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Questions and AnswersHere you will find the most frequently asked questions about dental implantations and orthodontics and the respective answers.
1. What is a dental implant made of?A dental implant is basically a dental root and replaces the natural root almost completely. The part of the denture that doesn't belong to the actual implant is fixed upon the artificial root. Most dental implants consist of different compositions of metals or ceramic. Today the metal titan, in its purest composition, has asserted itself as the ultimate material for the manufacturing of implants. Titan exhibits a very good biocompatibility, grows very tight to the jaw bone, and is perfectly compatible with tissue.
2. How many different implants are in use?In Germany alone, more than 75 different systems of implants are meanwhile freely available. These implants may differ considerably. Although the raw material of dental implants is either titan or ceramic, they are manufactured into many varying types of implants regarding surface texture, look, and suppliers for dental crowns. In effect, however, they serve one single purpose. Fixed dentures, designed to resemble natural teeth.
3. Since when have dental implants been used in dental medicine?For the replacement of tooth roots, implants made of titan have been in use since 1959, namely by dentists who attached them to the jaw bone. However, for German dentists, scientific approval of this method has not been accomplished before 1982. Since then, dental replacements have become ubiquitous treatments in dental medicine. Even more, its stunning growth rate has made them the fastest developing fields in dentistry. According to estimates, 4 to 5 million patients worldwide take advantage of the benefits dental implants provide.
4. How does a dental implant look like?There are a great number of different types of implants, and new scientific findings produce even more variants. The types most commonly found are those resembling a cylindrical form and those similar to a screw. The surface of those implants that face and are supposed to adhere to the jaw bone, is either grooved to, or resembles the thread of a regular screw. The size, or better, the actual diameter of the implant ranges between 3 to 6 millimeters. The length of dental implants may be somewhere between 9 to 15 millimeters.
5. What happens during an implantation?By dissecting the oral mucosa and folding it sideward, the dentist lays bare the jaw bone around the area where the implant is going to be inserted. Following that, the usual procedure would be for the dentist to drive a hole into the jaw bone where the implant will be engrafted, while the patient is under local anesthesia. Since there fixing methods for implants available on the market vary, the dentist may mill a groove into the jaw bone instead of driving a hole. Once done, either the dentist, or the oral surgeon will insert the implant into its hole and suture the mucosa together. Finally, for the period of wound healing, the implant is supplied with an interim prosthetic.
6. How long will a dental implant endure?Today a great number of dentists have become familiar with the insertion of implants. Thus the functionality of implants has considerably been increased; that is, the provision of full functionality of dental implants and prostheses hits 95 percent 5 years after the treatment. In short, dental implantations have become save and smooth procedures. Daily oral hygiene and regular dental care guarantees the patient to keep his or her implant intact for up to 15 years.
7. Which cases allow for the insertion of dental implants?To replace individual teeth: 8. Can all patients wear implants?Although age does not play a decisive role in whether someone can have an implant inserted, there are some limitations as to the principality of the option to wear one. What appears most critical in this regard is the condition of the jaw bone, and here particularly the state of the remaining osseous substance. Moreover, the general state of health of the patient's dentition and past and potential diseases of the teeth and the jaw bone are crucial factors for the dentist to make recommendations for the most appropriate treatments.
9. What are the medical conditions allowing for an implantation?
10. What is going to happen if the existing jaw bone comes in insufficient quantity and/or poor quality?In principle, implantations can be conducted even with jaw bones of insufficient quantity or poor quality. However, it may become necessary to support the jaw ridge, so as to provide the implants with the necessary grip to endure. To ensure the implant to remain fixed, oral surgeons apply a synthetic, osseous-like material. The oral surgeon inserts this synthetic, osseous-like bone-supporting material into the jaw bone in such a way that some sort of routing rail, along which the newly developing jaw bone would find some grip and foundation to adhere to. The synthetic osseous-like material is scattered with small voids. Within these voids or pores, the newly developing jaw bone may find its enduring grip. Made of pure plasma material, the synthetic bone substance will have been completely absorbed by the existing jaw bone within a year. Additionally, its biocompatibility is very good and infections are hardly documented.
