PATIENT INFORMATION: Dental Implants

DEUTSCH

patient checklist

WHAT … FOR ? (Indications)

Dental implants serve

• as replacement of teeth,
• to avoid grinding of teeth for crowns/bridges,
• to hold bridges,
• to stabilize dentures,
• for functional reasons (joint, face muscles),
• for esthetic reasons and
• as orthodontic anchor (temporary)

The graphic shows a typical implant consisting of a metallic screw fixed in the bone. Into this an abutment is placed, which in turn supports the visible dental crown.

 
lower molar implant (Xray shows the same)

NUMBERS

• There are no reliable and comparable data known, but rough estimates.
• USA: 3 Million people have 8.6 Mio implants (AAID 2016).
• USA: About 300.000 to 400.000 dental implants are placed per year in the USA (carefree).
• About 1.3 Mio dental implants are placed per year in Germany (DGI 2017, Symposium 2018, Wiesbaden).
• The global dental implants market is estimated to grow from $7,365.7 Million in 2015 to $10,427.7 Million in 2020 (marketsandmarkets 2016).

snapping attachments to hold a denture and counterpart within the denture

TIMES

• Many different techniques take different times.
• Healing times are shorter with 3D-supported techniques.
• Faster if no bone augmentation needed.
• Healing phase after placing takes usually 2-6 month.
• Under certain preconditions immediate loading (usually reduced use after placing) is possible.

Implant with and without visible dental crown in an upper smile area

CONTRAINDICATIONS (may be relative if preconditions can be changed)

• behavioral
  Poor oral hygiene, smoking, parafunction, no aftercare possible.
• medical
  Diabetes mellitus, infectious diseases, certain systemic/metabolism diseases, low ability for surgery, low bone quality, bone loss (see bone augmentation).
• pharmaceutical
  Biphosphonates (Review), chemotherapy, drugs, alcohol, corticosteroids, immune suppression, antidepressants, proton pump inhibitors.

RISKS

• at surgery
  Tissue injury, swallowing/inhaling parts, bone fracture, injury of neighbouring teeth or structures/nervs.
• short term
  Inflammation, injury of neighbouring teeth or structures.
  Foreign body reactions, allergic reactions, rejection.
  
• long term
  Implant dislocation, chronic inflammation, chronic pain, reoperation, fracture, implant loss.
  Superstructure (Crown/Bridge/Denture): loosening, fracture.

FAILURES

Risks depend from several preconditions like bone volume, bone quality, superstructure and reasons in connection with the above contraindications.
There are problems reported with abutments on implants (which may be renewed without surgery), but not with implants themselves.

MATERIALS

• Titanium: mostly Grade 4, Grade 5 Titanium
• Ceramic: Zirconium oxide ceramic
• PEEK: Polyetheretherketone

Dental implants come with many sizes and shapes. Most of them are screws, but blades, discs are used too. Individual shapes are possible. 3D-techniques allow individual designs. The surface of the implant is important (roughness, coating).

STATISTICS

• Survival Analysis of Dental Implants, Andrew Kai-Ming Kwan et al: after 5 years 94.4%    https://www.statistics.gov.hk/wsc/CPS014-P5-S.pdf
• Survival rates range from 91 – 97% since the late 1990ies (Knöfler 2004)
• Failing rate after 20 years 20.7% (range 2.6-54.3% according to system) (Gomez G, et al. 1996)
• Failure rate after 10 years with augmentations 26.7% (Schliephake H et al. 1997)
• The way the superstructure (crowns/bridges/dentures) is made is important in a long run (Knöfler, 2004)
• Patients experiencing technical and/or biological complications over a 9-year period was 42% (Department of Periodontology Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden, 2021)

LITERATURE

• Problems
  Most problems happen in the 1st year. No material related problems.
  Study warns of rare risk of chronic pain from dental implant surgery (Devine et al. Eur J Oral Implantol 9(2):179-186)
• Science/Future
  Most implants today are made of titanium. Ceramics have been increasingly important in recent times, plastics or derivatives might be an alternative too. Stem cell treatment seems to be possible.

CRITICISM

In Dental Implantology has to be discussed at which point a natural tooth may be maintained or not.

SELECTED PATIENT INFORMATION

Topics to be discussed while planning: Individual risks, sufficient bone or bone augmentation needed (see chapter on oral bone and soft tissue), 3D-planning necessary, pretreatment necessary, surgical guide necessary, alternative solutions, preparation, aftercare.

Questions to ask your dentist before getting dental implants:  (english)   (deutsch)

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IMPLANT PATIENT REGISTER

No register known. Implants are identifiable. Patients usually get a documentation (implant-passport), important for longterm care.

Identifying an unknown implant? If you don´t find it at Implant-Register®, maybe WHAT IMPLANT IS THAT? or Osseosource helps.
In the register of the registries you can check which ones are available.

The Implant-Register offers registration of implants online and you can download a printable version for your personal use.
It is useful to know which implant you have had inserted if problems with the implant occur later or, for example, the doctor or company can no longer be contacted.

MEDICAL SOCIETIES dealing with dental/oral implantology are listed here