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Implant or, to be exact, dental implant

On the basis of questions patients have frequently asked us, we would hereby like to give you an outline of implants as dental prostheses. This information can obviously not replace an individual consultation by a dentist or an oral surgeon. If your question is not listed, feel free to contact us directly. Contact

What exactly are implants?

An implant is practically an artificial tooth root, mostly made of titanium. They come in cylindrical or screw-like shapes. The implantation occurs after the preparation of the jawbone, and is done with special instruments or drills by an oral surgeon or a dentist professionally trained as an implantologist. A dental implant is usually made up of three elements.

  - Superstructure: prosthetic surface mounting (crown, bridge, telescope)
  - Implant jamb: connects the body of the implant with the superstructure
  - Body of the implant: is screwed or inserted into the jawbone.

How long do implants last?

The success quotas of implants over longer periods of time are over 90 percent, meaning that in most cases not only have the dental implants healed without a problem inside the jawbone, but also that after 10 years, more than 90 percent of the implants are still intact.

Dental implants protrude just like natural teeth in the oral cavity through the mucous membrane. That is why they are, like teeth, exposed to the adverse factors that exist in the oral cavity. These factors are: food particles trapped in the mouth, plaque and the connected pathogens. When tooth care is insufficient, processes similar to those for natural teeth can develop. These processes can lead, via the gingival pockets, to bone atrophy and thus endanger the implant. An absolute condition for a long-term success of implants is therefore a good oral hygiene, which should be backed by a continuous medical care even after the completion of the dental work.

Further risk factors for the long-term success of implants are smoking and certain medical conditions such as diabetes type I (insulin shots), long-term cortisone treatments, for instance in the case of some rheumatic disorders - but also a bad condition of the bones. This risk should be assessed in each individual case as accurately as possible.

What do implants cost?

For legal reasons, German physicians are not allowed to name prices on the Internet. But we are. That's why on the web pages of the Price comparison for dentures you can find price information for normal patients (over 90 percent of all patients). If you require a bone buildup first (a sinus lift) or there are other complications in your case, then the prices will be higher. In order to clarify this, a medical examination, including a checkup by an implantologist, is absolutely indispensable.

Do the health insurance companies cover at least part of the costs for an implant?

The private health funds will generally pay for a large part of the implant. In order to assess the amount of reimbursement, it helps if you submit a cost projection.

As a member of the compulsory health funds you will receive - within the scope of the findings-oriented fixed subsidies - the normal fixed subsidy, for implants as well. Because after January 2005 it has become irrelevant whether you replace a missing tooth through a bridge or an implant. In any case, you should submit a cost projection and treatment plan to your health insurance company for approval, before the start of the treatment.

Can the body reject implants too?

Reactions of rejection - as they are known from allergies - occur only extremely rarely in the case of implants, especially implants of pure titanium. In the earlier days, inflammations that have been known to occur in natural teeth as well as in implants, were wrongly considered to be rejection reactions. As opposed to earlier opinions, according to which the titanium surface enters into a virtual chemical bond with the bone cells, more recent examinations have shown that even titanium can lead to an unspecific foreign-body reaction. However, this does not lead to a rejection in the bone.

Even though titanium has in many respects fulfilled the long wish and search of oral surgery for a proper material for dental prostheses in the bone, scientists are constantly researching the possibility of improvements. The main focus points of the research are a surface optimisation of the titanium, but also entirely different materials.

What materials are implants made of?

The most frequently used systems are made of pure titanium. Titanium binds very well with the bones. There are almost no allergic reactions and the titanium has shown a good stability. The ceramic implants used in the earlier days have shown a very good healing capacity and are unbeatable from a cosmetic point of view. Of course, nowadays, they are used less and less because of their increased risk of breaking. However, scientists are constantly working to improve the mechanical characteristics of the ceramic.

Is there such a thing as the best implant system?

Generally, it is quite impossible to answer this question. The big implant systems have all reached a high level. Compared with similar products, each system has its own advantages in some cases, as well as its own disadvantages in others. Implant systems are in this sense comparable with car brands. All of the big brands produce good cars. But there is no one car which is superior to all the others in all aspects.

Decisive is not the implant manufacturer, but rather the skill of the implantologist and the collaboration of the patient (oral hygiene).

Must every lost tooth be replaced through an implant?

No: One stable implant can also support more teeth. The load capacity of an implant depends on the quality of the bone, as well as on its thickness, height and firmness, but also on its position in the dental arch. Additionally, it is also important whether the implant has to support a fixed or removable - also gum-born - prosthesis.

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.

Can children and youngsters also get implants?

In the case of young people, implants are used to support the dental adjustment. Implants in the palate or behind the alignment can replace more complex equipment.

