Frequently asked questions in dental implantology
Frequently asked questions on the subject of dental implantology.
Frequently asked questions from the field of dental implantology, gathered here quickly and clearly:
Implantology
The procedure is carried out after the area has been numbed with a local anaesthetic, under sedation, or under general anaesthesia if you prefer.
An implant can last a lifetime. That depends on the patient playing their part reliably. Implants have to be cared for like your own teeth – if anything, more thoroughly. Without conscientious oral hygiene an implant makes little sense in the long run.
A standard procedure takes about an hour including preparation and the check afterwards. Placing several implants takes longer. The exact time depends on the starting situation.
The cost depends on the starting situation – bone quality, the number of implants to be placed and the planned restoration. Bone grafting increases the total.
No binding figure can be given without an examination; that would pre-empt the advice of a dentist or dental laboratory.
More information can be found under COSTS.
No binding figure can be given without an examination; that would pre-empt the advice of a dentist or dental laboratory.
More information can be found under COSTS.
The effort for diagnostics and the instruments used are similar whether one implant or several are placed. Several implants therefore cost less than the sum of the equivalent individual procedures.
More information can be found under COSTS.
More information can be found under COSTS.
Private insurers pay according to the terms of the policy, in some cases the full amount. Statutory insurers contribute the fixed amounts laid down for the finding.
More information can be found under COVER.
More information can be found under COVER.
No allergic reactions, and therefore no rejections caused by them, are known. Where implants are lost, this usually happens during the healing period. Loading that is too early or incorrect, a difficult bone situation, poor planning and inadequate oral hygiene are the reasons for implant loss. With a success rate of up to 98 per cent, implantology is a recognised treatment in modern dentistry.
The classic forms of conventional restoration – bridges, crowns on prepared teeth and mucosa-borne dentures – are the familiar alternatives. Grinding down caries-free teeth is viewed critically, particularly in younger patients. To replace a single lost tooth with a conventional bridge, at least two healthy, caries-free teeth have to be prepared.
The result is an irreversible loss of tooth substance. Implant-supported single crowns and bridges involve surgery, but preserve more of the natural tooth. The decision against a conventional and in favour of an implant-supported solution can only be made after a thorough consultation with your dentist.
The result is an irreversible loss of tooth substance. Implant-supported single crowns and bridges involve surgery, but preserve more of the natural tooth. The decision against a conventional and in favour of an implant-supported solution can only be made after a thorough consultation with your dentist.
For the patient the question is how much they want to spend on their replacement teeth. Treatment with implants also always involves surgery.
The advantages are usually persuasive: patients who want to bite firmly again after years without teeth, or who suffer painful pressure points from wearing dentures, are generally convinced by the comfort and the quality of life they regain.
The advantages are usually persuasive: patients who want to bite firmly again after years without teeth, or who suffer painful pressure points from wearing dentures, are generally convinced by the comfort and the quality of life they regain.
With a bridge, healthy substance is sacrificed by grinding down the neighbouring teeth. The gap in the row of teeth is closed with a pontic. The tooth root itself is not replaced. The jawbone no longer receives the chewing pressure transmitted by the root. That natural loading is what normally stimulates the bone to regenerate. Without it, the bone recedes over time.
Purely mucosa-borne dentures lead to bone loss for the same reason – known as atrophy. Because of this the denture has to be adjusted again and again over the years. The result is often a poorly fitting restoration that markedly reduces the quality of life of many denture wearers.
Purely mucosa-borne dentures lead to bone loss for the same reason – known as atrophy. Because of this the denture has to be adjusted again and again over the years. The result is often a poorly fitting restoration that markedly reduces the quality of life of many denture wearers.
General anaesthesia requires the appropriate facilities and specialist anaesthetists. The patient is monitored throughout by the anaesthetist.
Like your own teeth, implant-supported teeth have to be cleaned thoroughly. Practices that place implants often offer a dedicated implant hygiene programme for the care and cleaning of implants and teeth.
Titanium has been used in dental implantology for more than 30 years and has proved to be a biocompatible, well-tolerated and safe material. No allergic reactions are known. Special implant surfaces can shorten the healing period. The most recent development is a bioactive surface intended to accelerate the initial healing process.
With implants a patient can usually bite firmly again and eat whatever they like.
The advantage: a balanced and varied diet becomes possible again.
The advantage: a balanced and varied diet becomes possible again.
This requires close cooperation and exchange with the patient's doctor. Blood sugar must of course be properly controlled.
Heavy smoking can jeopardise the long-term success of an implant. It is viewed particularly critically during the healing period.
In most cases four implants are placed in an edentulous jaw. That number corresponds to a recognised recommendation of the German Society for Dental and Oral Medicine (DGZMK). A denture can also be stabilised on two implants, but a purely implant-supported denture with greater comfort is better achieved on four.
Where a fixed, non-removable row of teeth is planned, six implants in the lower jaw and eight in the upper are recommended in most cases. The exact number can only be proposed by a dentist after a thorough examination.
Where a fixed, non-removable row of teeth is planned, six implants in the lower jaw and eight in the upper are recommended in most cases. The exact number can only be proposed by a dentist after a thorough examination.
That always depends on the individual situation. As a rule a healing period of eight to twelve weeks can be expected. In particular cases implants can be restored, and therefore loaded, early – that is, during healing.
A prosthetic plan may also provide for one implant to carry several teeth. The number of implants is determined by the size of the gap, the bone quality and the possible implant positions. The planned treatment concept – fixed or removable – also determines how many implants are needed.
General questions
A dental implant is an artificial tooth root, usually made of titanium, that is placed in the jawbone. Once it has healed in, it carries a crown, a bridge or a denture.
For a single-tooth implant including the crown the cost is usually between 1,400 and 3,000 euros. Bone grafting or an immediate restoration increase the figure. What counts is the treatment and cost plan drawn up by your dentist.
Through the practice search on Implantat-Berater: enter a postcode or town and choose a radius. The directory currently covers 452 practices working in implantology across 288 places.
An independent, advertising-free information portal for patients, published by Atres GmbH in Aachen. It makes no product recommendations, arranges no appointments and takes no part in any treatment.
Implant prosthetics
An abutment is screwed onto the healed implant to bridge the distance to the gum line. The crown, bridge or denture sits on top of that.
As a rule, no. The restoration is matched in shape and colour to your own teeth in the laboratory; in the visible area tooth-coloured ceramic is the material of choice.
Between placing the implant and the final restoration lies the healing period, which usually takes several months. During that time a temporary restoration can close the gap.
Costs
For a front tooth the cost is usually between 1,400 and 3,000 euros, for a back tooth between 1,250 and 2,500 euros. What counts is the treatment and cost plan drawn up by your dentist.
As a rule not in full. Since 2005 statutory insurers have paid a fixed subsidy based on the finding, calculated on a conventional restoration. The patient pays the rest.
Because the cost depends on your individual situation: on the effort and difficulty of the procedure, the diagnostics, the number of implants and the planned restoration.
In financial terms, often yes. Comparative studies suggest that a single-tooth implant becomes cheaper than a conventional bridge after about seven years, because the maintenance costs are lower.
Treatment
In four steps: consultation and diagnostics, getting the mouth healthy, placing the implant and – after the healing period – the restoration on top.
No. Implants are almost always placed as an outpatient procedure in the practice. Afterwards you should arrange to be collected and should not drive yourself for several hours.
Wear comfortable clothing and no make-up. With a local anaesthetic you may eat a light meal up to one hour beforehand. Under general anaesthesia, follow your dentist's instructions.
Because existing inflammation jeopardises healing. Periodontitis, caries and calculus are therefore treated before the implant is placed.
Diagnostics
Not in every case. A panoramic radiograph is sufficient for most implant procedures. A three-dimensional scan is indicated where bone is scarce or the situation is difficult.
The OPG is a two-dimensional panoramic image of the jaw and the usual basis for planning. CT and CBCT produce cross-sectional images and therefore a spatial view; CBCT is the technique developed specifically for the jaw region.
Usually 120 to 250 euros including the report. Statutory health insurers do not reimburse CBCT as part of implant planning.
From the radiograph. The panoramic image mainly shows bone height; width and density come from a three-dimensional scan where needed. That determines how many implants are possible.
What is a dental implant?
Of three parts: the implant body in the jawbone, the abutment on top of it, and the crown you can see. The implant body is made of pure titanium or of zirconium dioxide.
No allergies to commercially pure titanium are known. If you would nevertheless prefer a metal-free restoration, an implant made of zirconium dioxide is an option.
With a one-piece implant the head protrudes through the gum during healing – a second procedure is not needed. With a two-piece implant the mucosa is closed over it and reopened later.
Who are implants suitable for?
No. There is no upper age limit. What matters is not your age but the available bone, wound healing and general health.
As a rule, no. Jaw growth must be complete before an implant is placed, otherwise the jaw grows around the fixed implant.
