Swiss Health Magazine

Without gaps

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.

Thomas Varga

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.