Dental implants

Dental implant: structure, types, treatment & cost

If a tooth and its root are missing, a dental implant with the appropriate denture is a viable solution to replace the tooth. Placing dental implants is a proven routine method in dentistry to close tooth gaps permanently and in a pain-friendly manner. While the advantages of dental implants are undisputed, there is one catch: the sometimes high costs discourage many patients from having implants.

What is a dental implant?
What elements does a dental implant consist of?
Classification of dental implants according to types
When are dental implants used?
Special case: failure of teeth to be created
The implant treatment: what can I expect before the implantation?
Dental implants: the course of treatment
Painless implant treatment
Advantages and disadvantages of dental implants
Dental implant cost

What is a dental implant?

Dental implant
A dental implant is an artificial tooth root that is surgically inserted into the jawbone by a dental specialist. The implant serves as a carrier for the dental prosthesis (implant body) - so z. B. for a crown, bridge or removable dentures. Dental implants can not only replace a single tooth, but - if necessary - also several lost teeth. Dental implants are a stable, aesthetic and functional solution to replace lost teeth with a perfect fit. In the best case scenario, the dentures cannot be distinguished from the natural teeth.

Implants with the corresponding dentures not only mean a gain in quality of life, but are also very useful from a medical perspective. The reason: by transferring the chewing forces directly to the jawbone, dental implants can prevent bone loss. It is therefore very important not to wait too long before inserting an implant, because in the worst case the bone has already receded to such an extent that consequential damage to health can be expected.

What elements does a dental implant consist of?

Implants are usually made up of three components. These include the implant body, the implant abutment and the implant crown.
Implant body
The implant body forms the basis for an implant. The implant body is surgically implemented in the jawbone as an “artificial tooth root”. This mostly cylindrically shaped implant body is mostly firmly anchored in the jawbone via a thread. After a healing phase, the implant abutment and the implant crown can be inserted.
Implant abutment
The implant abutment - called an abutment in technical terms - is a precisely fitting titanium or ceramic connection that serves as an intermediate link between the implant body and the implant crown. Abutments have a connector on both sides. It can be screwed to the implant body on one side and to the implant crown on the other.
Implant crown
The dental prosthesis attached to the implant is called the implant crown. Implant crowns are usually made by specialized dental technicians. The fixation with the implant takes place via screw connections and mounts (implant posts) and often with the help of a medical cement. Implant crowns are mostly made of gold or titanium or made of ceramic. There are also implant crowns made from both materials. In particular, the high-priced ceramic crowns are considered to be particularly kind to the body and can perfectly replicate the natural tooth.

Classification of dental implants according to types

Placing an implant is now a routine procedure. Different types of implants enable individual solutions for the patient, depending on the clinical picture. The diameter of implants is 3.3 to 5 millimeters. In terms of length, the scope is between 8 and 15 millimeters. That depends entirely on the individual implant situation and also on the structure of the jaw.

Implants are divided into one-piece and two-piece systems, according to their structure (joints, grooves, perforations), but also according to different shapes, materials, surface properties and types.

Subdivision of the implants according to the shape: conical, step-shaped, leaf-shaped, needle-shaped and cylindrical
Subdivision of the implants according to the material: titanium and ceramic.
Subdivision of the implants according to the nature of the surface: etched, blasted with titanium or sandblasted
Division of the implants according to systems: one-piece and two-piece systems
Subdivision of implants according to types: from quick implants to mini implants to tilting and interim implants

Classification according to implant shapes

Before inserting the implant into the jawbone, the decision for the right shape is made. The selection that an oral surgeon has is extensive. One differentiates among other things:
Cylindrical implants without thread: They gain their primary stability through the specific press fit, i.e. through the clamping effect of the implant in the jawbone.

Stepped implants: either as cylinder or screw implants .
Conical implants: such as screw implants or stepped cylinder implants. Screw implants have self-tapping or pre-tapping threads. This also gives them good primary stability. Usually self-tapping threads are chosen. When the implant is screwed in, the thread is cut into the jawbone at the same time.
The majority of today's implants are screw-shaped. The only differences are in width, length and thread profile. In the past, leaf implants, disc implants and needle implants were often used. These forms are now rarely used.

