FAQ
Information on Dental Implants (surgical procedure, animation, images, an implant system, history and development, our experience ...) click here .
How long does it take to place an implant?
In the case of a patient with ideal anatomical conditions a single implant procedure lasts 15 minutes, often without the need for suturing the wound. If a number of implants are placed at the same time (e.g. four) the surgery takes about one hour. If together with the implant placement it is necessary to perform so-called "build bone” procedure (augmentation) then, in the most complicated cases, can such a combined treatment take up to 2.5 hours. In such cases we recommend our patients analgo-sedation or general anaesthesia.
How is an implant placement performed?
An implant placement is a small surgery intervention of which seriousness depends on the anatomical conditions of an individual patient. Under the anatomical conditions we understand the shape (height, width) and quality (density) of alveolar bone into which an implant will be placed and the state of soft tissues surrounding a future implant - gums, mucous membranes and muscle ligaments. An implant placement means the following:
1. Making a small incision (cut) in the gum where an implant will be placed (sometimes this step is not necessary)
2. Creating a bone bed (a hole) for an implant. This step must be done very carefully. The bone bed preparation can be carried out either by a rotary tool (a dental drill) or, in the case of a lower bone quality, by so-called condensers (pluggers) or dental spreaders (hand tools sparing even the smallest amount of bone tissue).
3. Placing of the implant into the bed bone.
4. Suturing of the wound (the implant remains hidden below the gum - it can be seen only on the X-ray) or screwing in of so-called healing-in cylinder or gingival former (so-called transgingival healing) - a flat metal stud in the gum is visible. In some cases, immediately after the implant placement, an implant superstructure and a tooth replacement (crown) can be fixed. It is called "immediate load" procedure.
It is on a dentist to decide which suitable operational techniques will be used during the surgery for the best outcome and for making the treatment for a patient as comfortable as possible.
Is it possible to place several implants at the same time?
Of course, it is a common practice to place multiple implants in one session. A dentist will recommend to a patient whether to place implants simultaneously or in groups in separate sessions. The dentist is in the best position to decide which surgical procedure is suitable for a patient and how quickly it can be performed on the given patient. A dentist always takes into account requirements of a patient. Sometimes it is possible to agree on a procedure, where the patient during surgery (such as a placement of the first implant in one place) expresses its consent to continue with other implants. Understandably, before the first implant placement most of the patients may fear of the unknown. After starting of the treatment and realizing that it is painless and takes place in a quiet atmosphere where the main priority is comfort, the fear of the treated patient always disappear and afterwards he is able to relax. If a patient within the overall treatment of the mouth needs more implants it is advisable for more reasons to place them at once or in as few steps as possible.
What awaits me after a subsidence of anaesthesia (1-2 days after the implant placement)?
After a subsidence of anaesthesia (numbness) patient's feeling is comparable to the feeling after a tooth extraction. In the area where an implant was placed the patient experiences sensitivity associated with the wounds created by the surgery. A sensitivity threshold is given by seriousness of a treatment and patient's individual perception of pain. During the first two days after the surgery we recommended patients to use commonly available analgesics for pain control. It is normal that patients after placement of a single implant have no sensitivity on the second or third day after the treatment. After more complicated treatments, it is normal to expect swelling of the area (it is not associated with an increased pain) around the third day after the surgery. This swelling can be reduced or eliminated by cooling of the operated area by applying of cooling sachets immediately after the surgery and another 12 to 24 hours. Accelerated absorption of swelling and an improved antibiotic effect can be also achieved by the administration of enzyme preparations (Wobenzym, Phlogenzym). These preparations have no onerous side effects to the body and are freely available for sale. Dosage will be determined by the dentist.
Most of the patients do not experience any problems 3-5 days after the implants placement (even a few at a time). In case of routine implants placement it is not necessary to arrange for your vacation or sick leave but you have to take into account the complexity of the surgery and consider the extent of your social or sporting activities in the days immediately after the surgery.
Will I have no teeth in the area of the implants placement?
Each treatment procedure in our clinic is planned so that the patient had the opportunity to get a temporary denture. The purpose of this teeth substitution is primarily a social effect on a patient. A patient is informed by a dentist about functionality of a temporary replacement (adjustments in diet, hygiene).
What are the forms of the temporary teeth replacement?
Temporary replacements can be divided into fixed (bridge) and removable (spacer, prosthesis).
The choice depends on the overall solution, conditions before an implantation and the number of implants. In case of one tooth replacement it is quite a common practice that a patient receives also a temporary crown on the implant immediately after the implantation. This is possible only if the patient is able to comply with prescribing instructions (must not load the crown directly during a specified period).
In case of several teeth replacement (bridge) and after an assessment that will show that the implants are strong enough, we are able to offer a temporary bridge on implants, if required. Such a solution is possible also in case of complete teeth replacement. This convenient temporary solution is even less risky if more implants are possible to place at the same time (e.g. 8 instead of 6 in the case of the toothless upper or lower jaw).
