Bone restructure

A sufficient amount of bone in the jaw is necessary to heal with dental implants. Depending on the shape and volume of the existing bone, we can offer you the best and most gentle method. A 3-D X-ray, a so-called DVT, is required for diagnosis. If there is no bone width of approx. 2mm, the jawbone can be stretched with the help of a bone spread. This method, which is carried out using piezo technology, a special ultrasound saw, is perceived by the patient as being particularly gentle. If the bone width is more than 2mm wide, bone can be transplanted, which is removed from the angle of the jaw in the same operation and fixed to the too narrow area with the help of a screw.

If the bone height is not available for an 8-12mm long implant, bone can also be increased by transplantation. If there are only a few millimeters missing, this is possible after taking bones from the maxillary sinus, and with larger defects from the iliac crest. In the upper jaw there is also the possibility of lifting the maxillary sinus floor. With an existing bone height of 6mm, this is possible with the internal sinus lift. The maxillary sinus floor is raised above the implant hole and the implant is placed at the same surgery date. If there is less bone, an external sinus lift must be performed. The external sinus lift enables the bone to be built up for several implants even when the bone is almost completely missing.

The unique, high hygiene standard of our practice with a clean air filter system in the OR (class Ib-OP) allows the removal of bones from the iliac crest, which usually leaves a scar only 2 cm long.

In addition to our own bones, we also use donor bones and bovine bone material.

You can support wound healing with the help of your own growth factors derived from your blood plasma. For this we take about 10 ml of blood and centrifuge it. This creates platelet rich fibrin (PRF) or growth factor rich fibrin (GFRF). This promotes wound healing and reduces postoperative pain.

Which implant is right for me?

Implants have been used to support dentures for over 40 years. The materials titanium and ceramic were available right from the start. Today’s implants are helical and have a rough surface so that the bone grows better. Particular attention is paid to the attachment of the gums.

Just like natural teeth, implants should last a lifetime. With good surgical work and careful oral hygiene, this is also possible.

Today, however, we also know of intolerance to titanium particles, which lead to inflammation and loss of the implant. A blood sample can show whether you belong to this patient group. For this, 10 ml of blood are picked up by courier and brought to a special laboratory
(https://www.imd-berlin.de/fachinformationen/diagnostikinformationen/titan-unvertraeglichkeit.html).

An alternative to the titanium implant is the ceramic implant, which is made of zirconium dioxide and does not release any metals. Prof. Koch(F.P. Koch et al. 2010, F.P. Koch et al. 2013;  https://www.ncbi.nlm.nih.gov/pubmed/?term=koch+zirkonia+mainz) die gute Anlagerung von Knochen und Zahnfleisch an Keramikimplantate zeigen.

What happens
after the implantation?

The bone actively connects to the surface of the implants after implantation and takes 3-6 months – depending on the bone quality and type of implant. During this time, the implant usually remains protected under the mucous membrane and you can wear temporary dentures so that the missing teeth are not visible. After healing, the implants are exposed with a small anesthetic and a small incision and treated with the help of a healing cap. It is important to design the gums so that dental aesthetics and implant health are ensured. Three weeks after the exposure, your family dentist starts taking the impression and producing the teeth.
 

If the bone conditions are good, implants can also be provided with temporary crowns immediately, so that you can do without temporary, removable dentures. This requires 3-D planning and additional measures to stabilize the implants. The risk of implant loss is also slightly higher than with the method of allowing the implants to heal before loading.

3-D Diagnostics
and Implantation

We use 3-D templates to position the implant exactly where the tooth should be. With the help of elaborate planning on the computer and a 3-D image (digital volume tomography – DVT), we first place the implant in the computer model. Once the optimal position of the implant has been found, we have the unique possibility of producing so-called guide templates with us. This is done with the help of our 3-D printers.

With this complex 3-D implantation we protect important structures such as nerves, blood vessels or neighboring tooth roots. The implants are then exactly where your dentist needs the crown build-up to achieve an optimal aesthetic result.

