Lexicon

Abutments

Also see: Implant superstructures

Parts of the superstructure, designed by the implant manufacturer for the connection between implant body (grown into the bone) and dental prosthesis. This includes above all:

• straight or angled solid bodies for the cementation of crowns
• screw joints for bar connections or screw-fixed crowns
• ball or magnet superstructures for attaching dentures

Not all implants require abutments: single piece implants comprise the implant body that becomes integrated with the bone and the abutment in a single piece. The advantage of this is that there is no loosening of connecting screws. Moreover, one piece implants are cheaper.

Analgetika

Pain killers. Divided into:

• simple analgetics belonging to the group of NSAIDs (nonsteroidal anti-inflammatory drugs). Amongst others, this group includes: Acetylsalicylic acid (ASS; Aspirin^®), Paracetamol (e.g. PCM; Benuron^®), Metamizole (Novaminsulfon; Novalgin^®) und Ibuprofen (e.g. Aktren^®).


• Narcotic analgesics acting on the central nervous system. Amongst others, this group includes Tramadol (e.g. Tramal^®), Tilidinse (e.g. Valoron^®) and very strong pain medication like morphine (e.g. MST^®).

Antibiotics

Group of drugs that disturb the metabolism of bacteria and thus inhibit their growth or directly kill them. They are used to treat bacterial infections or to prevent infections of this type. The most commonly used groups of antibiotics are:

• Penicillins (e.g. Penicillin; Amoxicillin, Ampicillin)
• Cephalosporines (e.g. Panoral^®; Suprax^®; Grüncef^®; Keimax^®)
• Tetracycline (z.B. Doxycyclin)
• Makrolide (z.B. Erythromycin; Rulid^®; Klacid^®; Zithromax^®)
• Gyrasehemmer (z.B. Ciprobay^®; Tarivid^®)
• Sulfonamide (z.B. Bactrim^®; Cotrim^®; Eusaprim^®)
• Aminoglycoside (z.B. Refobacin^®)

The administration of antibiotics during the placement of dental implants does not increase the probability of success of the implant. Nevertheless, antibiotic prophylaxis may be necessary, especially in high-risk patients.

Articulator

The articulator is a kind of replication of the human jaw joint. It is used in prosthetic dentistry (dental laboratories) to produce fitting prosthesis. In this process, the plaster models of the upper and lower law, which are made from an impression, are fixed in place in the articulator in the closed bite position that has been observed. This makes it possible to produce individual dental prosthesis and to simulate the function during the terminal occlusion as well as during mouth opening and lateral movements. As the articulator cannot fully imitate the movements of the mouth, it is nevertheless common that it is necessary to grind off the bridge at the time of integration.

Atrophy

Loss of body tissue, accompanied by an impairment of function. A distinction is drawn between atrophy due to inactivity, e.g. muscle atrophy or bone atrophy owing to an absence of appropriate loading of the tissue in question or pressure atrophy owing to constant localised over-loading of a tissue. Relevant for implantology, as the jaw bone may degenerate or atrophy owing to the absence of natural loading on the jaw bones after the loss of teeth When jaw atrophy is present, today BOI^®-implants are used for treatment, as these implants can be used without bone augmentation.

Augmentation

A synonym for the introduction of tissue augmentation- or tissue support material (e.g. bone augmentation). The introduced material is known as augmentate. Augmentation is undertaken for aesthetic reasons. In the past, bone augmentation was also used to create bone beds for implants. Ever since the introduction of BOI^®-implants, this measure has basically become redundant for this indication.

Basal implants

BOI^® - implants represent the most advanced form of basal implants. Basal implants differ from crestal implants (i.e. screw type implants) in that force transmission essentially occurs on the base bars that are to be inserted horizontally and not on the vertical shafts. For this reason   BOI^® - implants can also be used when only very little vertical bone is left. BOI^® - implants are placed in the jaw laterally and are often secured by means of fixation screws against early movement in the bone. BOI^® - implants heal under loading, however in individual cases it may be necessary to reduce chewing forces by means of medication to avoid excess loading on the bone bed.