Classification according to implant material

The material of dental implants has to meet high requirements, because implants should remain in the body for a long time. Therefore, implantologists usually choose biocompatible materials with high strength, which are well tolerated and which grow firmly together with the surrounding tissue and bone. As a rule, dental implants are made of pure titanium or a titanium alloy, so that no allergic or repulsive reactions occur. But ceramic implants are also well tolerated and score points in terms of aesthetics with their white color.

Today, dental implants mostly consist of the following materials:
Titanium Implants:
Titanium is the most common material used for dental implants. The biocompatibility of pure titanium is very good, and there are neither intolerance reactions nor allergies. Thanks to its surface structure, titanium can form a firm bond with the jawbone.

Ceramic implants:
Implants made of ceramic (zirconium oxide) are also extremely durable. The white color of the material also meets high aesthetic standards. Because of their similarity to the natural tooth substance, ceramic implants represent a high-quality, metal-free alternative. Due to their very good tolerance, they are also suitable for allergy sufferers.
The treating implantologist can best assess which material is most suitable in each case on the basis of his or her experience.

Classification according to the surface of the implant

The surface of the implant (outer surface of the implant body) is in direct contact with the body tissue and therefore has an impact on healing, stability and durability. An ideal implant surface can optimize biological reactions between the implant and the jawbone, both with titanium implants and ceramic implants (zirconium oxide dental implants). In this way, for example, the implant can be loaded at an early stage. A roughened surface has become established.

The surface properties of implants today are usually represented as follows:
irradiated with titanium

Classification according to implant systems

A distinction is made between two implant systems: the one-piece and the two-piece system. The two-part or multi-part implant system has now prevailed over the one-part.

One-piece implant system
This system consists of only one part. Because of its small diameter, it is often used in small tooth gaps. Since the implant head protrudes from the mucous membrane after insertion, problems can arise during the healing phase.
Two-part implant system
In this system, an implant is placed in the jawbone. After it has been inserted into the bone, the implant screw is closed with a cover disc and then covered by the gums. The dental implant can heal so well. The implant neck and the implant crown, for example an all-ceramic crown, are then screwed onto it. It is also an advantage of this two-part variant that the shape and angle of the implant abutment can be selected later. In this way, the dentures can be inserted into the row of teeth in the best possible way. In addition, the implant parts screwed together largely prevent the implant from being stressed during the healing period.

Classification according to implant types

There is a wide range of implants for the different anatomical conditions in the patient's jaw. The oral surgeon can choose between numerous types and sizes from the range of common implants. Some are intended for immediate restoration, others are preferred in the case of low bone status or bone density, and still others are intended for special areas in the jaw.

Overview of implant types:

Rapid implants: Immediately after the tooth has been removed, they are inserted into the jawbone and fitted with dentures. The work steps take place in one meeting. What is important here is extremely precise planning with digital measurement of the jaw and a fully prepared abutment and dentures. This variant is suitable if there is sufficient bone available and if the rapid implant has primary stability.
Narrow implants: These small dental implants are used in the anterior region. They are very delicate and are used for horizontal receding of the jawbone, for full dentures and other complicated dental prosthesis treatments. The models, which are also known as diameter-reduced implants, have proven themselves particularly in the individual tooth restoration of very narrow gaps in the upper jaw. They are often used as an alternative to orthodontic restoration with braces.
Mini-implants: They are mainly used when using full dentures and bridges, as well as in orthodontics and as interim dentures. The one-piece implants have a smaller diameter than conventional models. They are screwed into the jawbone, leaving a small area above the oral mucosa free to anchor the prosthesis. Mini-implants close narrow tooth gaps well and are also used in the context of immediate loading of implants when there is little bone available.
Ultra-short implants: They are especially chosen when difficult anatomical conditions require better load distribution. The very short implants have a large diameter and are therefore well suited if, for example, there is little bone left in the posterior region of the upper or lower jaw. This often occurs after a long time ago tooth extraction and failure to provide dental implants, among other things.
Tilting implants: These narrow, beveled implants are chosen by oral surgeons when there is little bone left. One of the advantages of tilting implants is the avoidance of bone build-up.
Conical implants: Most of these implants are used as screw implants. They are preferably used when there is only a small amount of bone available in the upper jaw and also with low bone density.
Interim implants: They represent a temporary solution. The very thin dental implants serve as a transition to immediate restoration - during the healing phase of the final implant. Interim implants are easy to insert and just as easy to remove.
Zygomatic implants: These very long implants (five centimeters) are anchored in the cheekbone at an angle of 45 degrees. Due to its particularly dense bone structure, it offers the best conditions for holding the zygoma implant. It is mainly used when the use of conventional implants does not promise much success. For example, if the upper bone shows significant bone loss and a bone transplant is no longer possible or is not desired.

