Frequently asked questions about dental implants

Frequently asked questions about dental implants

What is a dental implant?

A dental implant is an artificial root made of a biocompatible material used for replacing lost teeth for cosmetic or practical reasons or in order to carry previously planned dental work.  The material of dental implants is usually clean, unalloyed titanium.  Even in case of metal allergies, one doesn’t have to worry as titanium is hypoallergenic and fully accepted by the human body.

Why do I need a dental implant?

A dental implant is needed to replace missing teeth, for cosmetic or practical reasons (so the patient can chew properly or because there aren’t sufficient amount of teeth present to carry a bridge when a full restoration is needed).  With a dental implant, we can achieve a fixed solution without damaging the healthy neighbouring teeth in order to put a bridge over a gap.

Can I get dental implants?

This question is answered during a physical checkup.  The patient first completes a questionnaire allowing the dentist to gain important information about factors that can endanger an implant or exclude the patient from getting an implant.  Such risk factors can be diabetes or heavy smoking as well as infections or blood pressure problems.  Afterwards, a panoramic X-ray is done in order to determine whether there is sufficient bone substance.  Before the treatment, we also carry out a 3 dimensional CT Scan in so we can measure the bone depth in order to determine the correct implant sizes.

What is the advantage of dental implants?

The biggest advantage of dental implants is that they don’t impact other healthy teeth, that they provide a permanent, long-lasting, fixed solution that is highly aesthetic.  Different types of dental works can be fixed to implants in case there are several teeth missing or even if the patient has no teeth.  A single implant with a crown lasts longer than a bridge especially if a high-quality material like full-ceramic or Zirconia is being used and two healthy teeth won’t need to be impacted to put the bridge on.  Dental implants are fully biocompatible and hypoallergenic, so no allergic reactions to be expected even in case of a metal allergy.

What is the disadvantage of dental implants? What are the risks?

Generally, dental implants have no disadvantage but there are several factors that can increase the risk of a successful implant treatment or exclude the possibility of a dental implant treatment.  These are mainly diabetes or bacteria and viral illnesses or in case there isn’t sufficient bone available in the jaw.  After a dental treatment, it is very important to pay attention to oral hygiene!  Heavy smoking can also reduce the life-expectancy of dental implants.  In case of periodontal diseases (gum diseases) first, the periodontal problem has to be solved in order to make the gum ready for implants.

What material are dental implants made of?

Dental implants are mainly made out of unalloyed titanium in some cases of porcelain. There are approximately 80 implant manufacturers worldwide and they strive to constantly develop the implant screws to ensure integration with the bone as fast as possible. This mainly depends on the surface handling of the implant whether the pores are suitable for bone cells to grow inside and remain there.  In order to achieve this, there are several procedures like sandblasting, micro striation, souring or lining with hydroxyapatite.

Are there any differences between the different brands?

Yes, there are.  There are roughly 80 manufacturers worldwide and their common goal is to produce implants that can integrate quickly and efficiently with the jaw bone.  They constantly improve the implants but there are still implant types that have bad surface handling, which increases the possibility of an infection and incompatibility thus prevents successful integration with the bone.  Good surface handling is the most important criterium of a dental implant, as the body’s reaction to an implant and its ability to integrate it, depends on how good the surface handling is.  Also, the placement needs to be done with maximum care and attention, to ensure that no organic or artificial materials remain on the surface of the implants.

How long do dental implants last?

In case the osseointegration (integration with the bone) is completed successfully and the implant and bone are unified, implants normally last a lifetime.  This integration takes place in the first three to six months so if the implant remains in the bone during that time it usually remains there for life.  There can be illnesses or anatomic changes later causing an implant loosening or a wrongly executed dental work can also lead to the loss of an implant.  It is very important to ensure extremely good oral hygiene after a dental implant treatment and to see a dentist at least once a year for a checkup so that potential bacteria attacks on the implant work can be prevented or treated in a timely manner.  Most of the time losing an implant is not due to implant fault but due to the circumstances.  Nevertheless, one should always select the implant type carefully as old systems or systems with poor surface handling or questionable procedures like basal or needle implants always increase the risk of losing an implant.  At Evergreen Dental we only use the highest quality implants and the implant procedures are done by highly qualifies, experienced doctors.

