The most important questions and answers about implants


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Allergies
Is it possible to be allergic to implants?

Implants have been around for more than forty years. Over this period no reaction to titanium implants has been detected. The material has no allergenic components and is completely neutral in the body.

Age
Is there a minimum age for implants?

Bone growth should be completed at the time of implant placement. It is generally complete at the age of 18. Girls generally finish growing somewhat earlier, boys are often later. In cases of doubt this can easily be checked by an X-ray of the bones in the hand.

Is an implant still advisable at an advanced age?

It is basically never too late to improve your quality of life with implants. The treatment is so low-risk that implants can be placed in people who are 70, 80 or even 90 years of age. There is no upper age limit. If you would have other routine dental treatment and are in good health, you can also receive implants.

Day surgery procedure
Is an implant placement really a day surgery procedure?

Yes, implants are placed in the jawbone atraumatically and safely under local anesthetic. It is usually possible to place multiple implants in one session.

Work
When can I go back to work?

After a checkup you can usually return to normal life and go back to work on the following day.
(See also "Sport" under S)

Procedure
What is the actual procedure for implant placement?

Consultation, preliminary examination and planning
The procedure required for your personal situation will be described in detail at the initial consultation. Then you will be given a healing schedule and a cost estimate that will show you exactly what your implant treatment will cost. You submit this to your health fund and they will tell what you will have to pay and what they will pay.
Once the costs have been explained and the decision to have one or more implants has been made, any required preliminary treatment of your natural teeth or the gum will be discussed. Implant solutions are generally combined with restoration of all your teeth. Detailed diagnostics and treatment planning are essential for implant placement. The examination includes evaluation of the complete oral cavity, the mucous membrane, the teeth and the jawbone. To prevent any risks the dentist will take a complete medical history of your general health.
Then the placement of the implants will be precisely planned using X-ray images and plaster casts of your jaw. Sometimes computerized tomography (CT) will also be required for exact evaluation of the bone and the position of other important structures. After these preparations you will be given your implants at your next appointment. Wear comfortable clothing so you can be relaxed during the implant placement. You can still eat moderately up to one hour before the operation. It is best to follow the recommendations given to you at the initial consultation.

Placement of the implants
The procedure generally takes no longer than 20 minutes per implant. The procedure for implant placement is so atraumatic and safe that all implants can be placed in a day surgery procedure and usually in one session. The gums are opened at the previously specific locations. Then a precisely fitted, small implant site is prepared by atraumatic drilling into the bone and the implants are screwed into place.
The implants must usually heal in the bone without load for some weeks or months. Therefore, the gum is sutured over the implant and a temporary denture is placed. A short time later you will be able to leave the dentist's office with a smile. You should not attempt to drive after receiving anesthetic. Someone should pick you up or you should go home in a taxi. Do not eat or drink until the anesthetic has worn of completely.

Healing
The gum will normally heal very quickly and generally without pain. You will be given a checkup after two or three days and then about ten days the sutures can be removed.

Bone healing
During the bone healing phase bone cells adhere to the implants and gradually surround them. The implants become a permanent part of your jaw. This painless process takes four to six months in the upper jaw. In the lower jaw the bone is harder, which means that implants are more firmly placed from the start (primary stability) and the process may only take two to four months.
Until then you will be given a temporary denture or you can continue to use your usual denture after some modification. With some care you can eat normally immediately. Temporary appliances can also be so carefully made that they are virtually identical to your natural teeth during this transition period.

Implant uncovery
When healing is complete, the gum is opened again directly above the implants and what are known as gingiva formers are placed. They shape the gum for the subsequent tooth abutment so the gum will surround the new crown in exactly the same way as the natural teeth. The gum is shaped for the retaining elements of the denture when dentures are planned. Finally an impression of your jaw is made to act as a basis for fabrication of the crowns, the bridge or the prosthesis with its retaining elements. Then the temporary denture is replaced. You never leave the dentist's office without teeth at any time.

