The problem of implants in modern dentistry is very important. So, according to data provided by who, acquired and congenital adentia is one of the most common diseases of dental system and is in line with caries and periodontal pathologies.
Only in Russia, according to various sources, orthopedic treatment need between 45 and 75% of people in the world and this problem affected up to 75% of the population. In recent years, suffering from partial edentulous increasing number of young and Mature people.
Dental implantation is a procedure of implanting an implant in the jawbone of the patient with subsequent prosthetics of their crowns, bridge or conditionally removable dentures.
The implant is a pre-trained artificial construct that is embedded in the tissue of the jaw for future restorations. Implants are designed to replace the roots of lost teeth, allowing in the future to restore the dentition.
According to statistics, 86% of patients in dental offices give preference to non-removable dental constructions. It dental implantation can provide a fairly predictable success, which is confirmed by more than two decades of clinical research. Directly after implantation never acts as the primary therapeutic measures. In this regard, the minimum risk of complications.
Types of dental implants there are many, but they all have identical structure and consist of a head, neck and body.
The following types of implants: conventional implants, one-stage implants, basal implants and implantation by the technique “all-on-4”. Each of these varieties of implant has its own characteristics, advantages and disadvantages.
Classical implantation of teeth
A classical implant is the most popular implant among patients. Classical implantation is carried out in two successive stages.
- The first stage is surgical. In subgingival part, directly into the bone, the implant is introduced. When this procedure is completed, the patient will have to wait 1 month to six months. During this time the implant will fuse with the bone.Surgery its introduction as follows: gingival mucosa is cut for exposure of the surface of the bone, after which it made a hole under the implant. It is performed with the help of physiodispenser and special drill bits. In the resulting hole to screw in the implant, and the cut mucosa is sutured.During this process it is important to ensure that the bone is not subjected to excessive heating, since this will provoke inflammation (peri-implantitis) and will cause the implant will be otorgan. To prevent overheating during the drilling of the bone, it is constantly and intensively cooled with saline.Sometimes surgical stage of implantation can be extended for a period of 1 to 6 months. It is required if you have insufficient bone height or width. This problem is most common in patients who have lost teeth a long time ago and is due to atrophy of the bone without posterior load on it. To remedy the situation, the doctor will increase the alveolar process of the technique of bone grafting with bone mass (natural or artificial).
- The second step of the classical implant is a prosthesis. Over the installed implant re-cut the mucous membrane and screwed construction that forms the gums, giving it the desired contour. The process of healing takes 14 days. After 1 week implant abutment will be installed, then the doctor will make the crown and fix it with the screw screwing, or by using cements.The advantages of the classical implantation are as follows:
- A rational approach to the procedure. Phased installation allows the body to adapt to the foreign body and the rod to be fixed securely in the jawbone.
- Tooth design is detachable, and replace the crown will not be difficult. It is easy and does not require removal of the implant.
- Adjacent to the implant teeth will not suffer. They do not need to grind, to remove the pulp or sanded.
- In 99% of cases the implant will serve the patient for the rest of his life. Change as needed, will only need a crown or other fixed prosthesis on it.
- Load that is served to implant a uniform manner distributed over the entire jaw. In the same way there would be distribution of load on a natural tooth root.
- With conventional implants can be installed as a single tooth or all lost teeth.
- Be restored and chewing and front teeth.
The disadvantages of the conventional implant procedure include:
- A long period of time for treatment.
- The occurrence of possible difficulties that appear in patients, drawn with the implantation of the implant for longer than 1 month. As mentioned above, the bone atrophy significantly extends the life of the implant and leads to certain technical difficulties.
- There is a probability of violation of the appearance of the gums.
- The extensive list of contraindications.
- The risk of rejection of a foreign body.
- The high price of procedure.
- Complicated postoperative period with pain, edema, impaired chewing function.
One-stage dental implants
One-stage implantation is an alternative procedure to the classical method. Its main feature is that the rod will be installed into the bone tissue immediately after a tooth extraction. The operation is performed quickly and in one visit to the dental office, the patient gets rid of unnecessary tooth and acquires implant that replaces the diseased root. In this case, it is possible to avoid additional surgery to cut the gums.
To perform a one-stage procedure can be the case if the tooth are healthy and the bone tissue of the alveoli is strong.
The advantages of the one-stage procedure:
- The procedure is minimally invasive.
- The recovery period is significantly less than conventional implants.
- The installation of the tooth is performed in the ready-made hole, so no additional incisions are required.
- During the procedure and after it will not need a high dose of anesthesia.
- The procedure of tooth extraction and implant installation takes only a few hours.