What do I have to watch out for when having a dental implant treatment?

One should always choose the safest solution.  There are implant systems that can be loaded immediately according to the manufacturer but you have to be aware that an immediate pressure on the implant is endangering its integration with the bone and can lead to implant loss.  You have to know that the basis of success is the perfect integration of the implant with the bone, therefore, it should always be checked whether the surface handling of the implant is good.  As science is constantly improving in this field one should use one of the latest technologies but at the same time also ensure that there are sufficient amount of positive case studies.  It is the duty of your dentist to give you good advise and help you to choose the right implant type.
After dental treatment, one must practice excellent oral hygiene to make sure that no bacteria gets into the wound and risks the integration with the bone afterwards by attacking the bone cell around the implant.  Good implant surface handling plays a major role in this game; it defines the strength of the implant.
It is advisable to use an implant system with a good name that has been around for a while as the chance is much higher that those brands will still exist in 20 or 30 years and their abutments and necessary equipment are still going to be available in case, for example, a crown has to be changed. Especially, for this reason, it is very important to get an implant pass from the dentist to make sure that even after decades it will be clear what type and size of implant has been used.  This is important, in case a bridge or other dental work needs to be renewed on the implant.

What kinds of dental implants are there?

One-phase implants
These systems use a long implant that is placed into the jaw in a way that its upper part is above gum level and clearly visible. After the healing period, the crown can be placed on it without further invasion.
Subperiosteal implants (implants placed onto the jaw): These are placed under the gum onto the jaw usually consist of one frame and pins stretching out from it and expanding over the gum horizon. After the healing period, the dental work can be fixed on the pins.
Transosteal implants (implants driven through the jaw): during this process, the jaw is being drilled through and the through the drilling the screws are inserted and fixed by a metal plate. Pins are then used for the dental work to be fixed on, after the healing time. These implants are used in rare cases only, mainly in case there isn’t sufficient bone for other implant types and an additional anchoring is needed in order to mount the implants.
Two-phase dental implants – Endosteal implants (implants mounted into the jaw):
In case of two-phase dental implants the screws are inserted into holes drilled into the jaw and afterwards, the gum is stitched up.  After approximately 3 months, the bone cells surround the implant ensuring integration.  After this period the implant is strongly sitting in the bone and is able to carry the dental work.  Afterwards the gum is being opened (implant uncovering) and the planned dental work is attached with the help of an implant head called abutment.
Two-phase implants are the most common implant systems nowadays.  There are different types of form and technology of attaching.  Also, there are huge differences in surface handling, we mainly distinguish between screw, cylinder or blade implants.

What implant sizes are there?

Basically, there are three categories according to the size of the implants.  To determine which size will be used, the dentist needs to determine the bone situation (is there sufficient bone mass in the jaw to put in an implant?) and look at if there is enough room in the mouth for the implant.
Standard implants have a calibre of 3,5-4,2 millimeters and are used mostly in the front region.
Wide-tooth implants: usually have a calibre of 4,5-6 millimetres and are used in the rear region.
Mini implants: have a caliber of 2-3,5 milimeters and are used in case there isn’t enough space or bone between the roots for standard implants.

What are bone-level implants?

Bone-Level implants are the type of two-phase implants that are fully sunk into the jaw and stitched up for the healing time.  The advantage of these implant systems is that no surface is existing above the gum line where bacteria can stick on and cause infections.

What are tissue-level implants?

Tissue-Level implants are one-phase implants that are not fully sunk into the bone but their shoulder is hanging out a few millimetres above gum level contributing to the forming of soft tissue.

