Majestic snowy peaks, towering in rows over lakes and valleys…their solidity, indestructibility…who knows, maybe, the proximity of the mountains has played its role in the fact that the first dental implants took place in Switzerland? It is difficult to overestimate this breakthrough, all the more so since Swiss implants are considered the best in the world… and of course, the most qualified specialists in inserting them work here. The practice of the famous implantologist Thomas Varga, located in the French part of the country, pays special attention not only to dental care, but also to aesthetics. We asked the doctor to answer some common questions about implants.
— Doctor Varga, we usually go for a crown in the case of dental injury. If a tooth is completely lost, it is a bridge or an implant. Which of the two options, and in what circumstances, would be better, in your opinion?
— Bridges are preferable when it is impossible to insert an implant. For example, a patient has a systemic disease, or he/she takes anticoagulants. It can happen that there is a shortage of bone tissue and it needs to be built up — this is a long and complex procedure, in which both the patient’s own bone and artificial bone can be used. A bridge is placed quickly, in just 10 days. This is a great advantage for people with health problems. The disadvantage is that it is attached to the retainer teeth, which must be milled. And if too many teeth are lost, there is no longer the option of a bridge. The advantage of implants is obvious here, since they are inserted individually, separate from each other, like real teeth.
— But to insert them, as you say, takes a lot of time, doesn’t it?
— Yes, it takes several months. We have to wait for a certain period of time before subjecting the new «teeth» to any load. But implants are more advantageous from a hygienic point of view, since they are not connected to each other, and there is no need to mill the neighboring teeth.
— What should a person know before deciding to have an implant?
— First, you need to check if there are teeth affected by caries or parodontosis. If there are, then treatment is prescribed. All the teeth have to be restored to a healthy state. To make an implant, an accurate X-ray image and cast tooth model are required. The implant itself (the main part of the structure that is implanted in the bone) is inserted in one visit, and after a while, a temporary crown is placed on it for a period of, on average, two to four months — at most, six months — for the healing process to be completed. Sometimes it is necessary to wait longer if it is a question of lateral teeth, because they bear the greatest load. For aesthetic reasons, a temporary crown can be placed in the front (or a temporary bridge, which is placed on the implants if there are several of them) on the same day. Subsequently, they are replaced with permanent ones.
I recommend that patients from abroad stay for a week — you need to take this into account in your plans – and return after two or three months, as you will need two more visits to the doctor with an interval of ten days in between them.
In summarizing, we can say that with a successful combination of circumstances, implants can be inserted over four visits. The first includes an examination, cast model, and X-ray, and the second one (after a few days) includes implant insertion. The third visit is necessary after two or three months to check the healing process, and the fourth one is for the integration of the implant, additional checks, and adjustment of the bite. In difficult cases, more time is required for healing, especially if it is a question of the upper jaw, where the bones are more porous than in the lower one.
— Suppose that a patient did not consult a dentist for a long time, due to lack of time, and had a hole instead of a tooth for a year or even longer. Could any difficulties arise when inserting the implant?
— Yes, this complicates the situation. In the case of a prolonged absence of a tooth, there may be a deficiency of bone tissue and it is quite possible that it will be necessary to build it up. This type of treatment will require three additional months of healing, and only then will it be possible to insert the implant, and then three more months of waiting to check the implant’s success will be necessary. There are technologies that enable missing bone tissue to be built up at the same time as placing the implant, but this procedure is much more complicated. Therefore, it is in the patient’s interest to act as soon as possible, and not to remain without a tooth for longer than three months. There is one other way: if a fast result is required, the best option is a bridge.
— What are the newest methods for bone tissue repair available today?
— We use both artificial bone tissue and foreign tissue – we can take it, for example, from a cow, or from another person. But it is better to work with your own tissue. There are techniques whereby material is taken from the femur and implanted into the jawbone. New bone tissue can be implanted immediately in layers, but then the patient will need hospitalization.
— Are implants usually inserted under general anesthesia or with local anesthesia?
— At the request of the patient. If he/she wants 5–6 implants to be inserted at once and at the same time and to feel (or see) nothing, general anesthesia is the answer. We work with one of the best teams of Swiss anaesthetists. But in most cases, when it comes to one implant, local anesthesia is enough.
— From time to time, one hears about sad cases, when after so much time, the implant does not survive. Why does this happen? How can we prevent implant failure?
