Dentalnews (en)

As promised, today we shall give you a detailed explanation of yesterday’s implant x-ray!

What are the problems that should have been fixed before implanting, but weren’t?

Let’s begin with the diagnosis:

• Localised periodontitis (the red streak in the upper jaw on the left outlines the bone), it is obvious that in this area the bone has receded due to inflammation; periodontal treatment should have been performed before implanting.
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• Infected bone in several places (red circles); these infections should also have been treated before implanting.
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• Several teeth which received very poor root treatment (red arrows); root treatment should have been redone – correctly
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• A tooth, probably dead, which is causing an inflammation in the maxillary membrane (blue arrow and blue line); root treatment followed by general treatment of the entire maxillary sinus would have been the right thing to do

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Implants, in and of themselves, are an excellent way to provide your jaw with a permanent denture. However, you do have to make sure that the mouth is well prepared and there are no other problems which would prevent the implant from settling in properly!

Dental implants may be hazardous to your health!

This female patient received dental implants at a clinic in a large European city 2 days ago. Before the implants were inserted, she informed her doctor that she felt pain in her jaw every once in a while – in various places. The dentist replied „we’ll take care of that later …“
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Question is, when? It would have been much better practice to „clean up“ the patient’s jaw before inserting an implant, as inflammations in the mouth can lead to implant loss.
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Tomorrow we will explain the x-ray to you in detail, until then you can try to figure out where the problems are. In order to „read“ the x-ray correctly you will simply need to watch the following video.

Receding bone around implants

Bone sometimes tends to recede slightly around implants. You may not even feel any pain!

About 0.2 mm a year is considered „normal“. This is usually attributable to the implant system used, for example Astra® and Ankylos® implants hardly cause any recession at all. Actually, these systems often cause bone to accrue beyond the head of the implant, due to the conical connection of the abutments. Watch a video on this topic here.

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If bone recedes more than 0.2 mm, this may be due either to a bad positioning of the implant or an inflammation. Dentists call this peri-implantitis. This can only be treated in the initial stages, making regular check-ups‚ called re-calls, after implantation a must. This can help save your implant!

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An x-ray plainly shows the outlines of the bones.

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Watch a video on dental implants here!

Is a dentist with the title„Master of Implantology“ better able to perform implants than a “normal” dentist?

Master here, Master there, Master Master everywhere. There is more and more talk of additional training to become e.g. a “Master of Oral Implantology”.  This training has to be paid for but does not really say much about the actual skills of a dentist.

There are various reasons for this: first of all there are no general standards for these courses, some last a few days, others years. It also depends on why the dentist is doing them – some do it for the certificate, others to further their education.

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Another example should illustrate the problem of additional studies:

A doctor works in a hospital and handles broken jaws, tumors etc, but has no Master’s Degree. However, during the course of his or her career, s/he has performed innumerable operations on bones and hundreds of implants.

Another dentist takes a one-year course to become a „Master of Implantology“ but may only have actually attended 200 implant settings and only performed about 20 of them. Whatever institute charges the dentist for the course may not check to see how well the dentist works while performing this procedure …

Who would you rather have performing your implant?

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Don’t let certificates fool you, instead ask dentists how long they have been performing implants and where they have worked before. You have the right to ask these questions, and don’t get “taken in” by a dentist’s age …

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More information on this topic here!

What is the best type of bone to use in reconstruction?

If parodontitis goes untreated for a long time, or teeth are lost and not replaced, then bone starts to recede. And once it is time for a dental implant, there may not be enough bone matter available to support the implant.

Fortunately, there are various materials available to reconstruct bone, but which one of them is the best?

A rule of thumb is that the more similar replacement bone is to human bone, the better it heals. The best bone to use is the patient’s own – as long as the chunk of bone used does not exceed a specific size – you can find out more on that here.

From a certain size onwards it is better to use purified replacement bone, ideally human bone, or animal bone, for example from cattle. Bone substitutes can also be produced, e.g. from algae. Synthetic bone takes the longest to heal, although research is still being done on the subject.

It does not help to infuse bone from a donor with your own cells.

It is much more effective to mix replacement bone with your own blood – this is usually enough, and facilitates absorption during an operation, but it is unclear whether it helps healing.

There are many studies on this topic, but they are often poorly structured and do not observe evidence-based medical guidelines. Moreover, many of the materials used to replace bone are distributed by doctors themselves, and they all have their favorites, so it is hard to remain objective!