e>oral surgery maxillo facial surgery Dr. Kerstin u Stefan Bertram Salzburg/Austria next Airport und Freilassing

Tooth implants


Important foreword:

The questions and answers shown below can´t substitute an individual consultation at your dentist or oral surgeon!

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  What are implants at all?

> Implants are artificial tooth roots, setted into the jaw. Implants are produced out of biocompatible materials, tolerated charmlessly by the bone. The tooth itself is built up on the implant


Image links:

Image 1: model of implants setted into tooth spaces more behind

Image 2: model of implants in the front

Image 3: branemark implant

Image 4: showing a possibility of setting an implant (Ankylos)


 Do implants uphold forever?

Of course, implants are aspired to uphold forever. Like natural teeth implants reach into the oral cavity, too. Therefore, they are exposed to lots of inauspicious factors of one´s mouth. These are e.g. leftovers, plaque and all the other pathogens. If implants aren´t cared for, similar processes as if it was a natural tooth may uprise. These processes could at first lead to gingival pockets, then to loss of bone and at least the implant may be endangered. Oral hygiene is absolutely necessary for a long-time success. And of course, you should make an appointment at your oral surgeon regularly, therewith he can check the implants.

Other risk factors for a long-term success are heavy smoking and special general diseases like diabetes type I (insulin injections), long lasting Cortison treatments, e.g. if someone suffers from special rheumatic diseases, but also a bad substance of bone.


In every patient case the risks should be assessed carefully.



 Are implants repelled of the body?


Reactions of repellency—known with allergies—appear hardly ever, especially if implants of pure titanium are used.

In the past, inflammations, known with natural teeth and which even may appear with implants, were reputed to be a reaction of repellency by mistake. In contrast to earlier opinions, telling that the titanium surface coalesces in a chemical way to the bone cells, new studies show, that even titanium leads to an unspecific foreign substance reaction. But this doesn´t cause a repellency in the jaw.


Even if titanium has fulfilled the long yearned wishes of the dental surgery for a qualified material, that can replace a natural tooth root in the jaw, there are permanent studies to improve the state of the art. But the focus of the research is on the one hand optimizing the titanium surface and on the other hand developing totally new materials.



 What material are implants made off?


The most common implant systems are of pure titanium. It coalesces very good to the bone. There are nearly no allergic reactions and titanium shows a good stability. In the past, often implants made out off ceramics were used and they also showed a good healing and are unbeatable cosmetically. Nevertheless, they are setted more and more rarely, because of the large danger of breaking.

However, one is working all the time to improve the mechanical properties of ceramics.



 Which one is the best implant system?


This question can be answered generally. The well-known implant systems all have reached a high level. Every system shows in some cases advantages and in other cases disadvantages compared to other labels. I like the comparison between implant systems and cars. The well-known car companies produce good cars. But there are no cars, that are second to none in every segment. We work with Straumann ITI and Branemark. In the meantime, every implant system enacts about a lot of different implant forms and numberless parts. Decisively is not the fabricator of the implants, but the cooperation of the patient and the skill of the surgeon.


Link: image shows a cut-out of the offered implant forms and parts – just from one enterprise/company.


Link: image shows a cut-out of the offered implant forms and parts – just from one enterprise/company.

Entscheidend ist nicht der Implantathersteller, sondern die Mitarbeit des Patienten und die Kunst des Operateurs


  What do you think about the new implants developed in the USA?


I am frequently asked this question recently. One patient was very kindly and brought along an article out of the journal “’Echo der Frau”. This article was published because of an interview given by a dentist: “It´s the latest hit from the US and you even get it in Germany, too: tooth implants, that don´t wobble any more. That´s the breaktrough in the 40 years long lasting history of implanting simulated teeth!”


Behind these overwhelming statements hides the further development of the implant surface. This special plating of the surface is also useful with European implants, e.g. ITI.

I also prefer this refined surface, because I think it´s more advantageous than the “old one”.

But if this is true, it should be rarified by autonomic long-term studies.



  Do I need an implant for every lost tooth?

No: One stout implant is able to sustain several teeth. The strength depends on the starting situation of the jaw and on it´s thickness, level and tightness. Furthermore, it is important if the implant has to sustain dentures that can or can´t be taken off.



 After having lost all teeth, how many implants do I need therewith a denture stays?


Most frequently, we aspire 4 implants for an edental/ a toothless jaw (statement of the DGZMK 3 /98). A solution with 4 implants improves the stay of the denture, but it also offers less stability. If you decide for having a denture, you can´t take out (that´s one only removable for brushing through opening bolts or screws), we recommend standardly 6 implants in the lower jaw and 8 ones in the maxilla. Of course, the totally number of implants should be determined individually. For example, a longer implant can stand more pressure while chewing than a shorter one.


 What about the charges of implants?


