Being substitutes for the roots of natural teeth which have been extracted, the implants come to function as fixed supports for artificial teeth, both to replace a tooth individually and to support fixed bridges or false teeth, in the case of total loss of the teeth. Does this mean that anyone who has lost his or her teeth can resolve the problem with implants?

The ideal candidate must have good general and oral health, and have suitable bone in the upper jaw to handle the implants. It is equally important that he or she is aware of the need to maintain good oral hygiene constantly and visit the dentist regularly.

The indication for having implants involves a revision of the medical and dental history of the patient, a complete clinical examination of the oral tissue, the anatomic conformation and the consistency of support bone of the upper jaw, by means of radiographic techniques. It must also be studied how the teeth must be articulated, through plaster models. After a complete and careful study, the dentist will be ready to discuss with the candidate the benefits and the risks, besides the possibility of alternative and/or complementary treatments which can create conditions for having implants.

They are a new generation of implants, introduced from the 60’s onwards but which only now have been widely accepted. They are usually screws of titanium placed in the toothless areas and which are able the chewing and other functions in a manner similar to natural teeth.

It is usually performed in two stages: one for placing the implants – a more extensive operation – and the other, a few months later, to place the devices which will support the prostheses. The latter can be produced after this second stage.

They are certainly better than removable prostheses and false teeth ("moving bridges"). They have a functional capacity similar to the fixed prostheses in cases of relatively small edentulous spaces, but the option for another treatment must be carefully analyzed by the patient and the professional, as the situations are very different and prevent discussing with fixed rules. In the cases of total loss of teeth or later areas the solution with implants is usually better from the functional point of view.

Dental implants require a greater economic-financial investment than a fixed or removable bridge, or conventional false teeth. A dental implant requires an investment in time of approximately 4 thru 9 months until it has been completed. As with any surgical procedure, dental implants involve a risk of infection. However, with careful sterilization, asepsis and antisepsis and the use of antibiotics, this possibility is practically eliminated.

Long-term studies have shown that certain types of implants have success rates above 90% in the implants placed and success rates exceeding 97% as regards the prostheses (as the loss of an implant does not necessarily mean the loss of the prosthesis , as it is supported on other implants).

This success index, nevertheless, is the average, and it is not equally valid for all the regions of the mouth. The indices of failure in total lower edentulousness is almost 0%. In the back region of the upper jaw, with bone that is not very dense and after placing short implants (owing to the maxillary sinus ) the loss rate can reach 33% according to a recent study. However, generally speaking it is a procedure with an excellent prognosis..

Nothing. It is a material which has been used in orthopedics for may decades. Simply put titanium does not undergo corrosion when inserted in the human body and does have immunological rejection, as occurs with other metals of the same family, such as niobium for example. The success of the technique is due to a large set of factors and these features of titanium are without any doubt positive, but they do not in themselves guarantee the success of the procedure.

To sum up, the success depends on the planning, the surgical technique (which avoids the overheating of the bone), a period of cicatrisation without placing the prosthesis and a suitable prosthesis. This protocol (the complete recipe of how to do the implant) has details which cannot be ignored, and a competent professional well trained in the technique can obtain excellent results.

The surgical procedure varies depending on the type of implant and the patient. Most patients can undergo local anesthetic, in the dental consultory itself, provided that there are suitable conditions of asepsis. Other patients, however, need a general anesthetic and a brief stay in a hospital during the operational procedure, where the possible requirement of additional medical care can be attended to promptly.

The first surgical act refers to placing the implant and recovering the adjacent gum. Then there is the process of repair by which the bone tissue gathers around the  implant, fixing it firmly, which takes 3 thru 6 months. This we call bone-integration. In the cases of bone grafts this can take up to 9 months.

The second surgical procedure consists of a small intervention, only in the mucous fiber tissue which covers each implant, and the placing of the intermediary metallic parts which are a connection between the intra-bone implant and the tooth, through the gum. As with any operation, it will take a few weeks to cicatrize. Lastly there is the prosthetic part properly speaking , which includes the molding, making of the prosthesis, esthetic adjustment and articulation.

When all the treatment has been completed, comes the most important phase; the duty of the patient himself or herself, which covers measures of appropriate hygiene and regular visits to the dentist to prevent any future problems.

There are only two orders: impairment of general health which prevents the surgical act from being performed (such as a serious heart disease, for example) and the lack of sufficient bone to house the implants. Due to their diameter, the implants require a reasonable thickness and height of bone, and these requirements can prevent the execution of implants as per the conventional technique. There is no age limit: from puberty onwards anybody can receive implants.

Minimal. The operation is normally performed using a local anesthetic and it is much simpler than other dental surgical procedures, such as extracting a retained tooth for example. The post-operational phase is very good and most patients do not report ant great inconvenience. However, there is a certain risk inherent in any surgical intervention such as post-operational infection, too much edema and other problems which can occur, but in very low indices and which do not contraindicate the technique.

It is not difficult. There is a great deal of unnecessary mystification. A recent study made by the Faculty of Dentistry of Bauru of USP concluded that the success of implants does not depend on the clinical experience of the team, but only of adhering to the protocol, i.e. if the professional follows the technique exactly as he or she should, the chances of success are very high.