- And the implant and crown will be installed in just one visit to the dentist.
- Implants implanted simultaneously can act as a base for bridges, partial dentures and crowns.
Disadvantages of simultaneous implantation:
- To be able to set the prosthesis in the gum should be enough space after removal of the tooth.
- Near the remote tooth must be healthy teeth. They will take the load and allow the implant to better fit in.
- The risk of rejection of design exists even after a long time after implant placement.
- Due to the fact that the fixation of this implant is not entirely reliable, there is a risk of bias in the process of mastication.
Basal dental implants or multiple implants is a fairly complex manipulation, during which titanium rods are installed much deeper than the conventional implants. To accomplish it use special implants that are implanted in the basal jaw bone, not alveolar bone. Basal bone lies deeper, it is more durable and has no tendency to atrophy. To perform the procedure will take from 1 to 5 days.
Due to the special shape of the thread of the implant ensures a high degree of stability of the implanted structures immediately after its introduction. Prosthesis such install after 1-5 days.
The introduction often takes place through a small puncture in the mucous membrane and through a small hole in the bone. The need for drilling the impressive volume of bone tissue is missing. The particular shape of the implant allows it to be installed even in the case when the classical technology would not be enough bone thickness.
Advantages of basal implants the following:
- Minimal trauma to the tissues.
- Rapid restoration of chewing ability. The term can be less than weeks.
- The procedure of prosthesis does not require incisions and suturing, which significantly shortens the recovery period.
- Since the patient is allowed to chew on almost immediately after surgery, the metabolic processes do not have time to slow down. This, in turn, accelerates the survival rate of the prosthesis.
- The vast majority of cases, there is no need to build the bone tissue in its atrophy.
- A fewer number of contraindications to the operation. So the procedure due to its low morbidity can be recommended for people with hepatitis, HIV, diabetes, elderly patients.
Disadvantages of basal implantation the following:
- To restore with this method recommend at least three teeth in a row. Usually, one tooth of the basal methods do not recover.
- A dentist must undergo additional training for this technique of implantation.
All on four
“All on four” is a modern procedure of dental implants, where the prosthesis will stay in just four implants.
Indications for the use of this technique can be:
- The complete absence of teeth on both jaws;
- Severe atrophy of bone tissue, with periodontal disease and periodontitis (the possibility of using conventional implants missing);
- The removal of prostheses as a result of destruction of the teeth under them.
To perform the technique required to implant two implants in the anterior mandible and two in the area where the chewing teeth. The angle of insertion of the implants is 45 degrees.
The technique is gentle, allows you to set easy denture on the implanted pins and does not take a long time to recover.
The benefits of technology “all on four”:
- The cost of treatment will not be high, since the installation of the prosthesis in the absence of the dentition will require only 4 implants.
- High reliability of fixing.
- The masticatory load on the bone will be distributed evenly.
- Because of the angle of injection of 45 degrees, an implant fails to install even in a partially atrophied bone without its extension.
Disadvantages of the technique “all on four”:
- Massive prostheses for such implants are not fixed.
- There is a risk of rejection that exists and the different techniques of operation.
Planning implant surgery
The more carefully the patient and the doctor come to the question of planning of implantation, the higher the chances of success of the upcoming procedure.
The shortcomings and mistakes made at this stage can lead to the fact that you will need to either re-operate or re-prosthetics.
- Planning orthopedic. At this stage, the doctor with the patient determine the type of the future prosthesis. Perhaps they will stop the choice on the crown or on a bridge prosthesis. In the absence of teeth it is recommended to use a conditionally removable prosthesis on implants keeps much better.
- Starting from the type of prosthesis, the doctor will determine how many implants need to be implanted the patient:
- If there is no 1 tooth, 1 implant is implanted;
- If there are from 1 to 3 teeth, implanted 2-3 of the implant;
- If it is established conditionally removable denture for one jaw, you will need to 4 implants;
- If doesn’t have teeth, it is possible to implant in one jaw to 10 implants (this number is used when installing a fixed horseshoe-shaped bridge).
Stage of surgical planning. Stage of surgical planning allows you to avoid mistakes during the operation itself. So the doctor needs to know exactly where is the patient’s mandibular nerve where the maxillary sinus, what is the thickness of the bone between them and the site of the proposed implantation.When the bone is too narrow, you will need its capacity. At the same time, the physician and the patient determine in one or two stages you will undergo the procedure. This significant impact of bone density.As for the location of nerves, sinus, bone thickness, the maximum information can be obtained by means of computer tomography, which actively displaces the x-ray examination and a panoramic overview.
