Dental implants are essentially titanium screws that are inserted into the jaw or skull bone and serve as replacement for lost dental roots. Titanium is used because of its excellent biocompatibility, which is extremely important because it increases the chances of bone tissue accepting the implant. Next, a titanium – or lately zirconium- superstructure is attached to the implant and binds it to the dental prosthetic. If you are missing a single tooth, an implant and a crown can replace it, whereas implant-supported bridges serve as replacement if you are missing several teeth.
Patients missing all of their teeth often experience some difficulty when wearing complete dentures. Here dental implants prove very practical because they give you extra hold and security when wearing dentures – especially lower jaw dentures – and during chewing.
The implants we use
Nobel Biocare dental implants have been available for more than 40 years. They are made from chemically stable, commercially pure titanium variations using cutting-edge technology and a special cold-working process, which makes them especially firm and long-lasting.
Implant Direct is an American brand that, to dental professionals, symbolises a perfect success in the field of dental implants. The company was founded by Dr. Gerald Niznick, whose guideline has always been that patients need and deserve high-quality, innovative implant products at affordable prices.
In our practice we use the ASTRA TECH Implant System for implant prosthetic therapy. These Swedish implant products are among the best in the world. Our experience has shown that they provide excellent results.
Diagnostic techniques in implant treatment
CONE BEAM COMPUTED TOMOGRAPHY (CBCT SCAN)
CBCT scan offers an undistorted 3D view of the dentition to make the positioning of dental implants easier and more precise.
The 3D view of both bone and soft tissue at the same time and the implant procedure simulation give the patient insight into treatment planning.
Digital imaging helps us decide whether implant treatment is possible and whether there is any need for additional surgical procedures, instruments or materials.
One of the greatest advantages of 3D diagnostics is the possibility to choose the type of implants and the most simple and least invasive treatment option for each patient.
DIGITAL DENTAL RADIOGRAPHY (RVG)
Conventional radiography as mentioned above is a thing of the past. Our practice offers radiovisiography (RVG) digital imaging which decreases exposure times dramatically. This way patients get up to 90% less radiation than they would from a standard X-ray.
The greatest advantage of this method is immediate image availability and increased diagnosis precision. In our practice we use two types of RVG imaging: orthopantomogram and intraoral dental imaging.
Digital orthopantomogram provides a panoramic image showing a section of the whole upper and lower jaw.
Intraoral imaging gives us a detailed view of a single tooth, the dental crown, the root and the structure of the surrounding tissue (periodontium and alveolar bone).
Advantages of cbct:
- With the help of 3d visualization that the software provides, the patient is now able to follow the procedure on the computer screen.
- Bone density in the whole jaw can be accurately measured and the implant surgery planned in detail.
- Cbct makes it easier to decide on the length, width and the exact positioning of the dental implant
Advantages of digital rtg imaging:
- Images are available immediately and the scan can be done in our practice.
- Extremely accurate scans – much more precision than with any previous imaging technique.
- With the latest cbct machines the patient gets up to 90% less radiation, which is a negligible amount and roughly the equivalent of everyday radiation exposure.
Computer-aided implant surgery
A computer program for the analysis of CT images of the patient’s jaw serves for virtual planning of the implant procedure. It is a precise and accurate diagnostic method that enables the surgeon to see every change in the alveolar bone. It also shows, in exquisite detail, the surrounding teeth, the position of nerves, blood vessels and maxillary sinuses.
The program provides a perfect 3D reconstruction of the jaw, which makes it easier to plan the implant surgery – the number, length, diameter and angulation of implants, as well as their positioning relative to the surrounding soft and hard tissues. Computer-aided planning increases the precision of both the surgical and the prosthetic phases of treatment.
Immediate implant surgery
Immediate implant surgery is a method that places a dental implant of a certain size and shape into the extraction socket as soon as the tooth has been extracted. This makes it possible for the temporary prosthetic solution to be completed at the same time, which shortens the period between tooth loss and permanent prosthetic tooth placement. Also, this option is often more acceptable to patients in terms of both aesthetics and functionality. The greatest advantage of immediate implant surgery is that both the removal of the tooth and implant placement are completed in one visit. This significantly decreases alveolar bone resorption around the extracted tooth. The best candidates for immediate extraction and immediate implant are patients with no inflammation, whose surrounding bone is not compromised by infection or bone loss and whose gingiva is thick enough.
