Everything about dental implants – variants, treatment procedure, costs

What are dental implants?

Dental implants are artificial tooth roots where metal pins are fixed in the jaw. Strictly speaking, implants are not tooth replacements, but the basis for attaching a denture. The final prosthesis in the form of a crown, bridge, or fixed/removable prosthesis must still be attached to implants.

For whom are dental implants suitable?

Implants can replace all types of tooth loss – i.e. single missing teeth, multiple missing teeth, or even the entire set of teeth.

However, a prerequisite for implants is that the patient has stable bone in the affected jaw that can support the implants. If a patient does not have enough jawbone, it is possible to build up the jawbone.

In addition, a person should be willing to maintain a high level of oral hygiene.

How is the implant used?

Replacement of individual teeth

An implant can be used to replace individual teeth. In this case, the dental implant is fitted with a crown and functions virtually as an artificial tooth root for the crown.

Implant bridge

This is a bridge replacing several adjacent missing teeth. Unlike a “normal” dental bridge, it is not supported by the patient’s own teeth as abutment teeth, but by implants. For example, three teeth can be replaced by an implant bridge in which the middle replacement tooth is a pontic and the two outer replacement teeth are implant-supported bridge abutments.

Use of a fixed prosthesis

Dental implants can be used to anchor a complete denture. Usually 4-8 implants per jaw are implanted, on which bridges are then fixed. There are two concepts that are frequently used here:

• All-on-4 implant: A fixed bridge is screwed onto four dental implants.
• All-on-6 implant: Here, a fixed bridge is screwed onto six dental implants.
• All-on-8 implant: Here, a fixed bridge is screwed onto eight dental implants.

The number of implants needed depends on the stability required for the implant, as well as the bone density. In addition, more implants are usually recommended in the maxilla, where bone density is lower.

Use of a removable denture

Removable dentures can also be anchored to implants with a bar. For this purpose, four implants are often “splinted” to a bar, and so-called riders are incorporated into the removable prosthesis to enable it to be attached to the bar.

A removable denture usually requires fewer implants than a fixed denture, for example, it can be anchored with as few as four implants.

What are the variants?

There is an unmanageable variety of implant types on the market, which can be differentiated according to various aspects. Here we would like to consider the two typical distinguishing features: the position and the shape of the implant.

Position of the implant:

• Endosteal or endosteal implants (in the jawbone): This is the most common type of implant. where the implants are placed directly into the jawbone. Endosteal implants are used when the jawbone is healthy and has a sufficiently high bone density
• Superiosteal implants (between the gum and the jawbone): These are implants that are placed between the gum and the jawbone. Superiosteal implants are used when patients do not have enough healthy jawbone to use endosteal implants (in the jawbone). Superiosteal implants are used less frequently than endosteal implants
• Zygoma or zygomatic arch implants: This method is not very common due to its complexity. Here, implants are implanted in the zygomatic arch instead of the jawbone. This method is intended for patients whose jawbones are not strong enough to use endosteal implants

Shape of the implant:

• Screw implants: Threaded screw implants are the most commonly used type of dental implant. Conventional screw implants are screwed into a standardized hole that is previously milled into the jawbone. More modern screw implants can sometimes be screwed into the jaw without predrilling
• Hollow cylinder implants: These implants do not have a thread but are “tapped” into the jawbone, for this purpose a hole must also first be milled into the jawbone. Since the part of the jaw bone that is inside the cylinder after attaching hollow cylinder implants is less well supplied with blood, hollow cylinder implants are the better choice than screw implants only in rare cases
• Mini implants: These have a smaller diameter (2.3 mm) than standard implants (3 mm) and are made of a harder material than standard implants. Due to their size, they require less bone density than standard implants, but are less flexible in their use, e.g. they are used to replace smaller teeth or anchor full dentures.

How long does the treatment last?

The duration and start of treatment depends on the initial situation and the cause of tooth loss. For example, if there was an infection that led to tooth loss, a waiting period of at least one month should be observed before treatment.

Treatment from the initial consultation with the dentist to the finished implant and tooth replacement usually takes between three and nine months. If teeth have to be extracted beforehand or the jawbone has to be built up, the treatment period can be extended to more than a year.

What is the course of treatment?