Is there anything to beware of after the surgery?
Following the implants placement reparative and remodelling processes occur in bone tissue and also the soft tissue wounds result in increased blood flow in the area. The inscribed recommendations should be followed especially after moderate and major interventions.
To enhance the healing process (2-5 days after the operation) it is important to follow these recommendations:
- Do not smoke!
- Eat soft or liquid diet, chew on the healthy side of the mouth - strictly avoid direct load of the implants
- Eliminate increased blood flow or increased blood pressure (avoid – doing exercise, going sauna, lying on the operated face side; keep your head higher at night)
- Keep your oral hygiene - clean your teeth and, by following the individual instructions given, clean carefully also the area of implants
- Do not use painkillers containing salicylates (aspirin) as they increase bleeding
Is it possible that my body would not accept implants?
A dental implants placement is statistically the most successful medical method. Not healing-in of an implant is a very unique situation and always has a reason. It can be caused for example by a remnant of inflamed tissue in a bone, which had not been removed in the previous extraction and is not visible on X-ray. The implant activates an inflammation and is "rejected". An implant can be also rejected due to an improper operating procedure. If an implant is loaded too early or implants are overloaded due to their insufficient number it can also cause that implants are rejected. ... So, there are few possible causes but there is never the cause that "your body did not accept a implant". In our practice we are able to discern the reason of any complication and we know how to resolve this situation. If we decide for an implant placement we take full responsibility for ensuring that it will be healed-in. If this does not happen you do not pay for the surgery or we will place for you a new implant free of charge. We are giving this guarantee for each implant for more than 14 years now.
It is important to note that unsuccessful healing-in of an implant is a very unique situation and its possibility increases with the complexity of a planned treatment (procedures involving bone rebuilt, shorten healing-in time, overloading...)
What happens to the implant after its placement?
After placement of an implant into the bone bed remodelling of bone around the implant and cell adhesion to the implant surface occur (oseointegration). It will take 2-5 months (depending on difficulty of treatment and anatomical conditions) before the implant can be fully loaded by chewing.
After the healing-in period (bone-to-implant adhesion) a prosthetic phase of treatment begins. Impressions are made and then denture's manufacturing is planned.
How long will the implant last?
Lasting of the implant, after its healing-in properly and correctly loaded by prosthetic work (bridge, denture), is mainly in the hands of the patient. It will depend on his cooperation and his care for the teeth replacement. Especially in the first two years it is very important to have regular check-ups, particularly in dental hygiene. Once a year it is appropriate to make checking X-ray images and to assess possible changes in the bone near the implants. If changes are detected at an early stage they can receded and stabilized.
What steps are taken during the implant placement procedure?
The first step is placement of implants - the so-called surgical placement. As already mentioned, within a week after the surgery the patient is able to eat without any problems and healing-in of the implant is under way.
The second step within 2-5 months - the implants are checked-up and impressions for the prosthetic work are taken. This section is called the prosthetic part of the treatment.
In case the patient for any reason is not able to come to complete prosthetic work, the prosthetic part of the treatment can be done at a later date. However, it is not advisable to leave the implants without loading for more than a year.
Do I need to meet any requirements for an implant placement?
A candidate for an implant placement should, in addition to the medical requirements (such as sufficient space for placing an implant, overall health condition), meet also the "human" or "personality" requirement. It should be a person who takes care of himself, is able to maintain personal hygiene at a certain level (or has a desire and willingness to learn it) and understands what an implant is and how it works. From our perspective, it is also very important that the patient who requires the implant treatment was willing to cooperate during the healing process so that the joint effort and resources as efficiently as possible led to the final outcome. It is very important that the patient before his/her treatment truthfully filled in a questionnaire regarding his/her general health condition. The candidate must notify the dentist about any disease he/she is currently treated. Some diseases may partially or completely exclude the possibility of implants placement (absolute or relative contraindication). It is concerned mainly to the conditions when the total resistance of the body is reduced (immunodeficient states). It is not appropriate to place implants to patients undergoing treatment of cancer (chemotherapy, radiotherapy) or patients with severe or uncontrolled diabetes (diabetes mellitus) and metabolic disorders. In such patients it is important to consult the doctor who is treating their underlying disease and then decide if the treatment is suitable for them. Implants can be also placed to the patients who have mild form of diabetes and are under supervision (setting for treatment), although overall health conditions need to be taken into account when designing the treatment.
How should I care for the implants?
The greatest danger for the future of each healed-in implant with fixed prosthetic work (such as bridge, telescopic crown, implant abutment or prosthesis) are plaque, tartar and bacteria, vegetating of these impurities and creating an inflammation (periimplantitis). This process is very similar like with own teeth (periodontitis). Its initial stage is recognised by redness around the implant, swollen gingiva (gum), bleeding during dental hygiene... This condition can be avoided by good home hygiene and regular visits at a dental hygienist. In our practice, the implant surgeries are always followed with regular check-ups with the dentist (depending on the type and scope of work approx. in about 1-2 months) to ensure there are no difficulties with maintaining good hygiene around implants. If the hygiene is not sufficient, our Dental Hygienist not only do thorough cleaning of hard reachable places, but also teach the patient how and with what dental aids to achieve a desired result of cleaning.