BOI^® - implants are generally exposed to immediate loading, where the prosthetic construction takes the role of orthopaedic splinting. In contrast to screw implants, the woven bone which rapidly forms within the osteotomy slit soon contributes to stabilising the implant. The bone is later remodelled, so that regular osseointegration of the implant results by the end of the healing process.

BOI^®-implantologists   are not trained at universities, as there are currently no experts at German universities for this  procedure. Training, advanced training   and certification is undertaken by professional associations according to the guidance of implant manufacturers.

Secondary implantological restorations are a special application domain of BOI^®-implants:

After the loss of e.g. screw implants or blade implants further treatment with screw implants may not be possible. In contrast, treatment with BOI^® -implants is possible after all implant losses, independently of type of implant that has been lost. Implant replacement with BOI^® -implants is the preferred procedure, as it is not only possible to implant without bone augmentation but usually also without healing time (i.e.   immediate loading).

Biocompatibility

Ability of particular materials to remain in contact with body cells over extended periods of time without causing adverse reactions. Biocompatible materials include amongst others titanium and its alloys (e.g. Ti6Al4V, Ti15Mo) as well as particular ceramics and plastics

Bisphosphonates

Bisphosphonates are used to treat osteoporosis and bone tumours, among other indications, as they counteract bone loss by inhibiting bone resorption. When bone metabolism has been slowed in this manner, this interferes with the healing of implants however and any healing processes in the jaw bone. As a substantial risk of dying back of bone sections (osteonecrosis) also exists for other dentosurgical procedures such as tooth extractions, interventions in the jaw bone should be avoided wherever possible.

Not all bisphosphonates are particularly problematic in this context: bisphosphonates with nitrogen side chains appear to be associated with adverse side effects particularly frequently, which is why one should forego the use of these medications if possible. 
After these medications are discontinued, one should expect that they will continue to have an effect for an extremely long time.

Common bisphosphonates include: Actonel (Risedronat), Aredia (Pamidronic acid), Bondronat (Ibandronic acid), Bonefos (Clodronic acid), Clodron, Didronel (Etidronic acid), Fosamax (Alendronic acid), Ostac (Clodronic acid), Skelid (Tiludronic acid), Zometa (Zoledronic acid).

BMPs (Bone Morphogenetic Proteins)

Abbreviation of Bone Morphogenetic Proteins; special proteins produced by the body as local messengers for bone generation and bone healing. Areas of application of BMPs in medical practice are bone augmentation when defects are present and targeted acceleration of bone healing processes (bone fracture healing, implant healing) at the site of administration. Availability and dosage currently are not yet ready for practice in the area of dental medicine. All scientific studies available to date show that increased administration of BMPs does not have helpful effects in the dental-implantological area. Nevertheless, methods for the production and enrichment of BMPs are often used and increase treatment costs.

Bone augmentation

When there is not enough bone for the secure anchoring of a sufficiently large or, rather, long implant, extra bone may be added if crestal implants are to be used. Alternatively, BOI^®-implants may be used for restoration. For small amounts, this bone may be obtained during the operation (bone meal, which is collected in particular filters during drilling). For more extensive bone requirements, bone may be taken from bone-rich regions of the lower jaw, or the removal of a bone sliver from the hip bone may become necessary. These secondary procedures are usually safe, but can be associated with post-operative pain and swelling. Other procedures for obtaining bone are likely to be possible in future (BMP; PRP).

The bone obtained is then introduced at the desired site (maxillary sinus floor for sinus lift surgery, bone wall defects around the implant) and protected with a kind of film (membrane) to allow for undisturbed healing of the bone. By now, films that can be completely broken down in the body are most commonly used for this purpose. If so, removal is no longer necessary.

The literature cites failure rates for bone augmentation of between 5 and 45%.

If bone height is insufficient, the method of bone distraction can also be used.

Bone augmentation materials

These include:

• freeze-dried bone allograft (FDBA) from a bone bank (common in the USA; uncommon here)
• autogenous bone (taken from one site in the same patient, e.g. as a block of bone, and implanted elsewhere)
• as well as the large range of bone substitutes.

