Healthy teeth are not natural thing. Life leaves marks on our teeth. Very often there is a loss of tooth or a group of teeth. The tooth loss is usually caused by for example tooth disease as a consequence of a decay, periodontitis - associated with looseness of tooth or injury. Missing tooth or teeth cause not only aesthetic problem but also functional limits in many aspects. One of many solutions how to replace lost dental tissue are dental implants. They have been used for several decades.
How old are dental implants?
The history of dental implants dates back in early times. First mention about the ancestors of today’s classic implants have been in the period of ancient history. Archeologists found imitation of dental implants dating back in 1350 years. It has been related to Mayan civilization, a mandible, which is considered to be that of a woman in her twenties. It had tooth-shaped pieces of shell placed into the sockets that should probably function as lost teeth. In the early 20th of last century, specialists from all over the world inspired by this founding started to deal with studies that have been fundamental for future appearance of today’s implants. They have reached great development, mainly in the last decade. The improvement has concerned materials, shapes and also the method of placement in the jawbones. At present there is a range of implants and hot novelty on the Czech market are so-called mini implants (more information further in the text).
What are dental implants and what does the dental implantology deal with?
Dental implants are artificial replacements of missing teeth that are fixed directly in the jawbone - instead of the natural tooth’s root. They are made out of titanium, eventually from titanium alloy mostly in shape of screw or cylinder. The larger part of the implant is covered in the jawbone - so-called fixture; only its upper part is visible in the gum. An abutment is then placed on the implant that forms a supporting base for a dental replacement (crown or bridge).
Dental implantology is relatively new surgical specialty that deals with replacement of lost teeth with unconventional modern methods so-called dental implants. It is always little invasive outpatient procedure, which means that the patient can go home after the procedure. It is always cooperation of dentists and oral surgeons (who inserts implant), periodontist (who examines the structures that keeps the tooth in the oral cavity) and prosthodontis (who takes care of final appearance of the dental replacement).
Why dental implants Prague?
Prague has many attractive features for those considering dental implants abroad. Its location in Central Europe is easy to access; its mild climate is conducive to healing and its experienced clinics and teeth implant dentists ensure you'll receive the best possible care. Teeth implant Prague costs are often much more affordable than in the UK or with the NHS. For more information about getting to and around the Czech Republic, please visit our handy cosmetic surgery Prague info guide.
What are the types of today’s implant?
From historic point of view there are many different types although there are used only several of them. Examples are following:
Root Form Implants: they are the most important and most used, their main advantage is in principal unlimited durability and unlimited indication. They are applied into the bone. They are made out of titanium or its alloy. They are in shape of roller or screw. For better quality of healing its surface can be modified (sandblasting, plasma spraying or various chemical procedures). Sometimes it is covered with thin layer of material, which is similar to a bone - covered implant. Their diameter is 4mm and length from 8 to 16mm. These implants are inserted in two phases (two surgical procedures). Either immediately or in several weeks after the loss of tooth - IMMEDIATE IMPLANTATION. Or approximately after a year, when the wound after the tooth extraction is fully healed - DELAYED IMPLANTATION.
Blade Form Implants: they are used less often but they complete the screw implants with their features very well. They are also applied into the bone. They are made out of titanium and in various shape. They can be inserted even into a very narrow jawbone. They can be applied either in one or two visits.
Subperiosteal Implants: they are inserted between the bone and gum. Today it is almost unused type. It is custom made from chrome-cobalt alloy or titanium depending on the jawbone model gained by its impression of uncovered bone, i.e. surgically.
Transdental Implants: are inserted through dead tooth and they have the function to strengthen the tooth.
Mini Implants: “new miracle” in implantology. Those are naturally implant screws only 1,8mm in diameter and length from 10 to 18mm. They are made out of titanium alloy of high quality. Compared to standard implants they are much smaller in diameter (so they can be inserted even to patients that are unsuitable for classic implants). The method of inserting is also much easier and faster. In Czech Republic they have been used since 2002. A suitable candidate is anyone with remained jawbone of minimum width 2,2mm and to patients that have “weak bones”. Mini implants serve for temporary and permanent fixation and for stabilization of denture. Among the advantages belong also lower price, immediate placement of the denture and simple technique of the procedure under local anesthesia.
The innovation of the 21st century - Zirconia (Ceramic) Implants
Zirconia (ceramic) implants represent a new generation of implants. They are made out of extra strong zirconia ceramic that gives white look to the implants. Compared to the titanium made implants they are more aesthetic (the green color of the titanium implants may sometimes be visible through the gum). There are certain advantages compared to classic implants:
They can be used in patients allergic to titanium. Ceramic is fully accepted by any human tissue and therefore it has no allergic reactions.
