant may resorb) and heavy smoking. Since the implant is made of titanium, a biocompatible material, it will induce no allergies and will osseointegrate with no inflammation whatsoever.
How painful is the intervention?
The intervention is performed either in local anaesthesia or conscious sedation, and is therefore completely painless. If the surgery is performed in conscious sedation, the patient is conscious throughout, but will not be able to recall anything. The effect of the anaesthetic wears out in 1 to 2 hours and you may relieve your pain with the painkiller provided by us. According to our patients this is not even required in most cases, since often a cold compress will do.
Shall I receive medications after the operation?
Yes, patients always receive postoperative antibiotics, analgesics, anti-inflammatories and a mouthwash. When selecting these, drug allergies, if any, will be taken into account.
Can I wear a provisional denture following surgery?
Yes. Your old removable denture can be worn following a soft reline, but a new provisional removable denture can also be prepared. It shall be borne in mind, however, that the most harmful adversary of an implant is arguably a removable denture, which can exert uneven forces on, and irritate the gum over the implanted implant. High pressure on gums reduces blood supply, which may cause bone resorption, whereas our goal is actually bone formation. If you are using a temporary removable denture just for a smile, wear it as few times as you can, and always remember to remove it at home and rinse it with a toothbrush and toothpaste after each meal.
Will my new teeth look natural?
Yes, your new teeth will look natural. In many instances, however, there is an insufficient amount of bone in the jaw due to infections, bone loss, periodontitis or accident. Due to the extent of bone loss, fixing the implant at the ideal location, at the root of the old tooth, becomes unviable. Consequently, the shape of the bridge and the neck of the crown will not exactly be to the patient’s liking. In such cases, minimum compromises should be made. A few patients do nonetheless take the extra pains to travel and undergo 2 or 3 extra surgeries and incur the surcharges associated with bone grafting and gum contouring in order to achieve the desired aesthetic effect. The above notwithstanding, implants are currently the best solution for an aesthetic replacement of missing teeth.
What will happen if I do not have sufficient bone for placing the implant?
Prior to the implantation, three-dimensional X-rays (CT scans) are prepared and a custom-made treatment plan is drawn up. In most cases, patients have sufficient bone. Otherwise, different bone grafting and bone replacement methods are available to rebuild the bone, using that of the patient or by adding artificial bone. In such instances, healing will take longer, with around 6 to 9 months to complete. Sinus lift is one such surgery.
What implants do we work with?
The success of the implantation system of the Swiss-based company Straumann is evidenced by a
60-year history and successful companies in over 100 countries achieved by a wealth of professional research teams. At our clinic Straumann Bone Level implants are used, which connect to the abutment according to the cutting-edge platform-shifting principle, which serves to protect against implant-related inflammation (periimplantitis). Due to its structure and surface Straumann implants can often be implanted concurrently with bone replacement procedures, thus significantly shortening the duration of the treatment. Straumann’s innovative solutions and clinical researches have given rise to two implant families with two different special layers:
SLActive and Roxolid.
The Swiss company assumes a lifetime guarantee on Straumann implants if inspected on a regular basis, in other words, should any problems arise with your Straumann implant at any time in your life, the company will reimburse the material cost of the implant.
Figure: Straumann implant fixture following implantation in the lower jaw
We also use DIO UF or UF II implants. DIO implants also meet the highest quality and medical requirements: they have an acidic, sandblasted surface, a double attachment point and a platform shift to prevent inflammation. Once the implant is fixed, healing time is 3 to 6 months. As for value-for-money, this is a high-quality implant with excellent clinical results and affordability. The manufacturer (DIO Implant Corporation, Busan), assumes a 10-year warranty by default and a lifetime warranty with regular annual inspections duly performed.
W&H Implantmed SI-923
W&H Implantmed SI-923 is a surgical drill used in the fields of dental surgery, implantology as well as oral, maxillary and facial surgery.
During implantation, the dentist drills a hole in the jawbone under anaesthesia. With drills of different sizes, holes of varying sizes can be drilled until the diameter of the selected implant is attained.