Bone block

To augment the bone at a section of the jaw that is distinctly too narrow or too shallow, a larger block of bone can be harvested at a different site and then fixed to the target site by means of small screws. Such a bone block (or bone sliver) usually requires several months of healing, before it can securely support implant loads. 

The ascending branch of the lower jaw is a suitable site for the extraction of smaller bone blocks. For more extensive bone augmentation measures bone extraction from the iliac crest is necessary. These secondary procedures are usually safe, but can be associated with post-operative pain and swelling. Here too it is common to protect the bone with a membrane during the healing period. 

Bone substitutes

These materials, which have been developed for bone augmentation, are divided into two groups:

Synthetic materials

Almost all the synthetic materials consist of ß-tricalcium phosphate, a basic kind of ceramic that exhibits more or less pronounced osteoconductivity, depending on surface finish. The advantages of synthetic materials are stable material properties and, in comparison of materials derived from other species, risk-free implantation in humans.

Xenogeneic (derived from other species) materials

Xenogeneic materials contain hydoxylapatite from bone constituents or from corals and have a more complex three-dimensional structure, which is said to exhibit better osteoconductivity. 

The bone material most commonly used in implantology is made from cattle bone by means of a special method that removes any protein constituents. The purpose of this is to prevent allergic reactions or infections. 

Bone splitting

If the jaw is too narrow, the bone can be prepared for implant insertion by means of bone splitting. In one tried and tested method, the narrow bone is split into a lingual and labial blade before the implants are inserted into the resulting gap, and the remaining voids are filled with bone or bone substitute particles.

Another method relies on splitting, non-degrading drills of increasing size to create space for the implants, even in narrow bones.

Bridge

The bridge is a tried and tested form of fixed tooth replacement. In order to close any gaps that have arisen by means of a bridge, work on the neighbouring teeth (grinding) is necessary to make them suitable for supporting crowns. Implants can also serve as bridge abutments with the relevant superstructures. The gap itself is then closed by the pontic, which is designed in one piece together with the crowns by the dental technician. The crowns are then firmly glued onto the abutments (tooth or implant). Subsequently, a bridge cannot be removed and facilitates chewing permanently. In terms of material, a distinction is drawn between ceramic veneer or fully ceramic (metal-free) bridges and metal only (usually gold) bridges.

If both an implant and a tooth are used as abutments, the bridge is known as a hybrid bridge.

Ceramic implants (Zirconium implants)

After the use of ceramic implants was discontinued in the late 1980s due to unfavourable material properties, they have in recent times enjoyed a Renaissance.

These ceramic implants consist of high-strength zirconium oxide-ceramics, which is extremely break-resistant. Zirconium implants are biologically well tolerated. They have the advantage of being much closer to the natural colour of teeth (white instead of grey), which can be of advantage for aesthetic restoration, especially when the covering gums are very thin. They are seen as metal-free, which patients request more and more frequently.

Significantly higher costs and, to date, inferior scientific documentation/experience are seen as disadvantageous. Whether the healing quota and durability approaches that of titanium dental implants remains to be studied. As well, the optimal surface finish for this type of implant (important for healing) remains to be clarified. The fact that there are no flexible choices for the superstructure of one piece zirconium implants is particularly problematic, owing to the fact that the problem of screw connections in ceramic implants still awaits final resolution. This restricts applications, and creates the necessity to protect the implants with splints from premature loading for several months. A problem that cannot always be solved successfully. Immediate loading is not possible for ceramic implants.

Conclusion: This very interesting material opens up now possibilities for aesthetic and biocompatible dental prosthesis. However, ceramic implants cannot yet compete with modern titanium implants in terms of the safety and speed of healing as well as simplicity of use. Zirconium implants will only be universally applicable when surface finishes are optimised, superstructure connections improve the range of applications and when these features simplify closed healing without loading, and will - with corresponding clinical studies - certainly become very widespread.

Ceramic implants appear to be prone to a higher number of fractures after absorption of water (e.g. after approx. 5 years).

