Dental Implants

Dental implants are artificial tooth roots, usually made of titanium, used to support dental restorations such as crowns or bridges. Implants have long overcome their initial problems and present a standard restorative procedure in modern dentistry. They are applicable for a wide range of indications and represent a long-term substitute for conventional dental bridges and dentures. Implants can also be used to stabilise and support removable dentures or a full-arch fixed bridge.

There are a few cases in which dental implants are not to be recommended because of a specific condition of the jawbones (upper, lower, height, width and density), teeth and certain diseases such as some types of diabetes.

Can every patient have implants?
First of all, it must be checked whether the general state of health allows dental implant surgery. Then it is very important to determine if there is sufficient bone for implants to be inserted. If this is not the case, there are several surgical techniques for bone augmentation to make subsequent implantation possible.
How long is the healing period?
The healing period for dental implants is 2-3 months for the lower jaw and 6 months for the upper jaw.
In which cases are dental implants indicated?
Restoration of a single missing tooth to close the gap. In this way the healthy neighbouring teeth can remain intact instead of being prepared for bridge crowns.
Restoration of chewing function in cases of molar loss, the so-called “open-end” situation, where bridge restoration is not possible owing to the lack of at least one bridge-supporting molar.
Denture support in case of toothless jaws, providing excellent attachment and improvement in chewing function.
In all cases where the patient prefers a fixed restoration of a single, several or all missing tooth/teeth to a removable one.
Can the implant surgery fail?
Implant surgery can fail when the implant does not integrate with the bone or the tissues surrounding the implant become inflamed (peri-implantitis). This can occur as a result of sub-optimal bone preparation procedures, residual bone inflammation, premature loading or overloading of the implant.

Patients who smoke and patients with insufficient oral hygiene have a considerably higher risk of failure. The failure does not increase proportionally with the number of implants or the length of the surgical procedure.

An edentulous jaw is nowadays a routine case for dental implantology. Studies of such cases show a success rate of 97–99%. More difficulties are encountered with implants placed in visible areas of the upper jaw, especially if the teeth have been lost due either to trauma or inflammatory processes. The loss of bone substance in the upper jaw is usually much higher than in the lower, thus making remedial and reconstructive implant treatment more difficult.

Some implant manufacturers offer a guarantee period of up to ten years. This means that if the dental surgeon and the manufacturer agree, the patient can have new implants free of charge. Natural teeth always have natural movement. This is not the case with implants, which are rigidly anchored in the jaw. A loose implant means insufficient bone integration, which may necessitate its removal.

As a rule, implants do not fail – as with some other transplanted organs – because of the rejection by the immune system, but because of localised inflammation of the surrounding tissues. Such inflammatory processes are often induced by parodontitis or deficient oral hygiene. Bacteria can access the tissues at the gum line of the implant and cause an inflammation (peri-implantitis).

Most failures resulting in implant loss occur during the bone integration period or in the first 18 months after the loading.
What happens until I have my finished implant?
Basic remedial treatment – before

Before you can proceed with implants, all remaining teeth, the gums and the jawbones have to be restored to a healthy state. There is no point in inserting an expensive dental implant next to an old and defective amalgam filling or if the gums are inflamed and thus endanger the healing process. This means that the costs of the preceding remedial treatment have to be added to the costs of the implant and its superstructure in form of a crown or a bridge.

Bone grafting

In some people, the bone is simply too narrow and/or shallow to provide a stable foundation for an implant. The problems or insufficiencies in the underlying bone structure do not automatically eliminate you as a candidate for dental implants. With modern bone grafting (bone augmentation) techniques, you can still benefit from the superior qualities of dental implants over dentures or removable bridges.

A bone graft is a way of building up your existing bone so that it can provide a suitable base for implants. The bone in your jaw can be stimulated to grow either through natural or synthetic means. Your dentist will be able to help you determine the best method of bone grafting for your specific case. One or more of the following might be appropriate:
  • Collecting bone from your own mouth as the implant site is prepared and reusing that bone for grafting purposes. This is the simplest method of bone grafting and can be done from the dental chair.
  • Synthetic materials are sometimes used to stimulate bone growth, or your own blood factors can be used to help promote growth or accelerate the process.
  • In cases where the top jaw above the back teeth has insufficient bone to hold implants, the sinuses are lifted and bone is inserted into the sinus chambers to grow enough structure to secure dental implants.
  • Occasionally, it may be determined that the best course of treatment is to take bone from another part of the body (the hip is common) and use it to build the necessary bone in the mouth for dental implants. In this case, the dentist will work alongside a surgeon in a hospital setting. This option may be the lengthiest in terms of surgical time, but the success rates are high.
  • Sinus lifting is another surgical procedure for bone augmentation in the upper jaw. The dental surgeon thickens the inadequate part of atrophic upper jaw towards the sinus with the help of bone transplantation or synthetic bone, which lifts the bottom of the sinus and uses the sinus cavity to augment the bone. This allows dental implants to be placed in the bone of the upper jaw.
The goal in each of these cases is to help the patient grow new and healthy bone tissue that will support the dental implant procedure. Depending on the type and extent of bone grafting, the healing period can be three to four months. In some cases where the scope is less, bone grafting and setting of the implant can be done in one session.