Measuring dental implant stability
Osstell ISQ is a diagnostic device that precisely measures the quotient of implant stability and helps your dentist decide on the best moment to load the implant. Monitoring implant stability is a valuable diagnostic method that optimizes the treatment outcome. Low ISQ values show that the degree of osseointegration is not yet sufficient for implant loading. Measuring implant stability is quick, painless and non-invasive – over and done in just a few seconds. SmartPeg is attached to the implant and Osstell stimulates it by emitting magnetic pulses. SmartPeg automatically resonates in the directions with highest and lowest frequency, showing the degree of osseointegration; Osstell records the numerical values and shows them on a screen. The higher the ISQ value, the more stable the implant.
What if there is not enough bone for dental implants?
When back teeth in the upper jaw are missing, the sinus cavity becomes larger because the bone and soft tissue also deteriorate over time. A similar process happens in the lower jaw. These anatomic limitations make dental implant placement difficult – but there is a solution. We use dental panoramic radiograph (orthopantomograph) or dental cone beam computed tomography (CBCT) to determine the exact degree of deterioration and plan further treatment (bone augmentation or sinus lift).
A sinus lift is a surgical procedure during which the bottom of the sinus cavity is lifted so that there is enough room for the implant. Depending on the extent of the deformity, a sinus lift can be open (lateral / direct) or closed (osteotome / indirect). The procedure involves adding artificial bone (bone graft) and resorbable membrane below the sinus. Bone is given time to develop (usually 4-6 months), after which it is strong and large enough to support implants. Sinus lift is painless since it is performed using anaesthesia, but some patients experience a certain amount of pain and swelling in the area of surgery.
How to act before and after surgery?
Postoperative recovery (instructions to the patient)
If peri-implant mucosa covers the implant after placement (which may happen following the two-phase implant surgery method), the stitches over the implant need to be cleaned with cotton swabs dipped in mouth rinse. If your surgeon used resorbable stitches, they will dissolve in 2 to 3 weeks; non-resorbable stitches will need to be removed after 7 to 10 days.
If a healing abutment is attached to the implant fixture, it will remain visible for the next 3 months (i.e. until your prosthetic treatment is completed). It is important that you keep it completely clean throughout the healing period.
In rare cases the healing abutment may fall out. This is no cause for concern, as it can be reattached in every practice that uses the same type of implants.
Dental implants look, feel and – thanks to osseointegration – also function like natural teeth. When we lose a tooth, the jaw bone also starts to dissolve, which can eventually change the shape of your jaw. Dental implants stimulate bone growth and prevent bone loss and gum recession. In addition, getting implants does not affect your natural teeth, because it is not necessary to reshape (file down) healthy teeth in order to support the bridgework. Standard dentures can get unstable and come loose; dental implants will stabilize them and make them fit better. All in all, an implant is a long-lasting and aesthetically appealing solution to your tooth loss problem.
Implants are placed using local anaesthesia; the complete procedure does not take more than 30 minutes. If both bone density and primary implant stability are adequate, the dentist will attach a healing abutment right away. When bone density is low and bone augmentation is necessary, it is advisable to place a cover screw over the implant and allow for transmucosal healing first.
Dental implant procedure is done using local anaesthesia and special surgical instruments, and is therefore painless. The patient is discharged on the same day and is directed to reduce swelling with ice packs.
Complications following dental implant surgery are very rare. Maintaining excellent oral hygiene is a must. Plaque collects on teeth and can harden into tartar if not removed every day; tartar causes inflammation, gum recession and bone loss around the implant, which in some cases can even lead to implant failure.
Minimal ossification time is three months, and if bone augmentation (sinus lift, etc.) was also performed, it can take up to eight months. After that, dental prosthetic work is completed (crowns, bridges or prostheses).
We recommend a follow-up in our practice at least twice a year. Maintaining oral hygiene is a must! The patients are responsible for the long-lasting success of their implant prosthetic treatment.
When bone quality and quantity are insufficient for implant placement the surgeon will perform a bone augmentation procedure. If bone deficiency is not severe, granular artificial bone and collagen membrane are used. This technique is often done simultaneously with tooth extraction and implant placement (immediate implant placement procedure).