German doctors aren´t able to publish their charges in the internet, because of the german law. Recommendable is in any case an individual consultation, because the costs depend on the operative complexity. So the surgeon needs to have a look on the patient to tell you anything about the charges in detail. But of course it is possible to contact every oral surgeon or every dentist, who offers dental implants, via E-Mail or telephone and to ask for the charges of implants in general.






Do the health insurances pay at least partially for implants?


Often the private health insurances pay almost the whole costs for your implants. Therefore, it is helpful to send them an estimate before the operation.

The statutory health insurances only are able to pay for implants in extreme situations (e.g. sheer jaw, state after having had jaw cancer, an accident or congenital dysplasias of the jaw).




Do I need a general anaesthesia for implants?


No, it´s common to treat the patients with tooth implants under local anaesthesia. In every case the patient should be driven home after the treatment, because the stress on your circulation is much more than after having had a “normal dental treatment”.

A general anaesthesia is only advisable, if the treatment otherwise isn´t possible. Furthermore, there is the opportunity of getting a sedation jab, that gives the patient a feeling of calm and tranquillity.

Patients, who suffer under heart- or circulation diseases, should only be treated in the presence of an anaesthesist, who is able to keep a watch on those patients with special apparatuses.




How long am I put on the sick list?


Normally, it´s not possible to go working the following two days after the operation. We can give you more detail information as soon as we have had a look on you to estimate the complexity of the surgical intervention.




Which form of trouble should I be prepared for?


We can give you more detailed statements after an inquest (?) and having estimated the complexity of the surgical intervention. The patients often feel pain for some days. But you can easily suppress it with analgesics.

Furthermore, you´ll get a swelling. It increases during the first two days after the operation and then it´ll become better. The dimension of the swelling depends on the one hand on the complexity of the operation and on the other hand on the cooling through the patient. Besides, a visible haematoma could appear.





Is it possible to get an implant immediately after having pulled a tooth?


With setting immediate implants, there´s the advantage of less waiting-time and a faster using of the existing bone, because the jaw often removes fast-paced after having pulled a tooth. In every case, there should be the supposition, that the jaw stays stout after the pulling of a tooth and no inflammation rises up. To consider this situation, a surgery microscope or special eye glasses, that magnify, are very useful. Unfortunately, the mentioned prerequisites often aren´t given.


Therefore, out of reasons of safety, one waits normally after having pulled a tooth between 8 weeks and 6 months, in most cases the waiting-time amounts 4 months. During this time period, in the cavity of the jaw new functional bone has been regenerated. Another good possibility to bridge the time between pulling a tooth and setting the implants, are so-called template implants. These are very thin implants (made of the same material as the other ones, only with another form and size). To offer the patient a better stay of the dentures immediately after removing teeth, these template implants can be burdened instantly and they are removed as soon as the final implants have firmed.





How long do I have to wait until the denture respectively the crown is made?


There are obvious differences depending on the situation and on the loading of the implant. Mostly, one waits in the lower jaw 3 months and in the maxilla 4 or 5 months. In the front of the mandible, one is able to reduce the waiting-time even more if the situation is stout. Compared to the upper jaw behind, the bone is very supple, so that we are patient rather about 6 months. But not only the position of the implant is decisively, also the whole condition of the patient. If the patient is younger, the cure of the bone goes off faster than as if the patient is a bit older and suffers e.g. from diabetes. In the last time, fabricators of implants assert, it was possible to shorten the waiting-time with improved surface structures of the implants. W also use these “new” implants cauterized with acid, because probably they decrease the abrasion of the implants while turning. We are sceptical with estimating the publications of pretended revolutionary abbreviations of the waiting-time, because often the fabricators order these studies themselves and I think, the observation time of such implants is not yet sufficient to make a statement.

Of course, we are happy that research is done with the surface mutation of implants to shorten the healing time. This development is very pleasant for the patient. On the part of the hygienics, I gauge the tendency of increasing the implant surface by making it rougher critically. Even if the waiting-time can be shortened, there´s the danger of a settling with bacteria on the artificial jagged surfaces, if the oral hygiene is not optimal.



Are there several operations necessary?


Often, one intervention for setting the implants is enough. Implants, that had been setted under the mucosa, have to be ridded from the mucosa before they can be loaded. This happens in local anaesthesia and compared to the setting of the implants, it is a very short intervention.

Anyhow, it is possible that the jaw must be made stouter before setting an implant.




Is there a maximum age for implants?


No: Decisively is not the nominal age but the biological one. There´s a larger risk if a 50-years-old patient, who had had an organ transplantation, gets implants as if a patient at the age of 80 wants to have implants but feels hale and has a good structure of the jaw.




I suffer from osteoporosis, is setting implants still possible?


I don´t consider osteoporosis as an exclusion criterion. Indeed, I disabuse the patients about a longer waiting-time until the implants can be loaded. Some medicine like “Bisphosphonate may be a risk”




My jaw has already faded. Are implants still possible?


