How are lost teeth restored in general?

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.