Pronounced metabolic disorders as well as liver, kidney, blood and bone conditions may argue against an implant. Heavy smoking also jeopardises success. Whether it applies in your case is for your dentist to assess.
That depends on the findings. A bridge requires healthy neighbouring teeth to be ground down, and the bone underneath can recede for want of loading. An implant avoids both, but costs more.
The edentulous jaw with four tilted implants
With suitable anatomy, yes. If the rear implants are placed at an angle, four implants can carry a fixed full-arch restoration per jaw.
Because it makes better use of the available bone. The angled position also spares the maxillary sinus and the nerves and allows larger, more stable implants.
Often, yes. The technique was developed precisely for edentulous patients with bone loss and frequently avoids extensive grafting.
Removable implant-supported dentures on a bar
A metal bar that rigidly connects two or more implants. A removable full denture is held securely on it.
Yes. The bar connects the implants into a single unit; the denture is anchored on it and does not slip when you speak or chew.
Yes, that is intentional. Bar-retained restorations remain removable and therefore easy to clean – but they sit firmly while they are in place.
Removable implant-supported dentures with locators
A press-stud system that holds a removable denture on implants. It can be released and reinserted without much force.
One that is easy to handle. Where fine motor skills are declining, locator systems or magnetic attachments are preferable to those requiring high retention forces.
Yes, that is the point of these systems. They can be inserted and removed without force so that the denture and the implants can be cleaned properly at home.
Implant placement procedures
The dentist exposes the jawbone, prepares the implant site with special drills and places the implant precisely. Where bone is plentiful this can also be done without raising a flap.
One-stage means the implant heals openly, with its head protruding through the mucosa – a second procedure is not needed. Two-stage means the mucosa is sutured over it and the implant is exposed later.
No, not for several hours. Arrange to be collected or take a taxi home.
Immediate loading
As a rule, no. The implant needs several months to fuse with the bone. Immediate loading is only possible in exceptional cases and with special planning.
It can move instead of integrating. Excessive loading during the healing phase usually leads to problems, up to and including loss of the implant.
With immediate loading the implant carries the full chewing force straight away. With immediate restoration a temporary crown is fitted at once, but shaped so that hardly any force reaches the implant while chewing.
No. Temporary restorations bridge the time until the final one; in grafted areas temporary implants can also carry a provisional and protect the definitive implants.
Bone grafting
Filling in or widening the jawbone so that an implant finds secure support. Bone substitute material or the patient's own bone is used.
Because the body breaks down bone it no longer loads. After a longer period without teeth the remaining volume is often no longer sufficient for an implant.
Transplanted bone usually takes several months to heal before the implants are placed. If only a small defect is filled during implant placement, this additional waiting time is not needed – the implant itself still has to heal in.
Smaller amounts are taken from the mouth itself – from edentulous areas, the angle of the jaw or the chin. Where more is needed, bone is taken from the iliac crest.
Metal-free restorations
Yes. All-ceramic zirconium oxide needs no metal framework and is suitable for crowns, bridges and implant abutments.
For most restorations, yes. All-ceramic is now also used for multi-unit bridges. Whether it will hold in your case depends on the findings.
Above all for patients who react sensitively to metals in the mouth, and wherever appearance matters – tooth-coloured ceramic looks more natural in the visible area.
Dental laboratory
A dental laboratory. The dentist plans and places the implant; the dental technician makes the abutment and the crown, from an impression or a digital scan.
A splint made in the laboratory that transfers the implant position planned on the computer into the mouth. It guides the drill and makes placement more precise.
CAD/CAM means the abutment is designed on a computer and milled by machine. The result is an individually fitting part rather than a prefabricated standard abutment.
Caring for implants
Like your own teeth, only more consistently: brush after every substantial meal and clean between the teeth with an interdental brush. An ordinary toothbrush only reaches part of the surfaces.
More important than the brush itself are the aids for the spaces between the teeth. Your practice will show you which interdental brush suits your restoration.
Deposits can build up and inflame the tissue around the implant – peri-implantitis. It is the most common cause of late complications.
Checking quotes
That every item is listed: diagnostics, any bone grafting, placing the implant including materials, and the abutment and crown. If an item is missing, it becomes more expensive later.
Rarely. With little-known budget systems the supply of components is not assured, and if problems arise you will struggle to find a dentist experienced with them. Saving 150 euros can become expensive.
Because nobody can know what is needed without an examination. Implant treatment involves consultation, diagnostics and individual planning – a price without that basis is guesswork.
Cover by health insurance
Only in a few, particularly severe exceptional cases. The Federal Joint Committee has defined exceptional indications; they cover, for instance, large jaw defects after tumours or accidents.
A fixed amount that statutory health insurance contributes towards a restoration. It is based on the finding, not on the restoration you choose – if you opt for an implant, you receive the same amount as for the standard treatment.
Yes. Anyone who can show regular check-ups receives a higher fixed subsidy. Present your bonus booklet before the subsidy is determined.
Implants
Of pure titanium or of zirconium dioxide ceramic. Titanium is the standard; ceramic is mainly considered for patients who want a metal-free restoration.
Four things: the patient's available bone and bone density, the material, the design of the implant and its surface.
The idea is thousands of years old – the Etruscans and Egyptians already replaced teeth. The scientific breakthrough came in the 1950s and 1960s with the discovery that bone fuses with titanium.
Titanium implants
Because titanium combines three properties: mechanical strength, resistance to corrosion and compatibility with tissue. It bonds directly with the jawbone.
No allergies are known to commercially pure grade 4 titanium as used for implants. In air, titanium forms a protective oxide layer.
Titanium implants reach their load limit when the diameter is greatly reduced. Less surface is also available for integration into the bone.
Ceramic implants
Yes. Ceramic implants are made of zirconium dioxide and contain no metal. They are mainly considered for patients who react sensitively to metals in the mouth.
The gums respond well to ceramic because it is less prone to plaque. This is expected to reduce the risk of gum inflammation and peri-implantitis.
Fractures of all-ceramic implants have been reported in studies. With implants made of high-performance zirconium dioxide (Y-TZP) this risk is considerably lower.
Implant shape
Almost only root-shaped screw implants are used today – stepped, tapered and threaded screw implants. Cylindrical implants without a thread have become rare.
Endosseous means anchored in the bone. The implant body is fixed directly in the jawbone by means of a thread and, once integrated, sits as firmly as a natural tooth root.
Your dentist decides that after the diagnostics. Bone height, bone width and the planned restoration determine the type, length and diameter of the implant.
Narrow-diameter implants
Yes. Shorter and specially shaped implants can achieve long-term stability even in a thin jawbone.
In many cases, yes. Short implants were developed precisely for this – they spare you the additional procedure and the weeks of healing afterwards.
Not as a rule. What matters is the shape, the surface and the distribution of chewing forces. Whether short implants will work in your case is determined by the diagnostics.
Caries in children
From the second year of life. The main cause is sugary drinks, often given to small children in a bottle.
Yes, if they are drunk frequently and throughout the day. Fruit juices, teas and soft drinks contain sugar, from which deposits form on the teeth.
Yes. A saliva test shows the number and activity of caries bacteria. From that it is possible to estimate how susceptible a child is and to take action in good time.
Brushing milk teeth
From the first milk tooth. To begin with a soft brush or a cotton bud with a small amount of toothpaste is enough.
Twice a day, with a children's toothbrush and a toothpaste containing 1,000 ppm fluoride. Up to the second birthday a rice-grain-sized amount is enough, after that a pea-sized amount.
KAI is the German mnemonic for the order of brushing: first the chewing surfaces, then the outer surfaces, then the inner surfaces. That way no surface is forgotten.
Treatment under general anaesthesia for children
When a local anaesthetic is not workable – for instance with very young children – or when extensive treatment such as full restoration of the milk teeth is required.
Every anaesthetic is a medical procedure and is only carried out where there is a clear indication. The treating doctor or anaesthetist will explain the benefits and risks beforehand.
A mild form of sedation in which the child stays awake but is more relaxed. It is an alternative to general anaesthesia where a local anaesthetic alone is not enough.
Magnifying loupes
To see fine detail. Good vision is a prerequisite for accurate diagnosis and for precise work in the treatment area.
That depends on the system: Keplerian prism loupes magnify three to five times, Galilean loupes two to a little over three times, but with greater depth of field.
They allow more precise work because the dentist sees more. The aid does not guarantee a result – it improves the conditions for one.
Immediate implant placement
In selected cases, yes. The socket must be free of inflammation and there must be enough bone for solid support.
Here several weeks pass between extracting the tooth and placing the implant. The soft tissue can heal, the risk of infection falls, and the bone has not yet receded significantly.
You save one procedure and the wait until placement. The healing period itself is not shortened – even an immediately placed implant must not be loaded while it heals.
What to do after implant surgery
Avoid physical exertion and strain. Rest helps the wound to heal; the mouth should be left alone at first.
With throbbing pain on the day of the procedure, a numb feeling about twelve hours afterwards, pain or swelling after several days, renewed bleeding, or a loosened temporary restoration.
