The topic of immediate implantation (immediately after tooth extraction) is often exaggerated for marketing purposes. It sounds very appealing: a patient comes to the clinic with poor teeth and leaves it with new ones. Sometimes, this treatment is described using catchy names such as ‘teeth in an hour’. This may give the impression that this is the latest and most advanced method of dental implantation used by the most progressive professionals in all cases of dental implantation. Surely not all of us think to ourselves when reading this: ‘Isn’t it too good to be true?’ The advantage of both incisionless (flapless) implantation and immediate implantation is speed, but decisions must be made carefully. Otherwise, we will once again be faced with the old truth of life that we have to sacrifice something for speed. That sacrifice may be the aesthetics, precision and durability of the prosthesis.

Unlike traditional implantation, which is performed in stages several months after tooth extraction, when performing immediate implantation, we must predict how the bone will remodel after tooth extraction – whether the implant will remain covered by bone, whether the gums will recede, and whether the aesthetic appearance will be preserved. One of the advantages of immediate implantation, which is speculated about in popular literature, is that it stops bone resorption, which begins after tooth extraction. Unfortunately, scientific research shows that this is far from the truth. Immediately after tooth extraction, the layer of bone that held the tooth ligaments always shrinks. This always happens, regardless of the use of implants or bone substitutes. It is unfortunate that we do not yet have artificial materials that can radically change the natural biological processes of bone remodelling. Initial bone resorption continues for one and a half to two months after tooth extraction. The bone continues to heal for several more months. This is followed by secondary bone resorption, as that part of the jawbone no longer receives any load. If the bone is not stimulated, it deteriorates. Dental implants help to prevent secondary bone resorption, as they act like tooth roots, loading the jawbone and forcing it to strengthen.

This means that, according to scientific research, the most convenient time for the least risky implantation is several months after tooth extraction, when the initial, inevitable bone remodelling has ended but bone resorption due to inactivity has not yet begun. In addition, if we implant after the initial bone resorption has ended, we can clearly see how much bone is missing and needs to be grown (see “Gingival augmentation”).

That is why implantation immediately after tooth extraction is not always the best method. Immediate implantation is only one of the possible methods of implantation. If we want a predictable and long-lasting result, it can be used when the tooth was covered by a thick layer of bone and thick gums and when the treatment is performed by a highly experienced professional.

Does an implant always fuse with the bone?

Only a few percent of all implants fail to fuse. This usually happens within the first month after implantation. The main symptom is that the implant feels loose. Patients usually do not even feel it. An implant that has failed to integrate can be easily removed and a new one fitted after a few months. At our clinic, implants are replaced free of charge.

Can all patients undergo implantation?

In general, implantation cannot be performed on patients whose overall health does not permit tooth extractions. It is essential that any existing medical conditions (high blood pressure, diabetes, etc.) are under control. Advanced age is not a determining factor. After all, it is older people who most often begin to feel the lack of teeth, which is why they undergo the majority of dental implant treatments.

When is bone grafting performed?

Just like natural tooth roots, implants need to be covered with bone. This means that if there is not enough bone in the jaw where the tooth is missing to hold the artificial root firmly in place, a bone grafting procedure is performed before or at the same time as the implant placement.

How are dental prostheses on implants maintained?

Special care is usually not required. Implants are cleaned in the same way as natural teeth. In cases where there are no natural teeth left in the mouth and prostheses are held in place by implants, it is recommended to use toothpaste that does not contain fluoride compounds (see “revention of oral diseases” ). Unless otherwise instructed by your doctor, you should see a dental hygienist twice a year for professional cleaning and to check that the implants and remaining teeth are in good condition. High-quality and regular cleaning is essential for long-term use of implants and to prevent gum and bone inflammation.

Are dental implants long-lasting?

Restoring lost teeth with implants is one of the most long-lasting and advanced methods in prosthetics. Teeth are most often damaged by decay, but implant prostheses are definitely not. It should be remembered that we are not referring to natural teeth, but to prostheses. A dental implant is a very good replacement for a bad tooth, but it is not comparable to healthy, natural teeth. Porcelain coating is more likely to chip off prostheses on implants than prostheses fixed to teeth. Fortunately, it can be fixed.

