Implantology

The existence tooth is lost is relatively common. Whether he is now in an accident Oral cavity is knocked out or whether a Periodontal disease has destroyed the tooth holding apparatus so that it can no longer hold the tooth, both of which mean that the tooth can no longer remain in the oral cavity.

But it can also be that the dentist has to remove the tooth because it is so deep Caries the tooth substance and possibly also the Tooth root harmed so much. In this situation usually none can filling more can be done. The tooth would either have to be filled too much and thereby become unstable, or the tooth root is destroyed by caries, in which case the tooth has to be extracted in almost every case.

But what then? The missing tooth needs to be replaced somehow. bridges or Crown are very well known, but they cannot be regarded as the first treatment of choice in all cases. Many people still view dental implants with skepticism. Too expensive, what is it anyway, that's nothing for me - a dentist hears this very often when he suggests dental implants as a possible solution to replace a missing tooth. However, dental implants can be very useful

Structure of a dental implant

A dental implant is an im Jawbone anchored "alloplastic garment". Alloplastic describes the material from which the dental implant is made and means that this material does not occur in either the human or animal body. It is a foreign bodywhich is made from another substance and then transplanted into the human body. Alloplastic materials are either made in the laboratory or extracted from nature and then processed in the laboratory.

In this context, ready-made parts mean that the screw of the dental implant is not produced individually for each patient, but that the dentist has a type of Kit in his practice from which he only has to select the right size. To make this easier to understand, one can imagine the different sizes of screws that can be bought at a hardware store. The craftsman chooses the right screw that he needs for his work and does not produce an individual screw every time. So it will no imprint taken to select the screw size of the dental implant.

The department of Dentistry, which deals with the replacement of natural teeth with implants, is known as Implantology. Dentists who want to work in implantology should have special training, as placing implants is not that easy and great care and knowledge is required. The "Placement of implants“Is the technical term that is used for the insertion of the implants into the jawbone.

Dental implants are usually made up of three parts:

• The bottom part is the screwwhich is anchored in the jawbone and ideally should grow together with it. The dentist calls this process Osseointegration. (Osseointegration means nothing other than that the screw should grow firmly into the bone, i.e. should integrate.) Dental implants whose screws are not osseointegrated usually have one worse prognosis in terms of their lifespan in the mouth.
• The Abutment is screwed onto the screw, protrudes into the oral cavity and later carries the Crown. To be able to anchor a crown in the mouth, you need one Stumpthat protrudes into the oral cavity. The crown is glued onto this stump. In the case of natural teeth, the dentist can achieve a suitable stump shape by grinding the tooth; the abutment is already shaped so that the dental technician can produce a crown for it that fits well and which the dentist can then incorporate. Incorporate is the technical term for attaching dentures (crown, bridge, prosthesis) in the mouth.
• The Crown is the third and topmost part of the implant. It is the only part that will be visible later. Ideally, it is designed to look like the rest of the natural teeth so that nobody notices that a crown is in their mouth. Under no circumstances should the dental implant be recognizable as such. Implantology is currently concerned with how to use implants, especially in the Anterior region can make it as invisible as possible.

Most implant screws in Germany have one rotationally symmetrical Form, that is, they have one circular diameter and a thread. The circular diameter makes it easier to drill the hole in the jawbone into which the screw is to be inserted later. Thanks to the shape, the hole can now easily be pre-drilled with a special drill. The thread the screw takes care of mechanical hold in the jawbone and thus supports that Ingrowth the screw. There are also implant screws with smooth surface, however, with these it is very difficult to get a good hold in the bone so that the screw has enough time to grow in. Smooth surfaces have not proven themselves in practice, so implantology was looking for alternatives. The screw shape seems to be the best alternative. In the past, implants were used that had wings to the right and left so that there was sufficient retention (hold) in the bone. You had to open up the jawbone over a large area in order to be able to insert the implants. The Wound healing with such a large area it was of course more difficult and therefore more prone to Complications. With the current method of screw implants, the wound area is very small and healing usually takes place without complications.

Nowadays, at least in Germany, the vast majority of implants consist of titanium. Titanium has proven itself as a material in orthopedics for many years, all artificial joints or screws and plates for stabilizing broken bones are made of titanium. It has the advantage of not having any Allergies against this substance are known. Any metal placed in a moist medium will oxidize. The less noble the metal, the faster and stronger it is oxidation. So why is titanium as very ignoble Metal suitable for implant screws? It forms a very stable oxidation layer, i.e. the metal does oxidize, but no more ions from the titanium can get into the surrounding tissue because the oxidation layer remains stable. Titanium is very well accepted by the human body and usually grows in without complications.
gold As the most precious metal, it is absolutely unsuitable for implants. It doesn't oxidize, but its consistency is much too soft. It would not withstand the stress of chewing and would bend in the jawbone or break at some point.
The only disadvantage of titanium is that it is a dark colour Has. Especially with very thin crowns, the dark abutment shimmers through and provides an aesthetically somewhat unsatisfactory result. Implantology has tried to remedy this by making abutments Ceramics has developed. Unfortunately, such abutments are not very stable and split very easily. For this reason, they should only be used in exceptional cases and only with front teeth.

Implants made entirely of ceramic were only used briefly in implantology. The implants have excellent properties and are very well accepted by the body, so hardly any Rejection reactions are to be feared, unfortunately they splinter under Chewing stress but very easy. A splintered implant screw removal requires major surgery. Implants made entirely of ceramic were withdrawn from the market relatively soon.

