Dental implants every day is gaining popularity among different groups of the population. This is because this method of teeth replacement is fairly reliable because it was invented a few decades ago.
During all this time scientists have conducted thousands of scientific studies, invented a variety of implant systems, surveyed a large number of patients many years after treatment. This allowed to fully explore the possibilities of this field of dentistry, to combine all the information together and create a single set of specific data. With this data, it became known that implants take root in more than 90% of cases.
Numerous studies have helped to determine the most durable types of implants, which turned out to be intraosseous. Moreover, to date, invented many surgical and prosthetic treatment protocols that enable to carry out the operation with maximum preservation of soft tissues and bones, and prosthetics – achieving ideal aesthetics and function. Thus, we can conclude that implantation is not a “know-how” and time-proven method of dental rehabilitation.
Indications for implantation is any defects of the dentition up to the fully edentulous. That is, no matter how many teeth are missing, they can always be replaced with implants. The question of indications and contraindications to implantation has always remained controversial and ambiguous. This problem is due to the individuality of each case. For example, a woman 75 years old with hypertension of the second degree and multiple other somatic pathology wishing to take a course of total implantation.
The technique of the build up of gums
Procedure of implantation is determined at the stage of treatment planning. This is due to the fact that the implant is selected strictly individually. Takes into account age, health condition of the patient, his occupation and psychological state. For example, if young, relatively healthy person wants to immediately restore the lost tooth and to make the rapid implantation, then such a plan can be implemented.
However, if the person is in adulthood, has a chronic periodontal falling sick, suffering somatic pathologies, it is necessary to conduct special training, to eliminate all pathological processes, to achieve a state of remission and to perform a two-stage implantation. This classic method is more reliable and consistent, allowing you to control first, the engraftment of the implant, then the formation of the mucous membrane.
The traditional two-stage placement involves the separation of treatment into separate stages. The first – stage osseointegration. In this period carried out the dissection of the mucous membrane, is drilled in the bone bed for the implant and perform his dive. After that, the implant is closed with a flap of mucous membrane and tightly sewn. Next 3-4 month occurs the period of osseointegration. At this time, the bone tissue in the area of the implant lends itself to structural changes. In the first weeks after the implant, the bone tissue undergoes slight destructive processes. This is due to the fact that when drilling bone cutter destroys the layer of osteocytes (bone cells), with whom she had contact.
Consequently, the boundary of the ball of the bone begins Microtiterwells. However, as paradoxical as it may sound, but in this case necrosis is a normal process that after a short period of time disappears. Replaced active osseointegration. During this phase, perform several test x-ray images to ensure that engraftment occurs without deviation. After 3-5 months the mucosa over the implant is cut, the implant Unscrew the cover and install the healing abutment.
It is very interesting that most people know what it looks like the implant, but I have no idea what the healing abutment and the role it plays in implantation. In fact, his task is no less important than any other element of the design. The abutment is the part that is attached to the implant after osseointegration. This element looks like a screw with a metal cylinder or cone of a certain diameter and height (depending on the replaced tooth). With it, the mucous membrane acquires the necessary volume and structure by the “fouling” of the structure. The abutment implantation shivsena 2-3 weeks.
Given the good ability of the mucosa to growth and restoration, installation of this element in this period is considered sufficient. After you extract the driver into the implant and the abutment. From that moment, the orthopedic stage of treatment. That is, the task of the implant to screw the implant to control its integration and execute the build of the gums. The task of the orthopedic surgeon (prosthodontist) is to give the gums its natural appearance and aesthetic shape. As previously mentioned, prosthetic phase begins with the installation of abutment. This item performs the role of tooth. That is, it is a metal copy turned under the crown of the tooth.
The abutment establishes a temporary plastic crown, after which the mucosa becomes more physiological. Stage temporary restoration is very important for the overall outcome of treatment. It allows the mucosa to adapt to new conditions and to create a perfect adhesion of the gum to the crown, which will not vary from the contour of the gums “real” teeth. In addition, temporary crowns allow the person to get used to the new appearance, the parameters of a smile, the peculiarities of diction and chewing in a new environment. Also, an important role plays the opinion of loved ones (parents, spouses, friends) who can Express their criticism only in the case if the permanent crown is manufactured and you can easily make any changes.
The patient is given temporary crowns for several months and only after the complete adaptation of the gum he used to make the permanent construction. Thus, the formation of gums during implantation occurs only at the stage of temporary restoration. Permanent dentures are fixed with fully adapted mucosa. Ceramic crowns in the form are copies of time, however, they have higher quality physical characteristics. Permanent dentures are not erased, are more durable, they reproduce micro and relief of teeth. Also, they possess optimum optical characteristics (color, brightness, contrast, transparency, etc.) that significantly improves the aesthetics of your teeth.