Slight swelling in the first few days is not unusual after surgery. If it increases after several days or is joined by pain, you should contact your practice.
Video library: alternatives without implants
Three: a bridge as a fixed restoration, a partial or full denture as a removable one, or a combination of the two.
Small gaps are usually restored with a bridge. Larger gaps and free-end situations, for instance where the back teeth are missing, are closed with a denture.
In the upper jaw it covers the whole palate, which can impair the sense of taste. It is held by suction, not by firm anchorage.
Private health insurance
In principle yes – implant treatment is included in the benefits catalogue of private health insurance. How much is reimbursed is set out in your individual policy.
A statement from your dentist listing every foreseeable item of the planned treatment with its cost. It is the basis on which your insurer confirms reimbursement.
Yes, submit it to your insurer before treatment begins. That way you know in advance what proportion they will cover and what you will have to pay.
Implant tourism
The offer is often cheaper, but the risk is higher. Aftercare and check-ups are part of the treatment – and they no longer take place once you have travelled home.
Then the treating dentist is not there. Problems during healing, necessary follow-up treatment or a replacement part for an unfamiliar system are hard to resolve back home.
Because the success of an implant is not decided on the day of surgery but in the months that follow. Regular check-ups and implant hygiene are part of the treatment, not an extra.
Healing processes
Proteins from the patient's own blood that stimulate the body's own healing. A plasma is obtained from a small quantity of blood and used during surgery.
About 30 to 40 millilitres from a vein in the arm, before treatment. The blood plasma is obtained from it by a special process.
The techniques aim to support wound healing and bone regeneration. Whether they make sense in your case is for your dentist to decide – this is a supplementary measure, not a necessary one.
Individual, fixed solutions with implants
Depending on the amount of bone available and the planned prosthetic solution, the row of teeth is screwed onto four to six implants. This restoration sits firmly and can only be removed again by a dentist. It requires enough bone; whether bone grafting is needed is decided by the treating dentist.
Both are possible. Aesthetically the fixed, screwed-in row of teeth is the most demanding solution, but it requires enough bone. After a longer period without teeth the bone has receded and usually the gums have too; a removable, implant-supported denture is then more likely to be recommended, and it also sits firmly when chewing and speaking.
When a denture is less stable, chewing causes pressure pain. Many of those affected therefore change their diet, which can lead to deficiencies. The reduced food intake and the missing or incorrect loading of the jawbone additionally encourage bone loss.
Dental implantology — a proven form of treatment
About one million implants are placed in Germany every year. There are more than 100 different implant systems on the market, and not every one of them is fully ready for practical use; for many systems clinical studies are lacking. Long-term clinical data are therefore an important criterion when choosing a system.
Not every method presented in implantology is useful for patients. Treatment recommendations from the popular press should therefore be measured against the guidelines of the implantology societies. Implant treatment must be based on current scientific findings and be medically sensible and justifiable.
The dentist decides that after thorough consultation and diagnostics, working together with a master dental laboratory when planning the restoration. Implant treatment should only be carried out after competent and comprehensive advice from a doctor or surgeon and must be guided by the individual possibilities and needs of the patient.
Why are dental implants placed?
A conventional denture is borne by the mucosa. In many patients pressure sores develop after it has been worn for a longer time, and these can cause pain when chewing. Implants give the denture a firm hold again, stop it wobbling and thus prevent painful pressure sores.
Atrophy is the technical term for bone loss. If the jawbone is no longer loaded after a tooth is lost, it breaks down, much like a muscle that is no longer used; facial expression changes as a result as well. Implants transfer the chewing forces to the surrounding bone and stimulate its natural metabolism.
In most cases an implant-supported restoration allows greater chewing efficiency. With conventional, mucosa-borne dentures, by contrast, chewing function can often only be restored to a limited extent. Older people in particular find implant-supported restorations far more comfortable than a classic denture.
When should an implant be placed?
Early implant placement means placing the implant 4 to 8 weeks after the tooth is removed; the exact time depends on how the soft tissue heals. A delayed immediate placement, once the soft tissue has healed completely, is possible after 3 to 4 months, and late placement in healed bone about six months after the extraction.
Bone tissue needs a certain amount of loading. If the stimulation from the chewing forces is missing after a tooth is lost, the bone in the affected section of the jaw breaks down, and soft tissue is lost as well. A gap should therefore be closed as early as possible; an early time of placement also allows better aesthetic results.
As a rule the bone morphology at the implant site determines the procedure, that is the shape and condition of the bone at the place where the implant is to go. For immediate placement directly after the tooth is removed, the socket must also be empty and free of inflammation.
Are dental implants safe?
According to clinical studies the probability that an implant is still fully functional after ten years is over 90 per cent. There are also long-term studies that have followed implants for up to 15 years with a high success rate.
Studies show excellent long-term success for dental implants even where bone quality is poor. Good survival rates have also been demonstrated in more difficult situations, for example with narrow jaw ridges or with an upper jaw that has previously been built up (augmented). Bone quality and the amount of bone available remain important criteria for a positive prognosis.
Most implant studies are carried out under very controlled conditions at large universities and clinics, so the results could turn out differently in practice. For selected precision implants, however, survival rates in dental practices have proved to be just as good as under the more strictly controlled conditions.
What are the risks?
Damage to nerves is one of the possible complications, above all in the lower jaw, where the mandibular nerve (Nervus mandibularis) runs. Implant diagnostics before the procedure and locating the nerve during the operation are meant to prevent exactly that. The treating doctor explains the possible risks in detail beforehand.
Peri-implantitis is an inflammation with recession of the mucosa and the bone around one or more implants. It is one of the late complications, which are rare and usually go back to chronic infections or inadequate oral hygiene. If it is left untreated it attacks the adjoining bone and implants are lost.
Those named are medicines that disturb bone metabolism, in particular bisphosphonate preparations given intravenously, as well as cortisone treatments, which lower the immune defence. Radiotherapy or chemotherapy also increase the risk of losing an implant. How high the risk is depends on the severity of the illness and on the dosage.
What are the advantages of implants?
With an implant-supported restoration the palate of the upper jaw stays free of denture material. That is the difference from a mucosa-borne full denture: the patient gets their natural sense of taste back, and a good red wine tastes of red wine again. The free palate also has a positive effect on speech.
Implants direct the forces that arise when chewing evenly into the jawbone, just as natural tooth roots do. The bone is loaded as a result and stays vital instead of receding. Thanks to this natural loading the face keeps its profile and its natural expression.
Implant-supported teeth should sit stably and give a feeling of security: speaking freely, eating and enjoying everything. Patients who experience a full, mucosa-borne denture as a handicap gain in comfort and in self-confidence in their working and private lives.
Implant-supported single tooth
Because the implant takes over the function of the tooth root and passes the chewing force on to the jawbone. Thanks to this natural loading the bone stays vital and does not recede. The implant thus replaces the lost tooth root and at the same time serves as the pillar for the implant crown.
A new tooth should not only fulfil its function but, in the front region in particular, be indistinguishable from the natural teeth. Implant, new tooth and soft tissue should form a harmonious unit for this. All-ceramic abutments convince through shape, colour and natural appearance, and the crown can finish off perfectly with the gum.
They are left untouched. The dental implant replaces the lost tooth root and itself serves as the pillar for the crown; grinding down the neighbouring teeth is not necessary for this. Healthy tooth substance is preserved in this way.
Several missing teeth — implant-supported bridges
If the gap remains, bone loss and misalignment of the teeth and the jaw can follow. From a medical point of view it should therefore be closed again. An implant-supported bridge closes the gap without healthy neighbouring teeth having to be ground down.
There is no fixed number. The bone quality in each case and the size of the gap determine the exact number of implants needed. Several implants can carry a bridge together that closes the gap and ideally finishes off with the gum.
If several teeth are missing at the end of a row, the molars for example, this is called a free-end gap. With an implant restoration a fixed replacement can be provided in this situation too. For the patient that is considerably more comfortable than living with the gap.
OPG — panoramic radiograph
In most cases yes. The orthopantomogram (OPG), a two-dimensional panoramic image of the jaw, has proved its worth in implant diagnostics and as a rule provides enough information about the amount of bone available. Where bone volume is lacking or bone quality is poor, additional diagnostic steps may be added.
It is important that the course of the nerve in the lower jaw (Nervus mandibularis) can be clearly seen and is shown. Only then is the panoramic image suitable as a basis for planning the implant position. On screen the panoramic images can be analysed at leisure.
The cost of an orthopantomogram (OPG), the two-dimensional panoramic image of the jaw, is covered by health insurance. In most cases this image is enough as a basis for planning the implant position.
Three-dimensional diagnostics
Images and findings from three-dimensional diagnostics can often be shown to patients directly on screen and burned onto a CD for them to take away, for example in order to obtain a second opinion. The images exist as digital data and can be passed on in this way.