11. Does the implantation cause any pain?Good dentists take utmost care and see that during the placing of implants no pain will be caused. Local anesthesia is widely applied to suppress any throbbing or stings, or the dentist is cooperating with anesthetists who assume the duty to observe and monitor nervous patients while they are under general anesthesia.
12. Which disturbances are likely to be occurring after the placing of implants?Similar to tooth removals by surgery, the insertion of implants requires an extended period of wound healing. Despite careful dental care and hygiene, there remain the residual risks usually associated with removals of decaying teeth.
13. Are there, during or after implantations, any other concurrences likely to pose a risk?As after the placing of implants bacteria can infest the interspaces between the implant and the dissected oral mucosa, patients should be advised to prioritize oral hygiene, because other wise local inflammations are most likely to occur. Since laxity with regard to oral hygiene may cause inflammations, the wound healing process may come to a halt. This standstill of the healing process could eventually necessitate the removal of the implant, thus causing a loss of implants. These concurrences particularly concern the 20 months of the wound healing process. Moreover, pain and other hazards may arise after dental implantations in the following events.
14. Can dental implants be getting lost?Just as own teeth may be infested with periodontosis, can dental implants also be prone to such concurrences. Thus, dental implants may also be subject to loss if infested with periodontosis. To avoid these concurrences, patients need to sufficiently look after their dental hygiene.
15. What comes after the surgical procedure of a dental implantation?During the entire wound healing process, the implant should be checked by the dentist at regular intervals. This allows the consulting oral surgeon to see whether the implant is either accepted, or rejected by the jaw, and if its adhesion to the jaw bone is well under way. The time span, during which the implant is accepted by the jaw and increasingly adheres to the jaw bone, is usually about 8 months. Once the healing process is completed, the interim crown will be removed so as to make room for the prosthetic care. Thus, the entire process of planting an implant will have been accomplished within 6-8 months. Still, the patient should observe the regular follow-up checks.
16. How much would the placing of an implant cost?As a basic rule, implants are not covered and paid for by national health insurance companies. However, they will pay the amount usually calculated for regular care. In the event, no other dental treatment would yield satisfying results, but implantation would, or in cases where other methods are simply not applicable, they will pay. Therefore, before the onset of the planning stage of the actual implantation, patients are well advised to inform their health insurer. This is because the patient may be able to successfully negotiate coverage or the amount of coverage.
17. Can an implant be placed immediately subsequent to the removal of a tooth?This applies in certain cases, particularly where the jaw bone is in an excellent condition, stable, and without inflammations. An immediate implantation shortly after the removal of one or more teeth can help counteract the insidious decay of the jaw bone.
18. Can children and adolescents have implants?In order to circumvent laborious and expensive devises meant to adjust their teeth, implants have come to be an option for an increasing number of dentists and oral surgeons. However, the placing of implants in adolescents may turn out to be problematic as the jaw bone in not yet mature. Therefore, implants should be placed not before the last, larger period of growth because the jaw bone would not develop the usual way around the implant. As a general rule, young males should not be implanted artificial teeth before reaching 17 years of age, and young females should not be placed implants before turning 15. If there is no other way for children and adolescents than to resort to implants, the dentist may choose to use dental crowns instead, which are fixed by screws, making them easily adjustable to the growing jaw.
19. Is there a ban on alcohol after dental operations?
For three days following a dental operation, there is a ban not only on alcohol, but also on smoking. Moreover, one should abstain from diary products, fruit juices, and caffeine. If possible, you should take these food and stimulants not before at least one week after operation. This would keep you on the safe side and allows for a good wound healing without having to risk infections.
20. Is there a smoking ban after oral surgery?
Smoking reduces blood circulation not only during wound healing. However, nicotine and the additives contained in tobacco irritate the wound, too. All this may disturb a proper wound healing. As a basic rule, smoking and the consumption of nicotine in the widest sense should be avoided before the remnants of oral surgery have not entirely healed up.
21. Can I use denture adhesive cream after dental surgical operations?
Basically, economize your usage of dental adhesive cream after dental surgical treatments in general and abstain from it completely for the first three days following the operation. Otherwise, use dental adhesive only in selected points and use it sparingly. Alternatively, you may use denture adhesive pads instead of adhesive cream.