Composite bridge (hybrid bridge)

Bridge that uses implants as well as teeth as abutments.

Computer tomography (CT)

Radiological method where the structures to be examined are captured in different cross-sections by means of X-rays. The data obtained makes it possible to generate an accurate representation of each section in cross-sections - also in three dimensions. In implantology, this method is used to record bone dimensions as well as vulnerable structures with precision, which can be very helpful or necessary for planning. Radiation exposure is much lower than with conventional X-ray methods.

Connecting bar

Prosthetic construction where at least two teeth and/or implants are connected by a bar to which the prosthesis is fixed by means of riding clamps.

Crowns and bridges

The crown is actually the visible part of any tooth, but usually "crown" is taken to refer to the "artificial" crown made by a dental technician. As a so-called single crown, it can be pitched on the stump of a tooth (or on an implant) and restore the original tooth shape and function. But it can also be connected to further crowns via a pontic and thus close gaps between teeth as a bridge.

In the form of double crowns (telescopic crowns) and attachment crown, they also serve for clamp-free attachment of removable dental prostheses.

Dental implant

Medical device manufactured industrially or rarely individually with the aim of achieving a permanent connection between jaw bone and dental prosthesis after placement by an implantologist. Implants that aren't manufactured industrially are, for instance, frame implants. All dental implants are made from titanium or ceramics. In terms of shape, a distinction is drawn between so-called rotationally symmetrical implants, e.g. threaded or cylindrical implants and other designs. Other designs include BOI^®-implants for example.

The long-standing view that implants should resemble the root of a tooth as far as possible, fails to understand the actual connective apparatus between tooth and jaw bone (see periodontal apparatus). Even a consideration of the load distribution in the bones shows a clear difference. For example, when the natural roots of teeth are present, the masticatory pressures become forces that pull on the alveolar bone. Similarly, one can regard the wheel as a substitute for legs for the purpose of locomotion, even though there are hardly any commonalities in terms of appearance.

Dentures

Umbrella term for removable artificial teeth. Dentures generally transfer the chewing pressure partly or completely onto the gum, in contrast to crowns and bridges where the forces are absorbed via teeth and/or implants. In addition to suction effects of varying strength in cases of complete adontia, dentures may be anchored to teeth or implants by means of clamps, bars, magnets, ballhead systems, attachments or telescopes. 

In most cases, high-quality fixed bridge restorative measures can be integrated on suitable implant systems instead of dentures.

Digital Volume Tomography (DVT)

Imaging device for the three-dimensional representation of cranial structures. Similar to computer tomography but with lower radiation exposure and better imaging options with respect to implant-related questions . Data may be used in combination with markers and templates for surgery aided by navigation systems. Can be found in some dental surgeries.

Disk implants

Standardised umbrella term for all basal/lateral implants from different manufacturers.

Distraction osteogenesis

The translation explains the technique: "Bone formation by pulling apart", which goes back to the Russian physcian Ilizarov, who has used this technique to achieve revolutionary successes in lengthening legs since the end of the 1950s.

During the process, a bone that is not deep enough for an implant is split into an upper and a lower part. A special screw attached to these bone parts facilitates the gradual lifting of the upper bone ridge (approx. 1 mm per day), which exploits the ability of bones to heal fractures through bone formation (callus). However, this requires that the distraction device is tolerated within the mouth for several weeks, which is rewarded by approx. 10 mm of newly gained bone height in 12 weeks. If there is an infection, the mobilised bone segment is lost and much less bone is present at the end of the treatment than prior to the treatment.

Drilling template

The drilling template is an auxiliary tool for the precise placement of implants at the surgically and/or prosthetically desired location. 
Highly accurate drilling templates may be produced either by means of the dental impression or after 3D-mapping of the jaw (computer tomography CT, NewTom) and represent an alternative to navigation systems for the precision placement of the implant.
Important precondition for the application of the drilling template is the secure and unambiguous placement on the jaw.

Face-bow

A face-bow is used to determine the position of the jaw joint in order to achieve a more precise transfer of models in an articulator after taking an impression. It is a kind of frame that is fixed to the upper teeth and often to the bridge of the nose and ear canal. In the meantime, electronic scanning or measurement methods have come into use.

