A complete guide to dental implants in Cluj

Introduction

The consequences of tooth loss are manifold and if you are considering tooth replacement, a dental implant is the ideal solution to restore your ability to chew without worry. And thanks to innovative solutions in dentistry, anyone can benefit from a dental implant that will last you for the rest of your life. 

How long does it take to get a dental implant

The length of the dental procedure varies from patient to patient, and depends greatly on the complexity of the case.

Following an initial examination, the surgeon will assess the situation and be able to establish an approximate time prognosis. This initial examination consists of a general consultation which will involve x-ray investigations and in some cases 3D scanning of the arch. Following these investigations, the doctor will also decide on the next steps, such as whether or not you need bone augmentation. 

For example, if you do not need any adjacent procedures (e.g. bone augmentation, tooth extraction) the whole treatment period can last between 3-6 months, depending on the patient.

• Surgery

Assuming you do not need any pre-dental implant procedures (such as bone augmentation), you can proceed directly to the surgical application of the dental implant. The operation itself can take between 30 minutes and one hour per implant, depending on the difficulty and complexity of the case.

• Healing period

This period refers to the time between the application of the dental implant and the application of the actual tooth (the dental prosthetic crown). Depending on the individual patient's ability to heal, this period can last from 4-6 weeks to a maximum of 12 months. 

During this period, bone tissue adheres closely to the implant surface to provide secondary stability. Your doctor will be able to call you to the clinic for regular consultations to assess the progress of healing. 

• Fixing the crown

Depending on the individual case, bone implant surgery may be required. 

At the same time, there are situations in which it is necessary to augment the gums at the same time as the implants are uncovered.

Lastly, the final procedure of fixing the dental bridge and crown is a procedure of one or maximum two hours, divided into several sessions of impression (digital or analogue), try-in, application of the prosthetic crown.

When is it necessary to extract compromised teeth and replace them with an implant?

Our recommendation is that patients visit the dental clinic the first time they notice a cavity or feel discomfort. If patients delay visiting the dentist until the last moment, it is possible that the dental damage is too advanced, in which case the teeth cannot be restored. In these cases, their extraction and replacement with an implant is recommended.

Other situations where it is necessary to replace compromised teeth with an implant:

• If you have had an accident

Often after an accident, the teeth are the most affected. In some unfortunate cases, such as facial impaction accidents, where the crown and root of the teeth may fracture, the doctor will recommend restoring the affected teeth through dental implant treatment.

• In the case of an infection that got out of control

The first moment you notice the first signs (pain, swelling, tenderness to the touch) of a strong infection, call your dentist. Symptoms of a widespread infection include difficulty chewing, fever, difficulty biting, or in more severe cases, even difficulty continuing normal daily activities. 

If an infection spreads too far, the dentist may recommend, in addition to emergency treatment of the infection, extraction of the tooth and restoration of the dental arch by dental implant. 

• The cost of rehabilitating a tooth is too high 

In some situations, restorative dental work may lack predictability and require multiple sessions. This makes it impossible for the doctor to guarantee the treatments and make a prediction about the workmanship and cost. Removal of an infection may require complete root canal treatment and subsequent restoration. 

If you find yourself in a situation where these procedures require multiple sessions and the treatment cannot be predictable, you might consider a tooth extraction and replace the tooth using the dental implant. In this case you will solve the problem immediately, eliminating infection and getting rid of pain.

A special case is wisdom teeth. If they are compromised, it is not recommended to replace them with an implant as they do not affect the chewing or surrounding teeth. 

 Types of dental implants: choose the right one for you

1. Depending on the mode of fixation and shape 

• Endosteal implant

This is the most common type of implant, recognised as the most stable and natural. It can take many forms such as:

1. Root canal implant (which is also the most commonly used) - Cylindrical, conical or trapezoidal in shape. The endodontic implant is fixed into the alveolar bone where it will support one or more replacement teeth. 

Dental implants with screw-shaped grooves are the most commonly used because they mimic the root of a natural tooth. 

2. Blade Implant - This ranks among the earliest types of implants used in the past, which are rarely used today. It may still be suitable when the jawbone is too narrow for a root implant. 

