e>oral surgery maxillo facial surgery Dr. Kerstin u Stefan
Bertram Salzburg/Austria next Airport und Freilassing
questions and answers shown below can´t substitute an
individual consultation at your dentist or oral surgeon!
trickfilm in youtube:
are implants at all?
are artificial tooth roots, setted into the jaw. Implants are
produced out of biocompatible materials, tolerated charmlessly by the
tooth itself is built up on the implant
1: model of implants setted into tooth spaces more behind
2: model of implants in the front
3: branemark implant
4: showing a possibility of setting an implant (Ankylos)
implants uphold forever?
course, implants are aspired to uphold forever. Like natural teeth
implants reach into the oral cavity, too. Therefore, they are exposed
to lots of inauspicious factors of one´s mouth. These are
leftovers, plaque and all the other pathogens. If implants
cared for, similar processes as if it was a natural tooth may uprise.
These processes could at first lead to gingival pockets, then to loss
of bone and at least the implant may be endangered. Oral hygiene is
absolutely necessary for a long-time success. And of course, you
should make an appointment at your oral surgeon regularly, therewith
he can check the implants.
risk factors for a long-term success are heavy smoking and special
general diseases like diabetes type I (insulin injections), long
lasting Cortison treatments, e.g. if someone suffers from special
rheumatic diseases, but also a bad substance of bone.
every patient case the risks should be assessed carefully.
implants repelled of the body?
of repellency—known with allergies—appear hardly
especially if implants of pure titanium are used.
the past, inflammations, known with natural teeth and which even may
appear with implants, were reputed to be a reaction of repellency by
mistake. In contrast to earlier opinions, telling that the titanium
surface coalesces in a chemical way to the bone cells, new studies
show, that even titanium leads to an unspecific foreign substance
reaction. But this doesn´t cause a repellency in the jaw.
if titanium has fulfilled the long yearned wishes of the dental
surgery for a qualified material, that can replace a natural tooth
root in the jaw, there are permanent studies to improve the state of
the art. But the focus of the research is on the one hand optimizing
the titanium surface and on the other hand developing totally new
material are implants made off?
most common implant systems are of pure titanium. It coalesces very
good to the bone. There are nearly no allergic reactions and titanium
shows a good stability. In the past, often implants made out off
ceramics were used and they also showed a good healing and are
unbeatable cosmetically. Nevertheless, they are setted more and more
rarely, because of the large danger of breaking.
one is working all the time to improve the mechanical properties of
one is the best implant system?
question can be answered generally. The well-known implant systems
all have reached a high level. Every system shows in some cases
advantages and in other cases disadvantages compared to other labels.
I like the comparison between implant systems and cars. The
well-known car companies produce good cars. But there are no cars,
that are second to none in every segment. We work with Straumann ITI
and Branemark. In the meantime, every implant system enacts about a
lot of different implant forms and numberless parts. Decisively is
not the fabricator of the implants, but the cooperation of the
patient and the skill of the surgeon.
image shows a cut-out of the offered implant forms and parts
just from one enterprise/company.
ist nicht der Implantathersteller, sondern die Mitarbeit des
Patienten und die Kunst des Operateurs
do you think about the new implants developed in the USA?
am frequently asked this question recently. One patient was very
kindly and brought along an article out of the journal
der Frau”. This article was published because of an interview
given by a dentist: “It´s the latest hit from the
you even get it in Germany, too: tooth implants, that don´t
wobble any more. That´s the breaktrough in the 40 years long
lasting history of implanting simulated teeth!”
these overwhelming statements hides the further development of the
implant surface. This special plating of the surface is also useful
with European implants, e.g. ITI.
also prefer this refined surface, because I think it´s more
advantageous than the “old one”.
if this is true, it should be rarified by autonomic long-term
I need an implant for every lost tooth?
One stout implant is able to sustain several teeth. The strength
depends on the starting situation of the jaw and on it´s
thickness, level and tightness. Furthermore, it is important if the
implant has to sustain dentures that can or can´t be taken
having lost all teeth, how many implants do I need therewith a
frequently, we aspire 4 implants for an edental/ a toothless jaw
(statement of the DGZMK 3 /98). A solution with 4 implants improves
the stay of the denture, but it also offers less stability. If you
decide for having a denture, you can´t take out
one only removable for brushing through opening bolts or screws), we
recommend standardly 6 implants in the lower jaw and 8 ones in the
maxilla. Of course, the totally number of implants should be
determined individually. For example, a longer implant can stand more
pressure while chewing than a shorter one.
about the charges of implants?
doctors aren´t able to publish their charges in the internet,
because of the german law. Recommendable is in any case an individual
consultation, because the costs depend on the operative complexity.