In general, the longevity of implants is determined by:

• The initial condition of the bone and gums, as well as the patient’s ability to maintain good oral health;
• The professionalism of the dentist;
• The choice of a good implant manufacturer;

What is a dental implant?

One of the most modern and successful methods of restoring lost teeth is dental implantation. This is not a brand-new treatment method. It was used even in ancient civilisations. The first modern procedure of this kind was performed in Sweden in 1965. With the rapid development of implantology in recent decades, dental implantation has become an everyday phenomenon in practical dentistry.

A dental implant is an artificial root in the form of a screw that is inserted into the bone, to which a crown is attached.

How do dental implants hold in the bone?

Macroscopic and microscopic unevenness is created on the implant surface. Since the implant is made of a material that is compatible with the body, the bone simply grows over it and locks it in place. This is called the phenomenon of osseointegration. The ability of titanium to osseointegrate was discovered in Sweden in 1957.

What materials are dental implants made of?

Dental implants are usually made of titanium (Ti). This metal is widely used in medicine because it is highly biocompatible with natural tissues. The body does not recognise titanium as a foreign material. Allergies to titanium occur in 0.6% of the population.

The fabrication of dental implants from other materials (e.g. zirconium oxide ceramics) has not proven to be sufficiently effective in practice.

Who fabricates dental implants?

Currently, there are hundreds of dental implant manufacturers. The manufacturer is chosen by the doctor, as well as by the patient, based on their own reliability criteria. Very often, the decisive factor is price or marketing tricks. However, the long-term prospects of using dental implants are sometimes overlooked. After all, these “objects” are fitted inside our bodies.

When choosing an implant system, you need to have clear answers to the following questions:

• Do the people who manufacture the implants and ensure their quality have a high work ethic?
• If the implant fails to fuse, will there be any doubt that this could be the fault of the manufacturer?
• How does the bone react to these implants over time?
• Do these specific implants have any scientific basis?
• Is the quality of this manufacturer’s products continuously monitored by independent experts, and are long-term clinical studies conducted?
• Is this an old and reliable manufacturer that values its reputation?
• Is there a risk that the manufacturer will disappear one day, leaving you without the necessary information for future maintenance of the implants?
• Is the manufacturer well known among implantologists and will it be possible to repair the prostheses in different countries?

Although almost all dental implants are made from similar materials, they are not made by the same hands.

At our clinic, we use dental implants of varying prices, but only from reliable manufacturers, taking into account our patients’ needs. For example, we use implants from Dentsply, Swedish Astra Tech and Swiss Straumann (see: www.implantsforlife.com, www.dentsplyimplants.com, www.straumann.lt , www.straumann.com).

These long-standing manufacturers with a high work ethic are rightly considered to be among the most important creators of the “implantology bicycle”. The scientists who developed the Astra Tech and Straumann implants were the ones who made a number of fundamental discoveries that are now indispensable in modern dental implantology: they were among the first to use a precise, conical tooth crown-implant connection and the concept of different platforms, and they were the first to roughen the surface of implants and use microgrooves in the neck. As a result, implant systems by these manufacturers are known worldwide as the most scientifically proven dental implant systems and the most effective at protecting the jawbone over the years.

Implantation is a type of dental prosthesis that restores all missing teeth. Both the roots and crowns are restored. In other words, implants restore a tooth or all teeth when they are completely missing and cannot be replaced with other types of prostheses.

How are lost teeth restored in general?

When all or some of the teeth are lost, there are basically four options available.