22. Is pain after implantation a common occurrence?
Mild to medium pain after the placing of implants is not uncommon. Tiny injuries and swellings of the gingiva and the jaw bone are naturally accompanying the placement of implants. Customary pain killers are a good means to reduce the toothache that follows such a surgical proceeding. Toothaches caused by these circumstances will typically fade away within 24 hours.
23. Should I abstain from physical exercises after implantations?
After every implantation, you are well advised to abstain from severe physical exercises and workouts. This does not mean, however, to get you to bed as if having flu. Easy sports and going for a stroll support the healing process and help you not to focus on your dental treatment.
24. Can I take soft food after dental operations?
The intake of food after dental operations should be resumed only when the complete sensation of the anesthetized spot has been restored. Tea and a good stock is the best option for the first day following the surgical operation. Please stay away from alcohol, tobacco, or coffee. Rely on soft food until the stitches have been taken out. Meat broth, along with an egg, hamburger meat, mashed potatoes, and diluted juices would be a good choice here. Avoid diary products.
25. Are dental braces able to make misaligned wisdom teeth even?
It is never too late to use a dental brace for your misaligned teeth! Even wisdom teeth can be brought back into position.
26. Will all teeth have to be grinded before getting an overdenture?
Large dental gaps or teeth missing on the sides require dental treatment/care and the provision with an overdenture. The actual overdenture is constructed of two metal sleeves that fit into each other. This connection is also referred to as cold shut. These prostheses provide an excellent footing, even when only one single tooth is left in the jaw bone. The teeth function as pillars providing the support necessary for a good fixation of overdentures. The remaining dental substance will not be grinded and will be kept in full.
27. When will a dental bridge be getting loose?
Abnormal occlusions may be occurring if the chewing surfaces of the bridge are not properly designed. As a result, no optimal bite would be possible. If the dentist has inserted a bridge despite of periodontal diseases, such as gum inflammations, the areas concerned will be further enflamed and pillar teeth supporting the bridge will be giving way to the pressure from the bridge and therefore getting loose. If the number of supporting pillar teeth is insufficient, an overstressing of these teeth may occur. These pillar teeth, and with them the bridge, will be loosening over time. Also, it is possible for the single elements of the bridge to break away at the soldered and/or glued points and so lose their grip.
28. What effects have retainers?
Retainers, or removable dental braces, won’t be able to correct every dental misalignment. Retainers can only bend the lower and upper dental rows to one side. This way, the dental rows will be either expanded, or shortened. The removal of the retainer allows for daily dental care as usual. Moreover, retainers do not overstress your teeth.
However, one of their major disadvantages is that retainers can be removed at any time and their wearing requires a good portion of self-discipline and rigor, so as to avoid the fecklessness of the treatment.
Regular wearing of retainers, that is 14 to 16 hours a day, renders a precise wearing schedule necessary; or otherwise, their effectiveness and the desired results may be out of reach and no misaligned teeth will be corrected at all. The peridontium will be formed and adapted to the new positions of the teeth only if a permanent pressure is applied.
Since the forces and the pressure of a retainer are applied to the teeth’s crowns, not all movements of the denture you can do without a retainer will be possible while wearing one. In order to accomplish your goals, a profound diagnosis made by your dentist or orthodontist should provide you with the knowledge necessary to go for either a removable, or fixed brace.
29. What happens during a preliminary oral examination?
Having completed its medical studies in dentistry and a one-year practice as a dentist, becoming an orthodontist requires an additional three-year training in orthodontics.
Orthodontics is therefore one field of dental medicine. Oral surgeons are mainly concerned with the analysis of misaligned teeth and deformed jaws. They are experts in prophylaxis, preventive checkup, and treatment of misaligned teeth and deformed jaws. While working on the correction of the jaw bones, dental orthodontic treatments are often part of the overall treatment of the former.
30. What if dental implants do not adhere to the jaw bone?
Due to the lack or a cavernous structure of the jaw bone’s osseous substance, but also because of poorly carried out dentistry, dental implants may not properly adhere to the jaw bone. In this event, the implantation (following a restoration of the jaw bone’s osseous structure) may be reiterated. In cases of lost implants, the placing of new implants is basically an option for years afterwards. Since the jaw bone is permanently growing and can be restored by using autochthonous bone substance, new implants can be placed in the same spot over again.
