Dental implants

and Eva Rudolf-Müller, doctor

Dr. med. Philipp Nicol is a freelance writer for the medical editorial team.

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Eva Rudolf-Müller is a freelance writer in the medical team. She studied human medicine and newspaper sciences and has repeatedly worked in both areas - as a doctor in the clinic, as a reviewer, and as a medical journalist for various specialist journals. She is currently working in online journalism, where a wide range of medicine is offered to everyone.

More about the experts All content is checked by medical journalists.

Dental implants are a modern type of tooth replacement that is inserted after the loss of one or more teeth. The "artificial tooth roots" are anchored in the toothless jaw sections directly in the jawbone. Here you can read everything you need to know about dental implants, when to use them and what you need to consider after implantation.

What are dental implants?

If you lose one or more natural teeth, an implant can help. Tooth and tooth root are completely replaced by the implant. Dental implants consist of three parts:

• the implant body, which is anchored in the bone
• the neck part
• the crown (in technical language also "superstructure")

Depending on the type of crown used, the actual dental prosthesis, a distinction is made between fixed and removable dental implants.

For the most part, the dental implants consist of materials such as those used in hip or knee prostheses (titanium or titanium alloys). Since dental implants are anchored directly in the jawbone and grow in after three to eight months (osseointegration), dentists also refer to them as "endosseous" implants. The immune system does not react to the foreign body because the materials used are biocompatible - the body does not classify them as foreign.

The neck part of the implant, the point of passage through the oral mucosa, is very smooth, so that the oral mucosa can attach itself tightly. This is important to prevent bacteria from getting into the jawbone and causing inflammation.

The tooth crown is finally screwed or glued onto the head part of the neck part.

Implants from various manufacturers in over 100 different systems are currently available in Germany. They differ in their design, the nature of the surface and the variety of structures.

Mini implants

So-called mini-implants are being used with increasing frequency: These "minis" have a diameter of only around 2.5 millimeters and a length of less than ten, sometimes less than six millimeters. This makes them smaller than conventional dental implants, which makes insertion easier and more comfortable for the patient. The mucous membrane usually does not have to be cut open during the procedure. The wound in the bone is also smaller than with conventional implants, and there is no need for complex bone augmentation measures. Swelling and severe pain are therefore less with this so-called minimally invasive treatment.

The shorter treatment time is also reflected in the lower price of the "Minis".

The disadvantage is that special titanium alloys have to be used in the mini-implants because of the smaller diameter. Patients may react to these alloys with allergic reactions.

Dentists mainly use mini-implants when replacing small teeth, as the larger, conventional dental implants often cannot be used here due to lack of space.

When do you do dental implants?

The dentist can place implants for individual missing teeth as well as for complete edentulousness. Tooth loss can have various causes:

• Congenital (primary) causes: Congenital malformation of the teeth, often together with other, complex malformations of the facial area (e.g. cleft mouth and palate)
• Acquired (secondary) causes: accidents, tooth decay, periodontitis (disease of the periodontium), malnutrition, connective tissue diseases or tumor diseases

When not to use dental implants

Various health conditions may prohibit the use of dental implants. These include:

• severe cardiovascular disease
• Metabolic diseases (e.g. diabetes mellitus)
• Bleeding disorders
• regular use of medication (cytostatics, cortisone or bisphosphonates)
• heavy smoking
• too small jaw
• Grinding of teeth (bruxism)
• Nerves or blood vessels running too close to the implant
• a severely shrunk jawbone (bone atrophy)

What do you do with dental implants?

Precise planning of the treatment with appropriate education, diagnostics and follow-up care is important for a successful dental implant treatment.

The right dentist

The insertion of the dental implants should only be carried out by a specialized and certified dentist. Often dentists advertise with the designation "implantologist". However, this is not a professional or specialist title and is therefore not protected under professional law. Ultimately, every dentist can call himself an implantologist, regardless of his or her qualifications.

Therefore, pay attention to either the title "Master of Science in Oral Implantology" or the designation "Focus on Implantology". This is because these have been checked by medical associations and require that the dentist concerned has already carried out a certain number of operations - including at least 200 dental implants in total or 50 dental implants per year.