So the surgeon needs to have a look on the patient to tell you
anything about the charges in detail. But of course it is possible to
contact every oral surgeon or every dentist, who offers dental
implants, via E-Mail or telephone and to ask for the charges of
implants in general.
the health insurances pay at least partially for implants?
the private health insurances pay almost the whole costs for your
implants. Therefore, it is helpful to send them an estimate before
statutory health insurances only are able to pay for implants in
extreme situations (e.g. sheer jaw, state after having had jaw
cancer, an accident or congenital dysplasias of the jaw).
I need a general anaesthesia for implants?
it´s common to treat the patients with tooth implants under
local anaesthesia. In every case the patient should be driven home
after the treatment, because the stress on your circulation is much
more than after having had a “normal dental
general anaesthesia is only advisable, if the treatment otherwise
isn´t possible. Furthermore, there is the opportunity of
getting a sedation jab, that gives the patient a feeling of calm and
who suffer under heart- or circulation diseases, should only be
treated in the presence of an anaesthesist, who is able to keep a
watch on those patients with special apparatuses.
long am I put on the sick list?
it´s not possible to go working the following two days after
the operation. We can give you more detail information as soon as we
have had a look on you to estimate the complexity of the surgical
form of trouble should I be prepared for?
can give you more detailed statements after an inquest (?) and having
estimated the complexity of the surgical intervention. The patients
often feel pain for some days. But you can easily suppress it with
you´ll get a swelling. It increases during the first two days
after the operation and then it´ll become better. The
of the swelling depends on the one hand on the complexity of the
operation and on the other hand on the cooling through the patient.
Besides, a visible haematoma could appear.
it possible to get an implant immediately after having pulled a
setting immediate implants, there´s the advantage of less
waiting-time and a faster using of the existing bone, because the jaw
often removes fast-paced after having pulled a tooth. In every case,
there should be the supposition, that the jaw stays stout after the
pulling of a tooth and no inflammation rises up. To consider this
situation, a surgery microscope or special eye glasses, that magnify,
are very useful. Unfortunately, the mentioned prerequisites often
out of reasons of safety, one waits normally after having pulled a
tooth between 8 weeks and 6 months, in most cases the waiting-time
amounts 4 months. During this time period, in the cavity of the jaw
new functional bone has been regenerated. Another good possibility to
bridge the time between pulling a tooth and setting the implants, are
so-called template implants. These are very thin implants (made of
the same material as the other ones, only with another form and
size). To offer the patient a better stay of the dentures immediately
after removing teeth, these template implants can be burdened
instantly and they are removed as soon as the final implants have
long do I have to wait until the denture respectively the crown is
are obvious differences depending on the situation and on the loading
of the implant. Mostly, one waits in the lower jaw 3 months and in
the maxilla 4 or 5 months. In the front of the mandible, one is able
to reduce the waiting-time even more if the situation is stout.
Compared to the upper jaw behind, the bone is very supple, so that we
are patient rather about 6 months. But not only the position of the
implant is decisively, also the whole condition of the patient. If
the patient is younger, the cure of the bone goes off faster than as
if the patient is a bit older and suffers e.g. from diabetes. In the
last time, fabricators of implants assert, it was possible to shorten
the waiting-time with improved surface structures of the implants. W
also use these “new” implants cauterized with acid,
because probably they decrease the abrasion of the implants while
turning. We are sceptical with estimating the publications of
pretended revolutionary abbreviations of the waiting-time, because
often the fabricators order these studies themselves and I think, the
observation time of such implants is not yet sufficient to make a
course, we are happy that research is done with the surface mutation
of implants to shorten the healing time. This development is very
pleasant for the patient. On the part of the hygienics, I gauge the
tendency of increasing the implant surface by making it rougher
critically. Even if the waiting-time can be shortened,
the danger of a settling with bacteria on the artificial jagged
surfaces, if the oral hygiene is not optimal.
there several operations necessary?
one intervention for setting the implants is enough. Implants, that
had been setted under the mucosa, have to be ridded from the mucosa
before they can be loaded. This happens in local anaesthesia and
compared to the setting of the implants, it is a very short
it is possible that the jaw must be made stouter before setting an
there a maximum age for implants?
Decisively is not the nominal age but the biological one.
a larger risk if a 50-years-old patient, who had had an organ
transplantation, gets implants as if a patient at the age of 80 wants
to have implants but feels hale and has a good structure of the jaw.
suffer from osteoporosis, is setting implants still possible?
don´t consider osteoporosis as an exclusion criterion.