Implantmed’s LED lamp illuminates the inside of the mouth and the surgical area with exceptional accuracy, providing perfect conditions for the doctor to insert implants. Once a hole of appropriate diameter is attained, the second phase of inserting the implant into the jawbone may begin. Heat is generated in the course of bone drilling. It is therefore very important to continuously ensure cooling during the surgery. To create the most suitable bore, both the ideal drill speed and torque exerted on the bone are securely adjustable with this modern W&H Implantmed SI-923 implant engine.
Manufactured by W&H Dentalwer Bürmoos GmbH, Austria.
Information on the minimally invasive bone surgery device SA-320Piezomed (W&H)
An indispensable accessory of cutting-edge minimally invasive oral surgery, Piezomed (W&H) also features in Suba Dentál’s fleet of instruments. The operation of this surgical instrument and its feel in the mouth should be conceived of as similar to that of ultrasonic tartar removal. Highly similar in its sound, a tip vibrating at ultrasonic speed cuts the bone in a minimally invasive manner. In simplified terms this Piezo instrument is an oscillating scalpel designed to resect bone substance in bone graft surgeries and other hard-tissue interventions such as tooth extraction, resections, etc.).
Bone substance in the mouth can be resected in two ways:
- Bone substance is drilled away or a hole is bored into it by the surgeon.
- A minimum amount of bone substance is drilled away by means of a piezo in a minimally invasive manner.
The advantages of piezo surgery:
- Increased security in performing different surgical interventions such sinus lift, tooth extraction, root tip resection (apicoectomy), the cleaning of root canals with a periodontal condition and periodontal pocket cleaning.
- Brought into contact with the surrounding soft tissues, the tip of the Piezo will not harm or damage such soft tissues during bone resection (osteotomy). If bone is resected with a conventional rotating instrument, the tip of the drill may accidentally come into contact with soft tissues such as the tongue, gums, the maxillary sinus membrane (Schneiderian membrane), muscles, veins and nerves, and “snap at” the soft tissues, coiling them up and tearing them out.
- By means of the piezo’s tip the oral surgeon can handle osteotomy with ease and composure without having to worry about doing harm to the maxillary sinus, “coiling up” or “grinding” in soft tissue.
- Piezo surgery is reckoned as a state-of-art minimally invasive, atraumatic surgery seeing as in the course of the osteotomy a minimum amount of bone substance is affected, which greatly shortens healing time, rendering piezo surgery immensely more tissue-friendly than conventional bone grafts carried out with rotating instruments.
- Piezomed is an innovative piezo surgical device capable of automatically recognising the cutting tips placed therein in the interest of optimal operation and maximum efficiency.
- Piezomed has special LED-ring illumination excellently illuminating the surgical area.
- The ultrasonic vibration of osteotomy tips generates heat on the bone surface which is perfectly cooled by the spray system installed in the Piezo hand-piece during piezo surgery.
Downsides of piezo surgery:
- the device itself is extremely expensive.
- The ultrasound vibration does not bite on the bone substance as keenly as conventional bone drills, and many surgeons do not have the patience to work with it.
Piezo surgery can be likened to abdominal surgery. If there were no laparoscopic abdominal surgery, even a routine appendectomy would require a bigger incision meaning slow-healing wounds. With modern minimally invasive laparoscopic surgery, however, many surgical interventions can be performed with less pain and trauma, associated with lesser scabs than conventional abdominal surgeries. Piezosurgical instruments have an ultrasonic operating principle, but have greatly increased capacity as compared to conventional ultrasound devices.
Measurement of implant stability with the Osstell Beacon device
The implant is inserted into the jawbone and osseointegrates in 3 to 6 months’ time. The bone having formed in the site of a long-extracted tooth will be mature, with a density and consistency not matching that of a recent bone graft, and the stability of the implants inserted may therefore differ. An implant-borne crown or bridge can only be secured on a well-integrated implant. The Osstell implant stability instrument digitally displays the implant’s degree of stability in the bone by assigning it an ISQ (Implant stability quotient). Implant stability with an ISQ value exceeding 70 qualifies as excellent and the dentist can safely continue their work and proceed to fabricate the implant crown or implant bridge.
The operation of the the Osstell Beacon device is simple. An abutment called SmartPeg is screwed into the implant, the measuring instrument is brought into contact with it and digitally displays the stability reading. Should the stability of the implant be inadequate, another 3 months’ waiting time is recommended, until osseointegration is complete.