Preparation for implantation

The jawbone must be sufficiently wide and high for dental implantation. A minimum diameter is particularly necessary for the replacement of molars. If the bone is insufficient, techniques are used to augment the bone. A complex bone graft does not always have to be carried out. Usually only the width of the bones is missing. The alveolar ridge is split in the middle using an ultrasound saw and carefully stretched so that the implant can be placed immediately without waiting. The practice clinic M3 works with the ultrasound saw (also called piezo saw) as standard to protect nerves and soft tissue. This technique is perceived as particularly gentle by the patient.

If not only bones are missing in width, but also in height, further techniques are used. These so-called augmentation techniques transplant bones to where the implant is to be placed. Your own bone, which is obtained from another part of the body, or sterile biomaterial is used, which your body converts to your own bone.

Treatment under Anesthesia

Our experienced anesthesia specialists will help to ensure that your treatment runs safely and successfully. They work to guarantee a pain-free procedure, using the following methods:

Local Anesthesia
The most commonly used form of anesthesia is the local anesthetic, which numbs only the treated area. With today’s advanced technology and the use of topical sprays, even the injection is virtually painless.

Twilight Sleep (Conscious Sedation)

For twilight sleep, our anesthesia specialists will place the patient into a state of deep relaxation. The patient remains conscious and responsive but feels no pain during the procedure. His or her memory and perception of time are also clouded by the anesthetic. Used in combination with a local anesthetic, this method relieves all tension in the treated area during the procedure.

General Anesthesia

Should twilight sleep not be able to completely eliminate the fear of surgery or provide full painlessness, our anesthetists will employ a general anesthetic. Today’s modern and minimally aggressive methods are safe and tolerable for the body. With the aid of narcotic medication and computer-controlled anesthesia delivery, the patient is placed in a reliable dormant state.

Requirements for General Anesthesia and Twilight Sleep Treatment

Naturally, before the procedure, we and our anesthesia specialists will inform you of the requirements for the treatment in question in detail. We will additionally discuss and plan the details of your treatment and care before and after the procedure. Family members or trusted parties are welcome to be included in these consultations.

Anticipated Cost of General Anesthesia and Twilight Sleep Treatment

In many cases, the costs of these treatments are either partially reimbursed by health insurance companies or not at all. We will inform you of your share of the costs incurred in a detailed consultation regarding the plan for your course of treatment.

Osteitis and Osteomyelitis

Bone marrow inflammation (osteomyelitis) is an infectious inflammation of the bone marrow. Patients are often affected after taking bisphosphonates. These are medications used to treat bone metastases, myelomas or osteoporosis (e.g. zolendronate).

Osteitis, on the other hand, is a term used to describe an inflammation of the bone, in which all components of the bone are infected. Common causes for osteitis include open bone fractures and skeletal surgeries that have led to a bacterial contamination of the bone.

If such an acute illness is not treated – mostly surgically – at an early stage, it usually becomes chronic.

Tumors of the Mouth and Face

There exist various tumors of the mouth and face, both benign and malignant. They are usually surgically treatable using various modern procedures. The surgical techniques we employ allow for both the removal of the tumor and the reconstruction of the neighboring tissues. This requires an interdisciplinary cooperation between specialists in oncology, radiation therapy, nuclear medicine, and otorhinolaryngology.

Our objectives for this treatment are:

• A successful cancer therapy,
• Ensuring the functionality of the mouth and face,
• An improvement of your overall health,
• The preservation of your appearance.

Cleft lip, jaw, or palate

There are various types and degrees of cleft lip, cleft jaw, or cleft palate. Statistically speaking, about one in every 500 newborn children in Germany is affected with one of these deformities.

The treatment of patients with cleft lip and palate is offered in our practice from the age of 12. This usually involves correcting the shape of the lip, the nose (including nasal breathing) or the structure of the jawbone, the so-called intermaxillary osteoplastic. Tooth build-up is usually followed by dental implantation and prosthetic restoration. At the statutory health insurance companies, we make appropriate applications for reimbursement of costs.

• Isolated cleft lip
• Cleft palate
• Continuous cleft of the lip, jaw, and palate.