— In fact, if a detailed examination is performed before the implants are inserted, then all the risks are eliminated and so this does not happen. It is important to know what diseases are in the anamnesis, to examine closely the anatomical structure of the jaw. The gums must also be checked for the presence of bacteria and these must be eliminated with antibiotics or laser treatment. This is all done by responsible professional doctors. In any case, hygiene of the oral cavity is very important. If a person has an implant, it is advisable to see the dentist once every six months — this will help avoid many problems. The most severe situation is damage to the implant in the front teeth. It is necessary to remove it, to treat the cavity and to reinsert it. The risk group includes patients with diabetes and heavy smokers. I suggest to smokers that, if they are not ready to give up their habit, they should find another solution instead of implants.
— For how long can an implant remain without replacement? Can it stay in for one’s whole life?
— If the whole process, from the insertion to the healing, was successful, and this usually happens, then this period of use is unlimited. There are cases when implants have been inserted for more than forty years. But during this time, the crown suffered a great deal of wear. And today, next-generation implants are being manufactured which are much more technological. But in any case, no matter what quality the implants are, attention to oral hygiene is crucial: to clean the space between the teeth with dental floss or special silicone brushes, to massage the gums and many other preventive measures. And the more reconstructions there are in the mouth, the more attention you should pay to this issue. In addition, it is necessary to resort to professional dental cleaning from time to time.
— What is the maximum number of implants that can be inserted? Is there a limit?
— If a person with a prosthesis of the upper jaw comes to me, with no upper teeth, I can offer him/her a maximum of six implants. This will be quite enough to solve his/her problems completely by combining them with bridges. With a total absence of teeth, the maximum number is twelve, six on top and six below. Sometimes we can do more if missing teeth are asymmetrical. In short, each case requires its own solution.
This limitation is due to the fact that, over time, implants, if there are too many, give rise to a lack of bone or a decrease in blood circulation in the surrounding tissues, which gives rise to inflammation. These are foreign bodies in your body, remember… so you should not aim to replace all of your missing teeth with implants. This approach is typical of Americans. In Europe, we are trying to find the best solution so as not to impair blood circulation in the gums.
— Have you ever come across a patient with a wish to combine implantation with adornments?
— Yes, it happens. Once a patient came to me with a classic cut diamond — it needed to be screwed deep enough into the implant to be secure. There are people wishing to decorate their smile with zirconia (they are usually simply glued on). And once in New York, I happened to see a design with diamonds worth almost half a million dollars. It was a temporary patch on the front teeth, the full width of which were strewn with gold and diamonds. Perfect jewels!
— I heard about implants made of gold. Is this true? Or is it just decoration?
— Both. I have met people with gold implants — it is a good material. Some patients have asked me to insert gold crowns on their implants, but this is a matter of culture and taste.
— And what combination of materials for an implant is considered to be the best today?
— The implant itself is made of titanium, and the most suitable material for the crown is zirconium. Some people ask to have a crown made of ceramic. The disadvantage of this material is its fragility. Nevertheless, such implants are better than metal implants for those with thin bone tissue. There are also combined options, where the inner part is made of metal and the top is made of ceramic. This is also one of the solutions, but it is more a question of aesthetics. So, every time you have to assess all the factors.
Doctor of Medicine. He was born in Sweden in 1961. He graduated from the Royal School of Sergeants of the Swedish Army. From 1983, he studied at the Medical Faculty of the University of Lund and graduated with honors in 1988. He then continued his postgraduate studies. He is a graduate of the famous dental school in Malmö. In order to obtain the most versatile education and practical experience, he has worked in many leading dental clinics in Europe and Switzerland, including the Clinique la Prairie under the leadership of Dr. Pierre Disler. Since 1994, he has been conducting private dental practice, and he is also the head of Swiss Aesthetic Dentistry.
Food does not come on its own
Anorexia and bulimia — these are everyday words for many of us. They are written about in women’s magazines, they are spoken about in television talk shows… but what really lies behind these medical terms is known only to those who have encountered them in real life. The picture is truly horrific: a third of those with anorexia, mostly young girls, die from hunger and destruction of their internal organs. Many who survive become disabled, and the psyche changes irreversibly. The task of Dr. Claudia Elsig from Calda Clinic is to understand the causes of the disease and return a patient with eating disorders to a normal life.
— Dr. Elsig, there is a general opinion that anorexia and bulimia are female diseases. Is it true?
— Yes, it is. It’s mainly women who suffer from these diseases. According to the statistics, 1.1% of women in Germany are sufferers. But also 0.3% of men suffer from anorexia: that is, every fourth sufferer is a man. With regards to bulimia, these figures are 0.3% and 0.1%, respectively. In the United States, the ratio is approximately 1:3 among adolescents aged 13 to 18 years, and yet more often than not we talk about women.
— Why is this?