Do I have enough bone for a dental implant?

In order to determine that first a panoramic X-ray is made. It allows the dentist to see whether the bone height and width is sufficient for dental implants. As X-rays are only 2 dimensional, in order to determine the depth of the bone additionally a 3 dimensional CT scan has to be carried out.  This also allows the exact planning of the size and position of dental implants.  To find out what can be done if you don’t have sufficient bone for dental implants please read here.

How are dental implants built up?

Today mainly two-phase implants are used consisting of an implant screw and an implant abutment. First, the screw is inserted into the bone and after the healing time, the implant head (abutment) is used as a binding element between the screw and dental crown or bridge.  There are changes to that in case, for instance, a removable solution is being made that doesn’t require the in-between element.

Implant treatment step-by-step

The regular case:
Diagnosis (2D panoramic X-ray, then 3D CT scan) and method planning (crown, bridge, All-on-4, All-on-6, prostheses, etc.) – approximately 2 hours
Preparation:
– Extraction of bad teeth (afterwards healing time possible for max. 6-8 weeks) – one session, app. 15-45 minutes per tooth
– Sinus Lift or bone augmentation if needed (6 months healing time) – one session, app. 2 hours
3. Implant insertion – one session (app. 30 minutes preparation, afterwards 15-30 minutes per implant) (Healing time 3 months)
4. Making of the dental work on the implant(s) depending on the treatment type 3-12 days, altogether 3-5 sessions:
a). Impression (1-3 hours)
b) Frame probe (30-120 minutes)
c) Raw probe (30-120 minutes)
d) Tooth probe (30-120 minutes),
e) Handover (60-120 minutes)
6. After-care: at least once a year
For some implant types, the manufacturer claims that the implants can be loaded immediately. One-phase implants are designed to be this way. These are usually systems where the overall static of implants and dental work supposed to grant the necessary stability. The opinions about these vary but in many cases, the bone situation doesn’t allow any other possibility other than the usage of these so-called pin implants. The experts more or less agree that the risk can be minimised when two-phase implants are used.
Temporary implants: Temporary mini implants are placed in between the regular two-phase implants and only have the function of carrying a temporary dental work during the healing period. After the healing time, these implants are removed as they have fulfilled their function. Temporary implants can be placed and removed very easily and can carry both, removable and fixed solutions.
Implants with navigation: Thanks to the latest technologies and thanks to the digital revolution in dentistry, it is possible nowadays to
– plan the position of the implant with a 3D CT scan and an impression digitally,
– print an implant template with a 3D printer,
– insert the implants into the template and to ensure an exact and efficient implantation,
– create a temporary bridge which is also very precise and allows an immediate replacement of teeth. Also, in this case, the bridge is first fixed temporarily and then permanently after six months.
– make not only the dental work but also the abutment element individually.

How long does the healing procedure last until the final work can be done?

Normally the healing process takes three months.  If also a bone graft or sinus elevation (sinus lift) was needed the healing process can take up to six months before the implants can be placed.  If a bone augmentation had to be carried out, the healing time is 9 months before the implants can be put in the jaw.  After implantation, the healing time is 3 months.

How much do dental implants cost?

The costs for a two-phase implant usually consist of three parts, screw, abutment and uncovering. The dental work (i.e. dental crown, bridge, denture etc.) that is fixed on it is a separate cost.
How much does a full set of implant cost at Evergreen Dental?
We currently have an offer on where the implant, abutment and porcelain-fused-to-metal crown costs £850.

What can I do if I don′t have enough bone?