There is no need for the professional to be a specialist to perform the implant, or any prohibition. In other words, any dental  procedure can be performed by any dental surgeon. What matters is the degree of confidence and the relationship between the professional and the patient.

In theory it can be said that the high success rate is a good guarantee, but in biological processes there is always a certain amount of unpredictability. There is no absolute certainty of success but owing to the aforementioned success rates, the discomfort of the operation is usually worth the trouble, considering also that a certain amount of failures allows the procedure to be redone.

They are mostly due to the fact that the case is not accurately indicated for implants. Trying to do implants in cases which are not favorable must be a conscious option of the professional and the patient, after assessing all the alternatives. Some failures, nevertheless, occur in cases which appear to be extremely favorable and it is practically impossible to know the real reason.

It means the loss of the implant. Any movement is progressive and indicates lack of success.

It can be stated that in 95% of the cases, if the implants are not lost in the first two years of use, they will last all the patient’s life.

It depends on the system used and the local conditions. The esthetic aspect has improved a lot in recent years but it is not yet perfect. Remember: however good an implant is, it is only a prosthesis, i.e. the replacement of natural teeth by artificial ones. A high expectation related to implants is common, but it is usually followed by an amount of frustration. In many cases the esthetic solution is only acceptable. The best reasoning is functional: the implant is much better than other procedures of prosthesis and when teeth are lacking it is the best that can be done.

At least one clinical and radiographic control every year. It is also an obligation of the patient to appear at these controls.

A suitable planning usually minimizes these problems, but it can occur owing to the bone topography. These alternatives must be discussed before the operation, as during the surgical act the participation of the patient tends to be very passive and, we agree, that it is not exactly the best moment to talk about price and means of payment. When necessary appropriate implants are placed and all "bureaucratic" discussion is postponed.

No, especially in the treatment of the upper arch. A detailed study using computerized or linear tomography avoids surprises,  especially those of the preceding question.

The implants have functional results much better than those obtained by a set of false teeth and removable prostheses. The patients who have used a set of false teeth for a long time and then have an implant feel a noticeable improvement.

There are some ways: usually a surgical guide is made, which is a simulation of the prosthesis and guides the surgeon in placing the implants exactly in the places planned. Usually the cases most extensive done without this guide do not allow the patient to know with any accuracy what the final prosthesis will be like. Anyhow, the esthetic resolution is still the largest problem of the implants, especially in the upper cases.

Yes. In the area of the maxilla graft operations can be performed to increase the edge, removing the bone from the ileac crest or the oral cavity. Other operations such as the raising of the maxillary sinus or deviation of the mandibular channel in the lower area. It must be very clear that these procedures must only be used in cases of extreme necessity, with total awareness of all the risks and costs by the patient. The deviation of the mandibular channel, for example, has led to many cases of post-operational consequences (paresthesis) and does not seem to be sufficiently safe procedure to be recommended to the patient.

It does not usually exceed one or two hours. Only in exceptional cases is this time extended.

In the case of total edentulousness, the period without a prosthesis is restricted to 7 thru 15 days after the first operation. In the second stage, when the access is made to the implants, the patient does not remain without using the prosthesis. In the case of partial prostheses often the patient does not stay one day without the prosthesis. There is also the possibility of using mini-implants, between the implants, and immediately establishing a fixed prosthesis, eliminating the constriction of being without the prosthesis.

Some studies have shown that the largest problems after placing the prostheses are those of diction, usually surmountable in a short time, and problems of biting your cheeks, owing to the placing of teeth in areas which were edentulous for a long time. This is a very difficult problem to correct, but it also can be overcome. It should be pointed out that these are problems but that they are not common and most patients do not have any difficulties in adapting to the implants.

No, the natural tooth is best. In certain situations in which the natural teeth are very endangered by periodontal disease for  example, this may occur. A global planning, studying all the alternatives, including the cost, should be mandatory. There is no agreement about how endangered the teeth must be to make placing implants more advantageous.

There is no rejection as titanium is material which is immunologically inert. As regards contamination, when it occurs it is usually because of the operation and not failures in the manufacturing process. Any of the methods usually used to sterilize the implant, such as gamma rays or ethylene oxide, offer total safety. The good systems control sterilization, i.e. during the process test samples are placed with bacteria which only die if the process is done. The absence of growth of these bacteria is the indication of safety.

No, but there are not many restrictions. Some food can fracture even natural teeth. Anyhow, eating with a minimum of care is sufficient to preserve the teeth of the prostheses supported by implants. A positive fact is that it is relatively easy to repair fractured teeth.

It may occur, especially in areas where the bone is not very dense and which only allow short implant. Without any doubt it is a risk of the process. The best alternative is to try again, as after removing the implant the bone becomes a little more dense. The best thing is not to be in a rush to resolve the problem, which is very unpleasant but inherent in the procedure – although it does not often occur. Usually in the areas of greatest risk of loss the patient should be suitably warned before the operation.