3. Another type of implants are mini dental implants which are very thin and have low strength. They are only recommended for narrow interdental spaces (such as incisors, which are the narrowest teeth) or in some cases as temporary implants until the permanent implant is placed. 

• Subperiosteal implant

Much less commonly used, the subperiosteal implant is fixed to the jawbone, below the gum, by a system of metal plates and anchorage screws. It is shaped like a metal frame and fits snugly onto the bone. This type of implant is used for patients with low bone substrate and those who cannot wear traditional dentures. It is generally only recommended when conventional resources have been exhausted.

• Transosseous implant 

Used only in cases of severe bone atrophy, this implant is rarely used. It is remarkably stable as it is inserted through an incision in the chin area, through the jawbone and fixed underneath with a metal pad. This procedure is very complicated and is often carried out in a hospital under the supervision of anaesthetists. 

• Zygomatic implant 

These implants are only performed by a team of surgeons in very special cases. They are very long implants that are fixed into the upper jaw bone, with the tip fixed into the cheekbone (zygomatic) and are an alternative to the transosseous implant, being used for the upper jaw. 

It is performed in exceptional cases when the jawbone has almost completely resorbed, as the zygomatic bones retain their volume and density over time. These types of zygomatic implants are applied only under general anaesthesia.

It is generally recommended for patients who are unable or unwilling to make complex bone additions because it offers superior stability and allows for on-site addition of dental work. 

2. Depending on price 

There are countless types of dental implants on the market from different manufacturers, with a wide variety of prices. Here we present just a few examples in 3 categories:

• Lux Implants

They represent a superior class of implants that can bring certain advantages such as their innovative qualities, rigorous scientific studies and a high level of international standards. At the same time, the validity of these types of implants also comes from the fact that they were and are pioneers in the market, having laid the foundations for this industry.

In this department we can classify Straumann implants https://www.straumann.com/ or Nobel Biocare https://www.nobelbiocare.com/en-intwhich are also the most known globally. 

• Premium implants

We can include a wide variety in this class of implants, but some representative examples would be Megagen https://www.megagen.ro/, MIS https://www.mis-implants.com/, Alpha Bio, Bredent, Paltop and Biocon. These manufacturers bring superior quality materials and technology at an affordable price. 

• Low-cost implants

These types of implants are lower in price and quality than the rest. They are not recommended because although they are not much cheaper than the standard ones, they can affect the integrity of the final work. They can also fail, either during treatment or soon after, and in some cases may even require replacement with another implant. Because of these reasons, in the long run the implant may be more expensive than if you had invested in a quality implant in the first place.  

Low-cost dental implants do not have the proper surface treatment for the bone to heal properly. They do not have a stable prosthetic connection with the dental crown (common complications such as unscrewing of the work, decimation and periimplantitis - infection of the tissues around the dental implant).

Dental bridge or single tooth implant? Advantages and disadvantages

Even though the dental bridge and single tooth implant can have very similar results visually, the specific dental techniques of each procedure are very different. It is very important to be fully informed before deciding between these two solutions. 

We can compare taking into account several factors such as:

• How to fix and stability

The dental implant looks, feels and functions just like a normal tooth, being fixed into the alveolar bone. Because of this, the implant is very stable and can last a lifetime.

The dental bridge, on the other hand, is used to fill the space created by one or more missing teeth. It can rest on the teeth and roots of the remaining teeth, or on two implants, and the teeth on which it rests are called connecting teeth. 

Unfortunately, when the dental bridge rests on healthy teeth, the dentist will have to prepare and grind these teeth in order to fix a crown on which the dental bridge will rest, thus sacrificing a significant piece of the healthy tooth, which can sometimes even lead to the removal of the tooth's nerve. 

• Time 

When it comes to time and cost, dental bridges require fewer sessions. A dental implant requires several visits to the dentist's office (at least 3) and the total treatment time is a minimum of 3 months. 

The necessary dental bridge procedure is much simpler and does not require surgery - it can be completed in a week or two. 

• Cost

In most cases, cost is a deciding factor when patients choose between a dental implant and a dental bridge. 