There are several options for getting implants despite not having sufficient bone mass in the jaw.  Dentistry has made major progress in the recreation of bone, mainly by using bone substitution material that stimulates the bone cells to grow again.  The following procedures exist, depending on the volume that has to be replaced:
Bone graft: If some bone is missing in order to be able to accept a dental implant artificial bone is added during implantation. This material is called BioOss and uses cleaned and purified cow bone material.  This can be combined with the patient’s own bone gained from the back of the jaw.  There are successful study cases where extracted teeth of the patients are used as bone substitution material.  In doing so the extracted tooth is dissolved in a special liquid resulting in a mushy substance that can be used for bone grafting purposes.  The acceptance by the body is 100% as the substituting material origins from the own body.
Sinus elevation: Sinus-Lift or sinus elevation takes place in the upper jaw.  Losing bone in the upper jaw is always a bigger issue as the gravitation is working against us in fixing bone substitution material.  The BioOss, in this case, is fixed with titanium membranes and bolts, the healing time is six months. In approximately 50% of the cases, sinus elevation and implantation can be done in one session.
Bone augmentation: In case the bone loss is so extensive that the regular bone substituting methods are not sufficient, there is still the possibility of a bone transplantation.  This special treatment is only done by a few specialists and is being carried out in a hospital.  During this process, bone is taken from the hip area and is transferred to the jaw. The healing time is usually 9 months.  Evergreen Dental is one of the very few clinics in Hungary offering this type of treatment in cooperation with Szeged hospital.

What do I have to watch out for after a dental implant treatment?

A dental implant treatment is a surgical intervention in the jaw.  As with any kind of operation, hygiene is of paramount importance so a caring dentist will not only give you antibiotics and painkillers but also a special mouthwash that helps to avoid the threat of infection and will brief you what to look out for after the treatment. Usually, the compliance form contains all important information but smoking, alcohol and consumption of dairy products should definitely be avoided after dental surgery.

Does the insertion of dental implants hurt?

As the surgical intervention is done in local anaesthesia the patient doesn’t feel any pain.  Afterwards, some discomfort and sensitivity could be felt that’s why we always give painkillers.  For an even safer and more efficient implantation, you can choose the treatment to be aided with a template.  This is planned digitally based on a CT scan and an impression and is being created with a 3D printer.  In the template, the positions of the implants are pre-defined ensuring absolute precision and minimal invasion.

What side effects can occur after a dental treatment?

Normally the implants don’t cause any side effects only in extremely rare cases was an allergic reaction to titanium noted.  As we are talking about an operation though, like all surgical interventions, it can have short-term side effects like swollen gums and cheeks.  If using a serious two-phase implant system the success rate is around 99%.  In case a bone graft or sinus elevation is needed, an extreme difference in pressure (like travelling on an aeroplane) could cause bleeding in the sinus within the first week that could cause a hematoma. The hematoma should disappear after no later than two weeks.

How are nervous patients implanted?

In general, all patients are treated in local anaesthesia so no pain should be felt during the treatment.  Of course, there are anxious patients who would not prefer to sit in a dentist’s chair for this procedure.  For these patients, we usually offer the possibility to have it done under general anaesthetic (if no contraindication exists).  This is a very comfortable way to have this surgical intervention done as the patient sleeps during the whole treatment.

What is an implant pass?

The implant pass contains important information with regards to the implants that the patient has received.  These are the type, the size, the position and the serial number for verifying the originality.  You should always get an implant pass as integrated implants should last a lifetime but not necessarily the dental work on it and, for example, if you need a replacement bridge fixed on implants 20 years later, the dentist needs to know the type of implant you have in order to be able to arrange the necessary abutments and components.

What is the worst thing that can happen after an implant treatment?

The worst thing is the loss of the dental implant. The success rate with two-phase implants is above 99% though, meaning that an implant loss can usually be avoided as during diagnosis and the planning phase, the factors that can lead to an implant loss should be identified.

What are basal implants?

Basal implants offer the very last possibility if someone doesn’t have enough bone for regular two-phase implants but would like to have a permanent solution. This is often given in case of a fully toothless situation lasting over many years or in case the patient is a heavy smoker. These implants work differently as other systems these are placed in the harder, so-called bi-cortical part of the bone and not in the soft part. The hard part can’t disappear that easily. Also, these implants also made of titanium can be inserted not only vertically but also horizontally. You must know that experts’ opinion differs a lot on basal implants; many dentist chambers won’t consider the usage of basal implants.

