The loss of teeth is a serious problem both for the patient and for the dentist. It affects not only older people but also teenagers and young adults. It can lead to serious disorders in the functioning of the whole mouth, as well as a lowering of the quality of life or difficulties of a psychological nature, such as reduced self-confidence or reluctance to be in public places. Modern dentistry offers many solutions to this problem. Although there are many possibilities for filling gaps, the most physiological way is the introduction of an implant, and it is often the first treatment method proposed by the doctor.
What is an implant and what does it consist of?
An implant is a screw, in length and size usually corresponding to a tooth root. It is most often made of titanium – a material very well tolerated by the human body, which does not cause allergic reactions or inflammatory responses. Placing the implant in the bone is meant to provide stabilisation for the future prosthetic restoration (crown, bridge or denture) and to enable the transfer of chewing forces to the bone in a way that imitates the functioning of the patient's own teeth. Besides the screw, a healing screw (fitted for a period of about 2 weeks) and an abutment and prosthetic crown or bridge are also necessary to restore the gap.
When can an implant be placed?
Every situation in which a tooth has been lost is an indication for filling the gap. It should be remembered, however, that there are situations in which the possibilities of using implants are limited or contraindicated. Implants are not placed in children who have not finished their growth period – the age of 18 is assumed as a safe limit. Contraindications also include cancers, especially those treated with radiotherapy of the head and neck area. Habitual smoking also excludes patients from the possibility of implantation, at least until the habit is quit – nicotinism impairs the body's repair abilities, hinders healing and increases the predisposition to gum and periodontal diseases, which can be a cause of treatment failure. In other situations the doctor can propose the placement of implants to the patient.
What does implant placement look like?
Placing an implant in the bone is a procedure with a defined protocol. There are deviations from the standard principles, which the doctor presents in the treatment plan, but most often the process consists of three stages.
Stage I. Carrying out detailed diagnostics: an OPG image and CBCT tomography, to check whether there is a sufficient amount of bone tissue at the site of the planned placement. Then a surgical procedure is performed, most often under local anaesthesia, sometimes under general anaesthesia – it consists of drilling a hole in the bone into which the screw is introduced. After placing the implant, the doctor checks its stability and correct position, then sutures the wound. After the procedure the implant is not visible in the mouth – it is entirely in the bone. It is necessary to wait from 3 to 6 months until the implant integrates with the bone tissue.
Stage II. After the designated time, the doctor uncovers the implant and introduces a healing screw, which accelerates the regeneration of the gum in the area of the implant and ensures the correct appearance around the future crown. This stage lasts about 2 weeks.
Stage III. Two visits: taking impressions and fixing the prosthetic crown. At the first, impressions are taken and the doctor establishes with the patient the colour of the future crown. Then, in the laboratory, on the basis of the impression, a restoration consisting of an abutment and a crown is made. At the last visit the doctor screws the abutment to the implant and – after making sure the connection is stable – fixes the prosthetic crown.
Restoring a single tooth
Implants are most often proposed to patients who have many of their own teeth and few gaps. Such treatment makes it possible to preserve the undamaged neighbouring teeth (unlike a bridge, which requires grinding down the teeth on both sides of the gap) and provides an aesthetic, fixed and functional restoration. At the site of the missing tooth the doctor assesses the quality of the bone and the interdental space and, on this basis, selects the implant and presents a treatment plan. Placing an implant can be done both many years after the loss of the tooth and at the same visit at which the tooth was removed.
What if more teeth are missing?
When more teeth are missing, it is not necessary to place as many implants as there are gaps. There is the possibility of restoring 3 or 4 teeth using a bridge based on only 2 implants. An individual assessment of the conditions in the given patient is, however, always necessary.
Edentulism and implants
Edentulism is not a contraindication to treatment using implants. The use of screws makes it possible to significantly increase the patient's comfort – instead of removable, often hard-to-stabilise acrylic dentures, the gaps can be filled with work permanently fixed in the mouth or with much better stabilisation. Depending on the conditions, all the gaps can be restored with bridges on implants or an overdenture-type denture can be made, in which additional stabilisation comes from implants placed in the bone and equipped with special attachments.
What if we have too little bone?
An insufficient amount of bone at the site of the planned implant is a limitation, but not an insurmountable obstacle. In such a situation it is sometimes necessary to introduce additional bone or bone-substitute material, sometimes to raise the floor of the maxillary sinus. Such a procedure lengthens the treatment process and raises the cost of the procedure. We describe the details of the offer on the dental implants page.
Studies
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How far can we go? A 20-year meta-analysis of dental implant survival rates
Kupka J. R., König J., Al-Nawas B., Sagheb K., Schiegnitz E. (2024) · Clinical Oral Investigations · systematic review and meta-analysis, follow-up of at least 20 years
Implants can function for many years, but the risk of biological and technical complications grows over time. Implant survival is not the same as full success without inflammation, bone loss or prosthetic repairs.
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Long term clinical performance of 10 871 dental implants with up to 22 years of follow-up: A cohort study in 4247 patients
French D., Ofec R., Levin L. (2021) · Clinical Implant Dentistry and Related Research · large retrospective cohort study
An analysis of more than ten thousand implants showed high survival, but complications and failures were more frequent in patients with certain risk factors. Hygiene, control of periodontal disease and regular maintenance visits remain crucial.