Dental Implant
1. What is a dental implant?
A dental implant is an artificial "root" that we surgically place in the jawbone below the gum line. It allows to replace one or more missing teeth.
On this artificial root, we attach a dental prosthesis, usually a ceramic crown or bridge, or a removable prosthesis to stabilize, which will be placed directly on the abutments.
In everyday language, we often equate a dental implant with a complete tooth. In reality, like the tooth, the impant is made up of several parts (see diagram below):
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the visible part: the dental crown will be replaced by a ceramic prosthesis, also called crown;
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the hidden part: the root, located under the gum, inside the alveolar bone (the jawbone) will be replaced by 2 or 3 elements, respectively for the cemented prosthetic and the screwed one.
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the implant itself is inserted directly into your jawbone. Its design (conical/cylindrical), its dimensions (length/diameter) will depend on the implantation area (available space) and the prosthetic project,
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The prosthetic abutment is a part directly screwed into the implant allowing the connection between the implant and the prosthesis; indeed, the prosthesis cannot be directly sealed or screwed into the implant because this would irritate the gum and the bone (peri-implantitis). It is therefore this abutment that passes through the gum.
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In the case of the screw-retained prosthesis, a screw will be used to attach the prosthesis to the abutment (see question 3 for the difference between screwed and cemented prostheses).
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The implant and its abutment (its design, its surface, the material used) play an important role in the success of the operation, limiting post-operative complications such as peri-implantitis. The implant is made of titanium, a metal chosen for its high biocompatibility.
We only use Swiss implants from a brand renowned for its reliability.
Diagram of a complete reconstruction:
(1) Ceramic crown (2) Screw (3) Prosthetic abutment (4) Dental implant
2. Why place an implant?
Getting a dental implant is not only an aesthetic act; this improves the patient's quality of life in particular by restoring functional comfort by overcoming the difficulties of chewing and speech. It also avoids the inconvenience associated with removable prostheses or bone loss linked to the extraction of a tooth and its consequences.
When a tooth gap is created as a result of tooth loss or extraction, a chain reaction of problems can occur, including bone loss in the jaw, shifting of teeth, difficulty keeping teeth free of plaque and bacteria, grinding and clenching of teeth, and pain in the jaw joints.
This is because,
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the jawbone that supported the lost tooth begins to resorb. This bone resorption can lead to a decrease in bone density, which in turn can affect the health of neighboring teeth. At the same time, the gums of the surrounding teeth may recede, weakening the hold of the teeth.
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the teeth move by collapsing into the vacant space; in addition, the opposing tooth begins to move out of its socket.
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these displacements lead to changes in the occlusion and also to inappropriate chewing forces (clenching, grinding). In the long run, this leads to joint pain in the jaw.
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at the same time, it creates areas around the teeth that are difficult to clean, so that bacteria quickly accumulate, forming plaque, which ultimately can lead to cavities and periodontal disease.
3. Why choose a screw-retained prosthesis rather than a cemented one?
There are 2 techniques to fix the prosthesis (crown or bridge) on an implant:
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Screw-retained: the prosthesis is screwed directly into the implant or the implant abutment, without the use of cement.
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Bonded (cemented): the prosthesis is cemented to the abutment, which is itself screwed into the implant
In our practice, we only place screw-retained prostheses, except in exceptional cases, based on the criteria of aesthetics, functionality, tolerance, longevity and durability of the device. This is because,
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Gingival tolerance: screw-retained dentures are more easily tolerated by the gums than cemented dentures. Indeed, they do not use cement to connect the implant to the abutment and the abutment to the crown. However, cement residue, which is often difficult to see and therefore easier to accidentally leave close to the gums, can cause complications such as peri-implantitis.
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Aesthetics:
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given the risks of peri-implantitis mentioned above, to avoid contact between the cement and the gum, the cemented prosthesis may be buried less and the base line of the crown may appear.
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in the case of screw-retained prostheses, the screw hole will be filled with a composite whose color is not always exactly aligned with the color of the prosthesis. This slight difference in color is not really a problem since the hole is located either at the back of the tooth (for incisors) or on top for posterior teeth at the back of the mouth and therefore not visible.
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Longevity: One of the great advantages of screw-retained restorations is the possibility of removing them either to change the damaged prosthesis or to intervene for implant repair, cleaning or soft tissue examination.
4. What are the contraindications of dental implants?
The first type of contraindication is related to the area of intervention. Indeed, to place an implant, we need on the one hand that the gums are healthy and on the other hand, that the bone is of good quality and in sufficient quantity to accommodate the entire length of the screw to allow its fixation. If this is not the case, your dentist will suggest a bone graft or gum graft.
The second type of contraindication is related to your profile. Certain diseases or conditions make implant placement
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either contraindicated :
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Valvular diseases
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diseases that may have weakened the immune system
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severe renal insufficiency
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unbalanced diabetes
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or (temporarily) not recommended for people
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having a delicate oral hygiene
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suffering from periodontal disease (gingivitis, periodontitis)
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who smoke because smoking limits the vascularization of the gums
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being pregnant
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suffering from severe bruxism
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5. What should be done if there is not enough bone tissue?
During our diagnostic appointment, we will assess the lack or not of bone or gum tissue.
If this is the case, there are certain techniques to remedy the lack of bone with the use of shorter and wider implants, or perform a bone graft such as sinus filling for example.
6. How is the implant procedure? How long does it take?
Each surgery is unique, depending on the case, the type of implant and the tooth or teeth to be replaced. The number of sessions may vary, but you should expect to have about 6-7 appointments.