Face-bows are partly controversial among experts because the position of the ear does not actually coincide with the position of the jaw joints for all people and because the transfer of pathological relative positions to the articulator would lead to a retention of these problematic features in the new designs. There is no scientific evidence that prosthetic designs can be made more durable through the use of face-bows and complex articulators.

Even when the most elaborate measurement methods are used, careful grinding and subsequent honing of crowns, bridges and prosthesis in the mouth is unavoidable, as the jaw movements cannot be registered and reproduced in the articulator with complete accuracy.

Healing (closed or open)

If the gums were sutured together over the implants after placement, this is known as a closed healing or a two-stage procedure. If a gingiva former that remains visible was screwed directly into the implant, this is known as open healing (single-stage procedure).

During closed healing, the implant can heal well-protected from external influences. When open healing is used, one can save the trouble of uncovering the implants. After healing is complete, a dental impression can be made without additional surgical procedure. Both procedures have the some success rate in straightforward cases (without bone augmentation).

Sometimes when closed healing is used, the gums re-open slightly above the implant, revealing the screw plugs. This is completely harmless - when no bone augmentation was undertaken. This area should be given good dental care using a a toothbrush however.

One piece compression screw implants (KOS^®) also do not require an uncovering procedure.

Hybrid bridge

When a tooth as well as an implant serve as abutments for a bridge that is firmly glued in place, this is known as a hybrid or composite bridge. 

According to current scientific findings, it may be regarded as established that such a composite bridge may be seen as an appropriate restoration. In contrast to earlier assumptions, it was possible to demonstrate that the prognosis of such a bridge does not differ from a bridge that is supported only by implants.

Hybrid prosthesis

Hybrid prosthesis refers to the combined use of implants and teeth as abutments for supporting a removable dental prosthesis. Examples include telescopic prosthesis with teeth and implants as telescope abutments or combinations of telescopes and ballhead anchors on implants. Bar connections between tooth and implant are conceivable as well.

Fixed bridges that are supported by implants and teeth are called hybrid bridges

Hydroxylapatite

A inorganic substance present in the natural tooth enamel and bone, which is used by some implant manufacturers to coat implant surfaces to promote faster healing. 

Hydroxylapatite obtained from the bone of cattle or from coral is also used as a bone substitute for bone augmentation. The material can be modified in such a manner that it can be resorbed, insofar as this is desired in the case at hand.

Coating implants with this material harbours the risk that the coating will come off after many years.

Iliac crest bone graft

If the bone loss is so pronounced that a secure implant bed cannot be created by means of minor local bone augmentation measures, the extraction of a bone sliver from the iliac crest presents the only remaining option for rebuilding a jaw bone.

This procedure has been superseded, as many other materials have become available. The side effects of iliac crest transplants are substantial and the procedure may be undesirable for patients. Apart from wound pain, removal at the iliac crest and the unavoidable trauma to the muscles attached in this area can cause difficulties with walking and even interfere with clothing (often a belt is no longer possible) over months and even years after the operation.

Immediate implantation

Removal of a tooth or implant and insertion of a new implant during the same session. Is increasingly used for comfort (no additional provisional restoration) and bone preservation reasons.

Harbours an increased risk of infection as a consequence of colonisation by residual germs derived from the earlier tooth or implant.

Immediate loading

Immediate implant loading actually refers to the at least provisional restoration and masticatory loading of one or several implants within 24 hours after insertion of the implants. Patients increasingly likely to demand this and an explanation for any delays. (The suitability for immediate loading of various implant systems is currently being investigated in many externally funded studies.) 

The suitability of the BOI^®-system has already been confirmed in legal rulings. (Regional Court Köln File no.: 23 O 269/03)

(It is ironic that this decision, which is based on expert opinions, is cited by several professional associations without mention of the implant system and instead inappropriately applied to screw implant systems without clarification.)

Immediate restoration

Temporary restoration only fitted for aesthetic reasons but without masticatory function. Therefore apparent immediate loading, which has no stimulatory effects on bone growth.