Diagnostics and planning before implant placement account for the largest share of the CBCT scans taken. Cone beam computed tomography has become established throughout Germany because in critical situations it shows the bony starting position and anatomical peculiarities in detail and in three dimensions.
In difficult cases as well, more demanding procedures can be carried out with a promising prognosis if diagnostics and planning are detailed and reliable. That is why the decision in favour of an implant procedure in such situations should only be taken with the help of a three-dimensional image.
CT — computed tomography
A computed tomography (CT) scan is produced when a radiograph does not supply the desired information about the bone situation. In this imaging method many individual digital radiographs are combined by computer into a realistic image.
Highly developed computed tomography scanners make it possible to measure the amount of bone available and to analyse bone quality through density measurements. The image is free of distortion and metrically exact, so that the position and course of even the finest structures such as nerves can be followed precisely in three dimensions.
Slice images are individual sectional images of the jaw, on which the height and width of the bone can be measured directly. Combining the slice images produces a three-dimensional image of the jaw that allows a very precise diagnosis and exact planning of the implant position.
CBCT — cone beam computed tomography
No. Cone beam computed tomography (CBCT) manages with a fraction of the radiation exposure of a conventional computed tomography scan and delivers a very high resolution at the same time. The considerably lower radiation exposure is regarded as a key advantage of this technique.
Yes. Using the CBCT data a practitioner can move through the bone on screen before the operation and determine the length, angle, implant type and ideal position of the implants. The whole procedure can be planned virtually, down to the last detail, in this way.
No, cone beam computed tomography is not reimbursed by the statutory health insurers (gesetzliche Krankenkassen). It is only recommended where it helps to make implant placement easier to plan in complex and unclear situations and to avoid possible risks.
Implant restoration with backward planning
With backward planning the work goes backwards from the intended prosthetic restoration. The implants are placed exactly where the planned restoration needs them for optimal attachment and an attractive appearance.
In backward planning the surgeon or dentist and the dental technician work together as a team. On the basis of a digital, three-dimensional volume tomography scan they plan the individual restoration or a temporary one made of plastic in advance.
Analysing the data from digital implant planning provides precise information about the best possible tooth position. Special planning software is used to determine the suitable implant design and the optimal implant position. The plan is put into practice with the help of a drilling template.
How the implant heals in
Osseointegration is the firm fusing of the jawbone with the implant during the healing period. It requires primary stability, that is the mechanical hold that the thread of the implant gives immediately after it is placed. The bone growing onto it creates the secure basis for the new teeth.
The surface influences how the implant heals in and how firmly it holds in the jawbone. A distinction is made between the macro design, the material structure of the surface, and the micro design, the fine detail of the surface. New, microscopically structured surfaces are intended to speed up healing.
The time is determined by primary stability, that is the mechanical hold when the implant is screwed in, and by secondary stability from the bone growing onto the implant. Further criteria are the amount of bone available and the type of prosthetic restoration planned. Only the treating doctor can decide this.
Digital impressions with an intraoral scanner
Yes. An intraoral scanner is guided along the teeth of the upper and lower jaw without touching them and records the surfaces of the teeth and gums; special software converts the data into a 3D image. This scan replaces the conventional impression taken with a tray and impression material.
With a digital impression no foreign bodies such as an impression tray or impression material have to stay in the mouth for a longer time. The unpleasant gag reflex while the impression material sets and possible intolerance to impression materials do not occur. The scan can be interrupted at any time if needed.
The scanned data are available in real time and are checked while the scan is still going on. If an area needs improving, this is shown immediately. Intraoral scanners are expected to produce better-fitting restorations, so that impressions do not have to be repeated and work does not have to be made again.
Fitting the restoration
Both are possible: the restoration can be screwed onto the implants or cemented. Both versions are fixed and, like natural teeth, cannot be taken out of the mouth. Attaching the finished crowns, bridges or rows of teeth after healing is called insertion.
If a restoration is held in place with clasps, this can damage the remaining natural teeth in the long run. With a fixed, implant-supported restoration patients are spared this drawback, as well as the poor fit of a classic denture.
Only when the patient can chew everything, speak freely and laugh without a care again. The implant-supported teeth should blend in with the natural ones attractively and inconspicuously, work without trouble after a short period of getting used to them, and not affect facial expression adversely.
CAD/CAM technology enables computer-aided restorations
Zirconium dioxide, for example, a high-strength and biocompatible, that is well-tolerated, ceramic. Single teeth, bridges and whole rows of teeth can be milled from it. The material allows a convincing fit and good aesthetics.
Yes. The framework of zirconium dioxide ceramic made in the production centre is then matched by hand in a dental laboratory to the individually chosen tooth colour. In this way the ceramic combines a convincing fit with excellent aesthetics.
No. The model of the prepared tooth is first scanned digitally with a laser scanner, then a dental technician models the framework on the computer with special software. The data go to a production centre, which makes the framework; the colour matching is then done by hand in the dental laboratory.
Protection against peri-implantitis
Peri-implantitis is a bacterial inflammation of the tissue around a healed implant. It leads to pockets more than four millimetres deep and to a gradual loss of several millimetres of bone. Such inflammations are the most common cause of late complications and can, in the worst case, mean the loss of the implant.
An inflammation around an implant usually runs its course without pain and is therefore hard for patients to notice. The first signs are redness, bleeding and swelling of the gum around the implant. Because the inflammation is so silent, regular check-ups at the dental practice are important in order to detect it early.
Mucositis is comparable to an inflammation of the gums: there is bleeding, but the bone is not yet affected and there are no signs of bone loss. With peri-implantitis the bone is already affected, it recedes and the implant can become loose. Mucositis can precede peri-implantitis.
A new titanium-zirconium alloy: Roxolid® implants
Roxolid is an implant material made of titanium and zirconium that was developed specifically for dental implantology. The alloy is more stable than pure titanium, and mechanical tests have shown its greater strength compared with pure titanium. At the same time it promises good healing properties in the bone.
Implants with a smaller diameter are an option where there is little bone or little space, for example in the front tooth region, with very narrow gaps between the teeth or with a jaw ridge that is too thin. If the jawbone is too narrow for an implant of the usual thickness, the thinner implant can be placed while sparing tissue.
Because a narrower implant often fits into the bone that is there, bone grafting that would otherwise be needed can be dispensed with. That removes both the additional procedure and its healing time, and the treatment period becomes shorter. The surgical trauma is smaller as well.
Implant systems have to be safe
There are more than a hundred different implant systems on the market, and not every one of them is fully ready for practical use. More than 900,000 implants were placed in Germany in 2016. Studies and scientific assessments help in choosing a suitable system.
Yes, because only internationally active manufacturers can also ensure help abroad. That is important for people who travel a lot for work or privately. With very small systems there can be problems even within Germany if matching tools and components are missing or no dentist familiar with the system can be found.
With established systems, prosthetic components and abutments have to remain available for years even after a change of model. Practice has shown, however, that some systems that looked promising at first did not establish themselves on the market. Before treatment it is therefore worth looking at how durable the chosen system is.
Implant surfaces give the implant a firm hold
Most implant failures occur in the early treatment phase, that is in the first eight weeks after the implant is placed. That is what clinical experience shows. Because more and more implants are being placed, reducing the risks in precisely this early phase is moving into the centre of attention.
The composition, roughness and structure of the surface help to determine how securely bone and soft tissue attach to the implant. Primary stability directly after placement and secondary stability after healing depend on this. The part of the implant that comes into contact with the bone is the part that is roughened.
The SLA surface is created in two steps: first the titanium surface is sandblasted with coarse grit, then it goes into a strong acid bath for a few minutes. This creates a structure that the bone cells can bond with. Shortly after it was introduced, this surface was regarded as the gold standard.
Bioactive implant surfaces for better implant stability
An active implant surface is hydrophilic, which means it attracts fluid. Conventional titanium surfaces, by contrast, are hydrophobic and repel fluids. The active surface quickly attracts blood and proteins and is thereby intended to promote the formation of bone around the implant.
Optimising the implant surface at molecular level is intended to shorten the average healing time. Contact between bone and implant is to be strengthened considerably early on and all around the surface, which should speed up healing and osseointegration, that is the firm growing-in to the bone.
The active surfaces are a further development of the proven SLA concept. They aim at the stability of the implant in the critical early treatment phase and are intended to increase safety during the healing period. This should make the treatment easier to predict.
Temporary implants
Temporary implants, also called interim implants, are thinner implants that are placed in the jawbone between the actual implants. They heal through the gum and serve during the healing period as a temporary anchor for a provisional restoration.
Either a tooth-coloured, fixed bridge or a firmly fixed but removable denture can be anchored on temporary implants. An existing denture can also be adapted for this. In this way a patient leaves the practice on the day of the implant procedure with a provisional restoration.
Yes, once the permanent implants have healed the interim implants are removed again. Until then they keep all loading away from the definitive implants and from areas of bone that have been built up. This is intended to avoid micromovements that disturb the growing-in to the bone.