Experiences from other patients can also help you find the right dentist for your dental implants.

First contact

First of all, the dentist will ask you about previous illnesses or medication intake in an initial, detailed discussion. Then he will thoroughly examine your entire oral cavity. Imaging procedures such as x-rays, computed tomography or magnetic resonance tomography (magnetic resonance tomography, MRT) complement the preliminary examination.

If you have diseased teeth or inflammation of the gums, the dentist will treat them accordingly as part of the so-called pre-treatment.

Bone augmentation

Since dental implants are firmly anchored in the jawbone, the success of the implantation depends, among other things, on the bone mass of the jaw. If it is too low, the dentist speaks of jaw atrophy. In this case, bone augmentation must be considered:

The bone can be built up with procedures such as jaw spreading, sinus lift, inserting pieces of bone, for example from the pelvic bone, or by giving bone substitute materials.

Anesthetic procedure

Before dentists place an implant, the patient is usually given a local anesthetic (local anesthesia). General anesthesia is also possible at the patient's request. However, this has more side effects and causes additional costs that are often not covered by health insurance.

The operation

First, the dentist opens the mucous membrane over the jawbone with a small incision. After drilling a small hole, the dental implants are screwed or tapped into the bone and the mucous membrane is then closed with a suture (closed healing). Alternatively, the implant can also heal without suturing (open healing).

The actual dentures are usually only attached after the dental implants have healed (two-stage procedure). The chances of healing of the implant are then better than with direct attachment of the dentures (one-step procedure).

Overall, the operation takes about an hour and is most likely to be compared to pulling a wisdom tooth (extraction). The dentist pulls the sutures after about one to three weeks. A new anesthetic is not necessary for this.

This is followed by exposure: if the implant and tissue have healed well, an access is created in order to then screw the actual denture into the implant.

What are the risks of dental implants?

Patients with artificial heart valves or congenital heart defects have an increased risk of inflammation of the heart valves (endocarditis) and are therefore given preventive antibiotics.

Pain, swelling, and bruising are common consequences of dental implants. It is therefore helpful to cool the operated area immediately after the operation. If necessary, the dentist will also give you a pain reliever. If you have dental implant pain, you should inform your doctor.

infection

In the worst case, an infection (peri-implantitis) leads to the loss of the implant. The operated area can become infected immediately after the implantation, but also months later. It is caused by bacteria in the oral cavity. Risk factors include smoking, a dense jawbone with poor circulation, poor oral hygiene and a weakened immune system. Peri-implantitis is often noticeable through bleeding gums. Pain, on the other hand, is a rather rare symptom.

A preventive administration of antibiotics reduces the risk of infections and implant losses. Antibiotics are not suitable for the treatment of peri-implantitis, however, as they have poor access to the dental implants and therefore have little effect on the bacteria there. The implants then often have to be removed again.

Injuries from the procedure

Injuries to nerves, blood vessels and other structures when inserting the implants can cause pain and other complaints:

• Nerves: An injury to the mandibular nerve can cause permanent numbness of the chin and lower lip - a rare but serious complication.
• Tooth roots: Roots of neighboring teeth can be injured if they protrude into the drilling area.
• Blood vessels: Injuries to blood vessels when inserting dental implants are rare, but cannot be ruled out. Anyone who takes anticoagulant medication (e.g. acetysalicylic acid) must therefore discontinue them as a precaution before the operation.
• Bone: The implantation can injure the jawbone. In the case of severe jaw atrophy, the jaw may even break.

What do I have to consider after dental implants?

After inserting the dental implants, you should ensure thorough oral hygiene. To begin with, use a soft, gum-friendly toothbrush, dental floss, an interdental brush and an antibacterial mouthwash.

If possible, you should not smoke, as this can significantly impair the healing process.

Within the first year, your dentist will regularly examine the oral cavity and take x-rays to check that the dental implants are properly seated.

If implants are painful or have other problems, you should let your dentist know.

Dental implantation is a relatively safe and common dental procedure with around 200,000 operations per year. Modern dental implants expand the treatment options and can also achieve cosmetically convincing results.

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