• Missing teeth can be restored using removable dentures (bars, full or partial dentures). This is the cheapest and fastest option, but it is the most inconvenient in every respect and requires the longest adaptation period (see the service “Dental prosthetics”)..
• Missing teeth can be restored using bridge prostheses (see the service ‘Dental prostheses’). This is a quick and convenient solution, but it will require grinding and prosthetics of the adjacent teeth next to the gap. If the adjacent teeth are severely decayed, prosthetics will strengthen them. However, if these teeth are healthy or relatively healthy, grinding will shorten their lifespan. In addition, by damaging what is still healthy, we are violating the principle of medical ethics: first, do no harm (Latin: Primum non nocere, this principle was formulated according to the works of the famous Hippocrates).
• Missing teeth can be restored using implants: adjacent teeth will not be damaged and there will be no need to remove dentures.
• Lost teeth may be left unrestored. Technically, it is almost always possible to restore a tooth, but this depends greatly on the patient’s financial capabilities. Today, there is no reliable scientific evidence that it is necessary to have thirty-two or twenty-eight teeth throughout one’s entire life. How many teeth does a person need? It is a very individual matter. That is why, the first thing to do is to ask the patient how many teeth they specifically need to chew food normally, speak clearly and look good. The answers vary greatly. We all have very different needs, but there are some patterns. First of all, it depends on age. Older patients say that they need twenty teeth in a row, with no gaps, standing opposite each other (ten in each jaw). Interestingly, children also have twenty milk teeth and do not complain about missing any. However, let’s analyse what it means to have twenty teeth: no molars, only front teeth and canines. This is certainly enough for chewing food and speaking clearly (many older patients say that they have enough with fewer than twenty), but not everyone will like the fact that when they speak and smile, the end of their teeth will be visible, i.e. black gaps at the corners of their mouths. This means that for aesthetic reasons and to look good, you need to have at least one molar tooth. Therefore, according to most people, the minimum number of teeth required for chewing, speech and aesthetics is twenty-four (teeth on each side of the jaw up to and including the first molar).

What is a dental implant?

One of the most modern and successful methods of restoring lost teeth is dental implantation. This is not a brand-new treatment method. It was used even in ancient civilisations. The first modern procedure of this kind was performed in Sweden in 1965. With the rapid development of implantology in recent decades, dental implantation has become an everyday phenomenon in practical dentistry.

A dental implant is an artificial root in the form of a screw that is inserted into the bone, to which a crown is attached.

How is a traditional dental implant procedure performed?

1. During the first appointment, the condition of the patient’s remaining teeth, gums and jaws is assessed and a treatment plan is drawn up. This requires a panoramic X-ray showing both jaws with the remaining teeth. If there are any uncertainties, the doctor may recommend additional examination of the jaws using a CT scan.
2. A dental implant, like a natural root, must be fixed in the bone. Therefore, after thoroughly administering anaesthetic, an incision is made in the gum where the tooth is missing to expose the bone. A hole is made in the bone using special sterile drills, into which the artificial tooth root is screwed. If the implant is well fixed and covered with bone on all sides, a higher cap is immediately placed, which protrudes slightly from the gums like a small metal tablet. If the artificial root is poorly fixed in the bone or bone grafting is performed (see the treatment “Bone grafting”), a low cap is placed and the implant is completely sutured under the gums.
3. The patient is invited for a check-up after a week, and the stitches are removed.
4. Depending on the initial condition of the bone, after three to six months following implantation, a custom-made tooth crown is fabricated. The tooth can be fixed to the implant with special cement or screwed in with a screw. At our clinic, we usually use screw fixation so that the prosthesis can be easily removed and repaired if necessary.

Is implant surgery painful?

Implant surgery is carried out under local anaesthesia which means that the patient does not feel any pain during the treatment. After the surgery, painkillers are prescribed in case of discomfort. If extensive implant surgery or bone grafting is performed, more severe pain, swelling and bruising may occur during the first week. However, there is no pain during the entire healing period of the implant (three to six months).

After any surgery performed at our clinic, all patients receive guidelines on how to take care of their mouth, what to eat, what symptoms are normal after the surgery, and when to contact the doctor immediately.

Is it possible to implant without incision?

Incisionless implantation (also known as flapless implant surgery) is a quick treatment that causes minimal post-surgical discomfort for the patient. The dental implant is inserted through a small opening in the gum. As the entire opening is covered by the implant cap, there is no need to suture the wound.

This method is used in our clinic when the jawbone is wide enough at the site of the lost tooth and has sufficient bone and fixed gums (see “Jawbone augmentation” and “Gingival augmentation”). Incisionless implant surgery can only be performed by a highly experienced doctor; otherwise, the lifetime of the implant will be significantly reduced.