Placement of crowns, the bridge or the prosthesis
After about two weeks the gingival formers can be removed and your permanent crowns, your bridge or your prosthesis can be placed. The crowns or the bridge are screwed to the implants. The screws are invisible from the outside and no one will be able to detect any difference to your natural teeth. For implant-borne prostheses retaining elements are fixed to the implants and the opposite pieces are integrated into the prosthesis. When the prosthesis is placed in the mouth the two components are joined and the prosthesis is perfectly seated. From now on you can feel completely secure with a perfectly natural mouth feel.

Exception: Immediate loading
In some cases, such as if your bone situation is optimum, it may be possible to load the implant immediately. This means that a very high-quality temporary denture is fixed to the freshly placed implant immediately. Your implant is placed and on the same day you receive a fixed, natural-looking tooth.

Time of treatment
How many appointments at the dentist will I need for my new teeth?

This depends on the scope and type of your treatment concept. One appointment is usually all that is needed for the consultation in which all your questions will be answered. The preliminary examinations and planning will be at your next appointment. It will generally be possible to place your new "tooth roots" into your jawbone in a short time in a third session. This means a small incision in the gum at the specified locations. It will be closed with sutures over the implants. The incision will be checked one or two days after the operation to make sure that there are no problems. The sutures are removed about ten days later. Now you can wait for the bone to regenerate during the healing phase without stress and generally with no more dental appointments.

When and how are the teeth attached to the implant?

During a normal healing process the implants in the upper jaw will be integrated into the bone after about six months and in the lower jaw after about three months. They will then be a completely natural part of your jaw. The new crowns can now be permanently attached to the implants. The heads of the implants are uncovered and small caps are screwed temporarily to them to shape the gum correctly. An impression is made at this stage. The dental technician uses the impression as the base for fabrication of your denture. The denture is fixed securely to the implants after exact color matching and a try-in to make sure it is correct.

(See also "immediate loading" under I)

Will I be without teeth during the healing phase?

No. If you had a removable denture beforehand, in most cases you will be able to continue to use it after some minor adjustment. If you did not have a removable denture, the gap can be closed with a temporary denture. In some cases a temporary denture can even be fixed to the implants immediately. Very high-quality solutions, which are virtually identical to your final crowns and your natural teeth, are available for such long-term temporary dentures.

Consultation
How can I prepare myself for the initial consultation?

If you already have some general information before the consultation, you will be able to follow the explanations specific to your situation better. You can also use the consultation as an opportunity to get answers to all your questions. You may find it useful to prepare a list before going to the appointment so you won't forget anything. Note that any general diseases or medications that you take regularly must also be discussed at this appointment.

Anesthetic
Is it really true that a general anesthetic is not required for implant placement?

No. The pain response in the jaw can be completely suppressed with a local anesthetic. When the implant site is drilled into the bone and the implant is screwed into place, you will feel a vibration and a slight feeling of pressure but no pain. For most patients the procedure feels like treatment for caries, which is also conducted under local anesthetic. If you still want to sleep through the treatment, just ask.

Diabetes
If I am a diabetic can I also have an implant?

Yes. However, you should be stable before implant treatment. Unstable or untreated diabetes may cause problems with the healing process. In case of doubt consult your diabetes specialist.

Diseases
Are there any diseases that would prevent implant placement?

Not really, but if you suffer from a condition such as cardiovascular disease or osteoporosis, serious kidney damage, tendency to high blood pressure or an impaired immune system, you should always let us know. We can discuss your options and make a decision based on your general health profile.

Replacement or extension of the denture
Can implant-borne dentures be replaced or, if additional teeth are lost, extended?

Yes, dentures can be replaced or extended at any time. A single-tooth implant can be converted to an abutment for a bridge or prosthesis without difficulty, even after many years.

I already have a normal full denture. Do I need a new one for fixing to the implants?

If the existing denture can guarantee optimum loading of the implants and good chewing function, it is certainly possible to convert it for fixing to implants. Just ask and we can recommend the best solution.

What happens if one single tooth that is integrated into the denture as an abutment is lost?

If one tooth has to be removed, for example because of a root infection, it can generally be replaced with another implant without problems. The support and if necessary the prosthesis are then adjusted appropriately.
 
Eating
Can I bite and eat normally with an implant-borne denture?