Implants — guarantee and warranty
Brand manufacturers usually give a multi-year warranty on the implant and its abutment parts. Alongside that come services such as clinical documentation, compatibility between the individual components and training for practitioners. It is important to clarify before treatment exactly what the commitment covers.
Useful questions are: from what point does the commitment apply, which costs are reimbursed, are there upper limits or excluded services, how long does it run and which annual check-ups and preventive appointments is it tied to. Any limits and exclusions must be clear to patients before the implant treatment.
Warranty commitments can contain restrictions specific to particular indications, and heavy smoking is named expressly among them. Bone grafting that was not carried out, or the use of certain medicines, can play a part as well. What applies in an individual case must be set out clearly before treatment.
Planning your individual implant solution
A healthy mouth is required before an implant is placed. Carious defects, deposits, plaque and calculus on the roots must be removed. Gum disease, periodontal pockets and changes at the root tips should also be treated successfully and fully healed before the procedure is planned.
Whether a tooth is still worth saving has to be clarified case by case. What counts is the effort involved in treatment, the prognosis, prosthetic considerations and also the cost of keeping the tooth. Teeth that are no longer worth saving should be removed before implant surgery.
During the consultation the course of treatment, the expected result and the risks are explained. Alternative treatment options must be presented as well. A treatment and cost plan itemising every element sets out the cost. Detailed diagnostics must also come beforehand.
Gum disease — periodontal conditions
Numerous studies document a correlation between poor oral health and heart attack or stroke. Recent publications report a risk of coronary heart disease up to 25 per cent higher in patients with chronic inflammatory processes in the teeth. Connections with rheumatism and arthritis have also been investigated and documented.
With periodontitis, inflammatory substances collect in the deepened periodontal pockets. Through the bloodstream they can be carried to other parts of the body and trigger further illness. Gum disease is therefore not confined to the mouth but can affect general health as a whole.
Most gum diseases and their consequences can be prevented if treatment starts early, oral hygiene is thorough and the patient takes an active part. Long-term care by the dental team comes on top of that. Because the disease can also burden the rest of the body, early detection helps the whole person.
Gingivitis — inflammation of the gums
Gums that bleed on contact are a typical sign of gingivitis, an inflammatory change in the gums. It is usually caused by bacterial deposits and begins in the spaces between the teeth. The tissue at the neck of the tooth is then reddened or swollen and bleeds on contact with an interdental brush or a probe.
No, the opposite is right: plaque has to be removed especially thoroughly at the inflamed sites. Many people spare the bleeding area and therefore clean it less well. Careful and lastingly improved dental care at home allows inflammation of the gums to heal again.
Over time untreated gingivitis can endanger the tooth-supporting and tooth-retaining tissue, and periodontitis can develop at one or several teeth. The inflammation can destroy the fibres that connect the teeth to the jawbone and later lead to bone loss. The teeth then loosen and may be lost.
Periodontitis — inflammation of the tooth-supporting structures
No. Periodontitis is an inflammatory disease of the tooth-supporting structures and is often called periodontosis in everyday speech, which is not medically correct. Periodontosis itself does not run an inflammatory course. Periodontitis can occur at any age, at one tooth or several, and in different degrees of severity.
They are triggered by bacteria that collect between tooth and gum. If the deposits are not removed with a toothbrush and dental floss, they turn into hard calculus and the bacteria migrate deeper along the tooth. Deep pockets form in this way, and conventional cleaning methods can no longer clean them.
The immune system produces enzymes against the bacteria, but these do not only remove the germs, they also destroy the tooth-supporting structures. At an advanced stage the jawbone breaks down. Without intact supporting structures the tooth has no hold in its socket, begins to loosen and may be lost.
Assessment in periodontal disease
Because previous conditions such as diabetes or high blood pressure, medication taken and habits matter for the assessment. They are asked about alongside the acute symptoms when the findings are recorded. Patients are often also asked whether family members have had periodontitis.
Yes, there is a family predisposition. If periodontitis occurs despite conscientious oral hygiene, a genetic test can examine whether such a predisposition is present. Genetically predisposed patients face a much higher risk of developing periodontitis.
The periodontal status is an overview of the condition that the dentist enters on a two-page form before treatment begins. It is based on clinical and radiographic findings, among them the measured pocket depths. From the diagnosis the dentist then draws up the treatment plan with all the further steps.
Is tissue regeneration possible?
Enamel matrix proteins are proteins that can encourage the rebuilding of the tooth-supporting apparatus. They imitate the processes that take place while a tooth is developing and thereby enable the body to form the natural supporting apparatus of root cementum, fibre bundles and bone anew.
The natural anchorage consists of three basic elements: the root cementum, tiny bundles of fibres connecting root cementum and jawbone, and the jawbone itself. Where these supporting structures have broken down through periodontitis, they can be partly rebuilt depending on the extent of the loss.
A single application is normally sufficient. The regenerative process it sets off then continues over a longer period, usually more than a year. How much tissue can be recovered depends on how far the tooth-supporting apparatus has broken down.
Tissue regeneration after initial therapy
No. Bone lost to the inflammation does not grow back without supporting measures. The other tissues of the tooth-supporting apparatus also restore themselves only sparingly on their own. Depending on the extent of the loss, the supporting apparatus can be partly rebuilt by regenerative measures.
The long junctional epithelium is a tissue the body forms along with scar tissue during its own repairs. The tooth is then no longer firmly connected to the bone by the ligament but merely surrounded by connective tissue. It also creates a kind of slide by which new bacteria can recolonise the periodontal pocket.
Not necessarily. After the initial treatment the environment is free of inflammation again, but the deep periodontal pockets may still be there. In many cases additional treatment is therefore needed to help the body rebuild the tooth-supporting apparatus.
Guided tissue regeneration using membranes
The membrane serves as a mechanical barrier between the bone defect and the soft tissue so that the defect can heal undisturbed. It prevents the mucosa, that is the soft tissue, from growing into the cavity of the bone defect and allows bone-forming cells to colonise it undisturbed.
GTR stands for guided tissue regeneration, GBR for guided bone regeneration. Both work with membrane techniques and come into question where bone lost to periodontitis is to be made good by regenerative measures. In certain cases that is possible.
Because soft tissue heals faster than bone. Without a barrier it would grow into the defect and jeopardise the formation of the new bone. It is therefore kept away from the defect with a membrane so that bone-forming cells can settle there.
Treatment with antibiotic therapy
Antibiotics come into question to reduce germs and to reach even the deepest, least accessible parts of the periodontal pockets. They are used alongside the treatment or placed directly into the pockets as a special preparation. This requires optimum plaque control and the patient's conscientious cooperation.
Chlorhexidine preparations reduce the number of bacteria when they are introduced into the infected periodontal pockets. Rinsing with antibacterial solutions can support the initial therapy as well. Which measures are put together depends on the planned therapy and on the individual patient.
Only to a limited extent. Classic, conservative periodontal therapy recovers lost tissue only within limits. Where the loss of substance is great, new tissue has to be built up by surgery once this treatment is complete.
Regenerative treatment to rebuild the tooth-supporting structures
Regeneration begins immediately after treatment with enamel matrix proteins and continues over a longer period. In some cases the tissue-building process lasts more than a year. What is rebuilt in the process is root cementum, fibre bundles and bone.
Enamel matrix proteins are scientifically documented products and have been used worldwide in more than one million patients. They imitate the processes that take place while a tooth is developing and thereby enable the body to restore the natural tooth-supporting apparatus.
Scar and connective tissue worsen the prognosis for the previously diseased teeth. Regenerative methods such as the use of enamel matrix proteins are meant to avoid that and instead restore the complete supporting apparatus of root cementum, ligament and bone, ideally matching the original in form and function.
Gingival recession — receding gums and bone
There are conditions in which the gum and the bone beneath it recede without any previous inflammation. Common causes are incorrect brushing, misaligned teeth or grinding. In periodontology this largely inflammation-free receding is known as a recession defect.
No. Receding gums are an aesthetic drawback, but they can also cause discomfort. The exposed tooth necks and their sensitivity frequently cause pain for the person affected.
If periodontitis goes untreated, the inflammatory process advances and after a time reaches deeper regions of the tooth root. Bony defects develop in the process, mostly funnel-shaped, and are found in the areas between the teeth.
Dental plaque — a biofilm of bacteria
The deposit damages the enamel within as little as two days. Dental plaque, also called biofilm, consists of bacteria and their metabolic products, food residues and constituents of saliva. It is tenacious, clings firmly to the teeth and keeps growing if it is not removed.
Because what starts as a soft deposit develops over time into a hard layer that a toothbrush can no longer remove. This calculus has a rough surface, and that is exactly the ideal base for more bacteria to settle on.
No. Under normal conditions a healthy mouth maintains a complex balance between the bacteria on the mucosa and those on the tooth surfaces. Only when various factors shift that balance sharply can disease-causing germs multiply and do damage.
