Dentalnews (en)

Which therapy is appropriate for me-root canal treatment or an implant?

There are endless horror stories about “dead” teeth, meaning root canal treatment was performed. But: There are no such things as “dead” teeth. The tooth is a mineral and thus “lifeless”.
The tooth has a connective tissue- pulp. If the pulp gets infected, e.g. caused by cavity, a root canal treatment should be performed. If a bad root canal treatment is performed- without a coffer dam, visual augment and sterile endo box- the root treated tooth is like poison for the body!
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A well  treated root canal on a tooth can last a whole life!
The sealing of the tooth by the crown is also important-e.g. with a ceramic inlay or a crown. If the canals are well cleaned and filled as well as the ingresses are sealed by inlay or crown, the success rate of the whole procedure is pretty good. !
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Usually this treatment is very expensive, which lead us to the headline. It can cost 700€-1500€-prognosis and thus durability should bear in relation to the effort.
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If there are more problems (bone loss, heavy convoluted canals, focus on the root tip, big fillings) a tooth needs to be extracted. In this scenario an implant might be the solution. Remember:
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If you are a heavy smoker or you don´t like mouth hygiene that much, then a tooth implant is probably not the best choice, you try to save the tooth intensively.
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The anamnesis is important in the decision making what is the best treatment-implant or root canal treatment; it varies from case to case.

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Dentures supported by implants-different treatment waiting times

A fixed denture is always supported by bones, which means the masticatory force is either initiated by teeth or implants.

First implants has to be set in the bones, you call this an implantation. Nowadays minimal invasive techniques are standard, for example the swage technique.

Depending on whether the implant is treated with denture, you differentiate an..

o    immediate treatment

o– –immediate loading
o    open/muted  cure

If the implant is immediately exposed to the whole masticatory forces, you call it an immediate loading. It is possible if the quality of bones is ideal-especially in the lower jaw.

If the implant is immediately treated with denture, but is not exposed to the whole masticatory forces-the tooth is made smaller-it is called immediate treatment.

Whether the implant is loaded immediately or afterwards depends on different factors, especially on the quality of bones. Another factor is the extent of the implantation. For example, if a bone set up surgery is made in the same session, the mucous membrane is sutured tightly-a muted cure.

Sometimes the bone quality is not adequate for an immediate treatment. This would be a risk, since the tooth can be loosed before it is healed by the nutrition and/or the tongue. Either the implant is cured muted, or a so called gingiva shaper is fixed. The gingiva shaper saves the clearance surgery after the cure is done. You call this an open cure.

It is called muted cure if the implants are cured below the mucous membrane, so that the bone set up material cannot be infected-a bone loss would be the result. Through the mucous membrane occlusion the area of operations is protected from bacteria in the oral. The disadvantage of immediate treatment, immediate loading and open cure is the co called clearance surgery-the mucous membrane has to be open again after implant cure.

What does “dentures-supported by bones or mucous membrane” mean?

Depending on whether the masticatory force is initiated by bones (just like with your own teeth) or by mucous membrane. You differentiate from denture “supported by bones or mucous membrane”

It is called dentures- supported by bones, if  the masticatory force is located in the bones and the denture is hardly seated on the mucous membrane.

If  the masticatory force is primarily located in the mucous membrane and help remained teeth and/or implants (so called fixation elements) it is called dentures-supported by mucous membrane.

Often no fixation elements are used-  total denture. If fixation elements are used you call it a hybrid prosthesis. Better fixation can be improved through two implants. (pic. 1)You don´t need synthetic gums, but the masticatory force is not supported by these implants-so you see a mucous membrane supported denture placed on implants in this picture.

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A denture-supported by bones is trend setting in industrial countries. The reasons are:

• better comfort for the patient
• prevention of damages on fixation teeth (partial dentures-a classical example of a mucous membrane supported denture-is fixed on remained teeth)
• prevention of bone loss from the alveolar bone (Use it-or lose it)

Often a bone is not loaded naturally through a denture supported by mucous membrane (non physiological). The result is not only a bad fitting prosthesis, but also face changes (big lower jaw, small upper jaw). You can recognize bone loss because of recurrent pressure sores and/or a prosthesis, which is not fitting well anymore. The result is a denture lining-which compensate a bone loss.

Even if there are less bones left, a bone set up surgery can be made to use implants. Partial dentures and total dentures are implanted provisionally till the implants are healed.

Advantages of partial,- and total dentures opposite to implants are lower costs.

The good in your jaw, the bad in …?

Is there just one good implant system, or are all equally good?
Generally, it can be said that the systems currently on the market are by and large the same when it comes to effects on bone healing.
Although implant manufacturers advertise exceptional surfaces which supposedly speed up the healing process for bone, in practice and as shown by studies there is hardly any noticeable or proven difference. Depending on the quality of bone, dental implants take 0-3 months to heal completely, and even a little longer after operations involving bone reconstruction.
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When it comes to quality, what matters is the design of implant crowns. The dental crown is not directly connected to the implant, but rests on an intermediate layer, called an abutment (the red arrow in the picture).
The abutment is usually set onto the implant and screwed into place. This connection has its weak points, however. Some companies, such as Astra or Ankylos opted for a conical connection – and they turned out to be right!
More on this topic here !
Source: 2009_Implant-Systeme (Implant-systems)

What happens when a dental implant sticks out into the maxillary sinus?

Implants and bone reconstruction!
In order for dental implants to hold securely you need to have enough bone. But if a patient has been missing teeth for too long or suffered periodontitis, often there is not enough bone left in the upper jaw. An operation designed to reconstruct bone – called a sinus lift –  has to be performed before implanting.

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Bone reconstruction in the upper jaw
Despite the most careful planning, implants sometimes end up sticking out into the maxillary sinus. Patients must be informed, as a lot of them get dental implants without realizing that the maxillary sinus got damaged in the process.

Is there a greater risk of losing an implant?
Sinus infections may represent a risk, even during a common head cold, implants may get infected due to the lack of a protective bone layer. Then you can lose an implant.
The picture shows a patient with implants in her upper jaw (to the right in the picture). The implants (black) clearly stick out into the maxillary sinus (blue). The patient was not told about this problem – even though the implants stuck out from the very beginning. The operation took place three years ago, right now there are no inflammations around the implants – but there are some in the rest of the teeth!