Implantology with or without bone grafting

Conventional safety-based implantology is a traditional method that was developed in the 1960s for titanium implants. A hole is drilled into a section of healthy bone with the same shape as the implant for insertion. The implant is then inserted using a little pressure, or screwed into place. If any artificial bone grafting is required, this can be performed during the same surgical procedure. Due to the roughened outer surface of the titanium implant, the bone grows and fuses within around two months.

After this time, a permanent and extremely robust connection is formed between bone and implant. Only once the bone and implant are solidly fused together is the planned tooth replacement then affixed to the implant itself. Subsequent to this, chewing and stressing of the implant can occur.

Immediate restorations

In immediate restorations, an implant is set directly into the fresh wound left behind on removal of a natural tooth. This procedure generally requires for the underlying bone structure to be free of inflammation and be sufficiently stable in order for the implant to immediately find a secure hold in the jaw. Where only a small area needs building up, bone grafting can also be carried out during the same procedure. This procedure is particularly employed in the incisor area as it ensures the best option for preserving the appearance of the gums. These advantages, however, come with the disadvantage of increased infection risk.

Immediate loading

Immediate loading is the term used when the desired prosthesis is immediately affixed to the implants that are set as part of immediate restorations. This has the advantage that the desired appearance (a complete row of teeth) can be achieved immediately after removal of the diseased teeth. This advantage is once again, however, bound with an increased risk of implant loss. Even in the case of the fastest treatment methods, the bone must be left to heal over a period of eight weeks, fusing with the implants.

Implants immediately supplied with crowns, therefore, pose a particular challenge in terms of how patients understand the treatment and any given patient’s self-discipline, as the new teeth must be very carefully protected for this time. Unfortunately, these requirements are not mentioned enough in the press or in advertising. It is very rare for an implant provided using this procedure to fuse correctly without the proper protection and care.

Implantation with CT-based navigation

Since 1996, we have been using this highly sophisticated implantation technique. During planning for the procedure, computer tomographic imaging is carried out ("ConeBeam CT", "DVT") on the jaw using a prepared template created by us in practice. This allows our dentists to carry out comprehensive planning: the type, size, and best location of the implant(s) to be inserted can be planned ahead of time with computer-based three-dimensional rendering.

During the surgical appointment, implants are set into the exact positions as planned, using the templates as a guide. As a result, a previously manufactured provisional, or even permanent prosthesis can be affixed to the implants straight away, a type of immediate loading solution (see above). This clearly represents the fastest treatment option available and this is the reason why it has also drawn significant media attention.

However, by summing up the different inaccuracies that are involved in the process, it becomes clear that the standard precautionary and safety measures applied generally in implantology are also necessary in cases where these newer technologies are applied.

Even the savings in terms of time are only possible if no bone grafting procedure is required, as in this case, a surgical procedure must be carried out approx. 6 months beforehand, and the graft be fully healed before implants can be inserted.

In this case, then a second surgical procedure is required after the bone grafting surgery in order to insert the implants, compared to the conventional safety-based practices with just a single surgical procedure (implantation with simultaneous bone grafting).

For this reason, we only apply this treatment approach where the surgery can be carried out in a single appointment i.e. where no bone grafting is needed. This is because it is only in this case that this method can offer additional advantages to the patient.