Initial therapy in periodontal disease
In curettage the periodontal pockets and root surfaces are cleaned thoroughly under local anaesthetic. With special instruments, ultrasonic scalers for example, the practitioner removes the hard deposits clinging to the roots deep below the gum and smooths the roots. Closed or open curettage is generally paid for by health insurance.
Not necessarily. Gentler methods, often called minimally invasive, make it possible to clean deeper periodontal pockets too without cutting them open. The aim of the treatment is to remove the germs causing the disease, to reduce the pockets and to restore a healthy bacterial flora.
Teeth that are already markedly loose can if necessary be stabilised by joining them together with a splint on the back. In addition, the first phase of treatment removes hiding places for bacteria, such as those created by overhanging crown margins or damaged fillings.
The first visit to the dental practice
The first visit is recommended within six months of the first milk tooth appearing, so normally around the first birthday. Parents should announce the appointment in good time so that the child can prepare for it.
Children pick up their parents' fears subconsciously. That is why a positive choice of words matters. Sentences such as “There's nothing to be afraid of” or “it definitely won't hurt” send the wrong signal. Better is a phrasing like “You can look forward to it, today someone is going to take a good look at your teeth”.
Because a first treatment leaves a lasting impression on children, a preventive appointment makes a gentle introduction. Regular check-ups help the child build a positive relationship with the dentist. Along the way, any problems that arise are spotted early and are then easy to treat.
When to start brushing
Yes. Even before the first little teeth break through, the ridge of the jaw can be massaged regularly and gently with a soft children's toothbrush. Finger brushes are particularly suitable, because they make the pressure applied very easy to control.
Small children are at risk very early on from the various sugars that can cause caries. Brushing should therefore begin as soon as the first tooth has broken through, at the latest. If it starts early and playfully, children accept brushing more readily and get used to careful oral hygiene.
Well cared-for milk teeth are the best foundation for healthy permanent teeth. Anyone who learns proper dental care as a child has a good chance of enjoying healthy teeth as an adult too.
Procedures using dental lasers
Dental lasers are used, among other things, to prepare a tooth for a filling, to sterilise root canals, to expose implants and to remove caries gently. Another field of use is fighting infections of the gum. In sealing teeth, too, the laser supports the result.
The high-energy light of dental laser technology allows procedures to be carried out more gently. Treatments on teeth, gums and the soft tissues of the mouth are meant to be less invasive and less of a burden. The aim of using lasers is tissue-preserving procedures and sterile work with little bleeding.
Laser treatments are increasingly part of everyday dental practice, because more and more efficient therapeutic uses have become established and are scientifically documented. Which procedure the laser makes sense for is decided by the dentist.
Extraction — when teeth have to be removed
Extraction means removing a tooth without a larger incision being necessary; the whole tooth is taken out in the process. Where that is not enough, because the tooth lies awkwardly or the root is curved for example, a surgical approach is taken.
Surgical removal may become necessary where the roots are brittle, where the neck of the tooth is destroyed or badly damaged, where the root is curved or angled, or where the whole tooth substance is badly damaged by caries. Displaced teeth lying partly or wholly beneath the gum are also removed surgically.
Extracting a tooth is a routine procedure that in most cases can be carried out under local anaesthetic, given as an infiltration or a block. Where the tooth lies awkwardly, where several teeth are being removed or at the patient's request, the procedure can also take place under general anaesthesia.
Dental treatment without fear
Anxiety, a certain unease and an uncomfortable feeling about an upcoming dental appointment are reactions many people have. Thanks to precise pain control, however, there is no longer any reason for it today, because the anaesthetic can be dosed exactly and is safe.
Pain control today can be dosed exactly and is safe, and it makes even lengthy and complex procedures barely noticeable. Patients can therefore go through a treatment relaxed and calm. Which method is used is decided in each individual case between practitioner and patient.
Treatment concepts tailored to the individual patient allow relaxed care in a calm atmosphere. New, gentler treatment variants and minimally invasive procedures markedly reduce the burden and make a visit to a dental practice easier for particularly sensitive people.
Anaesthesia by an anaesthetist
The form of pain control ranges from local anaesthesia through sedation and twilight sleep to full general anaesthesia. It is matched precisely to the procedure and to the patient's individual sensitivity to pain. Which method comes into question is discussed in a detailed consultation.
Where treatment takes place under general anaesthesia, a specially trained anaesthetist looks after the patient during the procedure and while they come round. The anaesthetist induces the anaesthesia and monitors bodily functions such as heartbeat, breathing and blood pressure continuously. Vital functions are also checked constantly in special recovery rooms afterwards.
Procedures on patients with risk factors are carried out with circulatory observation and professional, continuous monitoring. The right form of pain control is decided together in the consultation by the patient, the treating dentist and, where an anaesthetic is involved, the anaesthetist as well.
Root canal treatment or apicoectomy
The aim of root canal treatment, also called endodontic treatment, is to keep a tooth functional. Bacteria and inflammation of the tooth nerve inside the tooth are treated and the remaining cavity is sealed. In most cases inflammation can be cured this way.
After a successful root canal treatment the treated tooth and the structures surrounding it are free of symptoms again. Complete healing is additionally checked by X-ray. A successfully root-treated tooth should show a periodontal space of normal width.
Then an apicoectomy, a root-end resection, still offers a chance of saving the tooth substance. The infected tip of the root and the surrounding inflamed tissue are removed in an outpatient operation, usually under local anaesthetic. Unlike conventional root treatment through the crown of the tooth, the root is reached through the jawbone.
Sports mouthguards — important protection for your teeth
A sports mouthguard is advisable for children, young people and adults who are active in sport. A good many sports carry a considerable risk of injury to the lips, cheeks, tongue and teeth. Ninety-five per cent of all dental injuries happen before the age of 21, for instance while inline skating or skateboarding.
It protects against needless tooth loss, against annoying injuries and against fractures, that is broken teeth. Besides the teeth, the lips, cheeks and tongue are at risk as well. Adults, too, face a raised risk of such injuries in many sports.
First the dentist takes an impression. A dental laboratory then makes the guard individually and to suit the sport, from a special plastic. Because plastic is used, there are hardly any limits to the imagination when it comes to the colour.
Anti-snoring appliances — help with sleep-related disorders
Snoring can have many causes. A common one is the tongue sinking back into the throat, where it narrows the airway. At this narrow point the tissue starts to vibrate, and that vibration produces the sound. Snoring counts as a sleep disorder and becomes more common with age.
An anti-snoring appliance is a mechanical construction that moves the lower jaw reliably and in a controlled way into a forward position. This is intended to open the airway and prevent snoring. The appliance counts as the first and simplest help against snoring.
No, the appliance is usually made of plastic and is produced individually for your own teeth by a special process. An exact diagnosis also comes before the treatment of a sleep disorder, because science distinguishes a wide variety of sleep-related conditions.
Dentoalveolar surgery
The term combines the Latin word dens for tooth with the word alveolus, the medical term for the tooth socket and its supporting structures. What is meant by it is the surgery of the oral cavity, that is the smaller surgical procedures on the teeth and the adjoining jawbone.
Yes. Dentoalveolar surgery includes, among other things, the removal of wisdom teeth, surgical tooth removal and extraction, root-end treatments and the removal of roots, as well as the removal or exposure of teeth that lie within the bone or are badly destroyed.
Modern techniques in dentoalveolar surgery rest increasingly on methods that are as minimally invasive as possible, that is on approaches with the smallest possible access and little burden on the tissue. They are developed with the greatest possible patient safety in mind.
Cleft lip and palate
It forms as early as during pregnancy. A cleft of this kind affects not only the appearance, it can also cause considerable functional problems with chewing, swallowing and speaking. It is therefore treated according to a long-term plan.
Treatment is always interdisciplinary and closely coordinated between the oral and maxillofacial surgeon, the orthodontist, the ear, nose and throat specialist and the speech therapist. The aim is a normalised appearance and a trouble-free function of the chewing apparatus, if possible by the time the child starts school.
The palatal plate is normally one of the first treatment steps and is fitted in the child's first days of life. It makes drinking easier for the baby. Grinding away parts of the underside of the plate can also shape the dental arch or narrow the cleft.
Dental trauma — treating accident-related injuries
Teeth lost through trauma, soft tissue injuries and injuries to the jaws or to the bone structures of the skull belong in the hands of specialists in oral and maxillofacial surgery. They work with modern imaging techniques in order to detect every injury and rule out risks as far as possible.
Osteosynthesis is a surgical method of fracture care, that is the treatment of broken bones. The bone fragments that belong together are brought into as normal a position as possible and fixed with plates and screws. The aim is to restore full function quickly.
Injuries to the bones of the facial skull are treated intraorally wherever possible. That means the incision runs inside the oral cavity. Visible scars on the face can be kept to a minimum in this way.
Orthognathic surgery — treating jaw and tooth misalignment
With a dysgnathia the upper and the lower jaw are unevenly developed and the facial profile looks disharmonious. On top of that come functional consequences such as obstructed nasal breathing, problems with the jaw joints and early tooth loss.