Indication for an implant

The best possible care for tooth gaps is that Replacement of the missing tooth without the Neighboring teeth to damage. At bridges For example, the neighboring teeth, which may be healthy, must be ground in order to give the bridge support. A bridge looks like a crown is placed on each of two adjacent teeth, while the missing tooth is bridged by the pontic that is spanned between the two crowns. It is also possible to create a bridge between an implant and a real tooth. This is always necessary if, for example, the two rear ones Molars have been lost. Either you decide on two implants, each replacing one tooth, or one implant that carries one crown while a remaining tooth carries the other crown. The missing teeth are then bridged by a bridge that is stretched between the implant and your own tooth.

In the anterior region, a bridge cannot provide a visually excellent result because the Dental papilla, so that Gums in the interdental spaces, cannot be restored. An implant can prevent both healthy teeth from being ground and restore missing dental papillae to a certain extent.

Toothless patients must Full dentures are made as dentures. Unfortunately, the hold of the full denture is not always very good and the denture slips when chewing. Also that is Taste experience significantly impaired when eating, as the palate completely from one Plastic plate is covered. If individual implants are placed across the jaw, the prosthesis can be anchored on these implants and the plastic plate covering the palate is no longer necessary. In order to be able to anchor such a full denture well, implants in the area of ​​the previous one are very often used Canines set. It is also possible to place several implants distributed over the entire jaw (usually eight), on which a very large bridge is then attached. This avoids having to wear a removable prosthesis. Most patients find a denture firmly anchored in the jaw more comfortable.
Implants are most commonly used to replace individual teeth. Implants are a very good solution, especially in the anterior region.

In order to be able to settle the supply with implants at least partially with the health insurance, there are four Indication classeswhen an implant can be placed.

• Class I.: Single tooth replacement (the replacement of a single missing tooth, no matter where in the jaw)
• Class II: Reduced remaining teeth (as already mentioned above; if several teeth are missing and these are to be replaced either by several implants or by a bridge from the implant to your own tooth)
• Class IIa: Free-end situation (if a tooth with a bridge is to be replaced by one's own tooth on an implant and the implant is to be placed at the end of the corresponding row of teeth)
• Class III: Edentulous jaw (if there are no more teeth of your own and the implants are intended to ensure that the prosthesis holds better or if a bridge is to be stretched over the entire jaw that is only held by implants)

Procedure for placing the implant

Implants can only be successfully anchored in the jawbone if there is sufficient bone substance. Implantology nowadays uses a three-dimensional X-ray image to determine whether there is enough bone. The patient is X-rayed in a special device and the dentist can view the jawbone from all sides on the computer and measure whether there is enough substance for an implant. If this is not the case, augmentation is possible. As part of an augmentation, bone that is not present is replaced with bone substitute materials or with one's own bone that has been removed from another location in the body and specially treated. The bone that has been grown in this way then has to heal for a certain period of time and attach itself to the jawbone. After the healing period, the implantologist will check again whether there is enough bone substance. If so, the implant can now be planned and placed.

In the upper jaw, a so-called sinus floor lift must sometimes be performed before the implants are inserted. This is always the case when there is a risk of the implant getting into a paranasal sinus (usually the maxillary sinus). The maxillary sinus is located very close to the tooth roots in the upper jaw and should never be opened with the implant. Therefore, the floor of the maxillary sinus may be raised before an implant is placed.
In the lower jaw, especially with planned implants in the posterior region, care must be taken that the nerves that run very close to the tooth root are not injured.
The implant screw is placed in the jaw at the first appointment. This is usually done under local anesthesia. However, a sterile environment should be provided and the drills used should have been sterilized beforehand. Local anesthesia is completely sufficient and is well tolerated by the patient. Only the surgical drape, under which the head is hidden, triggers claustrophobia in some. A hole is drilled into the jawbone with a drill that fits exactly to the later implant screw and the screw is screwed into it. The mucous membrane is then sutured again over the screw. The screw must now grow together with the bone for about six to eight weeks. Only then is the mucous membrane cut open again and a sulcus former is placed on the screw. The sulcus former is supposed to bring the gums to grow around the later crown and to form a papilla.
After another few weeks, the abutment is turned onto the screw instead of the sulcus former. With this abutment an impression of the row of teeth is made by the dental assistant. A temporary restoration that looks like a tooth is attached to the abutment. The impression is sent to the laboratory. Here the dental technician creates a crown that fits exactly onto the abutment and the rest of the teeth in the row of teeth. When this crown is finished, the patient gets a final appointment in the dental practice, where the temporary is then exchanged for the final crown.
It is very important to have the implant checked regularly. Implantology recommends annual x-ray controls, which can later be extended to five-year intervals.The implants should also be checked for possible damage by the dentist during the normal six-monthly check-ups.

When cannot an implant be inserted?

While the implant can be seen as the almost ideal solution for lost teeth, there are certain situations in which an implant is out of the question. People who suffer from a change in bone structure, such as in osteoporosis is the case or the Bisphosphonates have to take are usually unsuitable for implants, as great difficulties must be expected during the fusion with the jawbone. Even patients after one chemotherapy have to wait some time because chemotherapy weakens the immune system so much and the implant as foreign body cannot be securely anchored in the jawbone. In the case of insufficient Oral hygiene no implant should be placed either, as the risk for a Peri-implantitis, a disease similar to periodontal disease is increased. It ensures that the bone retracts and, as a result, the implants fall out. Also an already existing, untreated one Periodontal disease is an exclusion criterion. If left untreated, periodontal disease causes the jawbone to grow over time due to the inflammation, by Plaque caused withdraws. The implant can then no longer be anchored sufficiently and falls out. Treated periodontitis, on the other hand, is not a reason for exclusion from an implant.