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What is a titanium implant?

Implantology has developed rapidly over the past 20 years and is now an integral part of modern dentistry. Today, the implant is firmly “integrated” into the bone. This makes it possible to replace any teeth lost over the course of life with implants. Dental implants significantly improve patients’ quality of life—provided they are placed with the utmost precision and, in some cases, with the aid of a microscope.

Implants replace natural tooth roots in edentulous areas of the jaw. They serve as anchors for crowns, bridges, and dentures.

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Today’s standard implants are screws that roughly match the shape and size of a tooth root. Materials used for implant production are chosen to enable integration into the bone (osseointegration). The most commonly used material is titanium, followed by ceramic. According to professors from the University Dental Clinic in Vienna, titanium has the best success rate, with a 10-year prognosis of 95–98%.

There are laboratories that claim to detect and test for titanium incompatibilities. However, conventional medicine currently distances itself from such findings and remains highly skeptical. Nevertheless, as part of my commitment to inform you about all “treatment alternatives,” I have provided information about a laboratory that conducts tests for “titanium incompatibility”:
Laboratory Dostal, Saarpl. 9, 1190 Vienna, Tel: +43/1/368 24 72.

In our practice, we use titanium implants and abutments for crowns or bridges from Biotech Dental (https://www.biotech-dental.com). Biotech Dental abutments are also used for screw-retained or removable dentures.

How is implantation planned?

 

Thanks to the most advanced dental equipment in our office, including a 3D X-ray system from HDX Will (https://www.hdxwill.com), the bone structure is precisely recorded and analyzed before implantation. Based on this imaging data, a surgical guide (drill template) is created if necessary, ensuring that each implant is placed individually, predictably, and surrounded by sufficient bone.

How long should one wait after tooth extraction before implantation? Immediate implantation vs. delayed implantation

In principle, an implant can be placed immediately into the extraction socket after a gentle tooth extraction (immediate implantation). Except in cases involving dental trauma, this requires thorough planning. Standard procedure involves taking a 3D X-ray, performing 3D-guided computer planning, and, if necessary, creating a surgical guide. The tooth can then be extracted. A perfectly cleaned extraction socket (alveolus) is essential for predictable implant success.

If necessary, additional measures like PRF (Platelet Rich Fibrin), bone substitute material, and a resorbable membrane may be used to ensure the implant is surrounded by bone—either the patient’s own or a substitute.

The advantage of immediate implantation is that the aesthetic gum situation—especially in the front teeth area—is optimal. With delayed implantation, where a 6-month waiting period is observed, the gum may recede, making it difficult to restore. The downside of immediate implantation is a 5% higher failure rate, meaning implant loss.

If, during extraction, it becomes evident that there is insufficient bone or excessive bone inflammation for immediate implantation, or if the patient prefers to err on the side of caution, a two-stage approach is recommended. This involves extraction first, followed approximately 6 months later by implantation, possibly with bone augmentation and a membrane (delayed implantation, 98% implant success rate).

How is a titanium implant inserted into the jawbone?

Implants are inserted into the jawbone following standardized surgical techniques. The procedure is performed under local anesthesia and, under normal circumstances, is no more stressful than a standard dental treatment. Sterility is a crucial factor for the success of a dental implant. Preparing a sterile surgical field is an essential and time-intensive part of the procedure, taking about 30 minutes. As a result, the entire process for placing a single implant takes approximately one hour.

What is the actual procedure for implantation?

In principle, antibiotics are not necessary during implant placement today. However, if you prefer additional assurance to minimize bacteria in the bone, we can prescribe antibiotics for you.

On the day of implantation, the following steps can be expected:

After the office is prepared for sterile implantation, you will be invited in. Please let us know if you would like to listen to music, watch a film via video glasses, or simply relax. Once the surgical site is anesthetized, you will be covered with sterile drapes, and your oral area will be disinfected as thoroughly as possible.

The implantation then begins. If you wish, I can provide you with live updates on the progress. The implant will typically be visible through the mucosa with a cover screw or healing abutment. This method is called “open healing.”

If the implant’s stability is initially insufficient—for example, due to poor bone quality or inadequate bone volume—the implant will be reinforced with bone substitute material, covered with an artificial membrane, and buried beneath the mucosa. This method is known as “closed healing.” Such a covered implant will be uncovered 6 months later during a minor surgical procedure, and only then provided with a cover screw or healing abutment. Impressions are typically taken two weeks later, with the crown placed around three weeks after that.

You will receive sutures, which will be removed 14 days after the operation.

What happens in the days following implantation?

  • After 3 days: Post-operative check-up to monitor wound healing progress
  • After 14 days: Wound check and suture removal if necessary
  • After 3–6 months: Crowns or bridges are attached to the implant. For titanium implants, the healing time is usually 3 months, while for ceramic implants, it is typically 6 months.

