Tania Hadjipanagiotidou for dental implants

Η dentist Tania Hadjipanagiotidou talks about dental implants.

What are dental implants? Why should we use them? And why should we choose them over other treatments?

- A dental implant is a titanium screw that restores the root of a lost tooth. It is placed inside the jawbone and used as a base to restore one or more teeth, i.e. in the case of missing one tooth we place one implant, in the case of missing three teeth we usually place two implants and a bridge over these two implants with three teeth. It is the most conservative method of restoring the gap, the loss of our teeth. I choose it over other techniques because for a tooth that's gone, I place a new tooth, basically I don't disturb the adjacent teeth to put a bridge in. Bridges have been used for many, many years in dentistry and have solved and solve many, many problems, but in the case of a bridge I have to prepare, grind down the adjacent teeth, which may have been healthy or with small fillings. In this case my method is not conservative at all. So I choose to build an implant in my gap to restore my tooth loss rather than go to some techniques that interfere more with my teeth. There are also cases where I can't put in a bridge because I don't have a back bracket. In these cases it is necessary to put implants, otherwise our only solution would be a mobile denture or denture replacement if we are missing the teeth of the whole upper and lower jaw.

- So why would I prefer a replacement with implants over a denture?

- The denture is a mobile replacement, i.e. it goes in and out. I take it off, rinse it, put it back on, it has nothing to do with having a stationary substitute in my mouth, i.e. having my teeth practically in my mouth, like when I was 14 - 15 years old! Exactly the same thing happens to a person who is missing teeth or several teeth. In the case where he was to have a full denture, because he's missing all the teeth in the upper and lower jaw, I usually place six implants in the upper jaw and in the lower jaw I may place four implants or maybe four upper and four lower depending on the situation and do a mobile restoration. So it puts my mouth back to where it was when I was basically 14-15 years old.

- Very nice. Is it necessary to do a study of the prosthetic restoration before placing the implants?

- Yes, usually a prosthetic restoration study is done, so that the whole restoration with the implant is prosthetically predictable and the restoration is more functional and more aesthetic. We take some impressions, we do a study beforehand, and that way we know exactly where we want to place the implant and at what angle we want to place it. Now, if the jaw helps with that, meaning our bone at that point helps, it's even simpler, otherwise we find the right way to do it, so that the result remains aesthetic, but doesn't require too many interventions with grafts and so on.

- Can everyone get implants? How do I know if dental implants are right for me?

- All are good candidates for implants. What we do first of all is take a medical history where we ask what medications one is taking, if they have any general diseases. In the case that everything is in order, that is, he is not taking any medication that would prohibit us from placing the implants at that time, and he is not suffering from any other general disease, in which case we will then have to do a pre-treatment to place the implants, everyone else proceeds with a CT scan of the jaw that shows us the quality of the bone. So I see the height, thickness and quality of the bone where I want to place the implant and based on that CT scan I do the study and choose which implants to place in which places. So with a good medical history and with a pre-treatment in case someone is taking some medications that are against this procedure or suffering from some general disease, everything else is a routine case.

- Can you tell us now what the phases of implant treatment involve?

- First of all, as I said, we take a de-scan, that is, a study is done based on the CT scan of the jaw, we see the bone, we choose which implants we will put in and a prosthetic study is done. So I see where the implants need to be put in and then we usually get some antibiotics. We give some antibiotics to the patient and we come in and place the implants in the mouth under local anesthesia within a day. Usually by the time the anesthesia is over, the patient doesn't even need to take a deponent. The more sensitive ones get a depon the same day, but certainly the next day nobody feels anything at all. We do have some small bumps in the mouth that don't hurt. I'm a little careful 2-3 days not to eat anything hard, but that's about it. So it's a completely painless process and very, very quick. It usually takes a quarter, ten minutes to a quarter, to place an implant in the jaw.

- Is there a chance that the body will not accept the implants?

What happens in this case and also what is the success rate of implant placement? Do we also have side effects? I mean, I want to say what we have to watch out for, what can go wrong?

 

- Implant success rates worldwide are 98% in the mandible and 95% in the maxilla. This means that the success rates are very high. There is a case of implant failure. So I can place an implant and after a week or a few days I can see that there is some inflammation or some swelling there. In this case it may mean that an implant has failed or it may happen that I do a posterior loading, i.e. I put in the implant and place the tooth two and a half to three months later and then I see that the implant has not bonded well in the jawbone. In both of these cases, which are extremely low percentages for this to happen, nothing happens to anyone, I just remove the implant, clean the area and either place an implant in an adjacent area or wait a month to a month and a half and place a new implant back in the same place. So nothing happens to anyone, it just takes a little longer to recover.