Implant superstructures

Parts of the superstructure, designed by the implant manufacturer for the connection between implant body (grown into the bone) and dental prosthesis. This includes above all:

• straight or angled solid bodies for the cementation of crowns
• screw joints for bar connections or screw-fixed crowns
• ball- or magnet superstructures for attaching dentures

Implant surfaces

The exterior surface of the implant body, which will be in direct contact with body tissues and thus affects healing, stability and durability. Different types of surface are distinguished: Relatively smooth titanium surfaces (ze.g. machine-polished), surfaces roughened by ablation (corrosion/blasting)=micro-rough, strongly roughened surfaces due to application of additional titanium layer (Plasma-Flame-Method, TPS), surface coating with other substances (hydroxylapatite). Each of these surfaces has characteristic properties that may speak for application. It is currently accepted that slight roughening (micro-rough) e.g. by blasting with fine particles, presents the ideal surface finish for titanium implants.

Interim implants (Intermediate implants, transitional implants)

These small implants are inserted to achieve secure and comfortable anchoring for temporary dental prostheses (during the healing phase of the main implants and until the permanent dental prosthesis have been completed).

Interim implants have a lower diameter, are easy to insert and remove and can be used to anchor both fixed (bridges, single crowns) as well as removable dental prostheses. This raises the question why these durable implants are removed at all in some cases.

Maxillary sinus (Sinus maxillaris)

Large air space within the upper jaw bone between the roots of the upper posterior teeth and cheek bone/orbita floor. In cases of adontia and loss of the remaining bone, the sinus maxillaris can lie directly under the gums. The sinus maxillaries grows throughout life and thus displaces bone.

Maxillary sinusitis (Sinusitis maxillaris)

Inflammation of the maxillary sinus due to bacteria or viruses, accompanied by secret formation. Symptoms of acute inflammation: Pressure, head- upper jaw ache, tooth ache of the upper posterior teeth, swelling of the cheek, drainage of secretions via the nose. Chronic inflammation can be present without significant symptoms. May compromise implant treatment in the area of the upper posterior teeth in particular with sinus lift. The complication rate is not accurately known, as the parameters of sinus lift surgery vary from case to case. The frequency of problems is estimated at about 10-35% of interventions. A fraction of inserted implants have to be removed owing to problems associated with the maxillary sinus.

Membrane

A very thin, biocompatible film about the size of a stamp, which is used in implantology as a barrier between bone and soft tissue to allow for undisturbed healing after bone grafting. A distinction is drawn between membranes that are resorbed, that is, broken down by the body, and do not need to be removed and non-resorbed membranes.

Today, biocompatible fibrin membranes are increasingly used, which are obtained from the patient's own blood during the implantation procedure. These membranes are significantly cheaper than membranes that are available for purchase. As fibrin membranes are not produced by means of an industrial process, industry for its part has no interest in spreading the technology. The method is being suppressed somewhat.

Navigation systems

Sophisticated technical system, which supports the planing of implant positions by means of three-dimensional images (CT or DVT). Drilling templates or temporary dental prostheses are prepared as a result of such planning. During the operation, the current drill position relative to the jaw, within a tolerance range, is sent to the computer and compared with the previously prepared planing data. This allows the operating surgeon to check his/her current working position on screen at any point in time, and to make appropriate adjustments in the mouth. In contrast to endoscopic operating techniques in general medicine, where the operating surgeon can only see his/her current working position and adjust his/her action on screen, in dentistry it is still possible and necessary to operate guided by sight and touch. 

Dental navigations systems are in a sense similar to GPS navigation systems, which may be an aid, a gadget or even a distraction for the user. Even in road traffic it is legally impermissible to exclusively rely on such systems.

Für die allermeisten implantologischen Eingriffe dürften Aufwand und Nutzen allerdings in keinem vernünftigen Verhältnis stehen. 

Basically: Higher cost with questionable benefit means greater expenses for the patient.

One piece implants

Most implant systems provide the option of attaching different superstructures to the implant by means of screw- or plug-in connections.