What are the most advanced procedures in implantology?

The most modern procedures in implantation are linked to the digital development in dentistry.  There have been important innovations in the recent years and manufacturers strive to minimize the possibility of human failure as much as possible.
Implantation with an implant template: First a 3D CT scan is being made and an impression is taken.  These two components allow the simulation of the jaw on the computer.  The surgeon can plan the exact position and size of the implants.  After the planning is complete the template is printed on a 3D-printer (mainly of acrylic). In the template, the exact positions are predefined so the surgeon only has to apply the template and insert the implant screws through the holes which then get to their final position fast in a minimally invasive way
Navigated implantation: One step further is the implantation with a navigating system.  With this type of treatment not only the template for the surgical part is being digitally designed and 3D printed but also the whole dental work, completely metal-free.  In order not to overload the fresh implants, the dental work is first only done from light material (acrylic) and applied carefully for six months.  After the 6 months healing period it’s fixed permanently.  What’s really great is that everything can be planned uniquely.  The risk is minimal and the final results are of very high quality, very aesthetic and can be created much faster than conventionally.
Temporary implants:  Temporary mini implants are placed in between the regular two-phase implants and only have the function of carrying a temporary dental work during the healing period. Their surface is handled differently so they don’t integrate with the bone. After the healing time these implants are removed as they have fulfilled their function. Temporary implants can be placed and removed very easily and can carry both, removable and fixed solutions.

What is conus surface? What are conus implants?

The conus technology is one of the most advanced procedures in dentistry.  Conus refers to a cone; the form of these implants.  The implant screw has a funnel shape and the abutment has a cone shape. The abutment fits perfectly into the screw.  After the insertion, it gets fixed with a hex-key.  The pressure equivalent to a cold-press technique creates a vacuum and this way the implant screw and the abutment are stabilised perfectly.  Thanks to this technique any micro-movements of the implant can be fully excluded.  And it’s mainly these micro-movements that cause tiny gaps where bacteria can climb in and attach to the implant causing infection in the surrounding area or, in the worst case, lead to an implant loss.  When using conus implants, this risk is fully eliminated guaranteeing a long life for the implant.

Is it possible to do extractions and implants the same time?

It depends on the situation.  Especially in the front region, it’s mainly possible to do the implants right away in the rear area usually it’s not. It is advisable to have the wounds healed first after an extraction.  During the healing process after extractions, the situation changes anatomically not always allowing to plane the final position of the implants right away.  During an extraction it is very important to remove all root rests to create a perfect ground for the implants.  Usually, 6-8 weeks after extractions, the implantation can take place at the same place.  It is also possible that the implant perfectly fits into the gap where the tooth has been extracted from, and directly fills it up making a direct implantation even beneficial.
Also in many cases, there is enough space to insert the implants right next to the wound of the extracted tooth. Also, in this case, it is possible to do the implantation right away.  This is usually the case when bigger gaps or even a fully toothless status is given.

What are the possible solutions on dental implants?

Removable solutions:
Locator-prostheses
Made on 2-4 implants
Advantages: low priced, low risk, easy to repair
Bar-supported prostheses
Are made on 4-6 implants
Advantages: very stable, removable bridge, very comfortable, easy to clean
Permanent solutions
Cemented solutions
Crowns, bridges
Advantages: more aesthetic, lower price (standard abutment needed)
Disadvantages: difficult to remove, more difficult to clean
Possible material: e.Max full-ceramic, porcelain-fused-to-metal, Zirconia
Screw-retain solutions
Crowns, bridges
Advantages: easily removable, easy to repair
Disadvantages: screws could be visible
Field of use: All-on-4, All-on-6, Pekkton frame with ceramic fused to metal or Zirconia crown, lined with Pekkton composite.