 

Risk Factors for Dental Implants

  • Poor oral health: Periodontitis – inflammation of the periodontium, poor oral hygiene
  • General health conditions: Cardiovascular diseases, uncontrolled diabetes mellitus, chronic immune disorders*
  • Chemotherapy, radiation therapy: Must be strictly discussed with the treating oncologist
  • Blood-thinning medications: Aspirin®, ASS®, Eliquis®, Iscover®, Plavix®, Pradaxa®, Marcumar® require detailed internal medical clarification
  • Regular corticosteroid use
  • Reduced peripheral tissue perfusion: May occur with a combination of cardiovascular disease and hypercholesterolemia
  • Smoking: Nicotine in smoke significantly reduces microcirculation. Since implant healing largely depends on microcirculation, smoking severely impairs both the healing process and the long-term stability of implants. While implants can last a lifetime, smokers often lose them within weeks or months after implantation, or even years later. Smokers are explicitly excluded from free replacement of an implant lost within the first 2 years!

 

*You will receive a referral to an internist if you suffer from any of the above-mentioned general medical conditions to minimize both medical and implant-related complications in advance by consulting your doctor.

When do we not place dental implants?

  • When patients are taking medications such as bisphosphonates for the treatment of bone cancer or osteoporosis
  • Within the first six months after a heart attack
  • In patients with decompensated heart failure or acute shortness of breath (dyspnea) during exertion

 

Important notes:

Smoking increases implant failure from 2% to 40%. Therefore, smokers are excluded from free replacement of an implant lost within the first 2 years! However, the decision to proceed with implantation is ultimately up to you.

Chemotherapy or radiation therapy must be strictly discussed with the treating oncologist!

In cases of “poor” bone supply or “poor” bone quality:
As described above, it may also be necessary to use bone substitute material from Geistlich – Bio-Oss and a resorbable membrane from Geistlich – Bio-Gide/Perio-Gide to ensure the implant is completely surrounded by bone.

If the implant or bone situation requires complete sterility around the implant, I will cover the implant entirely with mucosa (closed healing). The implant will then heal “covered” and will be provided with a healing abutment during a short uncovering surgery 6 months after implantation. It can then be fitted with a crown 5 weeks later.

After the implant is screwed into the bone, an ISQ test (Implant Stability Quotient) is performed using ultrasound to determine how securely the implant is anchored in the bone.

Single-Tooth Implants: The Solution for Tooth Loss

For the loss of individual teeth, single-tooth implants are the preferred choice. The previously common practice of grinding down adjacent teeth is now a thing of the past.

Why Choose an Implant Instead of a Bridge?

When a tooth is lost, it creates a gap. A bridge can be placed over this gap, but this requires the adjacent teeth to be ground down to serve as bridge supports. This process necessitates healthy tooth structure in the supporting teeth. Additionally, the bridge supports can become overburdened, potentially leading to their loss, leaving two or even three teeth missing.

An alternative to grinding down the adjacent teeth is a single-tooth implant. In this case, the implant takes over the “work” of the lost tooth, rather than relying on the bridge supports.

Bridges on Dental Implants: For Multiple Missing Teeth

When multiple teeth are missing, a bridge supported by implants offers a stable and long-lasting solution. To avoid mechanical stresses, it is essential that the bridge is anchored only between implants and not between implants and natural teeth. A tooth is suspended by fibers (periodontal fibers), while an implant is firmly anchored in the bone.

On the top left, you can see a tooth suspended by fibers in the bone. On the top right, an implant fused with the bone is shown. Around the implant, the supporting fibers are completely absent!

Above, you can see a long tooth gap where two implants have been placed.

A bridge is now placed on these dental implants, restoring the patient’s chewing ability to a satisfactory level.

Full Dentures: Not the Final Destination

The complete loss of teeth does not mark the end of dental issues, nor does it mean the end of dentist visits. Traditional dentures often tend to slip and cause discomfort. When no teeth are left in the mouth, the anchor points needed to secure a denture are also absent.

However, with implants, it is now possible to “start over” to some extent. “New teeth”—dental implants—are screwed into the bone, and a denture is securely attached to them in the mouth. Depending on financial means, the denture can be permanently fixed to the implants.

Ball Anchor Connection for Dentures:
Alternatively, two implants are screwed into the bone, and the denture is secured onto the implants using “snap fasteners,” for example. This gives the patient’s own denture a more stable fit in the mouth.

Computer-Assisted Implantology: Precision through Technology
Precisely planned and executed implants minimize the risk of complications and accelerate the healing process.

Innovation Leaders: “All-on-4” and “Teeth in an Hour”
Concepts such as “All-on-4,” where implants are placed in such a way that no bone augmentation is needed, and “Teeth in an Hour,” where patients are provided with a provisional immediately after implantation, are revolutionizing implantology and offering patients quick and effective solutions for tooth loss.