It can be used in patients with thin soft tissues. Classic implants can be visible through the gum.
Compared to classic implants the ceramic implants are inserted as a one piece (screw in the bone with the abutment altogether). It reduces greatly the reason for implantation failure such as loosening of these two parts. In the Czech Republic the zirconia implants have so far been introduced in the dentist offices so there have not yet been great experience in our state.
Are you a good candidate for dental implants?
Dental implants can solve any patient’s defect associated with the loss of one or more teeth or all teeth in the upper and lower jaw. However, in some cases the implantation is not recommended (insufficient oral hygiene, untreated diabetes, diabetes treated with insulin, severe defects of blood clot, long lasting treatment with corticoids, osteoporosis and related drug intake, increased function of thyroid gland, tumor disease in the oral cavity, bad habits like teeth crunching ad grinding). The surgeon - stomatologist always decides about the indication after precise consideration and evaluation of the results received by dental specialists. He/she examines the oral cavity and jawbones. There needs to be also confirmation from the attending physician about the health state (long term drug intake, severe diseases that block the procedure).
Dental implants are inserted approximately from the age of 15 in girls and from 16 in guys - in time when the jawbones are almost developed. There is no upper age limit and implantation in patients in their eighties is not an exception.
Before the surgery
During the first visit the surgeon evaluates the state of your teeth, quality of jawbone and gums and makes RTG image of the jawbones. He/she will possibly ask you about your expectations and will set needed amount of the implants. If your jawbone is not enough wide for implant placement the surgeon will probably suggest one of the augmentation techniques. In this case of implant placement precedes surgical procedure and relatively long healing process (6 - 9 months).
If you have some of your infection disease (cold, virosis, aphthosis, lip herpes, etc.) the surgeon will probably suggest to postpone the implantation for few days. It is also not possible to perform the implantation by disease of oral cavity. In case you have valve, vascular or joint replacement, the surgeon should prescribe you antibiotics several days before the treatment to avoid possibilities of infection.
Augmentation of the jawbones
The jawbones adapt to a situation without teeth and if you lost your teeth a long time ago, the jawbone has probably narrowed to a great extent. It is impossible to insert an implant into a narrow jaw and that is when the surgeon will use bone augmentation techniques.
There are various types of procedures. Some are completely simple for the patient and are performed at the same time with implant placement. Other need surgical procedure. Most often the gum is opened by the surgeon and the bone is built up with a special synthetic material mixed with smashed bone from your jaws. Another option is bone grafting which is the transplantation of your own bone tissue taken from your chin, shin bone or hip bone. This treatment is performed under general anesthesia and it is a residential treatment. The most important and often used treatment is SINUS LIFT. It is used in case of loss of upper posterior teeth. The bone is here in most of the people very weakened by jawbone cavity - upper jawbone is concave and insufficient for dental implant. The bottom of the jawbone cavity is filled with special artificial material and the bone will form from it itself after certain time. At the same time the implants are inserted and they remain there for 9 months to heal in. Sinus lift does not require anesthesia or hospitalization. All bone augmentation procedures will take several months to heal.
What is the use of dental implants?
The implants have two ways of use: They enable to replace removable denture by a fixed bridge and they remove the need of teeth grinding because of the bridge. If there is one tooth or group of teeth missing implants with crowns or bridges will replace the missing teeth. If there are no teeth in the jawbones it is possible to make a fixed bridge or removable denture with the help of implants and restore the teeth. The replacement of lower teeth is substantially easier and less expensive compared to upper teeth.
The process of tooth implant placement
Teeth implants can be placed into a hole left by a recently extracted tooth or to replace teeth that have been missing for a longer time. Inserting one dental implant takes approximately 30 to 90 minutes. It is an outpatient procedure done usually in two phases. In the first phase an implant is inserted (today in the most used types into bone), the wound is sewed either with absorbable sutures that are not necessary to be taken out and/or by non-absorbable sutures that must be removed in 7 - 10 days. The implant is left to be healed in. The healing of the implant is important for creation of firm base for future replacement. In the upper jawbone it takes 6 months and in the lower jawbone 3 - 4 months. After this healing process in case of no complications the patient visits again the implantologist and he/she performs another (second one) surgical procedure. It is made by cut into the mucosa in the place of the implant and insertion of temporary titanium abutment that is already sticking out into the mouth. In approximately two weeks the gum in the surrounding of the abutment forms something like a cuff, which blocks the approach of microbes in the depth of implant. At that point the temporary abutment is replaced by final one. A tooth replacement can be then made on it (crown, bridge or total prosthesis) almost indistinguishable from the natural teeth.