I disabuse the patients about a longer waiting-time until the
implants can be loaded. Some medicine like “Bisphosphonate
be a risk”
jaw has already faded. Are implants still possible?
reach a certain long-term success, the jaw should normally have a
width of at least 5 mm and an altitude of 10 mm. These two factors
can be determined with an oversight x-ray picture, an inquest or
optionally a computer tomography.
there´s not enough bone, it´s possible to build up
one. Therefore I take (depending on the required amount) the chips
out of the implant drill hole and bone out of other areas of the jaw,
e.g. where the wisdom tooth has been. Sometimes even bone out of the
hip is necessary, especially to build up the lateral area of the
maxilla. If a patient lost the teeth there a longer time ago, the
bone fades and the sinus maxillary becomes larger. With a so called
lifting of the sinus maxillary base (known as sinus-lift, too), this
space is filled up again with bone. After 5 months this new bone can
it possible to provide children and teenager with implants?
support the orthodontic treatment, teenager can get implants, too.
These special implants, setted in the roof of the mouth or behind the
teeth, can substitute a costlier equipment. But the replacement of
lost teeth with implants is difficult, because the jaw of the
teenagers hasn´t finished growing. So the jaw around an
wouldn´t grow further normally. Therefore, implants
be setted before the last growth shear. That means at the age of 14
(girls) and the age of 16 (boys). I like to wait even longer (18
[girls] and 20 [boys] years), because even after the last growth
shear the jaw can grow 1 or 2 mm of altitude (this happens even until
the age of 25 with men!).
there be other possibilities out of an implantation, one can use
tooth crowns that can be changed. So one can compare the growing of
the jaw with transposing the visible tooth crown.
I have to be totally healthy for getting implants?
there are diseases that pose a higher risk. These are diabetes (when
pills aren´t sufficing), leukaemia, situation after a
therapy and heavy heart diseases. In every case we estimate the
individual risk after talking to your family doctor.
long do I have to descry checkups?
consider steady checkups of the implants for very important. Earlier
stages of inflammation can be treated much more easier than heavy
inflammations, that have led to a bone fading.
the following checkups are necessary:
the implants have been setted: after 2 days, after 7 days, then after
3 weeks and finally once in a month.
soon as your dentist has finished, you should visit your oral surgeon
for a checkup too after 6 weeks and afterwards two times within 3
months. If everything is alright, please let us have a look at the
implants one or two times a year.
is a preoperation before the implant setting necessary?
rationale while setting implants is, that the implant has to be into
the bone tightly. If this isn´t guaranteed, the bone has to
built up before. This intervention takes place some months before. Is
the implant fixed after setting, but a part of the implant body
covered with bone, one can cover this area in the same operation with
a filling material.
gold standard for consolidation and covering the implant is bone,
that was produced naturally in the body. This type of bone
lead to a defensive reaction and supports the regeneration even more
than artificial bone. The still living parts of the bone after the
transplantation are like germ cells for the new bone. The bone, that
should be transplanted, is taken preferably from qualified areas of
the jaw. The disadvantage of this method is the more voluminous
intervention. If a lot of bone has faded, one even takes bone parts
of the hip. This operation has to be put through in general
anaesthesia (I don´t do this, neither ambulant nor in the
there is the possibility to fill up smaller failures with special
membranes and replacement materials. To avoid separate interventions
in the jaw to get bone for transplanting, there are always new
developments in bone replacement materials. But until today, no other
long-term study with artificial bone could substitute using own bone
as the gold standard.
don´t think, that one´s own transplanted bone will
the gold standard forever. For example, there are new studies about
the so-called “Distraktionsosteogenese” which are
promisingly. This is a technique to spread too less bone constantly
and to increase it this way.
are keeping you up to date in every single case.
heard about special materials that can build up lost bone again
without an operation. What do you think about this?
materials are special proteins which are expected to support the
regeneration of the bone (BMP: Bone Morphogenetic Protein). Such
materials exist since about 10 years.
read an interesting article in a special german journal for doctors
about this subject. According to this article, there are no certain
results about standardized using of these materials with men.
the reason why we only use such materials, if there´s no
it´s very important to have a look on these studies, cause
results on animals are promising a lot. In the meantime, it is
succeeded breeding humane BMP´s. An ideal vehicle keeping the
BMP´s in their place of destination hasn´t been
yet, cause in the blood stream it is removed very fast.
told me, that implant healing was better, if one takes his own blood
and afterwards the blood is put back into the drill hole.
consists out of different parts. Besides the red blood cells, there
are a lot of proteins supporting the regeneration of bone. Therefore,
before the operation the parts are separated in a centrifuge and at
least the plasma parts with a higher concentration of these useful
proteins are put back into the wound. Our experiences show, that
these wounds are healing fast and without problems. Despite, I think
we should expect further long-term studies until it is possible to
load these types of implants immediately.
lot of other questions can only be answered in every special patient
case. Publishing further information on this internet page would
impinge against german occupational laws.
kindly ask you for your understanding!
you have any other improvement suggestions or do you need further
hesitate to contact us!
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