Nowadays dentistry offers several ways to restore lost teeth. Implantation is one of them.
Implantation doesn’t damage teeth adjacent to the lost one and avoids using a removable prosthesis. The success of implantation is about 97-99%. In some cases, the implant can be set on the day of tooth extraction, if this is not possible the setting of the implant is delayed for up to 3 months. Setting of an implants made under local anesthesia and takes up to15-20 minutes. After the implant setting it is necessary to wait 3-6 months for its osteontegration after what the final restoration is being made.
In our clinic we set implants:
- Nobel Biocare
- Bio 3
- Super Line
Implantation of teeth – the method of installing an artificial “root”, made of titanium or zirconium, in the upper or lower jaw. Dental implants are used as supports, on which are fastened either crowns, or removable or non-removable dentures.
This procedure, which consists of 2 stages:
- surgical stage (implantation of implants into the bone tissue of the jaw)
- orthopedic stage (prosthetics on implants with single crowns, bridges or conditionally removable prostheses).
Implant itself (synonyms – implant, implant) in shape resembles the root of the tooth. They make implants from high-quality medical titanium. After engraftment in the jaw, the intermediate part (abutment) is screwed into the implant, onto which the crown of the tooth is already fixed.
Recently, we began to tell you about implantation and implants.
Today we will continue this topic and tell you in which cases you need to resort to implantation of teeth:
1) Alternative to the bridge prosthesis in the absence of 1 or more teeth:
You can see how much the teeth that are adjacent to the missing teeth under the bridge supports are sharpened. Implantation of teeth allows to keep neighboring teeth healthy and alive (after all, they will not have to be grinded for crowns), which will prolong their service life. Remember that even qualitative crowns need to be changed in 8-10 years, and it is not a fact that the teeth under them will then be subject to repeated prosthetics. So the question is: what is the best implant or bridge – more rhetorical.
In addition, the cost of restoring one missing tooth with a bridged prosthesis made of 3 cermets (+ cost of preparing supporting teeth for crowns) is only slightly lower than the cost of implantation of one tooth. And only when neighboring teeth with missing teeth are destroyed or large seals are placed on them, then it is of course desirable to give preference to a bridge prosthesis.
2) End defects of the dentition:
when you do not have several last teeth – this means 2 alternatives: either implantation or a removable denture. And in this case there are no conditions for a normal fixation of a conventional removable prosthesis. This means that the removable denture will constantly fall out and balance. The exception will be a one-sided clasp prosthesis on the micro-lock, which will be attached to the last teeth on this side with a micro-lock.
This is the only type of prosthesis that will be well fixed on the teeth with a one-sided end defect in the dentition. However, the last 2 teeth from this side will need to make cermet crowns.
3) Complete absence of teeth:
the problem of a complete lack of teeth (especially on the lower jaw) is a poor fixation of a complete removable prosthesis, which can fall out during chewing during a conversation … Mini implants have been created to improve the fixation of complete removable prostheses. Such implants are implanted in the jaw in an amount of 2-3 or 4 pieces, and removable prostheses are fixed on the protruding fragments of these implants. Prostheses are fixed so well that such prostheses have been called conditional-removable dentures.
What are the advantages of dental implants before other types of prosthetics?
First, there is no need to grind your teeth under the crowns.
Secondly, strong teeth increase the approximate life expectancy by seven years, and this is proved by scientific research.
Thirdly, the external tooth on the implant does not differ from its own. Therefore, it is much easier to get used to it than to a removable denture. It just does not feel like a foreign body in the mouth, and the patient does not feel any discomfort after the end of treatment.
Implantation of teeth: contraindications
Implants of teeth – contraindications can be absolute (categorically impossible) and relative (under certain conditions – it is possible).
- A high risk of injuries to the mandibular nerve during surgery is in cases when it is implantation on the lower jaw and it is planned to screw the implants over the mandibular canal in which the mandibular nerve passes, while there is a lack of bone volume, and the patient refuses bone plastic ) or it is contraindicated to him.
- Injury of the mandibular nerve during implantation can lead to an impassive numbness in the cheek, lip, chin, and also drooling from the mouth.
- Uncontrolled diabetes mellitus of the second type is a relative contraindication; In this pathology, healing of wounds is slowed down due to problems with peripheral circulation. Anatomic considerations include the volume and height of the bones available. With any form of diabetes, the most suitable method is a one-stage basal implantation.
- Bruxism – implantation with bruxism is only possible if you sleep on special teeth before bedtime.
- Smoking, cardiovascular diseases, hepatitis, AIDS – in such diseases, the most suitable method is a one-stage basal implantation, because it is much more easily tolerated by this group of patients.
Planning an implant operation
The quality of the planning stage largely determines the success of the entire implantation of the teeth. Errors that can be tolerated at the stages of orthopedic and surgical planning can lead to the rejection of implants and the need for repeated surgery and prosthetics.
Orthopedic planning – first of all, the dentist-orthopedist must choose the type of prosthesis that will restore the missing teeth (coordinating it with the patient). It can be a single crown, a bridge made of several crowns, or a conditionally removable prosthesis with a complete absence of teeth, the fixation of which will be improved with the help of implants.
Based on the type of prosthesis it will be clear: how many implants will be needed to implant this patient:
→ with one missing tooth – 1 implant,
→ with two or three missing teeth – usually 2 implants,
→ if a conditionally removable denture is planned, then 2-4 implants per jaw,
→ if the teeth are missing completely and a completely unremovable horseshoe-shaped bridge is planned, then about 10 implants per jaw.