The cost of a dental bridge is much lower than the cost of a dental implant, and because the treatment time is also much shorter and does not require many office visits, you can save a lot of money that you would otherwise spend on labour and materials.

However, you should bear in mind that a dental implant is very durable and has an almost non-existent failure rate. The dental bridge will most likely need to be replaced at some point in life and has a much lower success rate than a dental implant. At the same time the dental bridge requires the inclusion of at least two teeth adjacent to the missing one, teeth that may be intact and will be devitalised for this purpose.

Although this is initially cheaper, in the long run the price could be lower for a dental implant. 

• Durability

As previously mentioned, dental implants have a very low failure rate, and usually last for the patient's lifetime. Since in most cases the bridge rests on healthy teeth, this means that if they decay and need filling or root canal treatment, the bridge is compromised and needs to be replaced. 

• Maintenance

The dental implant behaves exactly the same as a normal tooth and the recommended maintenance and hygiene routine is identical to that used daily for a normal tooth. On the other hand, your dental bridge will need extra hygiene, and specialised flossing to protect you from the build-up of bacteria that can lead to irritation and gum disease. 

When faced with the decision between a dental bridge and a dental implant, make sure you consider all the factors I have outlined and don't make any hasty decisions.  

Fixed prosthesis on 4 implants - false teeth in 24 hours

If all the teeth on the upper or lower jaw are missing or unrestorable, the simplest and most correct solution is fixed prosthesis on four implants. This is the ideal method that can quickly restore a full set of teeth to the patient. 

When the teeth are extracted, the jawbone recedes because it no longer has any function and is no longer stimulated by chewing. This retraction has visual, aesthetic consequences, creating an aged appearance. With the insertion of implants, the bone is stimulated again and the loss of facial support is prevented.

• Fixed dental work
  

Fixed dentures replace both missing teeth and gums, and look and are used just like natural teeth. The dentures are cemented or screwed onto the implants and have high strength and stability. 

It can only be decimated/screwed out and taken down by the dentist for periodic cleaning. 

• Mobile prosthesis (tip overdenture)

Mobile prostheses allow patient hygiene. They are comfortable, do not move and are usually more easily accepted by patients. 

These prostheses can be removed every evening, sanitised and then easily reattached. With them, the patient can lead a normal life without fear of the dentures falling out while chewing, talking or sneezing, as with regular dentures. 

There are 3 types of mobile prostheses depending on the way they are fitted:

1. On staples - ball-shaped clasp system placed on the implant fits into the recess in the denture
2. With the bar - a metal bar is used to join the implants and reinforce them, which is then joined to the prosthesis.
3. With telescopes - metal telescopes are attached to the implant (main telescope) and the prosthesis (secondary telescope) and then joined together for a stable fit

When is bone grafting necessary?

Following a tooth extraction, the jawbone or mandible no longer serves its purpose of supporting the teeth and begins to resorb in a short time. This process is fairly rapid in the first year (about 25%) and then slows down. Up to 60% of the bone may be resorbed 3 years after extraction, in which case the dental implant can no longer be conventionally fitted. 

In order to increase the volume of the bone, and to create sufficient space for the insertion and stabilisation of the dental implant, bone grafting is required. This procedure is commonly used by doctors and is painless because it is performed under local anaesthetic. 

Bone grafts are divided into several categories depending on their origin:

• Autograft 

It is harvested by grafting bone from the patient's own body. In this case, the doctor will harvest bone from areas not affected by resorption (angle of mandible, maxillary tuberosity, chin) and use it in the area of interest.

Because the bone block is harvested from your own body, there is no risk of rejection or infection.

Another advantage of this graft is that it provides a supply of living bone cells which helps the affected area regenerate faster.

• Allograft (bone taken from another person) - from specially designed biobanks. 

The advantages of this graft is increased availability, supply of viable material. Disadvantages include the possibility of disease transmission (very low risk).

• Xenograft (bone of animal origin, usually bovine). 

Because the graft is cleared of all tissue other than bone, it is recognised by the body as human bone. Over time it is resorbed and replaced with its own bone tissue.

Following bone addition surgery you will notice some swelling and bruising and feel some discomfort. These effects are completely normal, and will pass within a few days. Pain can also be easily controlled with medication. 