Implant systems where the superstructure required for tooth replacement is already integrated into the implant screw are known as one piece implants. After placement this superstructure (post for crowns, ballhead for attaching dentures) protrudes from the gums. Advantages are lower costs during production and higher break resistance.

One piece implant systems are mainly used in the context of immediate loading approaches. If safe healing and flexibility in the design of dental of dental prosthesis are required, one piece implant systems have clear disadvantages compared with two piece implant systems.

Osseointegration

Much publicised property of particular substances that are said to stimulate new bone formation. It has been scientifically demonstrated, however, that secondary osteons are stimulated and oriented through mechanical loading. Consequently, the immediate loading of suitable implants may be regarded as osteoinductive in the proper sense.

Osteoconductive

Common term for substances that are said to guide natural bone growth. This property is ascribed above all to bone substitutes by virtue of their geometrical properties.

From a medical perspective, the objective is to create voids that may be colonised by the patient's own bone. As bone grows more slowly than skin and mucous membranes, it is necessary to ensure that these voids are not filled by rapidly growing epithelial tissue (skin cells), and sometimes steps are taken to prevent this from happening by means of various membranes.

Osteoinductive

Much publicised property of particular substances that are said to stimulate new bone formation. It has been scientifically demonstrated, however, that secondary osteons are stimulated and oriented through mechanical loading. Consequently, the immediate loading of suitable implants may be regarded as osteoinductive in the proper sense.

Osteoporosis

Disease that leads to a loss of bone density.

Is regarded as a relative contraindication for implant treatment by various professionals. However, suitable implant systems mean that implantological restoration is possible even for patients who already suffer from osteoporosis.

Periodontitis (pyorrhea)

Bacterial infection of the periodontal apparatus promoted through dental plaques, calculus and concrements (calculus under the gum line). The resulting inflammation can usually be controlled by periodontitis treatment. In the long run, periodontitis leads to loosening and of the teeth and to teeth loss due to bone loss that is demonstrable on X-ray images.

Periodontitis treatment (Periodontal treatment)

Treatment of the causes of periodontitis. Apart from general and specific hygiene advice, this includes cleaning of the periodontal and infrabony pockets under local anaesthetic and polishing the root surface. The treatment produces a smooth root surface and firm and tight-fitting gums, the best preconditions to delay or even to avoid renewed disease.

Occasionally, antibiotics are administered in addition, and chargeable prophylaxis is carried out.

Periimplantitis

In analogy with periodontitis, inflammatory disease associated with bone loss of the tissue surrounding an implant.

Basically, the implant surface has a major influence on the development of this disease. The risk of the development and intensification of periimplantitis increases with increasing roughness in the area where implant emerges through the oral mucosa. If, when using screw implants, increased emphasis is placed on large contact areas with cortical bone (outer hard bone) with the aim of achieving osseointegration by virtue of rough surfaces, then peri-implantitis is very likely to occur as an inherent feature of the system. 

By virtue of their design, lateral implants, BOI^®-implants in particular, may be characterised as periimplantitis prophylactic, if not even periimplantitis resistant. With this type of implant, load transfer occurs in deeper, sterile and infection-resistant regions. The area at risk of infection where the implant emerges from the oral mucosa has a smooth thin surface, so that the situation here resembles the result of any proper periodontitis treatment.

Periodontal apparatus (Periodontium)

Entirety of tissues that facilitate the attachment of a tooth to the bone. This includes gums, alveolar bone and the periodontal ligament, the periodontal fibre construction connecting them. These tissues always have to be seen in direct relation to the tooth. If the tooth is missing for example, the alveolar bone degenerates and vice versa. If the alveolar bone is lost, for example due to periodontitis, the tooth will soon fall out. 

Periotest

Device for detection of tooth and implant loosening. However, it is acceptable within standard care to determine these by hand and eye.

Punch technique

Implant technique, where the size of the gum perforation is limited to the diameter of the implant by means of a punch or by other means. In contrast to open implantation, where the mucosa including the periosteum is folded out and the bone is visible during the operation.