No. A dental dysgnathia, that is a misalignment of the teeth, and smaller skeletal deviations of the jaws can be treated by orthodontic means. Only larger deviations are corrected surgically, and then in close coordination with the orthodontist.
No. Correcting misaligned jaws and teeth is necessary in order to prevent or eliminate functional problems such as a disturbed chewing function or jaw joint complaints caused by permanent overloading and incorrect loading. The correction can be carried out without external skin incisions and with minimally invasive surgical methods.
Caries infiltration — treatment without drilling
Not in every case. With caries infiltration a highly fluid resin is introduced into the enamel caries and blocks the diffusion paths for the acids that cause caries. Drilling is not necessary with this form of caries treatment.
The method is based on treating incipient tooth decay as early as possible, before the dreaded hole in the tooth develops. The sooner incipient caries is discovered, the better. It is a microinvasive method intended to preserve healthy tooth substance.
Once it has hardened, the resin that has penetrated prevents the germs that cause caries from advancing further. The carbohydrates these germs need in order to multiply, and the acid they produce as a metabolic product, no longer reach the deeper layers either. This acid is responsible for demineralisation, that is the decalcification of the tooth substance.
Surgical microscopes in microsurgery
The surgical microscope shows hidden, delicate areas, which can then also be treated. Magnifications of up to 25 times are possible. The illumination puts the light exactly where it is needed, so that even root canals can be lit up and imaged.
It is used for root canal treatment, that is in endodontics, in surgical procedures for more precise operating techniques, in the treatment of periodontal disease, that is disease of the tooth-supporting structures, and in filling therapy.
The magnified view opens up minimally invasive treatment methods, that is procedures with the smallest possible access. Even complex procedures can be carried out with high precision and maximum preservation of tooth substance. Only what can really be seen can be treated.
Ozone therapy — killing pathogens without side effects
A classic indication for ozone therapy is the treatment of periodontitis, that is an inflammation of the tooth-supporting structures. Ozone is intended to lower the number of germs in the gum pockets and can reduce the tendency to bleed.
Yes, to disinfect root canals that are hard to reach. Before the ozone therapy the canals are mechanically prepared and cleaned. Further fields of application are neuralgia of the jaw joints and reducing germs in caries at the neck of the tooth and on smooth tooth surfaces.
A tiny amount is used which is regarded as harmless and is intended to kill the pathogens with little pain and without side effects. For the patient the advantage lies in treatment that is less painful and shorter than conventional therapy.
Studies on implant costs and quality of life
Economically an implant solution is advisable above all when the remaining teeth need no treatment or only minimal treatment and enough jawbone is available. That is the conclusion of a study on the cost-effectiveness of implants when replacing individual missing teeth.
Yes. A scientific review of the cost-effectiveness of dental implants rates the single implant for replacing a single tooth as a cost-effective treatment option compared with the traditional three-unit fixed bridge.
When replacing several teeth, implants were associated in studies with higher initial costs than other treatment options, but at the same time with greater improvements in the quality of life connected with oral health. That applies to fixed as well as to removable implant-supported restorations.
Precise pain control during implant placement
For most implant procedures a local anaesthetic is enough to make the treatment painless. Its advantages are the low medical risk, the lower expenditure of time and money and the possibility for the patient to help during the procedure. An anaesthetist does not have to monitor them throughout.
Under sedation, the so-called twilight sleep, patients remain conscious throughout the procedure, are responsive and can react to instructions. Afterwards, however, they do not remember the details of the implant procedure. After waking up they are fit again relatively quickly.
General anaesthesia is advisable above all when many implants are placed or extensive bone grafting measures are necessary. An experienced anaesthetist looks after the patient while they go under, during the procedure and while they wake up, and monitors breathing, circulation, blood pressure and heart function.
Professional tooth cleaning
It begins with a thorough examination of the teeth, a systematic recording of the findings and an explanatory talk with tips on correct dental care. After that the deposits on the tooth surfaces, in the spaces between the teeth and in the gum pockets are removed. Finally the teeth are polished and coated with fluoride varnish.
Thorough cleaning of the teeth can reduce caries and periodontitis, and in many cases even prevent them. Professional tooth cleaning, caries prophylaxis and accompanying treatment in periodontal therapy offer this protection. They supplement daily dental care at home but do not replace it.
The fluoride varnish applied at the end of the treatment protects the cleaned tooth surfaces from the acid attacks of the bacteria in the mouth. Beforehand the teeth are smoothed, because bacteria settle above all on rough and cracked areas.
Air-flow devices remove deposits
A powder-water jet device is used for that. It applies a water-air mixture with a special cleaning powder and thereby removes discolouration and pigment deposits from the tooth surfaces, of the kind caused by smoking or by drinking tea or coffee. Its use is part of professional tooth cleaning.
A special cleaning powder of calcium carbonate and sodium bicarbonate, or a glycine powder, is added to the water-air mixture. The pressure of the water jet thereby reaches difficult places as well, such as deep gum pockets or narrow spaces between the teeth. Where tissue surfaces are sensitive, a gentle powder is important.
Statutory health insurers normally do not cover the cost of a professional tooth cleaning. Private health insurers and supplementary policies cover it depending on the tariff. Using a powder-water jet device as part of the tooth cleaning usually incurs no additional cost.
Cleaning is followed by polishing
The preceding cleaning steps have roughened the tooth surfaces, and without smoothing they would quickly be occupied by bacteria and deposits again. Polishing makes them shiny and very smooth and thereby makes it harder for new deposits to form.
The smooth tooth surfaces are polished to a high shine with small rubber cups and brushes and with fluoride polishing pastes of different grain sizes. Finally, applying fluoride gels or varnishes provides an additional protective film on the teeth.
Yes, the interdental spaces, that is the spaces between the teeth, are finely cleaned once more and then smoothed with dental floss, superfloss or polishing strips. The reason is the same as for the other surfaces: new deposits form less easily on smooth surfaces.
Periodontal pocket cleaning
Inflamed gums show themselves through redness and swelling. Added to that are troublesome bleeding gums and unpleasant bad breath, and later gum pockets form. Bacteria collect in these pockets and can ultimately lead to periodontitis.
Periodontitis is understood to be an inflammatory disease of the gums and the tooth-supporting structures. It can arise from bacteria that collect in gum pockets. It is usually preceded by inflamed gums with redness, swelling and bleeding.
The pockets are rinsed out with an antibacterial rinsing solution, which reduces the number of germs in the mouth, and cleaned with ultrasonic and hand instruments. That promotes the natural healing process, so that the gum pockets can close again. Handling these instruments requires special knowledge and experience.
Cleaning the tongue can reduce the risk of caries
Cleaning the tongue regularly is intended to reduce the individual risk of caries and to prevent new plaque from forming. It also promises fresher breath: bacteria colonise the tongue easily and cause bad breath there.
A coating on the tongue often disturbs the sense of taste. After a cleaning the taste receptors spread over the tongue react more sensitively again. The coating consists of bacteria that break down proteins and release sulphurous gases in the process.
There are special instruments for cleaning and caring for the tongue: tongue brushes, tongue scrapers and combinations of the two. They remove the bacterial coating on the tongue, which is often the cause of bad breath and an unpleasant odour.
Bad breath — a taboo for many
In most cases, about 90 percent, the source of the unpleasant odour lies in the mouth itself. The cause of bad breath, medically halitosis, is a bacterial breakdown of organic material in the oral cavity. Alongside poor oral hygiene and a bad state of the teeth, a coating on the tongue is among the most frequent causes.
Anaerobes are responsible, that is microorganisms that live in an oxygen-free environment. They settle between the papillae of the tongue surface, in the throat and in gum pockets. Most oral bacteria are found on the surface of the tongue, especially on the back of the tongue.
That does happen, but it is the rarer case. In only a small proportion of those affected are the unpleasant odours caused by problems with internal organs or by existing illnesses. Around 90 percent of cases have their origin in the area of the oral cavity.
All-ceramic restorations for aesthetically pleasing results
Zirconium oxide is a full-ceramic and therefore completely metal-free, biocompatible material that has established itself in dentistry as a framework material over many years. It has good physical properties and, in its function, properties similar to those of natural tooth substance.
Zirconium oxide is suitable for demanding aesthetic dental restorations, from the single crown through to long-span bridges in the posterior region. It is recommended especially for patients who value a metal-free restoration and for people who tend to have hypersensitivity reactions.
Zirconium oxide has a basic colour similar to dentine, that is a shade close to natural tooth bone, and good light transmission. The colouring and light reflection of veneers, inlays, crowns and bridges therefore make treated teeth look like natural teeth.
Shade and shape selection
The tooth shade has to be determined without interference from disturbing light sources or other light influences in the surroundings. Only in this way can the natural colouring be reliably transferred to the new teeth. Determining the shade counts as one of the most difficult steps in making a restoration.