Regardless of whether you have an implant-borne crown, bridge or prosthesis: you can eat, bite, talk and laugh just as you could formerly with your second set of teeth. The denture is so firmly fixed to your implants that you can feel quite secure.

Airport security inspection
Will the implant cause the metal detector to beep, such as during the security check at the airport?

No, no need to worry. Implants are not magnetic and they are also much too small for the detector to detect them. And even if the metal detector does beep and detect your implants, you will have your implant passport that will explain the problem quickly and without problems.

Foreign-body feeling
Will implant-borne teeth feel like my own or will I feel as if there is a foreign body in my jaw?

Implant-borne teeth will feel quite natural during talking, eating and laughing. You will not feel any difference.

Pacemaker
Could implants affect my pacemaker?

No. Implants have no electromagnetic effect. They pose no danger to the operation of your pacemaker.

Life
How long does an implant last?

After the healing phase a correctly placed quality implant is more resistant to most influences than the natural dental root. A titanium implant with the optimum prosthetic loading will not break. And it is not affected by caries. You can keep the gum and the implant site healthy with consistent oral hygiene. This means that implants can last for your entire life.

Implant material
What are implants made of?

Implants are made of pure surgical titanium. The material has had such good results that now 99% of all dental implant systems are made of this material. It is very stable and very compatible with the body. Titanium also becomes an integral part of the bone tissue. These positive properties have been tested not only in dental implantology but also in many other areas of medicine, such as joint prosthetics, for decades. The silver-gray color of titanium is also not a disadvantage, because implants - like natural roots - are completely in the jawbone and are invisible.
White implants of ceramic have also been available for some years. However, the first generations of aluminum oxide ceramics did not have sufficient material strength to compete with titanium. Current ceramic implants are made of extremely stable zirconium oxide ceramics and are currently being tested. Titanium is still the material of choice for implants.

Ceramic
What dental material is best for crowns?

Most crowns and bridges are made of metal or metal alloys and are veneered with ceramic to match the color of the tooth. The most esthetic alternative is porcelain. Zirconium oxide ceramic with its high strength is particularly suitable for implant-borne dentures. It is also suitable for single-tooth crowns and also for larger bridges and it reflects the light falling on it in exactly the same way as the natural tooth material. A denture of this material is virtually indistinguishable from the natural teeth.

Bone grafting
When might bone grafting be necessary?

If teeth are lost and the natural chewing load in the jaw is absent for an extended period, the bone gradually atrophies. This is analogous to a muscle that atrophies because it is not used. Certain bacteria may also destroy bone. This is referred to as periodontitis, better know as periodontosis, an infectious disease of the jawbone. If the bone substance is weakened or so that it cannot hold an implant, bone grafting is recommended. The bone tissue is restored as atraumatically as possible with bone from the body or bone-replacement material. A mixture of both is often used. The grafting material is applied directly to the bone and is gradually converted to resistant bone substance by the body. The bone can be widened or lifted with this method. At the back of the upper jaw the bone is generally lifted by a sinus lift procedure. This prevents part of the implant extending into the maxillary sinus. It is often possible to carry out the bone grafting immediately before implant placement. However, in other cases a separate procedure beforehand is required.

Cost
How much will it all cost?

The cost depends on the extent of the treatment and the number of implants. The general cost of an implant-borne crown including all medical and dental technician services is around 2000 euros. An implant-borne bridge (for three missing teeth) will start at around 4000 euros and a full prosthesis at 6000 euros. The healing and cost schedule, which will be given to you before starting the treatment, will list the exact cost of the treatment.

Reimbursement
Will my health insurance pay anything towards the treatment?

Yes. Since January 2005 the statutory health insurance funds in Germany also pay a fixed contribution for implant-borne dentures. The fixed contribution is based on the basic treatment. This is a crown, bridge or prosthesis that represents the minimum standard for a specific initial diagnosis.

For example, the following fixed contributions are derived from this:

- you will receive about 270 euros for a missing tooth.
- you will receive about 380 euros for four adjacent missing teeth.
- you will receive about 270 euros for five missing teeth or free-end edentulism.
- you will receive about 270 euros for a toothless lower jaw, and about 250 euros for a toothless upper jaw.