Surgical planning – in order to avoid a guaranteed failure during surgery, the implant surgeon must know exactly how the mandibular nerve passes (when implanted on the lower jaw), and how the maxillary sinus is located (with implantation on the upper jaw). The thickness of the bone that separates these formations will be the determining factor for the choice of the size (the length of the implants).
If the thickness of the bone is inadequate, this will be an indication for carrying out bone grafting (build up the bones). Also, surgical planning will take into account the choice of implantation techniques: a one-stage or two-stage procedure. It is also very important to determine the type of bone (its density), which will influence the choice of the type of implant, the technique of implantation and the determination of the terms of prosthetics.
Until recently, only orthopantomograms and targeted X-rays were used to determine the position of the sinuses, nerves and bone thickness, but in recent years, CT (computerized tomography) has been widely introduced. There are special programs for 3D computer simulation of the implantation operation, in which the surgeon downloads the results of the patient’s CT scan, and plans an operation on the computer. The use of CT and such programs can greatly facilitate the planning of the operation and minimize possible errors of the surgeon during the operation. However, be prepared for the fact that the use of such technologies will increase the cost of the service.
Surgical planning may also include the manufacture of a “surgical template”, which is a plate made of acrylic plastic, in which holes for future implants have been drilled (at different angles). This is necessary if you need to implant several implants at different angles to the jaw and to each other, which will be determined by the degree of preservation / atrophy of the bone at the site of implantation. This is very important, because if the corners are selected by eye directly during the operation, this will lead to the fact that the dentist-orthopedist will not be able to make prostheses / crowns for such implants in general, or they will be inaccurate, which will threaten complications.
The base stage of the operation: dental implantation
The surgical part of the implantation process consists of two stages: implantation of the implant itself and installation of the gingiva former. To implement the first part of the process, it is necessary to have the root remains of the previously placed tooth in place of the prosthesis installation, and a favorable hygienic situation in the oral cavity.
Internal, implanted part of the future artificial tooth has the form of a screw of a specific shape (cylindrical or conical, the so-called root-shaped implant). Bioinert material – titanium – is used for the production of screws. Zirconia is also used. It has higher cosmetic properties, because it does not shine through the mucosa of the gums, but the percentage of integration with the jaw bone in this material is worse than that of titanium and its alloys. Due to the special surface treatment of the implant and the nature of the thread, the adhesion of the product to the bone tissue is improved.
The procedure is performed under local anesthesia, the implantation time is about 20 minutes.
The implant is implanted into the prepared bone (previously there is a hole for the diameter of the screw), and to prevent heating of the bone during the implantation of the teeth, irrigation of the surrounding tissue with saline is performed. Irrigation reduces capillary bleeding in the gums, reduces the risk of inflammation of the soft tissues. After fixing the screw, its central opening is closed with a special plug, and the gum is sutured (seams are applied to the gingival tissue of the gum). To accelerate the healing of injections of special drugs. Stitches can be removed after ten or more days, depending on the situation and the condition of the patient.
The process of osseointegration, that is, fusion of the implant and jaw, can be three to six months or more, and for the lower jaw implantation is faster – the jaw tissue here is more dense. After the successful implantation process is completed, the second part of the implantation operation is performed – the setting of the gingiva former.
This procedure is less complicated surgically and consists of opening the gum over the implanted screw, removing the plug and installing the shaper. This stage takes about half an hour, and healing takes place within a week, as after the usual tooth extraction.
End of the process of implantation of teeth
The final stage of implantation is the production of a denture (the visible part of the tooth or teeth in bridge prosthetics). The crown is made of cermet or non-metal materials, depending on the wishes of the patient. Due to the experience of the specialists of our clinic, the quality of the visible part of the implants meets the aesthetic and functional requirements inherent in natural teeth. Moreover, the correct approach to placement of basic (supporting) implants in the performance of the prosthesis on the entire jaw or its part allows for improvement of the bite and the type of oral cavity as a whole.
Relative contraindications for dental implantation are:
1) excessively young (up to 16 or 22 years, depending on the policy of the dental clinic) or elderly (more than 70 years) the age of the patient;
2) excessive use of alcohol, tobacco products, drug dependence
3) systemic diseases (hypertension, oncology, metabolic abnormalities, ischemic heart disease, connective tissue diseases)
4) severe forms of periodontitis
Contraindications are considered relative, since the likelihood of a favorable prognosis for osseointegration depends on the severity of the disease and the condition of the patient as a whole. To absolute contraindications include problems of blood clotting (in this case, it is a contraindication to all surgical interventions), severe forms of renal failure, endocrine system and heart diseases, as well as intolerance to anesthesia.
They can be divided into two groups. The first refers to the natural consequences of any surgical intervention in the body and does not require a doctor’s visit:
- Pain. Typically, it appears after the action of anesthesia passes and can be felt for two to three days after the procedure. Reduce the manifestation of the pain syndrome can be with the help of painkillers, and it is desirable to consult in advance about the recommended medication from the specialist performing the procedure.
- Edema. Can be kept from several hours to several days, can be reduced with the help of cold compresses.
- The temperature rises above 37 degrees Celsius. A prolonged (more than three days) temperature above 37 degrees is the reason for going to the doctor.
- Bleeding. A small bleeding within two to three days is a kind of norm.
The second group of complications is associated with worsening of the patient’s condition due to improperly entered implantation process, including the development of infection at the site of manipulation:
- Bleeding and temperatures over 37 degrees for more than three days.
- Divergence of sutures at the implant site.
- Inflammation of mucosal tissues and gums around the site of manipulation, the so-called reimplant.
Avoid the occurrence of complications or reduce the intensity of unpleasant syndromes can, by following the recommendations of a specialist in oral hygiene and diet in the postoperative period.