There is a range of procedures that differ from the conventional two-phase insertion of replacement. For example in certain cases it is possible to skip the healing phase - crown or bridge is made immediately.
In most cases it is not a problem to place more than one dental implant during one visit, and even to perform a complete replacement of roots in the whole jaw. For the replacement of one tooth, always one implant is needed, the same is needed for the support of a bridge. If the dental implant serves as an implant-supported denture, usually a minimum two (in the lower jaw) and four (in the upper jaw) implants are applied. In cooperation with the dental laboratory your implant-supported denture is adjusted so that it would clip or hold to the implants.
The insertion of dental implants is performed under local anesthesia or analgosedation, which guarantees you a painless procedure. If you suffer from an allergy to any medications, tell your doctor, especially if you are allergic to Mezokain, Lidokain, etc.
After the treatment
The patient goes home after the treatment. The complications after the surgery are surprisingly mild. However, as a wish of the patient the surgeon can prescribe a sick note. After the implant placement there appear light post-surgical complications that are most intense the day of the surgery after fading away of the anesthesia. They last for about three days and they gradually fade away. It can be a swollen and painful cheek with bloody bruises, the wound can be reddish and swollen and also painful. Also slight bleeding and firmness of chewing muscles can occur. That disables opening of the mouth. Ice compress are therefore recommended on the treated cheek, the surgeon prescribes also drugs against pain. The food should be very soft or mashed in the first week. If these symptoms stay for more than a week immediately contact the implantologist.
Post-operative complications depend on the extent of the treatment. The risk of complications is highly increased by smoking; this greatly prolongs the healing process. After the first few days, which are necessary for the wound to heal, it is possible to use a temporary denture that helps you eat normally and have normal social contacts. The probability of perfect healing of the dental implant is almost 100% and the long-term success rate of the replacement of missing teeth is comparable to “classic” bridges.
What risks related to implant placement can occur?
Same as by all surgical procedures also implant placement is to a certain level connected with some health risks, they arise very rarely though. If they occur it is necessary to treat them. Those are:
Infection in the implantation wound
Damage of surrounding tissue (remaining teeth, blood vessels and nasal cavity)
Damage of surrounding nerve endings that cause pain and tingling in the treated area
Problems with cavities (if the implants are placed in the upper jaw very close to these structures)
Caring for dental implants
Most of the implantations is successful. Following can help:
1) Right care for the implants and keeping optimal hygiene of oral cavity
To ensure your teeth implants heal without complications, excellent dental hygiene is required. The implants must be cleaned with a special toothbrush, which your dentist will recommend to you, and also with the help of an inter-dental brush and dental floss, which should be a part of normal dental hygiene. Electronic toothbrushes that rotate are not recommended, they could unscrew the crown or even the actual implant. Your dentist or dental hygienist will show you tips for proper dental hygiene.
It is necessary to carefully prevent gingival inflammation. In case of any inflammation, the body may consider the implant to be a foreign element and may refuse it or damage its stability.
2) Regular check-up by the dentist
The frequency of those visits should be twice a year (approximately after 6 months). The surgeon checks up the level of oral hygiene, the implant’s condition, eventual oral cavity disease. By regular check-ups unsatisfactory care for the implants should reveal and possible associated complications. Only timely and effective therapy blocks implant elimination as a foreign element.
3) Change of existing habits
The patient should avoid hard food (such as ice, hard candies,….) that can lead to replacement damage.
What is the durability of the implant?
Main and important condition for the durability of the implant is its healing. Another factor is the quality of the dental hygiene, quality and volume of the jawbone, number of implants and many other. Theoretically the durability of an implant is not limited. In reality the implants do not remain in such way, so after 10 years there remain in perfect state around 95% of implants in the lower jawbone and 90% percent of implants in the upper jawbone. In smokers of more than ten cigarettes a day the results are worse of some percent. The long lasting performance of the implantations is in great extent influenced by quality (and therefore even by price) of the actual implant.
What is the price of the implant?
The price of the treatment consists in the cost for the implantation and for the prosthetic replacement (crown, bridge, denture). The health insurances except some exceptions do not cover the dental implants. The cost for the treatment is influenced mainly by the number, type and price level of used implants. Each situation is evaluated individually during the initial examination. The type, number and placement of the implants chooses the dentist based on theoretical rules and his/her experience. The patient chooses the price level. One dental implant without the crown costs 6000 - 9000 CZK (screwed implant of Czech manufacture or blade implant). Or 15000 - 23000 CZK in case of screwed.