Which type of implant is right for me?

The full answer

When people ask about “types of implants”, they usually mean a brand or a country. In Amman you will hear implants described by nationality; back home you may have heard them described by brand. The real difference between one implant and another sits somewhere else, so let us start with the implant itself.

What an implant is made of

Three parts. A small titanium root placed in the jawbone where the tooth used to be, which the bone knits around over months. A small connector, the abutment, that comes up through the gum. And on the abutment, the crown: the tooth you see and eat with. When we talk about the “type” of implant, we are talking about the root, the abutment and the system that joins them.

What actually differs between one implant and another

• The material. Most implants in the world are titanium, because bone bonds to it and the body usually accepts it. There are also implants made of a white ceramic material for particular cases, such as a rare sensitivity to metal, or thin gum in a spot that shows. The material is decided by your case, not by fashion.
• Size and shape. Implants come in different lengths and diameters, and the root is shaped differently: some tapered, some cylindrical. Thin bone needs a narrower implant, short bone needs a shorter one, and a back molar that chews hard needs a wider diameter if the bone allows it. This is the first thing the doctor decides from the scan.
• The surface. Most implant surfaces are not smooth. It is treated to help the bone bond to it, and every system has its own way of treating it. This is where the systems compete hardest, and it is nothing you can see with the naked eye.
• The crown connection. How the abutment and the crown fit onto the root: a connection inside the implant or on top of it, and its shape. This affects how stable the crown is and how the gum around it behaves over the years.
• The whole system. An implant is not a single part; it is a system: root, abutments, tools and replacement parts. A system documented to recognised medical standards has parts available for the long term, and that matters to you if a crown or an abutment needs replacing years from now, here or in another country.

And what decides which one is yours?

• Your bone first. Its density, height and width, which are seen on the right scan, not by eye.
• The position of the tooth. A front tooth needs a good shape and a tidy gum; a back tooth needs strength for chewing.
• The space. Between the teeth on either side of the gap.
• How many teeth are missing. One tooth is a different job from several, and sometimes a few implants, placed well, can carry a set of teeth.
• Your general health. Uncontrolled diabetes and heavy smoking change the plan.
• The doctor's familiarity with his system. Hands that know their system work more precisely in it.

So there is no one implant for everyone. There is an implant that suits this bone in this position, and nobody can tell you which one before they have seen your scan.

And the cost? The type of implant is one of the factors, and it is discussed after the examination. What decides it is explained on What decides the cost of your treatment. And if you are still weighing an implant against a bridge at all, start there: Implant or bridge: what actually differs.

German, Korean, Swiss, Italian, American: does the country matter?

This is how the question is asked in Amman: “German or Korean?” The honest answer: the country on the box is where the company is registered or where it manufactures, not a grade of quality. There are well-documented systems from many countries, and less documented systems from the same countries.

The same goes if you are comparing countries rather than boxes. Whether you have implants here or anywhere else, the questions that decide the result are the same, and none of them is a nationality: who places the implant, which system goes in, whether its parts will be found later, and who follows you up through the months the bone takes to heal.

What actually matters, whatever the country

• Documentation and parts years later. Explained above, under “The whole system”.
• The fit for your bone. A system, whatever its name, does you no good if it does not come in the size your bone needs.
• The hands that place it. Exactly the same implant, in different bone and with different planning, gives a different result. Planning on the scan, placing it in the right position at the right angle, and the follow-up afterwards: these make more difference than the name.

What to ask any clinic about the implant

These are questions to ask any clinic, and we are one of them. Not because you should doubt anyone, but so you know what is going into your bone:

• Which implant system will go in my mouth, and who manufactures it?
• Why this system and this size for my case?
• Can I take away a card or a sticker with the implant details (the system, the size and the lot number), so I have them if I need them years from now, or in another country?
• And will the parts be available years later?

If the answers are clear, good. If you did not follow them, ask again. Your teeth are not in a hurry.

Same-day implants: when they work and when they wait

You will see adverts promising an implant and a tooth on the same day, or within days. The idea genuinely exists in dentistry, but it covers two different things that get mixed up, and each comes with conditions.

Two different things

• Immediate placement: the implant goes in at the same visit as the extraction, into the space the root has just left. It saves a visit, and it saves the waiting period between the extraction and the implant.
• Immediate loading: a temporary tooth is fitted on the implant within days, instead of you going without a tooth until the healing is complete. Usually a tooth for appearance, not for chewing on.

Neither cancels the essential part: the bone has to knit around the implant over months before the final crown goes on. Same-day saves a visit or a wait. It does not save the healing.