— I think, first of all, it’s about the basic personality of a person. What do they do when there is a problem in their life? For some, it’s enough just to change their hairstyle or take a break. Others fall into depression and sink into their fears. Some start drinking or turn to drugs, and some develop eating disorders. The male psyche is different from the female one. Therefore, men with life problems are more likely to succumb to addictions or become aggressive towards others, while women destroy themselves through starvation…
I believe that society itself and the modern ideals of beauty are responsible for this. Women are much more exposed to media pressure in terms of appearance than men — and this is the result. However, the stronger sex has recently resorted to the plastic surgeon’s knife more often and undergone liposuction — in a word, started monitoring their appearance.
— In addition to the desire of young girls to follow these imposed standards of beauty, what other factors lead to anorexia and bulimia?
— Social pressure. Quite often, the root cause lies in the family. Many patients with eating disorders tell us of conflicts with relatives and rows during family meals. There are families where a certain amount of food is put on a plate for a child and he or she must eat it. In 18–19% of cases, the disease is a consequence of post-traumatic syndrome.
Girls who are subjected to excessive control at home are in the risk group. Each of their steps, each of their actions, is strictly regulated. The only sphere of life in which they are without parental control and in which they can establish their own rules is food.
Psychogenic overeating is closely related to feelings such as loneliness and inferiority. Love, tenderness, and empathy are replaced with food. Over the years of my medical practice, I have met many patients who have had eating disorders because of sexual abuse in childhood. Therefore, the main target of therapy is the hidden problem, not just the anorexia or bulimia itself.
— Tragic stories about death from anorexia of models and actresses quite often appear in the press. Is the disease really so dangerous? Or do only the most egregious cases appear in the pages of magazines?
— This is an extremely serious mental illness that ends in the death of one third of girls who suffer from it. They literally dwindle. They become so thin so that the heart and other internal organs can no longer perform their functions. For many, we are not talking about a full recovery if the situation is neglected. To be more precise, a doctor can lead a patient into a state in which it is possible to lead a normal life. But in the most difficult cases, mental changes may remain forever.
— Is it true that anorexia begins with a diet, with a desire to lose weight and, incredible as it may seem, to eat right?
— It’s possible, especially for girls of school age. They are often prone to peer pressure; they want to be «school stars» and they become an object of derision due to their excess weight. And after that, they start to starve themselves. During the diet, endorphins are activated, a state of euphoria arises and, over time, a dependence on it develops. A new «menu» becomes desirable and they continue to drink only juice, or kefir, or eat only apples…
Their ability to be objective about their appearance is lost. They look in the mirror and they think that their thighs are too thick or there are folds on their stomach…Gradually, they begin to see themselves as fat regardless of the real picture. They notice nothing except their «excess weight», even if others warn them that they are unhealthily thin. I believe that in this case, first of all, it is necessary to investigate the personality of the patient in order to understand what has led to the anorexia. After all, other girls also stick to diets, but do not become ill.
— At what point does the natural desire for a young woman to lose weight become a disease?
— If attempts to lose weight begin to interfere with a normal way of life, this is a clear symptom of the disease and a signal to the sufferer to seek qualified help. Often the patients themselves say that it has become a problem for them. The disease begins to have a social impact on the patients’ life long before the situation gets out of control and becomes dangerous.
— When ordinary people are on a diet or starve themselves, they still feel hungry. What happens to anorexic patients that they can bring themselves the point of death by starvation? Are they capable of such unnatural self-control?
— It’s not about self-control. Those suffering from anorexia do not feel hungry, because changes occur in the satiation center in the brain. And for those prone to overeating, on the contrary, the feeling of saturation disappears. They can eat non-stop. Only during treatment can we restore the normal operation of these parts of the brain. Patients must again learn to feel hungry or satisfied.
For those suffering from anorexia, food is disgusting, it makes you put on weight. Butter and other high-calorie foods really horrify them. We compile a ‘red list’ of food products with these patients, in which we list in detail all that they have denied themselves, and during the treatment we re-integrate it into their diet. First, we get them used to the smell, then we get them to touch the food with their tongue — they taste it and remember the feeling… this is a long process, during which we try to free the patient from the fear of eating. A food disorder cannot be treated in a few hours or days. The process usually takes 1–2 years, with weekly visits to the doctor.
— Is it possible to go into an anorexic phase through dieting at a more mature age?
— Grown-up women very rarely develop anorexia. Rather, it is a disease of the young and of adolescents. The average age of patients with bulimia is a little higher, 18–24 years old, although I have had patients aged over 30.
— And from the point of view of human physiology, why is bulimia so dangerous?
— With constant vomiting, the body loses its acidity and the potassium-sodium balance is upset. The stomach, intestines, heart, and all of the other organs suffer and this happens over a period of time.
Can you imagine how much a woman suffering from this disease can eat at a time?
