Dental implants and implantation

Smile restoration with implants after the loss of one, several or even all jaw teeth.

Pradinis > Dental implants and implantation

I am an oral surgeon Mindaugas Neverauskas, who has been practicing dental implants for 20 years. When I first started working, the most difficult thing was to convince doctors who were hostile to innovation of the benefits of dental implants, not patients. Now there is no doubt in anyone’s mind that a dental implant is by far the best alternative to restore a lost tooth. In all this time, the design of dental implants has evolved more slowly than the implant technique itself. In my daily practice, when faced with cases of varying severity, I have eventually discovered simpler and more effective solutions that allow me to easily resolve the most difficult situations. Therefore, for the patient, regardless of bone thickness, dental implant placement has become equally simple! Professional maturity has emerged, where every condition, every case, has a clear solution that has been repeatedly tested and is guaranteed to work. And when patients are sometimes surprised by different doctors’ different treatments of the complexity of a case, this is perfectly normal, because the doctor’s qualification, experience and skills vary. And dental implants are not made by clinics, but by doctors. Therefore, it is important to choose a specialist rather than an address.

Types of dental implants

Subcondylar, plate and, currently, the most widely used screw implantation. Helical implantation is popular for its reliability, safety, simplicity and aesthetic satndards. The first helical dental implant was placed in 1965 by Professor Branemark. This was the Swiss Straumann dental implant.

Prices

Here are the prices for this service. All prices are for services carried out by highly qualified professionals.

Straumann SLActive dental implant
750 €
Dental implant Straumann (Switzerland)
650 €
Medentica dental implant (Germany)
600 €
Screwing in the healing head
60 €
Maxillary sinus lift
860 €
Closed maxillary sinus lift
120 – 200 €
Alveolar bone reconstruction (ACR)
300 – 580 €
Implanting your own bone block
750 €
Placing artificial bone after tooth extraction
60 – 100 €
Lateral bone restoration during implant placement
60 – 200 €
Straumann coated screw
50 €

Principles of dental implants

Dantų implantacija 1

The dental implant is embedded in the bone during the surgery, where it remains for 3-4 months. During this time, the process of osseointegration takes place, when the bone cells grow into the implant’s sulcus and surface microspaces. This is also popularly known as “ingrowth”. Conversely, when the bone cells do not form a bony bond with the surface of the implant, we have ‘non-adhesion’ – the implant is then unstable. The implant has an internal pressure within it, into which the individual tooth will later be screwed using a special screw.

Why do some dental implants remain sewn in after surgery, while in others we see a detail or even a temporary tooth protruding above the gums?

If the bone is sparse and the implant has a weak fixation, it is sutured for safety. It is also fully sutured when the patient wears removable dentures or caps for straightening the teeth. The healing head (the part above the gums) is usually screwed in at the second stage, after the implant has healed after 3-4 months. It is only there to break up the gums and at the same time allow the doctor to reach the implant.

When is the healing head turned immediately ? Usually this is done when a single-moment implant placement (implant placement with tooth extraction) is performed, in some cases with bone augmentation, with certain types of implants. A temporary tooth can usually be screwed in immediately after the implantation: in the case of a edentulous jaw implantation (when 4 or more implants are joined to form a temporary bridge), in the aesthetic area when there are no other alternatives to make a temporary tooth (neighbouring teeth are prosthetic, a temporary plate of a single tooth is not possible).

What material dental implants are made of and how their surfaces differ

Dental implants have been made from titanium for many years. Dental implants are made from type 4 or 5 titanium. Type 4 has better adhesion characteristics and Type 5 has better strength characteristics. Titanium is a bioinert material to which there is no immune response. Most implants currently on the market are made of pure titanium, a few use zirconium impurities, which, according to the manufacturers, give the implant its strength. In reality, the material does not offer any decisive advantages, so it should not be a criterion when choosing an implant. Similarly, the surface of implants, where manufacturers also like to emphasise their uniqueness, is also a factor. All implants with different surfaces end up being osseointegrated (adherent) after 3-4 months. Therefore, this should also not be a serious consideration when choosing an implant. Yes, an implant with an active surface can heal in 1.5 months, but the cost is usually 100-200 euros more. However, rushing things can sometimes lead to unnecessary risks, so it’s best to trust a doctor who is just as interested in ultimate success.

Is there an allergy to implants?

If someone says they are allergic to titanium, I tend to doubt it very much. Titanium is used not only in the manufacture of dental implants, but also in heart valves, joint replacements and bone fusion parts. In my 20 years of implant work, I have never come across such a case, having screwed in over 15 000 implants. When sharing my experience with colleagues, no one has noticed any allergy to implants. There have certainly been many cases where patients have feared a possible allergy, but never an allergy has been confirmed.