How long does the healing period last?

It depends a lot from patient to patient. Even if the discomfort will disappear within 2 weeks, it can take 3 to 10 months for the new bone tissue to be stable enough to support an implant. 

That's why your doctor will call you in for regular check-ups to see how the bone is healing and whether it is strong enough. 

Contraindications dental implant

Overall, dental implants are a safe and effective dental procedure that helps patients not only regain the ability to chew correctly, but also their self-confidence and the ability to improve their social life. 

However, there are some cases where a dental implant is not recommended or cannot be inserted. 

1. Situations that can be easily resolved and are temporary:

These situations are transient or can be easily resolved, but delay the possibility of having a dental implant:

• Allergy to one of the materials from which the dental implant is made. Although this is rare, the impact is severe, so it is imperative to bear this in mind and opt for the right materials for each patient. 
• In the case of pregnancy or lactation, this surgery is not recommended, as it is not considered a medical emergency, and therefore one waits until after the birth and after the interruption of lactation to start the procedure.
• Age is also an important factor, as dental implants are not recommended for patients under 18 because they are still growing. 

2. Contraindications related to the patient's general health:

• In the case of heart disease, patients must be under the close supervision of a cardiologist, with whom our doctors will recommend this treatment. Patients suffering from bone diseases such as osteomalacia, osteogenesis imperfecta, Paget's disease, brittle bone syndrome, rheumatic fever, bone failure or osteoporosis are also in the group of those for whom dental implants are not indicated in most cases. 
• This group also includes patients suffering from serious diseases such as cancer (except patients in remission or with good response to treatment and with the opinion of the oncologist), uncontrolled diabetes, HIV, tuberculosis, etc. 

If you know you have a serious medical condition, have had recent surgery or have certain allergies, talk to your surgeon to determine together the best way to continue your dental treatment. 

Stages of intervention from A to Z

1. Initial consultation

During your initial consultation, your dentist will order an X-ray or CT scan, and take a cast of your teeth along with a standard set of pictures. You may also need to consult some specialists, including:

• ENT doctor
• Maxillofacial surgeon
• Orthodontist
• Periodontologist

Your doctor will carefully review your medical history and you will need to inform him or her if you have any medical conditions that could affect the outcome of the procedure. If you have any gum disease, then it will first be treated before the dental implant process begins. If you are perfectly healthy, then your dentist will develop a dental implant treatment plan that is specifically tailored to your needs.

If you are a smoker, it is mandatory to quit smoking during the dental implant stages for best results.

Next, your doctor will determine if you need a bone graft to secure your dental implant. If bone grafting is necessary, then he or she will let you know what to expect from this procedure and how it will affect the duration of your dental implant treatment. You will also discuss the cost of the bone graft, as well as the cost of the tooth extraction, the cost of the dental implant and the cost of the superimplant prosthetic restoration 

Although bone grafting and tooth extractions are the most commonly needed procedures before a dental implant, not everyone needs them. If your jawbone has enough volume to support the implant, then you should not need a graft. 

2. Dental extractions

The complexity of your dental extraction will depend on several factors and can increase both the cost and length of time required to complete the dental implant procedure.

If you have a completely destroyed tooth, you will need oral surgery to remove it. This will add to the number of steps required for the overall procedure.

And if your tooth is broken or damaged, you may need oral surgery. 

If you only need a simple tooth extraction, then healing will be easy and you won't lose too much time. However, the more complex the extraction procedure, the more difficult the recovery and the application of the dental implant will be. The type of anaesthetic used will also affect the recovery time.

3. Bone Addition

Bone grafting for dental implants is only necessary when the jawbone does not have enough volume to support the implant. Usually bone is taken from another part of the body and added to the jawbone, but bone of bovine origin can also be used. This will be used to thicken the jawbone so that it can support the implant, but this step will significantly increase the time needed for the dental implantation process. 

Bone graft healing usually takes between 4 and 12 months and requires several appointments at the dentist's office to ensure that healing progresses satisfactorily.

4. Fixing the dental implant

When you arrive at the office for your dental implant surgery your dentist will prepare you and explain the advantages, risks and complications of the surgery. In most cases a topical injection is used to anaesthetise the area requiring surgery. 