Insertion of implants

This stage involves boring one or more holes into the recipient bone and inserting or screwing in the implant(s). The surgeon stitches the gums over the implants. The procedure is done under local anaesthesia – or rarely general anaesthesia or sedation. Light pain, swelling and/or haematoma can be expected immediately after the surgery. As with all other surgeries, the recovery depends on a number of individual factors, such as the general health of the patient, complexity and extent of surgery. Dental surgeons say that removal of a wisdom tooth is more unpleasant. Some patients are incapacitated for a week and others, especially after immediate placement, as it is called, go to work the next day without any noteworthy problems. On average, patients qualify the pain as a 3 on a scale of 1 to 10.

Whether all the above treatment steps are carried out in a sequence with longer intervals in between them or in one single surgery depends on the case in question. The implant, mostly made of titanium alloy, grows together with the bone in a process called bone integration (osseointegration). The time required for an implant to become bone integrated is two to three months for the lower and five to six months for the upper jawbone. After this period the implants are loaded with the planed restoration and the treatment completed.
What is an immediate placement implant?
Immediate placement implants are placed into a tooth extraction site either immediately or just a few days after the tooth extraction. Immediate placement means in no way immediate loading of an implant. The loading of the implant with restoration is possible only after the bone integration interval, as required for standard implant procedures. An immediate placement can be carried out when the implant is placed in a single-root tooth site (usually), with well preserved, healthy bone and mucosa around it. The advantages of immediate implant placement are:
  • Reduction of overall treatment time
  • Preservation of bone substance
  • Sparing of treatment steps
This treatment is well documented, but should be carried out by a specialist in dental implantology.
What are the success rates?
Dental implants have long been approved as best practice treatment. The probability that an implant will still be fully functional after five years is 85–95% for the lower jaw and 80–90% for the upper jaw.
What you should clarify with your dental surgeon
Ask your dental surgeon

  • What is the expected life of the planned dental implant assuming proper oral hygiene?
  • What are the risks involved in the procedure?
  • What are the costs, even in case of failure?
  • Can the procedure be repeated?
  • What is a success and what a failure?
  • Will the dentist carry out the treatment alone or with another specialist?
  • How many similar surgical procedures has the dentist performed in the previous year?
  • How many of these were successful?
  • Which brand of implant is used and how long has the manufacturer been on the market? This is especially important because of possible need for replacement parts. A number of new manufacturers appear each year on the market, but they also tend to disappear rather quickly.

Additional aspects you should consider

  • Does the dental surgeon or the team invest sufficient time in counselling?
  • Are your questions answered specifically?
  • Is the dentist responsive to your needs?
  • What is the quality of the technical equipment? Is there a panoramic X-ray or CT?
  • What kind of specialist training does the dental surgeon have?
Advantages and disadvantages of dental implant restorations

  • Neighbouring teeth remain intact
  • Implants prevent jawbone degradation, unlike restorations with a number of bridge or dentures types
  • When used as denture anchors, implants prevent denture movement and/or sore spots on the gums
  • Implants allow stronger bite than dentures
  • Speech remains widely unaffected


  • Not every patient and every jaw is suited for implants
  • Single-tooth restoration is relatively uncomplicated whereas larger restorations may involve much longer treatment intervals and several surgeries
  • Implants are rigid, without nerves or flexibility – some patients report “foreign object” feeling
  • Essential prerequisite is careful and thorough oral hygiene
  • Substantial costs: average total costs in Austria for a single-tooth replacement with a dental implant and a crown, in a standard procedure without bone grafting or sinus lift, are from €1,800 to €2,500.*

*(Association for Consumer Information (2010): “Teeth: fillings, crowns, implants, orthodontic braces, orals surgery – how to recognise quality and compare prices”