The use of a closed procedure often causes only minor postoperative swelling, but is very demanding in terms of bone availability and imaging thereof. This is necessarily followed by open implant healing. When only little or unsuitable bone is available, operation by sight is always preferable to punch techniques. 

Primary stability

Stability of the implant immediately after insertion without osseointegration. For screw implants, this may be measured with the help of a torque wrench. Absolutely essential for immediate loading.

Professional tooth cleaning

Cleaning of the teeth carried out by professionals. Private service that goes beyond calculus removal but does not include systematic periodontitis treatment.

PRP

Abbreviation for platelet rich plasma, which is obtained from blood through special filtration and centrifugation. This yields a small amount of plasma liquid with concentrated platelets (thrombocytes), rich in messenger substances that promote healing and growth. 

Quantity of precious metal

The quantity of a dental (gold-)alloy that is used during the production of dental prosthesis, in particular for crown-bridge-constructions.

Relining

A technique used with dentures to backfill any bone loss under the base of the denture with denture plastics.

Sinus lift

This is a very common form of bone augmentation and a common prerequisite for implantation in the region of the upper posterior teeth. In contrast to onlay osteoplasty, which aims to increase the bone height and/or width in the direction of the oral cavity, sinus lift is used to improve the bone material available in the direction of the maxillary sinus, towards the eyes that is. One can distinguish between internal and external sinus lift, where access is either gained through the bone bore holes for the implant or laterally through the jaw bone. Healthy paranasal sinus mucosa is used as an upper boundary of the resulting cavity that is filled with autogeneous bone, bone substitutes or a combination of both. See "osteoconductive"

This additional procedure can be avoided by using particular types of implants, such as BOI^®, as these do not require a minimum bone depth. In addition it is possible to anchor BOI^® implants trans-sinusal, that is, obliquely through a healthy maxillary sinus.

Superconstruction

Dental prosthesis fixed on teeth or implants. The implants themselves are not part of the superconstruction.

Teeth in one hour

Computer-aided procedure for determining implant position on the basis of three-dimensional patient information (CT or DVT). This patient-specific information is subsequently transmitted electronically, and corresponding drilling templates and bridges are prepared in automatic processes. The template allows the operating surgeon to manually transfer the computer-generated implant position onto the patient within certain tolerance limits. The previously prepared bridge can subsequently be screwed onto the implants with the aid of compensating sleeves to achieve immediate loading. However, this approach requires a bone availability that exists in only in very few patients.

Telescopic prosthesis (Double crown)

Anchoring of prosthesis where fixation is provided by a double crown system. In contrast to management by means of a bar or retaining attachment, telescopic crowns bear loads individually axially and without blocking.

Temporary prosthesis

Artificial teeth worn by the patient until the permanent insertion of crowns, bridges or prosthesis. In this context one must distinguish between dentures, crowns and bridges. 

When temporary prosthesis are used in fresh implantation areas, no force transmission usually takes place, as the prosthesis does not abut. In cases of extensive bone augmentation this can mean that it is not possible to wear a temporary prosthesis for extended periods.

Temporary crowns or bridges can really only be used with transgingivally healing implant systems that a suitable for immediate loading. This is the most comfortable temporary restoration. Some implant systems, such as BOI^®, actually require this immediate restoration.

So-called "temporary implants" which are only used by a small number of outsiders for provisional restoration appear to be medically obsolete and increase costs considerably relative to recognised immediate restoration options.

Titanium

Biocompatible metal that is used for making implants in many areas of medicine.

Uncovering

If the gums were sutured tightly over the implant during implantation, this is known as covered healing or a two-stage procedure, as the implant still needs to be made accessible by means of a second procedure, known as uncovering.

The procedure is usually minor. The gums directly above the implant are numbed and open by means of a small incision with a special punch or by means of a laser. A so-called gingiva former is then usually inserted to ensure that the opened site can heal in the desired form for the crown or dental prosthesis to come. Pain can sometimes arise due to the pressure of the gingiva former. A course of antibiotics is generally not required.

Veneer

Tooth coloured coating made from ceramics or plastics on the stability-conferring metal of ceramic frame.