The doctor will make an incision in the gum so that the jawbone is exposed, then use special small drill bits to make an osteotomy (hole in the bone) under continuous cooling so as not to destroy the bone by heat (necrosis) so as to insert the implant into the jawbone. The most commonly used is the medical titanium dental implant because it is very strong but also very light and the body tolerates it very well. 

This procedure can take up to two hours and surgical sutures will be applied at the end of the procedure. You will need to come into the surgery to have your sutures removed in a week or two, and it can take up to 6 weeks for the incision to heal completely. 

It is imperative that you follow your doctor's care instructions during this time, otherwise your dental implant may fail. If you prefer, you can wear a temporary denture or crown during the healing process, as directed by your doctor.

Pain after the implant procedure can usually be managed by using over-the-counter medication. If it becomes too severe, call your dentist quickly.

You will receive a healing cap to wear for about two weeks, as this ensures that your gums will not heal over the implant. If it comes off, let your dentist know so you can come back to reapply it. 

During the healing period, a process known as osseointegration will take place.

5. Osseointegration

Osseointegration is the process by which tissues form around the implant and assimilate it into the alveolar bone of the jaw and mandible so that it becomes stable and fully fixed in the bone. 

‍

The implant material is biocompatible, which means that the body does not reject it during the healing process and over time, it will become an integral part of the jawbone. This process usually takes 3 to 6 months for the lower jaw and up to 7 months for the upper jaw. 

Smoking can lead to the failure of the whole process, so it is imperative to give up this vice at least for this duration. Smoking significantly decreases the vascularity of the tissues and has a negative effect on its healing.

6. Placement of the slip 

Once your gums have had time to heal completely, you will be able to return to the clinic for the addition of the dental implant filling. The abutment secures the crown, but is sometimes installed at the same time as the metal post. 

Although recovery from the installation of the bridge usually takes about 2 weeks, the fabrication of the permanent crown can take longer, so in some cases you will need to wear a temporary crown to cover the gap and protect the bridge. 

7. Placement of artificial tooth or teeth 

The placement of temporary and permanent crowns is the last step of the dental implant procedure performed by the dentist. Once the surgery has fully healed and osseointegration is complete, your dentist will take impressions of your teeth and mouth and use these impressions to fabricate your final dental crown. 

Until the fabrication is complete you will be able to receive a temporary crown and then return to the clinic for the final time in this treatment for the placement of the permanent crown. In this final phase, the tooth will be permanently attached to the abutment and the dentist will incise or screw it onto the post.

Do dental implants hurt?

In short, no! Your dentist will make sure that you are as comfortable as possible during the whole process, and that any discomfort you feel is kept to a minimum. During the procedure your dentist will use a local anaesthetic to ensure you don't feel anything. At the same time the anti-inflammatory and anti-allergy medication prescribed helps greatly in the post-operative management of pain and oedema (swelling).

• What to expect during surgery

The first step before surgery is always to administer local anaesthesia. In some cases where the operation is more complicated, even general anaesthesia may be administered. 

The local anaesthetic will numb the entire area of the operation, so the procedure will not cause you any pain! You may feel pressure at times, but no pain. 

• In the healing phase

After the operation, it is normal to experience discomfort and moderate pain for up to 7-10 days. The intensity and duration you will feel pain depends on the type of procedure and each body's ability to heal. These pains can be kept under control with the help of medication prescribed by your dentist, and after about 10 days after the operation, you will be able to resume your normal lifestyle, including strenuous sporting activities. 

How much does a dental implant cost?

The price of a dental implant varies widely depending on certain criteria:

• Type of implant 

From premium to low-cost implants there is a wide variety of prices. However, dental implants are meant to last a lifetime, so our advice is to invest in a premium dental implant that is more durable and ticks all the safety and hygiene boxes. 

• The complexity of oral rehabilitation

The cost of an implant does not include the overall treatment of dental prosthetic restoration and rehabilitation. Our patient does not pay for a dental implant but for the workmanship and execution of the treatment plan which ultimately results in aesthetic, functional and oral masticatory rehabilitation.