When are dental implants used?

Toothless jaw: In the toothless upper jaw, in many cases a total denture can achieve a suction effect that ensures relatively good stability. However, the more the jawbone recedes over the years, the more difficult it becomes to ensure this hold. In such cases, implants are the perfect alternative for more stability and security.

For anatomical reasons, a full denture cannot achieve a hold comparable to that in the upper jaw in the lower jaw. This is especially true in the case of advanced bone loss, which develops very quickly in the edentulous lower jaw. Implants are therefore the ideal solution for fixed dentures, especially in the edentulous lower jaw, and at the same time prevent further regression of the jawbone.

Free-end situation: In a free-end situation, the row of teeth is shortened on one or both sides due to tooth loss and can only be supplied with removable dentures without implants.
Gaps: A gap refers to the absence of one or more teeth within a row of teeth in the arch shape. Whether the gap is restored with a fixed bridge or an implant depends on the remaining teeth and the size of the gap.
Single tooth replacement: For single tooth replacement, both an implant restoration and a fixed bridge, possibly also an adhesive bridge in the anterior tooth area, are conceivable. The advantage of the implant is that the neighboring teeth of this gap do not have to be ground in order to close them with a bridge. The implant therefore protects the hard tooth substance. In addition, implants stop bone loss at the site of the missing tooth. The jawbone is thus preserved.
Special case: failure of teeth to be created
About every third adult is affected by the failure to create teeth. One or more of the permanent 32 teeth are missing. It also occasionally happens that one or more wisdom teeth are missing. A tooth failure can have different causes. A hereditary genetic defect, developmental disorders, cleft lip and palate, or Down's syndrome can cause non-predisposition. The resulting tooth gap should be closed so that the neighboring teeth or the opposite tooth do not grow into it. This could result in a disorder of the clenching (occlusion disorder). In addition, closing the gap makes sense for aesthetic reasons alone. To treat the non-abutment, implants can be inserted into the tooth gap in addition to dental bridges. A new tooth crown is then fixed on them. The implants sit directly in the jawbone and therefore do not need to be attached to the neighboring teeth such as bridges. So they are gentle on the substance.

The implant treatment: what can I expect before the implantation?

Preliminary discussion with the dentist: Before the implantation is planned, the attending dentist conducts a detailed discussion . The content of this conversation is the type of prosthetic restoration and the required number of implants. One is enough for individual teeth. Several are required for one prosthesis.
Preliminary examination: During the preliminary examination, the framework conditions for bone formation are checked.
The attending physician must ensure that you have inflammation, that there is enough bone for the implant and that you are suitable for the surgical procedure. If there is an inflammation in the jaw, it must first be treated. If there is not enough bone, bone grafting can be carried out.
Planning the implant: As part of the planning, a treatment and cost plan is created that gives you an overview of the costs for the implant. The statutory health insurance companies do not cover any costs for treatment with dental implants. You only subsidize the implant-supported dentures. Patients therefore receive the fixed allowance for the corresponding standard care with dentures.

Dental implants: the course of treatment

Anesthesia: Before the procedure, the surgical site in the jaw is locally anesthetized with a syringe so that the patient does not feel anything. In some cases, twilight sleep (sedation) or general anesthesia is also used. The dentist will discuss the type of anesthesia with the patient before the operation.
Operation - The placement of the implants: As soon as the anesthetic is effective and the patient can no longer feel anything, the oral mucosa over the jawbone is opened with a small incision. The jawbone is exposed so that it becomes visible. The dentist attaches a so-called drilling template and drills the implant bed (the place into which the implant is screwed) into the jawbone. The patient does not feel any pain, only the vibration of the drill. After drilling, the artificial tooth roots are screwed into the jawbone. They are provided with a lid for closed healing.