- How long can I wait until I get new teeth and what will I have by then?

- There are two ways of placing the teeth. One is immediate loading, i.e. I do the surgery today and place the teeth today or tomorrow and there is also the delayed loading, i.e. I place the implants today and the teeth are placed after two and a half to three months. Depending on the patient's case, one or the other method is chosen. When an implant is placed very tightly in the jaw, I have the possibility to place the teeth on the same day, i.e. immediate loading. Of course, the success rates are a little bit lower in this case, so if someone is not in a hurry for some business reasons or whatever and there is no immediate aesthetic issue, we usually choose to put the teeth in after a period of time rather than on the same day, because the success rates are a little bit lower.

- Will people know I have implants?

- No, that's the goal and the bet: so that no one will know that we have done any kind of restoration in the mouth, either with implants or with any other procedure. Modern materials are very similar to our natural teeth in shape, in transparencies, in everything. In addition, the way the implants are placed, the gums, the healing of the gums around the implants, all of these things play a huge role in ultimately having a very, very natural result. In no way can one understand that we have something foreign in our mouth and even the behaviour of an implant is like a natural tooth, since it is a fixed restoration, it does not go in and out of the mouth, as it is permanently attached. I brush them like I brush my natural teeth, I eat what I eat with my natural teeth. I don't do anything differently than I would if I had my natural teeth and given the quality and texture of the modern materials that dental technicians use for porcelain, we get a very, very natural result.

- Are the implants essentially as strong in the chewing process?

- Yes, they are as strong as natural teeth, they need the same brushing as natural teeth, which means I have to take care of them as I take care of my natural teeth. The only thing I have to take care of after the implants are placed is to learn to brush my teeth and the implants effectively, that is, the teeth on the implants. In fact, as far as how to brush, I insist very much and we learn it here in the office. I even suggest some specific toothbrushes that I like and the patient comes in and we do a lesson on how to brush their teeth from there on out. It's something very, very easy, but no one has taught it to us. We are not born knowing how to brush. When a patient leaves here after the restoration with implants, he will also learn how to brush, that is, he will get a brushing master, so to speak, so that he will never have a problem with either his teeth or his implants again.

- How many years is the lifespan of the implants?

- Implants last for many, many years, we are not yet able to say scientifically how many years an implant can last. There is, of course, the ageing of the tissues, that is, if someone places an implant at 20, we do not know at 80 or 90 whether this implant will remain in the mouth. There is tissue aging and bone resorption. It's a proven fact and from there, how I take care of my teeth plays a huge role. Whether I clench my teeth, i.e. grinding, also plays a huge role, as in recent years too many people have developed grinding, i.e. clenching or grinding of the teeth at night while sleeping. All this must be taken into account and there must be specific prevention. Has anyone had implants? They need to learn how to brush, to come in every six months to at least have a check-up. He may not need anything at all, but he should come in to have an x-ray taken, see how he brushes, see if there is any inflammation in his mouth, and in case there is a roar, wear a mouth guard at night when he sleeps to avoid side effects on his teeth and implants and everything else will be fine.

- If someone has lost teeth from periodontitis, can they be replaced with dental implants?

- Yes, it can be done. When I lose teeth from periodontitis I have lost bone that supports my tooth, so surely at that point the jawbone will be a little higher. We usually find bone a little higher to place the implant, but especially if it's in the cosmetic zone, we may need to do some graft preparation to make the final restoration more aesthetic. However, it is done and it is a very common procedure for teeth lost from periodontitis to be restored with implants.

- In another case of tooth loss, is it better to have a conventional bridge or an implant?

- We all understand that placing an implant in the place where I am missing a tooth is the most conservative restoration, i.e. I lost a tooth, I put in a tooth, I don't worry about the adjacent teeth, the adjacent teeth, the front and the back. In the case of the bridge, I have to grind the front and back tooth, that is to remove dental substance around and above, so that the porcelain bridge can eventually be put in and restore the gap between the teeth. Of course, bridges have worked for many, many years in dentistry and in fact the new bridges, with the ways we make them and the new systems that dental technicians use, are both very aesthetically pleasing and very, very durable. They absolutely protect the teeth and are very, very tissue friendly, but I still have not had my teeth intervened on. Placing an implant does not interfere with the teeth, as I place an implant in the gap and restore it permanently.