In the end, a two-stage implantation can last about a year. People gradually approaching to the desired result. Naturally, this type of treatment more reliable and easy for the doctor because for the past year implantologist and an orthopedist have the opportunity to feel the characteristics of the patient and more careful to treat.
The popularity of Express implantation is growing every day. This is primarily due to marketing efforts of private dental clinics. They recruit people that guarantee to restore the lost tooth in just a few days. Having considered superficial information about two-stage procedure, you can imagine what a tremendous amount of work implantologist and an orthopedist perform the Express implant in a short period of time. In the first visit to diagnose and treatment planning. During the second visit the patient the implant is screwed together with the abutment (for Express implantation they are manufactured as one piece construction).
Then get a print or scan of the mouth, and the next day fixed temporary structures. At this stage, every doctor, depending on his working Protocol selects the period of use of temporary restorations. Preferably, the patient is able to get used to them and appreciate their form. But often, experts fix permanent crowns as early as possible in order to justify to a patient a temporary advantage Express-implantation. This can be done only if the doctor is confident in my abilities. This factor is very important, because in the process of treatment at the same time the load on the implant osseointegration and partial resorption of bone (due to load).
Along with partial resorption of the bone occurs and a certain decline in the soft tissues. If all these processes do not take into account, that around the crown there will be a violation of adjoining gums and the absence of gingival papilla. The restoration will look very unattractive and in between the teeth will be determined by the so-called “black triangles”
Looks like the gums after the implantation?
The appearance of the gums after the implantation does not depend on the operation technique. First and foremost the aesthetics of the gums associated with the quality of the implantation. If treatment is implemented at the highest level, the gums will be pale pink. Its contour is symmetrical with the contours of the gums of the opposite side. The gingival papilla fills the entire space between the crown and adjacent teeth. If the color of the artificial crown, its shape and dimensions correspond to the rest of the teeth after treatment, no differences live tooth implant.
Moreover, this applies not only to people, not related to dentistry. Quality work can be so precisely matched to the shape of the face, muscle tone, skin color, even an expert will not always detect the presence of the artificial crown on the implant. Moreover, the implant and restoration, performed at the highest level, will provide the aesthetics and function of design not only on the first two or three years, but for the next ten years with appropriate care for the condition of the oral cavity and organism as a whole.
It should be noted that at this age, surgery is highly undesirable. Moreover, the body of an elderly person no longer has such an active detoxification and regenerating function, as at a young age. Therefore, antibiotics, analgesics, anti-inflammatory drugs, injections of solutions of anesthetics – all this has manifested in the health status of the elderly person.
It is also worth noting that the implantation of an invalid in childhood. The constant restructuring of the jaw bone, teething characterizes children’s teeth – jaw system as a dynamic structure. Therefore, the implant being stationary element, can delay the growth of the jaws, may lead to incorrect and incomplete eruption of teeth.
Persons with decompensated forms of diabetes mellitus, immunodeficiencies of various types, mental disorders implantation is carried out only in exceptional cases. Moreover, such treatment is performed after a thorough and comprehensive examination by other specialists.
Effects after the procedure
Implantation is quite a serious intervention, so the risk of complications and negative effects is always there. If we talk about the actual implantation, while complications can occur, which are characteristic of many unsuccessful surgeries. Some complications arise from the fact that the patient did not report any systemic pathologies. Other troubles may appear due to a defective diagnosis of the patient and planning of treatment. If we talk about common areas for surgical complications include allergic reaction to anesthesia, bleeding, fainting, collapse, hypertensive crisis, seizures, asthma, epilepsy, angina.
Looking at the list of these States is easy to understand that most of them can be avoided by informing the physician about the underlying disease. For example, hypertension, asthma, epilepsy, and angina – is the pathology, the presence of which person is required to go to the doctor and receives a medical report. About allergic reactions to anesthetics and antibiotics, the patient may not know, so before the operation should only be done after Allergy test. The bleeding may occur in diseases of the blood vessels, and for other reasons. For example, the individual anatomy of the person can assume such a position of the blood vessel, which is not characteristic of most people. On this basis, the surgeon may accidentally damage the artery or vein.
The same situation can happen in ignorance of the anatomy of the human body. Complicated tooth extraction before implantation increase the likelihood of uncontrollable bleeding. Syncope, collapse and increase in pressure can occur suddenly with a person of any age and gender. The reason for this may be fear of surgery, pain in substandard anesthesia or mild vascular tone. In any case, these situations are the place to be during surgery. The appearance of these complications does not cause a loss of an experienced surgeon. This is due to the fact that such conditions occur regularly, for their relief there is a clear Protocol of action and for patients, these States are no physical consequences do not bear.