How long the operation will take cannot be given in general terms. Depending on the number of implants and the condition of the bone, the entire procedure can take 15 minutes to a few hours.
The wound closure: The type of wound closure depends on whether open or closed healing is planned.

In the case of open healing, implants with a neck that is as smooth as possible and that extends through the gums into the oral cavity are used. There is already contact between the implanted root and the oral cavity during the healing phase (single-phase procedure). The missing tooth is temporarily provided with a temporary denture.

Closed healing is when the gums are sutured again after the implant has been inserted. In this way, the implant - protected from external influences - can heal well into the bone. After healing, however, the implant must be exposed through a small incision (using a laser or a punch) (two-phase procedure). Only then do patients receive their final dentures.
Healing: The implant has to heal into the bone for approx. 3 months and should not be stressed during this time.

Immediately after implantation, patients are allowed to:
do not smoke
do not drink coffee or alcohol
do not expose yourself to exertion
Very thorough oral hygiene and disinfecting rinses prevent wound infection above the implant. Some patients are given an antibiotic to prevent inflammation. To ensure that the tooth does not cause any problems, regular checks should be carried out at the dentist.
Uncovering - inserting the dental prosthesis: In the two-phase procedure, the implant is only exposed in a second procedure, after the healing phase. When this phase has also been completed, the prosthetic restoration (taking impressions, fitting, final integration of the dentures) begins.

With the single-phase procedure, the implant protrudes from the gum as it heals. This makes it possible to incorporate the dentures earlier.

Painless implant treatment

Many patients shy away from implant treatment because they are afraid of the painful operation. But the treatment can be carried out pain-free and stress-free thanks to modern anesthetic methods. If you are particularly afraid of dental treatment, you can get a particularly relaxed implant restoration with additional measures such as sedation or general anesthesia. An overview of the procedures for painless implant treatment:

Local anesthesia

With local anesthesia - also known as "local anesthesia" in parlance - the respective surgical area is anesthetized by an injection so that neither pain nor touch is felt during the implant operation.

Oral sedation

So-called sedatives act on the brain during oral sedation and have a calming effect. Oral sedation makes you sleepy and has the effect that you can often not even remember the treatment. Because of the drowsiness, however, the patient should be observed and cared for for some time after treatment.

Sedation with nitrous oxide

The laughing gas inhaled through a mask has an anxiety-relieving and relaxing effect. You will be fit again quickly after the treatment. In the USA, sedation with nitrous oxide is already very common - in Germany, more and more dental practices are now offering this method.

general anesthetic

For anxious patients , implant treatments are also possible under general anesthesia if requested. However, general anesthesia always requires ventilation. Therefore this method is relatively expensive.
The overview shows - there are many ways to get painless implant treatment. Depending on the fear and pain sensation, the patient can choose between local anesthesia or even general anesthesia.

Advantages and disadvantages of dental implants

Benefits of Dental Implants
Dental implants not only offer a deceptively realistic look, but also provide good protection against the breakdown of the jawbone. In addition, implants make it possible to close tooth gaps without grinding the neighboring, natural teeth. Implants can also fill larger tooth gaps that cannot be bridged with conventional bridges. Even with a completely edentulous jaw, great successes can be achieved with the help of implants. Last but not least, implants are characterized by their special longevity.
Disadvantages of dental implants
Inadequate oral hygiene threatens peri-implantitis. This is an inflammatory disease around the implant. If at first only the gum line is affected, then later the gums and the jawbones are also affected by peri-implantitis. If the peri-implantitis is not treated appropriately, there is a risk of losing the implant.

Another disadvantage is the relatively high cost of an implant restoration. Depending on the effort and material involved, the 4,000 USD can quickly be exceeded. In order to protect yourself against the high costs of implant treatment.

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