The different natural tooth colours come about through the refraction of light in the hard tooth substance. How the colour turns out is determined by the composition of enamel and dentine, that is of the outer hard layer and the tooth bone beneath it. That is why the right colour is determined individually for every patient.
A restoration is considered successful when it is aesthetically pleasing, functionally convincing and not recognisable as a restoration. It has to fit homogeneously into the natural set of teeth. From the patients' point of view colour and shape are decisive for that, and therefore determine the outcome of the treatment.
Fillings in ceramic or composite
Amalgam fillings have durability figures similar to those of ceramic inlays or composites. Because of their mercury content, however, they are regarded as less advisable. Ceramic filling materials and modern resins likewise meet the requirements for stability, durability, tolerability and appearance.
Composites, that is resin materials, are used for smaller defects in the anterior and posterior region. In practice they count as valuable and versatile materials. Like every filling they have to be stable and durable, must not burden the body and have to look aesthetic.
Ceramic inlays, that is precisely fitting inlay fillings made of ceramic, should not differ from natural teeth in shape and colour. They are the right choice when a natural appearance and high durability are wanted. The material also offers very high chewing stability.
Whitening — gentle lightening of the teeth
Discolouration can have many causes: tobacco, medication and foods such as coffee, tea or red wine. Natural signs of ageing also make the tooth colour darker. Teeth discoloured in this way can be lightened with the bleaching method.
During bleaching a gel containing peroxide is applied. It triggers an oxidation process whose oxygen reaction changes the colour-giving molecules in the tooth. In this way the tooth becomes lighter. The method is suitable for individual teeth as well as for the whole row of teeth.
Bleaching can be carried out at home as well as in the dental practice, but should always take place under medical supervision. If the teeth darken again after a certain time, the procedure can be repeated.
Veneers — ceramic facings
No, the tooth is only minimally prepared. As little tooth substance as possible should be ground away or damaged in order to attach the facing shells. The shells are fixed to the tooth surface with a special adhesive. That is why veneers count as a substance-preserving solution.
Veneers can be as thin as contact lenses. They are thin, translucent ceramic shells that are bonded onto the visible part of the tooth. Because of their natural transparency light can shine through them as it does with natural teeth, and the colour can be individually matched.
Veneers even out irregularities, discolouration or damage in the anterior region. They can cover strong tooth discolouration and correct misalignments. They are used preferably for cosmetic corrections on the front teeth, because they preserve tooth substance.
Prosthetics in aesthetic dentistry
Zirconium oxide, also called zirconium dioxide, is a metal-free ceramic material for restorations. Only materials that have been specifically tested for their tolerability are used. The trend in aesthetically demanding prosthetics is towards such metal-free and biocompatible materials.
No. Metal-free ceramics or zirconium oxide only produce a biocompatible and non-allergenic restoration if they are also processed with correspondingly gentle methods. So alongside the choice of material, the way it is processed decides how well tolerated the restoration is in the end.
It offers a wide range of services for correcting the appearance of the teeth, repairing damage and closing gaps. The aim is a natural appearance of the restored teeth. The possible applications are becoming ever more complex and versatile.
Restorations on telescopic crowns
A double crown, also called a telescopic structure, consists of two parts. A cap is cemented onto the prepared tooth and protects it. A second crown is attached on top of it, and this in turn holds the removable denture. In this way the restoration is anchored to the existing teeth.
No, with the telescopic technique visible retaining elements such as clasps can be dispensed with. The restoration is not recognisable as such. Instead the denture is held by double crowns on the existing teeth, which connect fixed and removable restorations with one another.
Telescopic structures need extra space, which can mean that the palate is partly covered. Set against that, the advantages are the appealing aesthetics, the good wearing comfort and the easy extension of the restoration if further teeth are lost later.
Crowns and bridges in ceramic
If the loss of substance is large, the dentist crowns a tooth in order to restore its chewing function and its shape. The crown is placed over the remaining tooth. If a good aesthetic effect is to be achieved, metal-free crowns made of ceramic are a good option.
Gaps are closed for medical and aesthetic reasons, so that the chewing forces in the mouth are distributed harmoniously again. Depending on the condition of the neighbouring teeth, an implant or a fixed bridge can be considered for that.
If the neighbouring teeth are free of larger fillings and damage, implantology is a good option, because this healthy tooth substance is preserved. If the neighbouring teeth need treatment anyway, or if there are other reasons that rule out an implant, the fixed bridge is an alternative.
Precision attachments in restorations
An attachment is an anchoring element with which a removable restoration is fixed to the supporting teeth without clasps. For this, existing teeth are crowned and the attachments are firmly connected to these crowns. The removable part then holds on these anchors.
The attachment technique counts as a particularly high-quality and elaborate form of removable restoration, because the supporting teeth are crowned. These crowns are usually veneered with ceramic. Unlike clasps, the anchoring elements are not visible and therefore more aesthetically pleasing.
The attachment anchorage ensures that the removable restoration sits firmly on the supporting teeth without clasps. The combination of fixed and removable restoration offers good wearing comfort and a long service life of the prosthetics.
Digital impressions
Not with a digital impression. Instead of a tray, impression material and long setting times, the situation in the mouth is recorded with an intraoral scanner, that is a device that works directly in the mouth. That is meant to spare you the unpleasantness of the conventional impression, which is often accompanied by an unpleasant gag reflex.
Digital recording can shorten the treatment time with high scanning speeds, because the impression is taken quickly and precisely. With a conventional impression, on the other hand, inaccuracies can mean that the whole procedure has to be repeated.
On the basis of the digital 3D impression, proposals for the further prosthetic treatment can be presented on screen and the individual treatment steps agreed. The scanner's data are available directly as a digital data set for that.
The 106 topics covered here
Implantology
General questions
Implant prosthetics
Costs
Treatment
Diagnostics
What is a dental implant?
Who are implants suitable for?
The edentulous jaw with four tilted implants
Removable implant-supported dentures on a bar
Removable implant-supported dentures with locators
Implant placement procedures
Immediate loading
Bone grafting
Metal-free restorations
Dental laboratory
Caring for implants
Checking quotes
Cover by health insurance
Implants
Titanium implants
Ceramic implants
Implant shape
Narrow-diameter implants
Caries in children
Brushing milk teeth
Treatment under general anaesthesia for children
Magnifying loupes
Immediate implant placement
What to do after implant surgery
Video library: alternatives without implants
Private health insurance
Implant tourism
Healing processes
Individual, fixed solutions with implants
Dental implantology — a proven form of treatment
Why are dental implants placed?
When should an implant be placed?
Are dental implants safe?
What are the risks?
What are the advantages of implants?
Implant-supported single tooth
Several missing teeth — implant-supported bridges
OPG — panoramic radiograph
Three-dimensional diagnostics
CT — computed tomography
CBCT — cone beam computed tomography
Implant restoration with backward planning
How the implant heals in
Digital impressions with an intraoral scanner
Fitting the restoration
CAD/CAM technology enables computer-aided restorations
Protection against peri-implantitis
A new titanium-zirconium alloy: Roxolid® implants
Implant systems have to be safe
Implant surfaces give the implant a firm hold
Bioactive implant surfaces for better implant stability
Temporary implants
Implants — guarantee and warranty
Planning your individual implant solution
Gum disease — periodontal conditions
Gingivitis — inflammation of the gums
Periodontitis — inflammation of the tooth-supporting structures
Assessment in periodontal disease
Is tissue regeneration possible?
Tissue regeneration after initial therapy
Guided tissue regeneration using membranes
Treatment with antibiotic therapy
Regenerative treatment to rebuild the tooth-supporting structures
Gingival recession — receding gums and bone
Dental plaque — a biofilm of bacteria
Initial therapy in periodontal disease
The first visit to the dental practice
When to start brushing
Procedures using dental lasers
Extraction — when teeth have to be removed
Dental treatment without fear
Anaesthesia by an anaesthetist
Root canal treatment or apicoectomy
Sports mouthguards — important protection for your teeth
Anti-snoring appliances — help with sleep-related disorders
Dentoalveolar surgery
Cleft lip and palate
Dental trauma — treating accident-related injuries
Orthognathic surgery — treating jaw and tooth misalignment
Caries infiltration — treatment without drilling
Surgical microscopes in microsurgery
Ozone therapy — killing pathogens without side effects
Studies on implant costs and quality of life
Precise pain control during implant placement
Professional tooth cleaning
Air-flow devices remove deposits
Cleaning is followed by polishing
Periodontal pocket cleaning
Cleaning the tongue can reduce the risk of caries
Bad breath — a taboo for many
All-ceramic restorations for aesthetically pleasing results
Shade and shape selection
Fillings in ceramic or composite
Whitening — gentle lightening of the teeth
Veneers — ceramic facings
Prosthetics in aesthetic dentistry
Restorations on telescopic crowns
Crowns and bridges in ceramic
Precision attachments in restorations
Digital impressions