How much will it cost?
In our practice, a single implant placement costs 600 euro. We have been using solely implants from the world-class providers such Ankylos and Xive for about 14 years now. These are reputable products of Friadent Company (http://www.dentsply-friadent.com/en/525.htm). Both implant systems are on the market for more than 20 years, this means nearly 30 years of clinical studies, research, experiences and communication with clinicians (dentists). Since we do not keep changing implant systems, we and also our colleagues, laboratory technicians (who make dentures), are able to achieve mastery in working with these systems. In other words, we know our product very well so we know what we are working with and what we can expect from it. For this reason, we are also the training place where other doctors come to be trained....
In our practice, we are giving 100% guarantee for implant placement. There is no charge for an implant (100% - full refund is guaranteed to patient) if any complication occurs during the healing process (read the answers to the following question), which should lead to the implant removal. Alternatively, the implant is replaced by a new one free of charge. Our practice bears all risks and costs associated with loss of materials, time and labour associated. We can afford to offer this guarantee to patients on the basis of our long experience in the field of implantology.
Of course, there are more costs associated with the implant therapy after the initial placement of an implant. Sequentially, it is necessary to construct a prosthetic work for implants whether a bridge or a hybrid denture or a single crown. It would not be right at this point to write how much will cost the final treatment as it is individual for each patient. At an initial non-binding consultation each patient will receive an accurate financial and time schedule of the treatment that is tailored to his/her needs and possibilities.
What are the possible complications with the implant treatment?
Complications with the treatment by dental implants are equal to any other medical method. It is important to recognize them in an early stage and know how to solve them. First of all, it is important to say that after the implants placement swelling and tenderness in the operated area is a normal healing process that last a week (of course depending on the type and extent of the treatment). If a patient feels pain or has swelling following two weeks after the treatment the cause should be searched for.... In simple terms, the complications can be divided into two stages - early and late.
Early complications are reflected in the continuing sensitivity of the area of the inserted implant, mild swelling or purulent discharge formation in the area in the first weeks after implantation. These symptoms may be caused by an inflammation around the newly placed implant (by infection from contaminated environment, by exacerbating infectious process within the old bone, by improper preparation of the bone bed for the implant etc. ...). This means that the initial nonhealing-in of the implant may or may not be the result of improperly "implanted" implant. Sometimes we can see the remnants of inflammatory tissue in the depth of a bone left by previous complicated inflammation or inconsistent removal of inflammatory tissue after a tooth extraction. In some cases (rather exceptionally) we are able to suppress the inflammation medically by administration of suitable antibiotics. Mostly, however, we proceed to removal of the affected implant, cleaning of the wound and after its healing to the re-implantation. This procedure is costly for each practice (a clinic bears the costs associated with buying a new implant and the necessary materials - in any case, the implant must not be sterilized again and used!) but it is the only proper and guaranteed long-term good solution for the patient. Finally, it should be added that such situations occur very rarely because an experienced implantologist places an implant only where its success is expected....
A special form of an early non-inflammatory complication in the jaw is discomfort or interruption of nerve n. mandibularis or its branch n. mentalis by the embedded implant. If suppression or destruction of these nerves occurs the patient feels abnormal skin sensations in the lip (paresthesia) or even loss of bodily sensation (anaesthesia). To avoid this complication it is important to analyse preoperative X-rays and to involve an experienced surgeon. In the case of the lower lip paraesthesia following the implants placement it is important to note this fact to the dentist the first few days after the implants placement. By an early (and quite simple) removal of implants, which irritate the nerve, a further nerve damage is prevented and sensitivity returns to normal.
A late complication is called the complication that occurs after healing-in (osseointegration) of an implant. It is therefore a condition where on the implant is already fitted properly prepared prosthetic (improperly made prosthetic are not used in our practice so we will not write about them ... just to let you know that even a very poorly made replacement may cause a loss of implants - we encounter in practice with anything ...). Such a late complication is called "periimplantitis" and has a very similar process to periodontitis. The cause is improper hygiene or lack of patient's discipline (not attending dental hygiene). The process is as follows: initially only reddened gums, plaque accumulation, bacteria, tartar, gradually creating a so-called bone-sac, a bone around the implant slowly subsidises and creates funnel bone defect around it. Such a process can be reversed at an early stage by the right treatment, at later stages (patient ignores inflammation, bleeding during hygiene) an implant should be removed and later it can be replaced. In principle, the sooner is the situation addressed, the easier the solution is. Again, it needs to be emphasized that in patients who come to the dental hygiene at least 1-2 times a year is such a state precluded. In conclusion, it needs to be said that the late complications around implants are "in the hands of patients themselves."