To reach a certain long-term success, the jaw should normally have a width of at least 5 mm and an altitude of 10 mm. These two factors can be determined with an oversight x-ray picture, an inquest or optionally a computer tomography.

If there´s not enough bone, it´s possible to build up new one. Therefore I take (depending on the required amount) the chips out of the implant drill hole and bone out of other areas of the jaw, e.g. where the wisdom tooth has been. Sometimes even bone out of the hip is necessary, especially to build up the lateral area of the maxilla. If a patient lost the teeth there a longer time ago, the bone fades and the sinus maxillary becomes larger. With a so called lifting of the sinus maxillary base (known as sinus-lift, too), this space is filled up again with bone. After 5 months this new bone can uphold implants.




Is it possible to provide children and teenager with implants?


To support the orthodontic treatment, teenager can get implants, too. These special implants, setted in the roof of the mouth or behind the teeth, can substitute a costlier equipment. But the replacement of lost teeth with implants is difficult, because the jaw of the teenagers hasn´t finished growing. So the jaw around an implant wouldn´t grow further normally. Therefore, implants shouldn´t be setted before the last growth shear. That means at the age of 14 (girls) and the age of 16 (boys). I like to wait even longer (18 [girls] and 20 [boys] years), because even after the last growth shear the jaw can grow 1 or 2 mm of altitude (this happens even until the age of 25 with men!).

Shouldn´t there be other possibilities out of an implantation, one can use tooth crowns that can be changed. So one can compare the growing of the jaw with transposing the visible tooth crown.



Do I have to be totally healthy for getting implants?


No, there are diseases that pose a higher risk. These are diabetes (when pills aren´t sufficing), leukaemia, situation after a radiation therapy and heavy heart diseases. In every case we estimate the individual risk after talking to your family doctor.




How long do I have to descry checkups?


I consider steady checkups of the implants for very important. Earlier stages of inflammation can be treated much more easier than heavy inflammations, that have led to a bone fading.

Normally, the following checkups are necessary:

when the implants have been setted: after 2 days, after 7 days, then after 3 weeks and finally once in a month.

As soon as your dentist has finished, you should visit your oral surgeon for a checkup too after 6 weeks and afterwards two times within 3 months. If everything is alright, please let us have a look at the implants one or two times a year.




When is a preoperation before the implant setting necessary?


The rationale while setting implants is, that the implant has to be into the bone tightly. If this isn´t guaranteed, the bone has to be built up before. This intervention takes place some months before. Is the implant fixed after setting, but a part of the implant body isn´t covered with bone, one can cover this area in the same operation with a filling material.

The gold standard for consolidation and covering the implant is bone, that was produced naturally in the body. This type of bone doesn´t lead to a defensive reaction and supports the regeneration even more than artificial bone. The still living parts of the bone after the transplantation are like germ cells for the new bone. The bone, that should be transplanted, is taken preferably from qualified areas of the jaw. The disadvantage of this method is the more voluminous intervention. If a lot of bone has faded, one even takes bone parts of the hip. This operation has to be put through in general anaesthesia (I don´t do this, neither ambulant nor in the hospital).

Furthermore, there is the possibility to fill up smaller failures with special membranes and replacement materials. To avoid separate interventions in the jaw to get bone for transplanting, there are always new developments in bone replacement materials. But until today, no other long-term study with artificial bone could substitute using own bone as the gold standard.

I don´t think, that one´s own transplanted bone will stay the gold standard forever. For example, there are new studies about the so-called “Distraktionsosteogenese” which are very promisingly. This is a technique to spread too less bone constantly and to increase it this way.


We are keeping you up to date in every single case.



I heard about special materials that can build up lost bone again without an operation. What do you think about this?


These materials are special proteins which are expected to support the regeneration of the bone (BMP: Bone Morphogenetic Protein). Such materials exist since about 10 years.

I read an interesting article in a special german journal for doctors about this subject. According to this article, there are no certain results about standardized using of these materials with men.

That´s the reason why we only use such materials, if there´s no other possibility.


But it´s very important to have a look on these studies, cause the results on animals are promising a lot. In the meantime, it is succeeded breeding humane BMP´s. An ideal vehicle keeping the BMP´s in their place of destination hasn´t been found yet, cause in the blood stream it is removed very fast.



Someone told me, that implant healing was better, if one takes his own blood and afterwards the blood is put back into the drill hole.


Blood consists out of different parts. Besides the red blood cells, there are a lot of proteins supporting the regeneration of bone. Therefore, before the operation the parts are separated in a centrifuge and at least the plasma parts with a higher concentration of these useful proteins are put back into the wound. Our experiences show, that these wounds are healing fast and without problems. Despite, I think we should expect further long-term studies until it is possible to load these types of implants immediately.




A lot of other questions can only be answered in every special patient case. Publishing further information on this internet page would impinge against german occupational laws.


We kindly ask you for your understanding!


Do you have any other improvement suggestions or do you need further special information?

Don´t hesitate to contact us!

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