Implants are like a construction set
Placing a dental implant into the jawbone is comparable to screwing a dowel into the wall. In both cases, a hole is first drilled into which the dowel, or implant, is inserted flush. The dentist places a temporary denture on top of this to close it during the healing phase. After less than half an hour, everything is over. The patient is no longer stressed as if a tooth were being extracted. Now an implant needs about four weeks to four months of rest to grow in well. After that, the doctor screws a build-up post (abutment) onto the dental implant and attaches a crown to it or uses it as an attachment point/pillar for other high-quality dental prostheses: this is comparable to a construction kit - the implant as a basis offers many build-up options.
The weak point: abutment-implant connection
There are two options for this connection:
- Pin connection: Here, the abutment is inserted into the implant, like a snug-fitting cork in a wine bottle, and fixed in place with a screw. Since both parts are made of titanium, there must be a certain amount of play, otherwise the abutment could not be inserted into the implant.
This means that there is always a microscopically small joint gap - due to the design.
- Cone connection: A cone is found, for example, on pharmacist's bottles with their characteristic, precisely ground-in glass stopper. This connection is absolutely precise. Transferred to an implant, even a layman can easily imagine that no microscopically small gap remains. This is because metal does not have to be pushed into metal, but the cone of the abutment closes like a perfect conical lid on the dental implant and is then also fixed with a screw.
Micro-gap, pumping effect and abrasion
What is a micro-gap or fissure?
Almost everyone is familiar with fissure sealing. The dentist seals the grooves in the chewing surfaces of the molars with a special varnish to prevent caries bacteria from hiding and to better protect the teeth. The world is upside down, because in the case of implants with a plug-in connection, the dentist creates just that - a perfect hiding place for bacteria of all kinds and their decay products (e.g. endotoxins). Inaccessible to our immune system! In the joint gap around the abutment of the dental implants.
What is the pump effect?
Enormous forces are generated during chewing. This causes the crown and abutment in the implant to move back and forth slightly with every chewing movement. While the gap closes on one side, it opens a little wider on the other, and in the process the bacterial soup is pressed out of the joint gap and runs over the gum, which directly surrounds an implant. This bacterial soup is called "bone-damaging fluid", "contaminated substances" or "microbial contamination" by an expert panel and is responsible for the fact that around many implants with a plug-in connection, the jawbone recedes in a plate-shaped manner and an aesthetically unattractive, dark edge is usually visible between the implant and the gums.
And what is abrasion
? The micromovements between the implant and the abutment cause the two components to rub against each other, which can lead to metal abrasion. The expert speaks of abrasion. This could also produce the smallest titanium particles, so-called nanoparticles. The question remains whether such nanoparticles spread throughout the soft tissue of the entire body and what consequences this could have. (cf. second video by Mr Dipl.-Ing. Holger Zipprich)
Solution: Implants with self-locking tapered connection as tooth replacement
Far from it! According to a dentist at an expert panel on implantology: "Implants with a plug-in connection have too many fans, especially the prosthetic plus points and the easy handling speak for this variant.... And from the prosthodontist's point of view, I say bluntly: I don't like the tapered dental implants, no matter what advantages are discussed."
And what do you say as a patient?
The question is: Do you want implants with microgaps - incl. "bone-damaging fluid"?
For us in the editorial team (we are all patients) the matter is clear:
We insist in future on implants with real, self-locking tapered connection
. For us, having a new perfect bacterial focus implanted with every implant with a plug-in connection lacks any reasonableness, especially since there is an excellent alternative. And no one can say whether these "contaminated substances" from the microgap might not also damage other areas of our body or trigger or promote diseases. After all, no bacterial focus is healthy, I suppose?
And if dentists are not prepared to grow from medical challenges and want to make their job as easy as possible, then that may be their right. But then we patients also have the right to choose more motivated doctors. For us, an absolute NO GO!
But not all cones are equal
There are over 100 different implant manufacturers on the market in Germany alone. And as with all products, there are also considerable differences in implants with tapered connections, as the Zipprich study shows. The quality depends on:
- the angle of the taper (taper angle)
- the length of the cone surface
- the tension of the binding screw
- and the manufacturing tolerances (how exact is the fit)
1. The expert discussion to which we refer several times in the text was published in the "Dental Magazin" under the title: "EXPERTENZIRKEL - Platform-Switching: effektiv oder egal?".
2. Gute Einblicke für Interessierte bieten die beiden Videos. Die Unterschiede bei Implantat-Abutment-Verbindungen bei verschiedenen Implantat-Systemen von Dipl.-Ing. Holger Zipprich, Poliklinik für zahnärztliche Prothetik, Sektion Werkstoffkunde, Theodor-Stern-Kai 7 / Haus 29, D-60590 Frankfurt am Main, Tel: +49 (0)69/6301-4714, eMail:firstname.lastname@example.org
So kommt Herr Zipprich zu der Aussage: "Plattform-switching is not able to prevent the bone loss" heißt: dass Plattform-Switching Knochenschwund nicht verhindern kann. Es reduziert den Mikrospalt bei Steckverbindungen, kann ihn bauartbedingt aber nicht verhindern.
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