In computer-assisted implantation (CI), a three-dimensional image of your bone is created using a cone beam computed tomography (CBCT) scan. The implants are then planned and placed in the computed bone image.

Subsequently, a drilling template is created using this planning. This template includes drill guides (drill sleeves) that are used to assist with the implantation process.

This drilling template can now be used for the implantation of individual teeth,

or also to provide an edentulous patient with “new teeth” on implants.

“All-on-4”

If there is insufficient bone in the posterior region of the upper jaw due to the sinuses, the “All-on-4” concept can be implemented. Using a drilling template, the implants are placed “around the sinuses,” eliminating the need for bone graft material.

“Teeth in an Hour”

With the “Teeth in an Hour” concept, implants are placed using cone beam computed tomography (CBCT), computer planning, and a drilling template. In addition to the previously mentioned steps, a provisional tooth restoration is fabricated on the virtual implants prior to implantation. This provisional is placed on the new implants in the mouth immediately after implantation.

Advantages for Patients:

  • Fixed dental prosthetics immediately after the procedure
  • No 6-month phase with a full denture following extraction
  • No 3-month healing phase after implantation
  • Shortened treatment duration, as the 6-month healing phase after extraction and the 3-month osseointegration phase are eliminated

 

Disadvantage for Patients:
Due to the immediate implantation after extraction and the immediate loading with a provisional restoration, there is a risk of implant loss during the healing phase. For this reason, if the bone supply allows, more implants are placed than will ultimately be required.

This method is suitable for all patients who have sufficient bone after extraction. If the patient still has their own teeth that can no longer be preserved, they come to the clinic with those teeth and leave with a provisional restoration on the new implants.

Dental Implant: Titanium or Ceramic?

Materials used for manufacturing implants are selected based on their ability to integrate into the bone (osseointegration). Two materials are ideally suited for dental implants: titanium and zirconium dioxide ceramic.

According to professors from the University Dental Clinic in Vienna, titanium offers the best success rate, with a 10-year prognosis of 95–98%. However, recent studies have shown that titanium can corrode. Whether this has a medical effect on our body, I cannot confirm.

What is certain is that zirconium dioxide implants show no evidence of corrosion, galvanic forces (metal-metal interactions), or interactions with the body. Therefore, I recommend ceramic implants to patients who want a metal-free and as “healthy” an implant as possible in their bone.

For more detailed information, please visit our dedicated ceramic implant page.

Advantages and Disadvantages of Titanium and Zirconium Dioxide Ceramic Implants

Titanium Implant

Zirconium Dioxide Implant

Titanium can oxidize, and its oxidation products may contribute to recurring inflammation around the implant and, according to alternative medicine practitioners, may lead to focal infections.

In 20% of cases, patients develop bone inflammation after several years.
Because titanium is gray, rough, and metallic, the implant must “disappear” under the gum and be placed at bone level. From the bone level, a second part—a so-called abutment—must extend through the gum. This transition can, in some cases, cause implant inflammation (peri-implantitis).
Titanium is a metal and conducts.
Almost never breaks.
Immediate implantation is possible, and immediate restoration is conceivable with high stability.
Delayed implantation 6 months after extraction is safer but often requires immediate bone augmentation at the time of extraction using Bio-Oss (bovine origin) and a membrane derived from pigs or a PRF membrane (created from a blood draw and centrifugation).
98% success rate for osseointegration.
In case of implant loss, a replacement implant is placed either immediately or at a later stage free of charge.
Healing time: 3 months, after which the crown is placed on the implant.

“New” Implant Material
Still in the process of gaining wider acceptance.
Zirconium dioxide is completely biologically neutral and considered “fully reacted.”
Risk of bone inflammation: 5%.
Since ceramic implants are a single piece extending from the bone into the oral cavity, there is no abutment gap as with titanium implants, meaning no inflammation occurs, similar to a natural tooth.
Zirconium dioxide is white and thus tooth-colored.
Must not be placed next to root-treated teeth.
Zirconium is neutral and non-conductive.
Breakage occurs in 1 out of 300 implants; if broken, it must be milled out and replaced.
According to current research, zirconium does not trigger allergies.
In our practice, due to the lower failure rate, we only offer delayed implantation—6 months after extraction. However, this often requires immediate bone augmentation at the time of extraction using Bio-Oss (bovine origin) and a membrane derived from pigs, or a PRF membrane created from a blood draw and centrifugation.
95% success rate for osseointegration.
In case of implant loss, a replacement implant is placed either immediately or at a later stage free of charge.
Healing time: usually 6 months, but delayed healing requiring a longer period can occur. After healing, the crown is placed on the implant.

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You can only treat properly what you can see. The microscope allows us to precisely examine and treat teeth and gums with up to 20x magnification. We therefore give our patients a 10-year guarantee on microscope-based treatments (except root canals).

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