Mucositis and peri-implantitis
These complications should be allocated in a special section as they are specific to implantation. In the presence of their teeth in humans, as a rule, there are three most common problems: caries, periodontitis and periodontal disease. After implantation, the probability of losing an artificial tooth still remains. The reason for these effects is perimented – inflammation of bone around integrated dental implants.
The prevalence of snoring ranges from 2% to 43% of cases. It is very interesting that the implant root in 95-99% of cases, and the surrounding bone inflamed with a probability of 43%. This is because the period of osseointegration is controlled by the doctor, which is regularly conducted professional hygiene of the oral cavity. During the treatment the patient understands the responsibility that lies on it. Also the important role played by human motivation to quickly obtain the aesthetic and functional result. After the installation of permanent restorations is more than six months, people start treating the implants with less care.
Gradually, the amount of hygiene is beginning to be limited to toothpaste and brush, and the cleaning time is reduced to a minimum. In the end, the infection gradually penetrates into the area between the abutment and the gum, which causes mucositis – a superficial inflammation of the gums around the implant. Mucositis than it resembles gingivitis: in the field of crowns occurs inflammation of the gums that is accompanied by pain, swelling, itching and bleeding. Pockets can stand the purulent contents. This situation is even clinically quite bright, however, with timely treatment to the doctor the inflammatory process can be completely eliminated.
If Mokosica when the patient calls for specialized care, the disease can go into peri-implantitis. In this case, the inflammation goes on the bone tissue around the implant. In the beginning the hearth of defeat may have a local form, and eventually affects the whole bone around the implant. This condition without professional intervention leads to mobility of the implant and its loss. If this happens, all treatment will have to begin again.
First will have to eliminate the inflammatory process in the bone. You then need to hold the plastic bone to the required volume. And only after that we can start the first phase of the actual implant. It is worth noting that the old crowns and implants cannot be reused. Despite the very high cost, after extraction from the bone you can leave them except as a souvenir and motivation to oral hygiene. Even a thorough treatment of the implant will not allow it to be reused. This is due to its unique surface, which is treated with various acids and blasting to obtain rough surface. If at least the minimum number of pathogens will remain in the recesses of the implant, peri-implantitis likely to recur. Therefore, to efficiently use a new, completely sterile design and not to repeat previous mistakes.
Recession of the gums after the implantation
This complication is quite frequent especially when performing Express-implantation immediately after tooth extraction. But, this does not mean that this method of implant affects the gums. Rather this effect is due to the natural loss of soft tissue after tooth extraction. Incidentally, the same processes occur with the bone tissue. It is quite physiological processes that must yield to surgical correction. Most often, the amount of recession ranges from 1-2 mm, but in some cases these indicators may be more significant, which appears as a splitting of the gums. To restore the aesthetic and barrier properties of the gums, it is plastic.
The operation is performed under local anesthesia. Depending on the size and localization of the defect is selected the method of substitution. The specialist determines the most appropriate donor site in the mouth and takes from him the transplant. This fabric is moved in the defect and sutured.
In addition to the natural attrition of the gums, it can be caused by aggressive brushing with a stiff brush, drinking hot beverages, Smoking and other addictions. After performing the gum plastics of the patient to re-include all recommendations, information about the need for rational oral hygiene and the possible consequences.
Care after the procedure
Care after implantation is no less important than the quality of the operation itself. Expensive implants is like buying a car, it requires regular professional maintenance and self-care. Only when these conditions are met, you can talk about the longevity of the restoration.
Basic rules of care are to 2 times a day, brush your teeth with a brush of medium hardness. The paste must be used on the recommendation of a dentist. If there is a tendency to inflammatory periodontal disease, it is recommended to use toothpaste with herbs (for example, Parodontax, Blend-a-med “Herbal”, Colgate “the Healing herbs”). If the teeth are a large number of seals, so there is a tendency to carious lesions.
Prevention needs to use a toothpaste with microelements (Blend-a-med “Anti-caries, Lacalut “Flour”, Sensodyne “Repair&Protect”). If inclinations to such pathologies it is not revealed, the pastes are preferably combined with each other. About whitening toothpaste I should say that it can be used more than once a week. With frequent use of its abrasive particles can adversely affect the hard tissue of the teeth and soft gum tissue.
It is difficult to perecent the use of dental floss and brushes. They do an excellent job with cleaning the interdental spaces from plaque. Before purchasing these hygiene it is recommended to consult a physician hygienist. This will allow an individual to choose the size of tooth brushes that will further enhance the efficiency of procedures.