When it works

When the extraction site is clean, with no infection and no abscess; when there is enough bone around it to hold the implant from the first moment; when the implant sits firmly the moment it is placed; and when the bite does not load the temporary tooth. Very often the decision is made at the moment of extraction itself, when the doctor sees the bone with his own eyes, not beforehand over the phone or by email.

When it waits

• Infection or an abscess where the tooth was: an implant is usually not placed into an infected site. It is treated, it heals, and then the implant is decided.
• Thin or shrunken bone: sometimes it needs building up first, which is an extra stage with its own healing time.
• A back molar that chews hard: immediate loading there usually waits, because the pressure threatens the bond with the bone.
• Uncontrolled diabetes or heavy smoking: healing is slower, and the plan becomes a calmer one. Dental implants when you have diabetes.

Do dental implants cause cancer?

A question asked often, and asked quietly. So let us answer it in a normal voice: there is no scientific evidence that dental implants cause cancer.

Titanium has been used inside the human body for decades: in hip and knee replacements, and in the plates and screws that hold broken bones. The body usually accepts it, it does not rust, and reactions to it are very rare, and bone bonds to it. That is exactly why it was chosen for implants.

What can actually happen around an implant

Inflammation of the gum and bone around it. That is the most common problem after an implant, and it happens most often when cleaning and check-ups are neglected, or with smoking and a history of gum disease. It is not cancer, it can be treated, and the earlier it is caught the simpler the treatment. A sensitivity to metal is very rare, and it is discussed at the examination if you have a history of allergy to metals. What makes an implant last, and what shortens it.

What deserves a check, implant or no implant

Any sore in the mouth that has not healed in weeks, a white or red patch that stays, or a lump that does not go away is examined by the doctor regardless of the implant. Not because the implant caused it, but because a mouth needs checking whenever something new appears in it and does not go.

And if you have a history of cancer?

That changes the plan; it does not necessarily rule it out. If you have had radiotherapy to the jaw or neck, or you take certain medicines for the bones (some osteoporosis medicines, or medicines given alongside cancer treatment), say so at the examination in your first sentence, because healing in the bone is affected, and the doctor coordinates with your own physician before any decision, even if that physician is in another country.

What to do from today

1. 1

   Do not choose an implant from the internetThe name you liked in an article, or the brand your neighbour or your dentist back home swears by, is a name for bone other than yours. Read so you know what to ask, not so you decide in place of the examination.

2. 2

   Say what actually matters to youDo you want a tooth as soon as possible? Is there an event, a trip, or a posting that ends? Are you afraid of the surgery? Each of these changes the order of the plan, and the right moment to say it is the first visit.

3. 3

   Have your health details readyDiabetes, blood pressure, blood thinners, smoking, allergy to metals, medicines for the bones, past radiotherapy. Not so you are ruled out, but so the plan is built right from day one. And do not stop any medicine on your own.

4. 4

   If the tooth is still in placeIf an implant is on your mind, say so before the extraction, wherever it is done: the extraction can be done in a way that helps preserve the bone, and the final call on same-day placement is made at the moment of extraction, when the doctor sees the bone.

5. 5

   Book an examination and a scanThe right scan shows your bone and its measurements; the examination shows the gum, the bite and the space. After that you hear which system and which size, and why, and whether a same-day implant applies to you. And you decide.

When to call

If the gap has been there for a long time and nothing hurts, that is not an emergency, but do not leave it for years. Some situations, though, do not wait until you have decided on a type of implant:

• Call today: a broken or loose tooth with swelling, an abscess or a fever. The infection is treated first, and the implant decision comes after.
• Call today: a new implant where the swelling is growing after the first days instead of easing, or a fever, or bleeding that does not stop.
• Call this week: a tooth that is due to be extracted, here or anywhere else, and you want to know whether an implant can go in at the same visit. The planning happens before the extraction; the final confirmation comes at the moment of extraction, when the doctor sees the bone.
• Call this week: an older implant, placed here or abroad, and the gum around it bleeds or hurts or gives off a bad taste, or the crown on it has moved.
• Call this week: a sore or a patch in the mouth that has not gone in weeks, implant or no implant.

Call and we will find you the earliest slot, and tell you what to do until you arrive. Before any painkiller, ask the doctor first, so it suits your case. If it hurts badly now and the clinic is closed: what to do until morning. If the swelling has reached your eye, or it has become hard to swallow or breathe, that is a hospital emergency, not an appointment. And if the clinic is closed and the bleeding will not stop with pressure, or the swelling is growing, or you have a high fever, go to the nearest hospital emergency department, and let us know as soon as we open.

Questions people ask