Do I need a special test before getting dental implants?

Firstly, dental implants are often a less traumatic procedure than removing a molar tooth. And do we do any blood tests, for example, before removing a tooth? There are only a few absolute contraindications against dental implants: Oncology patients who have received radiation therapy to the head, patients undergoing chemotherapy, patients who have recently undergone heart surgery. It may not be recommended for patients taking bisphosphonates for osteoporosis.

Is a 3D CT scan necessary before dental implants

The main examination before dental implant placement is a clinical examination of the mouth and a panoramic X-ray. A 3D CT scan is available but not always necessary, and is therefore often superfluous. The panoramic X-ray shows the height of the bone, which is a key parameter. The width of the bone is monitored by inspection and by tapping in the oral cavity. If the bone is thin, it is not so important whether it is 2 or 3 mm thick, as this does not affect the implantation technique, as it is already clear that bone thickening will be necessary. Again, this depends on the skill and technique of the doctor. If 100 times the radiation exposure can be avoided, it should be avoided. 3D tomography is usually performed with digital or guided implants, and in more complex cases to identify the anatomy of the alveolar nerve and maxillary sinus.

 

How dental implants are placed

Implantation starts with local anaesthesia. With the help of special drills, an implant bed is formed in the bone and the dental implant is screwed into the projection of the missing tooth. If necessary, the wound is sutured.

Duration of dental implant placement

A single implant insertion usually takes on average 5-10 minutes for a skilled surgeon. We are talking about the procedure itself, not counting anaesthesia. More time is spent getting ready, signing the paperwork, prescriptions, and listening to the post-operative instructions.

What you should know after dental implant surgery – Memo

  • Antibiotics prescribed by your doctor must be used.
  • It is normal to have a lot of soreness or pain after the procedure, which is very individual. Usually, pain and inflammation-reducing drugs (ibuprofen, ibumetine, etc.) are enough to relieve it.It is important to remember that the gynaecologist does not assess the symptoms of pain until after a week. Therefore, complaints such as “I’m in pain after 3 or 4 days” are not evaluated in any way. The only help is to change the pain medication.
  • Post-operative swelling is not a complication. Swelling is a normal reaction of the tissues to trauma and bleeding. Usually, the swelling is highest 2-4 days after surgery and then decreases. Therefore, if you are swollen on the first day after surgery and more swollen on the second or third day, this is normal. If the bone is restored in addition to the dental implant, there will always be more or less swelling. To prevent swelling, it is advisable to refrigerate the jaw on the day after surgery.
  • The healing of the wound can only be assessed by the surgeon who operated on the wound, and after one week at the earliest. Until then, we can only observe. The appearance of the wound should not be taken into account. You do not have to like it. Remember that wounds in the mouth, where it is constantly moist, look different from wounds in the skin. You may see swollen bright red or cyanotic gums at the edges of the wound. You may also see a lot of whitish plaque. This is fibrin, which is needed for tissue regeneration. Patients often mistake it for pus.
  • Usually, the doctor will make an appointment to remove the stitches. This does not mean that all the sutures must be in the mouth by then. Some may come loose and fall out the same day. This usually does not affect the final result, so it should not be exaggerated. The wound shall not be stitched a second time.
  • If, after a week, you are taking painkillers because you find it difficult to fall asleep, and the pain only gets worse a week later, you need to see or at least contact the doctor who performed the surgery.
  • If the implant is screwed in with a healing head, i.e. if you can see part of the implant protruding above the gums, you must not grasp or twist it for at least 2 months. Even if it is not stuck, try not to chew hard food in that area. The healing head can only be turned by the surgeon who operated on you, or by another doctor with his/her permission. Therefore, if you feel that the part above the gum is stuck or something has fallen out, please consult your doctor first. Take a picture of what has fallen out and send it to him. Under no circumstances should you try to fix it yourself, or worse (when you live abroad or in another country or city) go to another medical institution. Before 2 months have passed, if the healing head is pushing hard, we can dislodge the implant.
  • In cases where artificial bone is placed, one white bone granule may slip through the edges of the wound in the first few weeks. Sometimes these small bone granules can appear after 2 or more years. The excess is simply removed with a few swipes of the instruments.
  • Bleeding after a dental implant can occur if one or more teeth have been removed, or if the implant has been inserted with a healing head or artificial bone. Remember! Clots in the oral cavity are better than clots under the wound. To prevent bleeding, place a cold pack on the jaw and a swab of a clean material (e.g. a binto clump) on the wound and bite it.