Step 1: Consultation, preparation of the treatment plan and preoperative planning

As a prerequisite for treatment, a detailed consultation should be conducted with the attending physician. Here, the patient should discuss any concerns and desires with the dentist and the dentist will educate the patient on the various options. Based on the initial findings, the physician creates a treatment plan for the patient.

For the optimal determination of the patient’s initial situation, modern dental clinics nowadays use sophisticated technical equipment, with the help of which, for example, the patient’s entire jaw can be scanned. This dental volumetric tomograph has a 3D imaging mode, and a special navigation system, with which a very high degree of safety can be ensured during the planning of the procedure.

Additional step: bone augmentation (necessary if bone volume is too low)

In order for the implant to be anchored stably enough, there must be sufficient bone volume, otherwise there is a risk that the implant will not withstand the chewing pressure and may break out. As a rule of thumb, the bone surrounding the implant should be at least 2 mm thick. It may happen that the jawbone in the area of the tooth gap has already partially degenerated. In such cases, bone augmentation can be performed to prepare the jawbone for the dental implant.

There are different variants and materials used for bone augmentation (e.g. autologous bone, natural bone substitute material, synthetic bone substitute material). For larger defects in the jawbone, there is the possibility of a so-called iliac crest extraction, in which bone is taken from the hip.

In the maxillary region, the sinus lift is one of the most common bone augmentation procedures. In this procedure, the mucosa between the maxillary sinus and the jawbone is lifted slightly and the resulting cavity is filled with the bone substitute material. The body naturally breaks this down and replaces it with bone.

In the mandible, a bone graft is normally used. For this purpose, bone is usually harvested from the healthy part of the mandible and placed in the area of the implant.

In the case of a small bone defect, it may be possible to perform the bone augmentation and implant placement at the same time.

Step 2: Implantation

The placement of implants is usually done on an outpatient basis and under local anesthesia. If a patient needs several implants, they can also be inserted in one session.

The implantation process depends on the type of implant used. The process for an endosteal screw implant (implanted in the jawbone) is briefly described here. The dentist first makes a small incision in the gum to access the jawbone. In the second step, a standardized hole is milled in the jawbone, into which the implant is then placed.

After placing the implant, the incision in the gum is sutured closed with a few stitches.

Step 3: Healing phase

Now the so-called healing phase begins, during which the jaw heals. With an implant in the upper jaw this can take 4-6 months, with the slightly more stable lower jaw it can go faster with about 2-4 months.

The jawbone grows together with the implant over time (so-called osseointegration).

Nowadays, during the healing phase, the patient usually wears a temporary fixed prosthesis.

Step 4: Attaching the denture

When the jawbone has healed, the gums must be prepared for the denture. The gum should enclose the denture like a natural tooth. For this purpose, the gum is opened and a small post, the so-called “gum former” is attached to the implant.

In addition, an impression is taken, on the basis of which a dental technician makes a dental prosthesis – this takes about 2 weeks. After these two weeks, the “gum former” is then replaced by the final denture, which is firmly anchored to the implant.

Step 5: Oral hygiene and follow-up checks

Particularly in the first few days after insertion of the denture, the patient should not put too much weight on it, even if it is already stable. Accordingly, dental care should first be performed with a soft toothbrush. Any swelling or mild inflammation that may occur can be treated with medication, and antiseptic irrigation can help prevent inflammation. From the second week after insertion of the denture or after a follow-up appointment, there are hardly any restrictions.

In general, good oral hygiene, prophylaxis and regular follow-up examinations protect against so-called periimplantitis, which can be caused by a bacterial disease of the gums. In addition to good dental hygiene, it is recommended to have professional dental cleaning at least twice a year. In addition, a follow-up check of the implants should be performed by the dentist approximately every six months. Here, not only is the correct hold of the implant checked, but the gums are also examined for possible initial signs of peri-implantitis.

What are advantages of implants?

Esthetics and function: No other method replaces the tooth as naturally as a tooth replacement based on dental implants. Dental prosthesis based on dental implants is almost indistinguishable from other teeth in terms of appearance and bite feeling.

High durability: Today, an implant can last a lifetime. However, the ceramic crowns or another attachment on the implant may need to be replaced over time – ceramic crowns have a shelf life of 10-15 years depending on care.