31. What are oral surgeons capable of - which dentists aren’t?
The areas of expertise of oral surgeons are oral and maxillofacial surgery. These fields are to provide for the restoration of the functions necessary for speaking, swallowing, and chewing. Prevention, therapy, and diagnostics of oral surgery refer also to the esthetical restoration after diseases, misalignments, injuries, and deformations and may concern the entire facial area. For practicing oral surgery in Germany, oral surgeons need an adequate education in dental and human medicine.
32. What are the costs of implants for upper jaw prostheses?
To guarantee a proper fixation of upper jaw prostheses, the dentist would require 6 implants if no teeth are remaining. For the placing of one implant with subsequent prosthetic aftercare, the dentist will usually charge 1,200 to 2,400 Euros. Prices for one implant including build-up vary significantly not only in Germany, but also among the member states of the European Union. It may be worth the time and effort to invite offers from a number of dentists.
33. What if the implant has gotten loose?
If the loosening of an implant cannot be related to the prosthesis, or its build-up, your dentist will make a panoramic X-ray. Having done so, your dentist can check the X-ray pictures and see if a gap has been developed between the implant and the jaw bone, or whether there are other causes responsible for the loosening of the implant.
In order to avoid damages to the implant due to forces from outside, implants necessitate considerably more dental care than own teeth. Bacteria and germs would have it easier to intrude, which adds to the loosening of the implant as the space between gingiva and implant is not sealed. This is because of the fact, that, dissimilar to own teeth, the gum does not adhere to the implant. Admittedly, loosening of implants may also be due to the existence of wrongly applied/overly stresses caused by an erroneous build-up of the prosthesis. Germs can easily enter if screw implants have gotten loose. Infections will follow. Eventually, the implant is dropping out of the jaw bone.
34. What to do if the implant is too close to its neighboring tooth?
Implants placed too close to their neighboring teeth are always in such a position due to poorly carried out work by the dentist or implantologist. If the positioning of the implant has led to the damaging of the neighboring tooth, the only way to avoid further damage would be to deaden the own tooth and fill the root. In constellations where dental roots are very close to one another, chances are that the placement of implants damage neighboring teeth. Particularly front teeth of the lower jaw are naturally carrying the risk of getting damaged through the insertion of implants. As a logical consequence, a thorough planning and strict monitoring through X-raying after the drilling of the cavity for the implant becomes necessary before the placing of the artificial tooth. Prior to the placing of implants, every good dentist will outline the limits of what can be ultimately achieved.
35. What kind of pain should be anticipated after the insertion of an implant?
All operational treatments necessary for implantations will always be carried out by the dentist under local anesthesia. The placing of implants is a surgical operation that is accompanied by pain caused by the wound. Particularly on the day of operation, but also during the days immediately following, mild to medium aches will occur. The sensation of pain depends on the individual pain perception and the psychological condition of the patient. The dentist will provide you with information about the pain to be anticipated and makes sure that you will have the right pain killers. These pain killers may be taken prior to the dental operation, so as to disallow the sensation of pain.
36. Which nerves are running through the jaw?
Between the fourth and fifths teeth, also called teeth number 34, 35, 44, and 45, there is the lower exit of nerves providing for the sensations of the front part of the lower jaw and the lips. If implants have been placed too close to these roots, or exits of nerves, pains and feelings of dumbness may occur.
A nerve, leaving the jaw, is running along the back part of the lower jaw. Moreover, there are 2 nerves just below the eye socket. The so-called plexus is a nerve that leaves the fossa pterygopalatina and provides sensation for the entire upper jaw. This nerve runs further along the nasopharynx and the unpaired channel of the incisor teeth. This allows the front palate to be provided with nerves. Even today, it is not entirely certain or verified where nerves exactly come from. There is also scientific dispute on how many nerves run around the oral cavity.
37. What interaction does exist between spinal disk and brace/retainer?
Most dentists and other medical experts agree with the thesis that crooked teeth may lead to backaches. There are basic connections between misaligned teeth and the use of braces, on the one hand, and the reduction of backache and headache, on the other. Not just the interaction between spinal column/spinal disk and misaligned teeth is an urgent matter in dental surgery, but also the reduction of aches associated with this through the administration of braces/retainers is a widely discussed topic.