Cost of dental implants: how much do dental implants cost and why do prices vary

What can lead to price differences:

  • The cost of a dental implant procedure at a more well-known clinic in Vilnius is usually higher than at a clinic in the provinces for the same procedure;
  • Anterior dental implants in the aesthetic zone may cost more;
  • Doctor’s expertise and experience;
  • A suspiciously low price may hide unnamed surprises (e.g. unnecessary expensive pre-procedure investigations, costly healing head insertion procedure, higher prices for implant-supported prosthetics);
  • Various promotions to attract customers; manipulative discounting with an unrealistic starting price;
  • Implants from small manufacturers are used. More expensive implants from well-known companies may not have a better fit, but they have a wider range of prosthetic solutions and more precise and high-quality prosthetic components;
  • The complexity of the case can also lead to significant price differences. For example, a single implantation with bone restoration will cost more than without additional procedures.In 2023, the average cost of a dental implantation without a crown in Vilnius is about 700 euros;

Overall, the cost of dental implants has changed the least over the last ten years compared to other dental procedures.

Are dental implants covered?

The State Patients’ Fund (VLK) identifies the following groups of people who are entitled to compensation for dentures. 1. Children under 18 years 2. Persons who have reached the age of old-age pension 3. Persons who have been recognised as unable to work or partially able to work in accordance with the procedure laid down in the Law on Social Integration of Disabled Persons of the Republic of Lithuania 4. Persons who have received treatment for oncological diseases of the mouth, face and jaws. As dental implants are often the only solution, the answer is yes. Currently, the amount available for prosthetics, which includes dental implants, can range from EUR 670 to EUR 2 062 for pensioners and from EUR 342 to EUR 2 062 for children under 18. The Pilėnė clinic in Vilnius has concluded agreements with patient funds, so you can also get reimbursed services here. More detailed information on how to get reimbursed is available in a separate section of our website.

The best dental implants

It is a misconception that the manufacturer of the dental implant is the decisive factor for a successful surgery. The most important thing is the experience and skills of the doctor. Correct planning of the implantation, selection of the type of dental implant, formation of the implant bed in the bone in case of thin, hard bone, the ability to remove the tooth, restoration of the bone, formation of the soft tissues around the implant, quality prosthesis of the implant – these are some of the factors that are much more important than the “best dental implant”. There are over 300 implant manufacturers in the world. Some are more well-known, others less so. If we were only talking about the fit of the implant, there would not be much difference between them. And whereas in the past the major manufacturers used to have a qualitative advantage in prosthetic components, now the differences are not so obvious. It also happens that small manufacturers have some convenient solutions for specific situations. Therefore, we cannot claim that some implants are superior to others. For example, the most popular dental implants in Lithuania are the Swiss Straumann, the Korean Megagen, Osstem, Neobiotech, the Swedish Nobel, the Brazilian Neodent, the German Ancylos, etc., to name a few. Prices may vary, but this is not an indicator.

Misleading advertising about dental implants

Nowadays, when social advertising is successfully used to find new customers, some marketing tricks in dentistry are not always correct and are sometimes just eye-rolling and deceiving patients.
I have noticed that more and more consultations are about what not to do, not what to do, and why not to do it. It is very easy to manipulate a person without specific knowledge.

1. Implantation without incision

Since the invention of dental implants, incisionless dental implantation has also been introduced. And it’s not a new or advanced technique. It is not necessary to unstick the wallpaper in order to cut the woodpecker into the wall. Any implantologist will be happy to insert an implant without an incision because it is easier. Why, then, do we not do this often and where is the populism?

