| back to part one of the article
How many implants do I need for a prosthesis in the case of a complete loss of my own teeth?
In the case of a toothless jaw, doctors usually go for 4 implants (Statement of the DGZMK 3/98). A solution containing only 2 implants actually improves the footing, but it offers less stability than 4 implants. If the prosthesis is fixed (that is, if it can only be removed by dismantling the bolts or screws for cleaning), then the standard solution calls for 6 implants in the lower jaw and 8 in the upper jaw. Naturally, the number must be determined on an individual basis. A long implant can sustain a greater mastication pressure than a shorter one.
Does one need to undergo general anaesthesia to get an implant?
No, implants are usually inserted with local anaesthesia, that is, after getting a shot. Even so, the patients should have someone to drive them home after the procedure, because the strain is much bigger than in the case of a normal dental treatment. A general anaesthesia is advisable only if the intervention cannot be carried out under local anaesthesia. Furthermore, there is the possibility of a sedative shot, which will place patients in a sleep-like state.
Finally, in the case of patients who suffer from serious cardio-vascular problems, an anaesthesiologist should monitor the patients' condition throughout the intervention, with the help of special equipment.
When will I be able to work after getting an implant?
Most frequently you will not be completely fit to work on the day following the intervention and on the day after that. You can receive more accurate information only after an examination and assessment of the complexity of the intervention has been made.
What discomfort am I likely to experience?
For this you can receive more accurate information only after an examination and assessment of the complexity of the intervention has been made. Often there is discomfort for a few days, but this can be suppressed with pain-killers.
Furthermore, there will be swelling. The swelling will grow in the first two days after the intervention, and then it will gradually decrease. The magnitude of the swelling depends both on the size of the intervention and on the amount of cooling applied by the patients. There can also be a visible haematoma.
Is it possible to insert an implant immediately after the removal of a tooth?
Yes, but... the immediate implantation has the advantage of a shorter waiting period and above all of the quicker use of the still existing bone, because the thin bone of the alveole usually degrades very quickly after the extraction of the tooth. In any case, this is feasible only under the condition that the bone is stable after the removal of the tooth and does not exhibit signs of inflammation. To assess this situation, a surgical microscope or magnifying glasses are very useful. Unfortunately, in the majority of cases the above-mentioned requirements are not met.
So, for safety reasons, there is usually a waiting period of between 8 weeks and 6 months after the extraction of the tooth - often: 4 months. In this period of time, a new functional bone has developed from the bone cavity of the displaced tooth. Transitional implants offer a good possibility of helping patients temporarily after the loss of the tooth. These are thin implants (same material as the final implants, but another shape and size), which can do the job immediately, in order to offer patients a better footing for the prosthesis and which can be removed as soon as the final thick implants have healed into place.
How long must I wait after the implantation until the prosthesis or crown, respectively, can be attached?
With respect to this, there are significant differences depending on the state of the implant and the strain it is exposed to. In the lower jaw you would usually have to wait for 3 months, and in the upper jaw for 4-5 months. In the front area of the lower jaw, the waiting time can be furthermore reduced when the conditions are stable. On the other hand, in the posterior area of the upper jaw the bone is so soft that it is preferable to have patience for 6 months. But the waiting period depends not only on the situation of the implant, but also on the overall condition of the patient. The process of bone healing is faster for younger patients than for aged diabetics. Recent research shows that with the help of a structured implant surface, the healing time can be reduced further. This is good news for the patients. For reasons of hygiene, some dentists are very critical of the trend to enlarge the surface of the implants through abrasion. Even if this does reduce the healing time, there is still the danger that bacteria will settle in on the heavily jagged implant surface if the oral hygiene is not good enough.
Must I undergo oral surgery several times?
Often one intervention is enough to insert the implant. In the case of implants which have to be inserted underneath the mucous membrane, these have to be freed of the membrane before they can be used to attach the prosthesis. This occurs under local anaesthesia and is, compared to inserting the implant, a very small intervention.
But it can also be the case that aside from inserting the implant, the dentist also has to stabilise the bone, etc.
Is there a maximum age for implant patients?
No: Decisive is not the nominal age, but the biological one. An implant on a 50-year-old patient with an organ transplant is usually more risky than an implant on a lusty 80-year-old patient with a good bone structure.
I have osteoporosis, can I still get implants?
The osteoporosis is not an disqualifying criterion for getting an implant. The final decision can be made only after a detailed examination of each individual case.
My jaw has already shrunk significantly. Is an implant still possible?
As a rule, in order to ensure the long-term success of an implant, the jawbone should be at least 5 mm wide and 10 mm high. The height and width of the jawbone can be determined through a panoramic X-ray picture, an examination and, where applicable, a computerised tomography. If there isn't enough bone available, it's possible to get a bone buildup. For the bone buildup the following will be used, depending on the necessary quantities: bone chippings from the drill hole of the implant, bone from another region of the jaw, such as, for instance, the wisdom-tooth area or, in case more is needed, also from the hip bone. Bone fragments from the hip bone are used especially for the buildup of bones in the side areas of the upper jaw. In that area, in case of tooth loss, the bone dwindles at the expense of the maxillary sinus. Through a so-called lift of the maxillary sinus floor, often called a sinus lift, this space will be filled with bone again. 5 months later this newly created bone can be used to hold implants.
on to part three of the article
| 