No sacrifice of healthy tooth substance: Unlike crowns and bridges, no healthy teeth have to be ground down when implants are inserted.

Prevention of bone resorption: The imitation of the natural tooth roots prevents bone resorption, which is partly caused by dentures, when the bone under the denture is no longer properly loaded.

What are disadvantages of implants?

High effort and treatment time: Placing dental implants is a relatively invasive surgical method to replace missing teeth. On average, it takes 3 to 6 months for the implants to heal completely.

The expense increases in particular if preparatory measures for the implant, such as bone augmentation, are necessary.

Highest cost among tooth replacement options: Dental implants are the most expensive of all tooth replacement options. For a single implant with crown (without bone augmentation), for example, costs of CHF 2,200 to CHF 5,000 can be expected in Switzerland.

Risk of surgery and wound healing disorders: Surgical interventions are always associated with a certain risk, for example, there may be disturbances in wound healing.

Risk of peri-implantitis: There is a certain risk of peri-implantitis with implants. Prei-implantitis is an inflammation of the tissue adjacent to the implant. This can be a serious complication in the course of implant treatment. Overreaction of the immune system is often the cause of peri-implantitis. Specific risk factors may increase the occurrence of prei-implantitis, e.g. smoking, placing the implant too deep, insufficient oral hygiene, narrow bones or an existing immune deficiency.

What costs should I expect?

In Switzerland

In Switzerland, a single dental implant including a crown and excluding bone augmentation costs approximately CHF 2,500 to 5,000, depending on the manufacturer. With bone augmentation, costs per dental implant of 3,500 to 5,500 can be expected. With multiple dental implants, the cost per dental implant decreases.

Bridges on 4 implants (ALL-ON-4®) per jaw currently cost CHF 8,000 to CHF 15,000 in Switzerland.

In European foreign countries

Germany and Austria have a slightly lower price level for dental implants than Switzerland. A single dental implant without bone augmentation costs between EUR 1,500 and EUR 3,500, with bone augmentation between EUR 1,800 and EUR 4,500 and bridges on 4 implants (ALL-ON-4®) cost approx. EUR 5,000 – EUR 15,000 per jaw.

Patients can save significantly on treatment costs if they seek treatment in Southern and Eastern Europe. In Greece, Hungary and the Czech Republic, a single dental implant without bone augmentation costs between EUR 1,000 and EUR 2,500, with bone augmentation between EUR 1,300 and EUR 2,500 and bridges on 4 implants (ALL-ON-4®) cost approx. EUR 5,000 – EUR 11,000 per jaw.

The following table provides an overview of the typical price levels for a single dental implant with and without bone augmentation, as well as for an ALL-ON-4® implant for one jaw in the countries mentioned:

Country	Cost 1 dental implant	Cost 1 dental implant with bone augmentation	Cost ALL-ON-4® implant (1 jaw)
Country	Cost 1 dental implant	Cost 1 dental implant with bone augmentation	Cost ALL-ON-4® implant (1 jaw)
Switzerland	CHF 2’200 – 5’000	CHF 3’200 – 6’000	CHF 8’000 – 15’000
Germany	EUR 1’500 – 3’500	EUR 1’800 – 4’500	EUR 5’000 – 15’000
Austria	EUR 1’800 – 2’500	EUR 2’100 – 4’500	EUR 7’000 – 15’000
Greece	EUR 1’000 – 2’500	EUR 2’000 – 2’500	EUR 6’000 – 7’000
Hungary	EUR 900 – 1’600	EUR 1’300 – 2’400	EUR 5’000 – 7’000
Czech Republic	EUR 1’000 – 1’500	EUr 1’300 – 2’500	EUR 6’500 – 11’000

Sources: Various dental practice websites.

Who covers the cost of dental implants?

In Switzerland, the basic insurance usually does not cover dental treatment costs, normally 100% of dental costs have to be paid by the patient. An exception exists if certain serious diseases of the masticatory system are present or if the consequences of serious diseases make dental treatment necessary.

Private supplementary dental insurance in Switzerland usually covers the costs of dental implants. Most insurance companies offer different rates with reimbursements between 50% and 80%, but often there is a maximum reimbursement in one year.

In case of tooth loss as a result of an accident, the accident insurance covers the costs of implant treatment after clarification.

Last update: December 13, 2022