The replacement of lost teeth through implants in the case of young people is, however, problematic because the growth process of the jawbone is still incomplete. The jaw around an implant will no longer grow normally. This is why implants should not be inserted before the big growth spurt. That is, not before the age of 14 for girls and 16 for boys. I would wait even longer (until the age of 18 for girls and 20 for boys), because even after the big growth spurt, the jaw can still grow 1 to 2 mm in height. (for young men, until 25 years of age!)

If an alternative to the implant is not available, then it is possible to cosmetically compensate for the growth of the jawbone through modifications to the visible crowns, with the help of removable crowns (crowns that can be unscrewed).

Must I be completely healthy in order to get an implant?

No, but there are illnesses that present a higher risk than others. Some of these illnesses are: diabetes which requires insulin shots, leukaemia, the patient's condition after the irradiation of the jawbone, and serious cardio-vascular problems. In each individual case, an accurate evaluation of the risks involved can be made after consultation with your family doctor. Each time, you have to carry out a risks and benefits analysis. For instance, an implantation will not be ruled out in the case of a patient with gastrointestinal cancer who undergoes chemotherapy, because the gastrointestinal tract needs foods rich in dietary fibre. In such cases, the risks and benefits analysis should take place always in the triangle patient - family doctor - implantologist.

How often will I have to have checkups after getting an implant?

Examinations of the implants at regular intervals of time are imperative and extremely necessary, because it is much easier to treat potential inflammations at an early stage. Moreover, serious inflammations can lead to the destruction of the bone and thus to loss of the implant.

After the insertion of the implant it is necessary to have checkups: after 2 days, after 7 days, after 3 weeks, and from then on, monthly.

After the completion of all the dental work: the first time after 6 weeks, then twice every three months, then twice every six months, and later once a year.

When is preliminary surgery necessary before the insertion of the implant?

The basic principle of implant insertion states that the implant must be fixed firmly into the bone. If this requirement is not met, then it is necessary to build up the bone first. This takes place a couple of months before.

If the implant is fixed firmly after insertion, but a part of its body is still not covered by the bone, then it is possible to cover this part with a filler material in the same intervention.

Optimal for the insertion and the covering of the implant is of course your own bone, because it cannot generate reactions of rejection and it stimulates the regeneration of bones more than artificial materials. Those parts of the bone which are still alive after the transplant become gametes for new bones. The bone material for the transplant is usually obtained from adequate parts of the jawbone. The drawback of this method is the more extensive surgery required. In the case of a more serious loss of bone, parts of the pelvic bones may also be used. This requires a general anaesthesia. It is also possible to remedy smaller flaws by filling them with special membranes and bone replacement material. To avoid the surgery in which your own bone is extracted for transplantation, new bone replacement materials are constantly being developed (Munich Symposium 1999). So far though, independent long-term research has shown that none of these materials can replace the bone in terms of optimal qualities.

However, more recent research results give us a reason to be hopeful. For instance, research on the so-called 'distraction osteogenesis' suggests very promising results. This is a process through which a bone that is too small is constantly being expanded and enlarged.

Please get individual advice and information from your dentist or oral surgeon.

I have heard about special materials with which degenerated bones can be built up without undergoing surgery. What is your opinion?

This refers to proteins which are purported to help the regeneration and reproduction of bones (BMP: Bone Morphogenetic Protein). These materials have been on the market for about 10 years now.

An interesting article on this topic could be found in the Official Journal of the German Medical Society on July 19, 1999. According to the article, there are as yet no clear results about standardised use on humans.

You would be well-advised to follow the research on this site (but not only here, of course), because the good results of the experiments on animals suggest that the future might bring good news for us too. In the meantime, scientists have managed to grow human BMP (in other words, bone-regenerating protein). However, a carrier substance which could keep the BMP on the spot where its action is needed, has yet to be found, because once the BMP enters the bloodstream, it decomposes very quickly. We are looking forward to the homologation of some of these bone-regenerating proteins in Europe this year, after the United Stated have already approved the first ones.

I have heard that implants will heal better if one gives a blood sample before the intervention and then has this blood reinjected into the drill hole.

The blood contains various elements. In the blood plasma, besides the (oxygen-carrying) red blood cells, there are also many proteins, which help the regeneration of the bone. For this, before the intervention the doctor will draw blood from your arm, place it in a centrifuge where the various elements are separated, and finally reinject this plasma containing a higher concentration of useful proteins back into the wound. According to current research, patients have exhibited wounds which have healed strikingly fast and without problems. But one has to wait for more in-depth research before one can assume that implants in which own plasma has been used can endure the strain immediately.