  • The surfaces of the jaws into which the implants are drilled are not some kind of square blocks or tables. And there are only a handful of cases in which an implant can be safely drilled through the mucosa. The word safe means, first of all, that the long-term prognosis of the implant is good, i.e. that the bone walls around the implant are thick enough. So, if some kind of bone restoration is involved, this method is automatically not suitable. And that is 90% of all cases.
  •  We often read in advertisements : “no need for a bone restoration procedure”. Sorry. Who does not need this procedure? Your bone? Because it suddenly became thicker with the use of the edentulous implant 🙂 Or should it be more correct to say that it is not possible to do it because the implant is incisionless.
  • Often, the argument used in advertisements is that implantation without an incision is very fast, e.g. within 15 minutes. First of all, a simple implant with an incision does not take longer than 10 minutes. The other thing is that, in order to do the implantation “state-of-the-art” as advertised, we need to make a special guide and, in order to make it, we need to make a 3D CT scan. So where is the speed? Not to mention the fact that this will increase the cost and require unnecessary irradiation 100 times more.
  • It is said that there will be no swelling and no pain. Again, it is not mentioned that in cases where there is no need for additional bone, there will also never be any swelling after a classical incisional implantation. As regards pain, this is an absolute lie. Pain is not caused by a stitched wound. By the way, a screwed implant “without incision” is also a wound. Pain is usually associated with high pressure on the bone tissue or severe osseointegration (popularly, severe adhesion).
  • X-rays cannot always be trusted blindly. Medical experts laugh that it is the science of shadows. It’s about an implant that should last a lifetime. The surgeon must be sure that he has done the best he can. But it is only by seeing the “naked” bone in person that the doctor will be able to select the right implant and screw it in where it needs to go.
  • Confusion between single-moment implantation and incisionless implantation. Single-moment implantation is performed immediately after straightening and the most important part is the straightening itself. Naturally, once the tooth has been erupted and the implant has been rotated, there is usually no need to make an incision. Thus, the indications for when a sectionless implantation can be performed are few and the chances of being able to perform it are much lower than you might think.
Dantų implantacija 5

2. Implantation with microscope or microscopic implantation

If a person cannot see the implant in their hand or see the space between their teeth, then the first thing they need is glasses. In dental implant surgery, it is very important to be able to see the whole oral cavity in order to assess the direction of the implant and the relationship of the implant to the surrounding tissues. It is also important to observe the patient himself (people sometimes do not come out when they start to feel unwell). Not to mention the speed of the procedure. The microscope allows us to see very fine details, but it does not show us what is going on around us, which is why it is more suitable for treating root canals or for grinding teeth. In the case of a dental implant, the microscope is more of a distraction than a help. It should therefore be treated as a fancy name with a flavour of artificial uniqueness, affecting the duration of the operation (making it longer but not safer) rather than the result.

3. Dental implantation with sedation

First of all, as I mentioned before, a simple single-tooth implant takes about 5-10 minutes. This is equivalent to a simple straightening. Secondly, sedation is intravenous anaesthesia, and it is not fresh water injected into the body. Residual effects or late complications after dental sedation are the subject of lectures by anaesthetists. Third. The patient is usually our helper during surgery. By turning his head, by yawning more, he contributes to a better visibility of the mouth and thus to the speed of the operation. Fourth. When the patient is unconscious or partially conscious, there is a greater risk of aspiration of small parts of the implant. Fifth. The average cost of the procedure is over €300. In my opinion, this additional service is sometimes speculated upon and overpriced without any serious indication. Possible indications: major implant procedure, e.g. edentulous jaw; all-on-4, panicky patient fear. In my experience, even the worst fears can be successfully cured from fear of the dentist and this should be the goal that leads to the best solution.

4. Digital implantation. Guided implantation

Another marketing gem. The technology has not yet emerged where implants are inserted by a robot. Human eyes and hands are needed everywhere. And it is only human skill and experience that determine success. Today, we can scan a patient’s mouth, take a 3D CT scan and, if we have enough bone (which is rare) in a toothless mouth, we can make an implant guide with the approximate positions of the implants, so that when the implants are screwed in, we can make a temporary bridge (temporary teeth) even before the implantation procedure. Thus, the technology is expensive because it requires additional tests, additional tools and can only be valuable for patients who are edentulous and have enough bone. This technology increases the cost of the procedure by an average of 1500-2000 euro. e.g. if an all-on-4 implantation of a edentulous jaw with temporary teeth that will be placed after a few days would cost about 4000-4500 euro, the cost of a digital implant with the help of the digital implant, with the fixation of the temporary teeth immediately after the procedure, would be between 5500 and 65500 euro. A toothless jaw or a toothless jaw on one side can be a serious indication (reason) for digital implant placement. For example, if one or more teeth are missing, an experienced dentist will insert the implants correctly and without additional guides, and temporary teeth can be made in a simpler way if they are really needed in the case of a small defect. There is currently a trend towards using the name digital implantation in advertisements without actually doing it. Simply, a digital impression is taken with an intraoral scanner and an implant guide (an instrument showing the position of the implant) is produced in the laboratory, but not the temporary teeth. This is not a digital implant, but simply a digital impression. And this is misleading advertising. The argument ‘precision’ is usually used, and it does not define a digital implant, but a guided implant. Guided implantation is an integral part of digital implantation, but it is often deliberately conflated. When a doctor tries to use guided implantation in rudimentary situations, this does not always mean safety, but the opposite…