If you can confirm that you have had regular dental examinations for the last five years before starting treatment, the fixed contribution is increased by 20 percent. If you can confirm regular dental examinations for the last ten years the fixed contribution is increased to 30 percent.

Medications
Are there any interactions with medications?

This may be possible with specific medications. Cortisone, for example, can affect the metabolism and immune situation of the body in such a way as to cause problems with healing. Anticoagulation medications may cause serious hemorrhage during implant placement. If you take any medications regularly, you should tell the dentist what they are during the initial consultation.

Night
Must I remove an implant-supported prosthesis at night?

A conventional denture must be removed at night because it may come adrift during sleep and may block the pharynx or respiratory passages. However, an implant-borne denture is normally fixed, so it can be left in place at night without problems. If you wish, you can wear your denture around the clock.

Periodontitis / periodontosis
(See also "bone grafting" under B)

Risks
Are there any risks involved with implant placement?

An implant placement is a minor operation. Complications, such as injury to nerves and blood vessels, are always possible during implant placement. However, this is most unlikely with the current methods of diagnostics and planning. The risks involved with implant placement are normally no greater than those in removal of a wisdom tooth.
A sudden rejection reaction of a completely healed implant is also very improbable. However, in rare cases the implant may not be securely integrated into the bone. In such a case it would not be sufficiently resistant to loading and would most likely have to be removed under local anesthetic. However, it is normally possible to replace it with a new implant, often is the same session - if that is what you want.

And if an implant becomes infected?

When detected early enough, infections, which are caused by bacteria, can usually be treated successfully. If you attend your postoperative care and prophylaxis appointments regularly and also clean your teeth conscientiously at home, you should be safe.

Are implants advisable for smokers?

The long-term success rate of implants can be adversely affected by smoking. Please describe your smoking habits in the initial consultation to allow the risk to be assessed accurately in your case.

Pain
Will I be in pain after the operation?

The gum will probably be sensitive for the first few days but will not bleed. Your cheek may swell temporarily and feel uncomfortable. Most patients will not even need a painkiller on the following day and will be able to return to normal life.

Attractive teeth
I only need single implants but I would like to have all my teeth made brighter and more attractive. Is this possible?

Darker teeth can often be brightened by bleaching. Unattractive tooth fronts can be covered with plastic or thin ceramic coatings, known as veneers. The crowns for the implants will then be made lighter in color or shaped to match the new appearance of the teeth. Ask us about it: there is a solution for almost every problem.

Sinus lift
(See also "bone grafting" under B)

Immediate loading
What exactly is "immediate loading" and is it applicable to me?

The standard protocol for implant-borne teeth requires an unloaded healing phase after placement of the implant. In this protocol the gap is temporarily closed by a classical temporary denture, which can for example be fixed to the neighboring teeth. With immediate loading new implant systems and methods are used, which under specific conditions allow the denture or the temporary denture to be fixed to the implants immediately. Patients receive their implants and on the same day they receive fixed, natural-looking teeth. Whether immediate loading is something for you depends on the status of the jawbone and the position of the implants. Just ask us about the options.
(See also "length of treatment" under L)

Immediate implant placement
Can implants be placed immediately after extraction of teeth?

Yes, that can often be done today. The implant is placed in the fresh wound immediately after extraction of a tooth. This is referred to as immediate implant placement (not to be confused with immediate loading of implants).

Exercise
And can I exercise normally after implant placement?

Movement is basically not a problem after implant placement. However, if you want to participate in vigorous exercise, discuss it with us first. We may recommend waiting a few days to avoid affecting the healing process.

Tooth care
How do I care for my implant-borne teeth?

Implant-borne teeth not only look like natural teeth. They can also be cleaned just as easily with a toothbrush - including an electric toothbrush - and tooth paste. The interdental spaces and the transition areas to the gum are particularly important with implants. Bacteria colonize these regions very quickly and can attack the gum and over time also the jawbone around the implant. This can be prevented with dental floss or small interdental brushes. If you wish our prophylaxis team can show you how to use the instruments and will arrange for professional cleaning at regular intervals - such as every three months. This will remove stubborn plaque deposits and keep your teeth brilliant and looking like new.
Praxis Dr. Robert Vogt und Dr. Dana Anastasiu