— Not really. Probably a lot?
— It’s not just a lot! It’s a huge amount! Imagine a table filled with dishes for a family meal where visitors are expected. Bowls of salad, a huge dish of pasta with sauce, a basket of bread, chocolate bars, cakes, fruit, cheese, sweet drinks… all this is consumed by one person in 35–40 minutes! They eat until the body refuses any more food. And at the end of the meal, they drink mineral water with ice cream, as carbonic acid helps induce vomiting.
Bulimic patients can have up to 5–8 gorge attacks a day, if circumstances permit and no one is around, and at work they are unable to think of anything else other than food. They return home, put all the dishes on the table, consume them, and then comes the vomiting. Thus does the evening pass. Such women have, as a rule, no family – it’s simply impossible. They are mired in debt — huge amounts of money go on food!
— So those suffering from bulimia must be very fat. After all, they consume a huge amount of food.
— Not necessary. Some women compensate for their eating disorders with manic sport activity. They eat uncontrollably and then spend hours in exhausting workouts. So if one of your friends or relatives is too keen on the gym, this is a reason to sound the alarm.
— And how does the treatment work?
— The treatment takes at least 3 months. This is extremely intensive therapy: 4–8 consultations a week instead of one. In addition we have a psychologist, under whose supervision the patient will have to train to eat a normal meal every day.
Outpatient treatment is not accompanied by home treatment; the patients have to do a lot themselves. Do not forget that this is a long and complex process, as with any form of dependency. After 4–6 weeks, the therapist will come and see how the knowledge acquired is being used in practice – how you go shopping, how you eat only at the dinner table, not in bed or in front of the TV. He will make sure that you do not create large food reserves again. And here, above all, the patient’s motivation is necessary.
Much more difficult is the situation with girls who are not yet 18 years old. The parents bring them to the clinic. They pay bills and think that they’ve played their part. But we must involve the family in the process of treatment, too. We must find out what led to the anorexia and contributed to the development of the disease, and we must know what the atmosphere is like at home. Sometimes this is a very complex and even controversial issue. In addition, the doctor must find a balance in the provision of information. On one hand these are the girl’s parents, but on the other they might be the basic cause of the disease. Sometimes the impact on the family is as important for a successful outcome as working with the patients themselves.
— What is the difference between outpatient and inpatient treatment?
— As a rule, outpatient treatment lasts longer: at least 6–7 months. I always recommend taking breaks to practice at home what you have learned in the clinic. There is no need to meet more often than three times a week. Nevertheless, all of this is very individual. Motivation and life circumstances — all of this plays its part. For example, I had a patient who lived with her sick father; she helped him at home. But during her childhood he had raped her, which was the reason for her eating behavior. We knew that the treatment could not be 100% successful as long as she lived with him. But she could not abandon him because of her compassion for him and his illness, and she understood this; so you always need to look at specific circumstances.
What is the best form of treatment for patients from other countries? To spend 2–3 months in the clinic or visit the doctor regularly?
— Every case is different but, as a rule, I recommend an intensive course for 2–3 months for patients from abroad to see what is happening to them, how they change and how they feel. Maybe they should repeat it again in six months. Everything depends on their state of health and on the specific situation. We do not follow any standard programs. However, it is obligatory for foreign patients also that the therapist goes to their home and see how the treatment is being implemented at home to be convinced of its effectiveness.
— What else, besides professional medical help, allows you to quickly return the patient to a normal life?
— The higher the motivation, the better the social and family support, then the greater the chance of success. We integrate the maximum number of resources into the treatment: for example, family and friends. This approach significantly increases the likelihood of a successful outcome.
Claudia M. Elsig
Dr. Med., medical specialist in psychiatry and psychotherapy and CEO and Head of the Medical Overall Management in the Calda Clinic, graduated from the medical faculty of Zurich University in 1994. For more than 16 years she has been engaged in a private medical psychiatricpsychotherapeutic practice. 2010-2014 – Head of Special Consultation Hour Clinical Hypnosis, Psychiatric Private Clinic Sanatorium Kilchberg, Kilchberg/CH. 2011-2015 – Medical Director and Head of Psychiatry, The Kusnacht Practice AG, Küsnacht/CH. Dr. Claudia M. Elsig is the author of several educational and training works. She is a member of the Swiss Society for Psychiatry and Psychotherapy (SGPP), the Swiss Society for Behavioral and Cognitive Therapy (SGVT), the Swiss Medical Society for Hypnosis (SMSH), the German Society for Hypnosis and Hypnotherapy (DGH), the Swiss Society for EMDR (EMDR Switzerland), and the Swiss Society for Anti-Aging Medicine and Prevention (SSAAMP).