5. A unique way to restore teeth with the all-on-4 technique

Often, advertisements emphasise that “a unique method of restoring jaw teeth has emerged ” all on 4 “. First of all, this is neither a new method nor a new technique. The name ‘all on 4’ belongs to the Nobel company, which popularised the name more than 10 years ago by proving that 4 implants are often enough to restore 12 teeth per jaw. Until then, toothless jaws were also restored with different numbers of implants, including 4 implants. And this has been going on for more than 30 years. It is up to the doctor to decide what the safe number of implants should be, because each person’s case is individual and depends on bone parameters, age, bite, choice of temporary prosthesis, financial possibilities, etc. In other words, the method must be chosen according to the patient’s case, not the case must be adapted to the method! For example, in the case of severe bone atrophy or unfavourable sinus anatomy, it is either unsafe or simply not possible to restore the teeth in the maxilla using the “all on 4” method.

6. Zygomatic and pterygoid implants

These are specific long implants used to restore the teeth of the upper jaw in cases of severe bone atrophy to avoid sinus lift surgery. It may seem like a simpler solution to avoid bone restoration surgery. This is not true. The sinus lift surgery itself takes on average about 30 minutes and is a safe procedure. (In 20 years of performing about 1000 of these surgeries, there has never been a case of a repeat surgery or a failure). Therefore, the mere claim that sinus lift surgery will be avoided seems strange. And the alternative of using long implants, which require a similar operation to a sinus lift, seems even stranger. Zygomatic implants pass through the sinus cavity, so there is always a risk of late complications of sinusitis because we have a foreign body in the sinus cavity that is not covered by bone. It would be a major challenge to remove such an implant with one end in the maxillary alveolar bone and the other end somewhere near the eye socket. Pterigoid implants are similar long implants but they are rotated at the end of the maxilla in the projection of the mental teeth. This is usually done with the help of guides, as it would be difficult to physically hit the narrow strip of bone without help. However, a slight deviation here can have severe consequences, as the main blood vessels pass close by. The mere fact that such a complication is possible should therefore be a contraindication, since we are not talking about a life-saving operation, but about restoring teeth. The main argument for zygomatic and pterygid implants is the speed, which saves half a year, but the weight of the complications and the risks are, in my opinion, too great in the context of restoring teeth.

7. Zirconium implants (biological implants)

Usually, advertising claims are made such as: a) most closely resembles a natural tooth b) does not cause any allergic reactions c) does not disturb the blood flow to the gums d) reduces bone resorption e) attracts less bacteria All of these claims are easily refuted. The physical properties of zirconium do not allow it to be used to the same extent as titanium. For example, thin zirconia implants used in the aesthetic area can usually only be single-cored, i.e. the prosthetist cannot screw on the crown, which is a major disadvantage. The use of thin-diameter zirconia implants is therefore very limited. Not all companies also have a wide-diameter bicuspid implant. The wide range of prosthetic components used in titanium implants is greatly reduced in the case of zirconium implants due to the fragility of zirconium, which makes them unsuitable for toothless jaw restorations and large bridges. Late complications have also been little studied. These facts alone should prevent zirconium implants from being presented as an alternative to titanium implants. As for the supposed better aesthetics. All implants are rotated to be covered by bone, so that we cannot see the surface of the implant, and the prosthetic part (the crown) slides into the implant and provides all the aesthetics. The crowns of titanium implants are usually made of zirconium ceramic. Therefore, the argument that something should be more beautiful with zirconia implants is frivolous. As I said earlier, an allergy to titanium exists only in theory, just as it could exist in theory to zirconium. If the gums heal after the surgery, it means that the blood flow is not disturbed. In addition, the gums are in contact with the crown and not with the implant. Currently, crowns are made of zirconium. Bone resorption is not dependent on the material and is therefore not affected. Titanium does not attract bacteria, bacteria are attracted by plaque and deep gingival pockets. Thus, zirconium implants are for the time being a much more expensive alternative for a much narrower range of indications, with no significant advantages over titanium implants.

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Google Review left 2023-09-28

I have been visiting Pilėnė for many years. Only the best marks to all the doctors for the quality of their work, thanks to them the fear of dental treatment is reduced, they work gently and the nurses are always supportive. A special hangover for the hygienist Jūrate. Thorough, kind, never in a hurry and always pleasant.

My heartfelt recommendation

I. D.

Google Review left 2022-03-02

I would like to thank orthodontist Živilė and her assistant very much for their excellent work and for giving me a smile.I had been having dental complexes for 15 years, and now I can smile with confidence. Questions were always answered during the visit, including quick replies by email. I really recommend it, the visits are short but everything is done precisely. Good luck with your smiles 🙂