By employing braces, orthodontists attempt to regulate the growing of teeth, be it either to stimulate, or to curb them. Only removable braces, or retainers, are suitable for this type of therapy. In order accomplish their goal, which is to take away pressure from the spinal disk through the regulation of the denture, most cases require accompanying therapies. Therapeutic exercises for the general improvement of posture and breathing support the patient’s motivation. This inner drive is essential for the accomplishment of the therapy’s goals, that is, it encourages interaction between retainer and spinal disk.
38. How long is the waiting period for an implant after dental extraction accompanied by an infection?
In the past, insertions of implants have been carried out by dentists in several stages. Firstly, the tooth was replaced, and secondly, implantation was followed by, thirdly, a healing phase of up to 3 months. After that, the implant was exposed and a subsequent prosthetic care, the mounting of the crown, had been applied.
In cases, where the final build-up of the implant was causing problems, the patient's waiting period would become a real torture. Particularly after the removal of the entire set of teeth, the patient was faced with the wearing of a full prosthesis under tough conditions. Today, modern dentistry allows the patient to have all teeth removed, all implants placed and a bridge put on it – in just about one single session at your dentist. The dentist will advise the patient to apply pressure to the implant only if all conditions in this regard would allow for taking such a risk. If the conditions are not existent, implants should be given time to heal and adhere to the osseous structure before prosthetic care is to be administered.
39. How long does it take, after the removal of a tooth, for the maxillary sinus to heal?
The wound will have closed within one week following the operative treatment. By then, swellings at the inner parts of the cheeks recede, any impairment regarding the opening of the mouth will fade away, and difficulties swallowing will be gone. The dentist will take the stitches out after 8 to 10 days, and, normal conditions provided, the maxillary sinus will be healed up within 14 days following the removal of tooth.
40. How long lasts a dental bridge?
As a basic rule of thumb, dental bridges will last as long as their wearers are living. However, this is a very hypothetical answer as something will always stand in its way. Multiple causes see to it that dental bridges will have gotten loose ahead of time, tend to slacken due to age, or simply break apart. There is always a variety of reasons for it.
In order to guarantee the longevity of a dental bridge, regular prophylactic check-ups at your dentist are indispensable. Oral hygienic measures, such as flossing your teeth or brushing them with a soft toothbrush twice a day, are of utmost importance.
41. How should an implant be positioned?
If the patient is able to wholeheartedly chew again, and laugh and speak within 4 to 6 weeks after the implantation, the position of the implant is supposedly alright.
42. How many orthodontists are there in Germany?
There are approximately 3,500 orthodontists in Germany. Almost 3,000 of them are organized in the BDK, the professional association of German orthodontists. Orthodontics is a professional specialization within the larger field of medical dentistry and can, as such, only be practiced in Germany. The approbation as a specialized dentist for orthodontics is the result of further training of dentists followed by an examination.
43. Where runs the lingual nerve?
At the inner part of the lower jaw runs the lingual nerve, which might get damaged by poorly carried out work of inexperienced dentists, but only in extremely infrequent cases. Complications with the lower jaw may occur not only during the removal of the wisdom teeth. This is because of the narrowly positioned nerve tracts there. This is true in particular for the nerve tract in which the mandibular nerve is running. It may happen, though, that the wisdom tooth is surrounded by this nerve.
44. What is osseous substance made of?
Bones, or the material that bones consist of, are in 30% made of organic substances. These are, generally speaking, cells and collagen. Collagen (protein glue) makes for the bone’s flexibility.
Moreover, up to 70% of the bones’ material is made of inorganic substances, such as calcium, minerals, and water. With its 95% share, calcium holds the major part of it. Calcium also makes for the bone’s stability.
One of its striking characteristic is its relative lightweight, compared to our actual body weight. This is grounded in the very construction of the bone, with the inner part lacking a compact structure.
All bones combined, their weight adds to a mere 11% of our overall weight. It is the only human organ that repairs itself after the occurrence of fissures or fractures by developing new osseous substance.
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