1. The implantology consultation and treatment plan
Prior to the procedure, we perform a 3D (or Cone-Beam) scan of the patient's jaw. These 3D images are transmitted and used by a specialized simulation software to visualize the available bone volume as well as any anatomical obstacles (sinuses, nerves, etc.).
The dental surgeon can then directly simulate on his screen the positioning of the future implant(s), its shape and size, its placement angle and thus optimally anticipate the surgical procedure.
In some cases, the implant placement must be preceded by a gingival and/or bone graft in order to ensure an adequate volume of gum and/or bone to allow the placement of the dental implant.
2. The surgical intervention
This phase consists of placing the implant: in the bone:
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access to the bone by cutting and removing the gum
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preparation of the bone to receive the screw with the help of drills of adapted diameter
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placement of the screw at the same level as the bone under the gum and then of its healing screw
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closing the gum with stitches around the implant.
We perform our procedures in a dedicated operating room to ensure asepsis during placement. This procedure is performed under local anesthesia.
The duration of the procedure varies depending on the complexity of the procedure (number and location of implants, volume of available bone, etc.).
After a few days, the patient returns to the office to remove the stitches.
3. The healing phase
The next phase is the osseointegration phase, which is essential for the success of the dental implant, during which the direct structural and functional connection between the living bone and the surface of an artificial titanium implant takes place. The quality of the implant and its surface finish is crucial to the success of the procedure. During this process, the implant also attaches to the gum.
The healing phase can last from 2 to 6 months.
4. The prosthetic phase
This phase consists of 3 steps.
A first appointment will consist of:
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[exceptional case: reopening of the gum to free the head of the implant if it was buried]
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taking the impression to build the prosthesis
Approximately one week later, a second appointment will allow :
the placement of the abutment that will receive the final prosthesis
the installation of the ceramic prosthesis (usually screwed in - see Question 3)
In the very likely case of a screwed prosthesis, a third appointment will be necessary to
ensure that the prosthesis is screwed in after the implant has been in place for a few days
fill in the access hole to the screw
The next phase is the maintenance phase. It is important to guarantee the durability of the implant and is based on good oral hygiene and regular appointments with your dentist (see Question 11).
7. Explanatory videos for single or multiple dental implant placements
8. How long between the different phases of implant placement?
Sometimes, before placing a dental implant, your dentist may need to perform procedures to prepare the reception site.
This may include
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Orthodontic treatment to create the right space for the implant,
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extraction if the tooth is severely damaged, decayed or infected
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Bone grafting to create a stable base for the implant by increasing the volume and density of the bone,
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a gingival graft to ensure good support for the implant.
8. Is it painful to get a dental implant?
Implant placement is performed under local anaesthesia and is therefore not painful in itself. After placement, temporary discomfort and side effects are possible and vary considerably from person to person, depending on the number of implants and their position in the dentition.
Some patients will tolerate the surgery very well, while others will experience mild to moderate pain. As with any surgical procedure, implant placement can have side effects:
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Mild bleeding: possible in the 2-3 days after the procedure.
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Swelling: swelling around the operated area is quite normal after surgery. Apply an ice pack to the swollen area.
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Haematomas: bruises may occur in the cheek, eyes or neck within 3 days after the operation. They are harmless and can quickly disappear with an Arnica cream applied by massage.
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Temperature: a slight increase in temperature may occur, a natural reaction after this type of surgery.
9. How long does an implant last?
The life span of dental implants depends on several factors. The first is related to the quality of the material, in particular the implant itself; we only use implants made in Switzerland. The second factor is the health of the surrounding gum and bone, which is affected by the patient's oral hygiene. If the patient respects the maintenance care, the life of his implant could be 10 to 15 years, even more for the most careful.
10. How to take care of an implant?
Even if dental implants intrinsically require little maintenance, it is important to have an excellent oral hygiene in order to avoid gingival infections in particular. In this, the patient himself plays an essential role for the durability of the implant, avoiding in particular the risks of peri-implantitis: the main cause of which is the formation of dental plaque [brushing twice a day for 3 minutes with a toothbrush, ideally an electric one, and a suitable toothpaste; use of interdental brushes].
An annual visit is also necessary to verify that there is no deterioration of your dental implant. Your dentist will perform an X-ray examination to evaluate the quality of the bone in which your implant is positioned. These x-rays will be compared to previous ones to identify any changes. He will also check the health of your gums in order to detect certain complications at an early stage.
11. What if I move? The implant passport
An implant passport is given to you after the procedure (*). It allows the traceability of your new implant device.
Indeed, to ensure the follow-up of your implant and its evolution during its life (and yours with possible moves), it is important to record a maximum of information on the work done. Thanks to this passport and the internationally recognized and available Swiss implants, you can be followed and treated anywhere in the world.
The passport therefore meets the various standards of traceability. It includes 2 sections:
1. the "Implant Surgery" section mentions
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The manufacturer of the implant, its reference and its batch number
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The measurements of the implant (length, diameter, composition)
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The positioning of the implant
2. The "Implant Prosthesis" section specifies
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the material constituting the prosthetic abutment
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the nature of the prosthesis
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the connection method of the prosthesis (screwed or cemented); in the case of cemented prosthesis, the type of cement used and its batch number.
We also keep a copy of this information in our medical archives.
(*) The implant passport is a document established by the National Council of Dentists (CNOD).
12. What age for implant placement?
The average minimum age for a dental implant is 18 years old. This is because this is the age when growth is usually complete and the bone tissue in the jaw is fully developed.
For seniors, there is no age limit for implant placement.
As mentioned in the question "contraindications", implant placement depends on the condition of the bone and its environment as well as the patient's ability to heal normally.
Certain cardiac pathologies or certain treatments may contraindicate any surgery.
Discuss this with your dentist.