- When a woman is in menopause, is the bone able to accept implants?

- All these are checked by X-ray. Usually there is no problem from menopause. With certain techniques I can place implants even in a bone that has a small problem. Where there is an issue is in the medications a woman can take during menopause. There is a certain category of medication that prohibits us from placing implants directly and in that case we make a consultation with her doctor. Maybe she can stop the medications, her anti-osteoporosis medications, for a short period of time or we can count the time since she has taken her last dose of the medications and wait usually 3 months to put in the implants. After 3 months she can get her treatment again. So only the osteoporosis drugs are the ones to watch out for in the case of menopause and that's because they can create some side effect there.

- If someone is a smoker and smokes 20 cigarettes a day is there a problem for implants?

- We all know that cigarettes damage teeth and dental tissues, so it would be a good thing if someone stopped smoking. But we know that it is difficult for someone to make the decision. So it is not a deterrent to smoke, although we would prefer not to smoke, but since we do smoke, we place implants in those cases as well. Besides, the check-ups are frequent, so once every six months someone has to come in to have their implants checked and learn to brush their teeth very well. So we are not changing the treatment for someone who smokes, as you said 20 cigarettes, to someone who does not smoke. It is the same way of dealing.

- Are there any diseases that do not allow the use of dental implants?

- As I said before, in case we have osteoporosis and we are taking some medications, a check should be done, when it started, how long a woman has been taking these medications and when she took the last dose. Usually a lot of times we take these medications in an injection once every six months. If they're pills, to know how long a woman has been taking these pills so that she can stop treatment for a period of time or if she's taken, if she's had the injection, it's been a quarter usually, depending of course on how long she's been taking them. After we place the implants she can then resume her treatment again.

On the other hand there is diabetes where there has to be a study, that is, we have to look at blood sugar levels. If it is too high there is a relative contraindication, because high sugar affects the dental tissues, the bone and therefore the implants too much. So that's where you have to do a study, adjust the sugar and then place the implants. Now medications that one may be taking, such as anticoagulants, for certain conditions and there is a little bit of groundwork done there in consultation with the cardiologist. In this case there is no issue, that is after a small change in treatment within 2 to 3 days we can put implants in.

- Is there an age limit for implants? Is someone, say, too old to get implants?

- No, there is no upper age limit. There is a lower age limit, since you have to be over 18 years old to get implants. There is no upper limit, as there is no contraindication to having implants at an older age. Equally at older ages, where there is usually more tooth loss, is where most of our patients are. So there is no contraindication because of advanced age and as long as of course our patient's health is good, we proceed with the restoration as normal.

- In conclusion, we would like to ask what are the conditions

 for the placement of implants, if there are generally any requirements?

 

The prerequisite is that the corresponding bone exists, but even if the corresponding bone does not exist where I want to put the implant, I create it. How do I create it? I create it with grafts that I place in the area. I may have to wait a period of time for the graft to set in case I don't have enough bone and then place an implant, but I may have little bone loss and be able to place the implant and graft together.

Everything else with the general health issues we check and get them where we want them so we can place the implants. Otherwise there is no other restriction. We do this particular study at the beginning with x-rays, initial impressions and I proceed to the implant rehabilitation which is a very, very easy solution, completely painless, very quick and which really resets, brings back time, which means I'm back to 14 to 15 years old. I tell my patients very often that there are people who wear dentures for years and they decide at some point to throw them away and get implants. Then they go back to their 14 - 15 years and they can't believe that they no longer have to have anything in and out of their mouths, that I have my teeth like I had them when I was a kid!

 

One last question. In such a case, by throwing away the dentures and putting in implants, the teeth will actually be nicer, which means the smile, if I understand correctly.

 

- I'm not discussing it! The aesthetics are now impeccable with the new materials used by the dental technicians in the dental implants and with their correct placement by us in the right places. The restoration is very natural, it's harmless, nothing moves, I eat and drink what I want, as long as I brush properly and have the checkup that I need once every six months.

 

- Very good, Mrs.Hadjipanagiotidou, thank you very much!

Images with dental implants

Here we show a picture with dental implants. See the improvement in the patient's smile:

At the following link you can see more pictures with dental implants, before and after treatment.

 

 

 

---