It is difficult to give an estimate for the whole procedure, but if we consider an implant for a single tooth, without bone addition, you can take as a reference these amounts that you can consult in the price list .

To these prices will be added: the price of the necessary investigations before the operation, and other materials that will be needed during the whole procedure.

At Prolident, we provide you with quality treatment at fair prices. Contact us with confidence to make an appointment or with any questions, we are at your disposal. What's more, your first consultation will always be free! 

Will I have teeth during implant healing?

Even though the dental implant treatment period can be lengthy, you don't have to wait to enjoy full teeth.

While the implants are healing, you have several temporary options such as:

• Kemeny dentures - These look similar to regular dentures, only they are partial and can be used when only a few teeth are missing. 
• Temporary dental bridges - These can be attached to the teeth adjacent to the dental implant and will temporarily replace the missing tooth. 
• Temporary crowns - Although these look exactly like a real tooth, they are made of high-quality composite materials, and you will be advised not to eat particularly hard foods during this period.

Can implants have complications?

Dental implants are very safe and have a success rate of about 95-99%. However, in some rare cases, certain complications may occur after the insertion of implants, such as:

• Decoding the work
• Unscrewing the work
• Implant fracture
• Peri-implantitis (inflammation of the gum with loss of bone support)

• How can I prevent these complications? 

The safest way to prevent these complications is to have regular check-ups to check the bite and occlusal contacts (contact between the upper and lower jaw teeth), which prevents most complications. Regular professional hygiene also helps to maintain and prevent infectious complications. 

• What can I do if I constantly have a problem with dental implant treatment? 

If you notice any problems with any stage of your dental implant treatment, call your dentist and they will guide you to the next steps. If the implant has failed, it will be extracted (explanted), and if possible, replaced with a new one.

Recovery after dental implant

• How long does pain persist after dental implants?

The length of time the pain persists depends greatly on the patient, the body's resistance and the complexity of the procedure. 

For example, in the case of a simple procedure, without bone grafting, for a single tooth, you will probably feel a little discomfort for up to 7-10 days. In this case you will probably only have minor swelling and minimal pain, for which your dentist will prescribe anti-inflammatory medication.  

In the case of a complex procedure, you will probably feel more discomfort, but this can be kept under control by the medication prescribed by your doctor. After the operation, you will probably be advised to eat only soft, easy-to-chew foods for 6 weeks. 

• Postoperative care

The lifestyle you follow can strongly impact your healing time. Keep in mind that carbonated drinks and alcohol can affect the operated area and delay healing. Also, avoid smoking and too cold, hot, strong or spicy foods as much as possible. 

In the hours immediately after the operation, try to rest. Do not plan any activity that involves major physical or mental effort. Avoid driving and strenuous activities such as running, lifting weights or any other type of physical exercise, as these activities can cause large haematomas and/or bleeding of the surgical wound. 

For a few days after surgery, avoid strenuous exercise. You can instead go for a walk or do some light stretching to loosen up. While brushing your teeth, avoid putting pressure on the wound, do not touch the area with a toothbrush or floss. You can also rinse your mouth with mouthwash recommended by your doctor specifically for the procedure you underwent.

• Postoperative symptoms

It is normal to notice some swelling and bruising on your face after surgery. These will subside in a few days. But if you notice any pus or develop a fever, contact your doctor urgently. 

Care and maintenance of dental implants

Caring for dental implants is almost the same as caring for the rest of your teeth, with a few small differences. Properly maintained dental implants can last a lifetime! That's why you should always take care to practice proper hygiene and visit your doctor for routine check-ups. 

• Brushing dental implants is identical to brushing natural teeth. 

However, it is best to invest in a toothbrush with soft bristles so as not to damage the soft tissue around the implant, and avoid using abrasive products that can lead to implant damage. Any scratches may also attract unwanted bacteria. 

Even if your dental implant cannot develop cavities, it is very important to keep it clean. That's why brushing your teeth at least twice a day and flossing are mandatory.  

• Regular consultations

Although dental implants are designed to last a lifetime, they can develop complications in rare cases. That's why it's important to visit your dentist regularly, every 6 months. Your dentist will be able to ensure that you prevent any unpleasant situations early on.