Modern dentists have adopted special programs after loading in which CT scan of the patient, is an electronic three-dimensional planning of the operation. This allows you to minimize the risk of medical errors, but will cost a bit more.
When preparing the patient for implantation of several implants, the planning will include the process of making acrylic plates, in which different angles are provided with holes. This is a very important procedure, as it allows you to choose the angle of drilling is not on the eyes, and considering how the jaw of the patient during the procedure.
Possible complications after dental implantation
Though the procedure of implant placement is quite safe, it is not excluded adverse health consequences.
Doctors note the following possible complications of dental implants:
- Rejection of the implant. When the rejection of an installed object occurred before the moment was done prosthetics, it could be a reaction of the patient to implanted foreign body. However, it is not necessary to exclude a possible medical error made during installation. In the case when signs of rejection occur after the installation of the prosthesis, when the patient began to chew with it, it definitely points to a medical mistake.
- Atrophic processes of bone surrounding the implant. To failure performed procedure would unambiguously indicate a decrease in bone by more than 1 mm in the first year after installation of the structure. The same goes for bone loss of 0.1 mm in the second and subsequent year after installation.
- Peri-implantitis is a process that is characterized by inflammation of the mucosa with possible seizure of the bones, which are located around the implant. Most often it is the inflammation develops because of infection. At risk are smokers, patients with diabetes, patients who violate the rules of oral hygiene, as well as those people who are too thin oral mucosa.
Early complications after the procedure include:
- Pain syndrome, which is inevitable and always occurs after the anesthesia is completed. Normal, and pain persist for 1-2 days after the operation. The doctor will recommend the patient take any painkillers during this period. If the pain persist for a longer period of time, it may indicate the accession of inflammation or injury of the nerve.
- Swelling of damaged tissues. Increasing swelling after an average of three hours after the operation. A week later, the swelling should fully subside. If to the damaged site in a timely manner to apply cold, it is possible to reduce the swelling of tissues. (see also: First aid for edema)
- Bleeding. If it is poorly expressed and is bothering the patient only in the first days after implant placement, it is the norm. When the bleeding continues for a longer time period and tends to strengthen, it may indicate damage to the blood vessels, which increases the risk of formation of hematomas. The risk of hematomas is that perhaps the festering wounds and joints.
- The increase in body temperature. Increasing the level on the thermometer to a value in the 37-37,5 degrees on the first day after implant placement is the norm. However, when this temperature is kept more than three days, it’s possible that it indicates the beginning of the inflammatory process.
- Joints – one of the possible early complications of the procedure of implantation. This can occur as a result of their faulty application, because the application of mechanical injury or due to the onset of the inflammatory process.
- Numbness the location of the implant. In normal, the numbness should pass after a maximum of five hours after the operation. In this case it will be due to done anesthesia. If numbness persists longer, then it may indicate damage to the facial nerve, which runs through the lower jaw. Therefore, this complication can only occur when the implant is in the lower jaw. Heals nerve is quite long – several months.
- Inflammation of the soft tissues can also be a complication related to the early period after implant surgery.
If the patient discovers any symptoms that indicate the development of complications, you must immediately seek the assistance of your dentist. The earlier they are diagnosed, the more chance that therapeutic measures will bring success and the implant will be able to keep.
Contraindications to dental implantation
Dentist-orthopedist before treatment is required to determine the need for and possibility of installation of the implant in each case. Because these structures are designed not only to perform the function of chewing and to improve cosmetic effect, but are a preventative tool in the fight against irregularities in dentition as a whole. Therefore, their installation must be reasonable and not to harm the patient.
Contraindications to dental implantation is a very serious issue, as ignoring them can lead to very serious consequences and increase the risks of unfavorable completion of the implantation process.
All contraindications can be divided into two large groups: psycho-emotional and somatic.
Contraindications to implantation of psycho-emotional groups are represented by different psychoses, depressive mood, hypochondria and psychosis.
In turn, somatic contraindications can be absolute or relative.
- Any seropositive infections like: AIDS, tuberculosis, gonorrhoea, etc.
- Diseases of the bone system.
- Diseases of the endocrine areas, such as dysfunction of adrenal under-or over-function of the parathyroid and thyroid glands, diabetes mellitus, occurring on the first type.
- All systemic diseases of the blood and organs of hematopoiesis.
- The presence of chronic diseases of the cardiovascular system. So, implantation is prohibited in hypertension, arrhythmia and angina.
- Chronic kidney disease, liver and pulmonary system in the decompensated form.
- The presence of malignant cancer.
- Systemic connective tissue disease, diffuse damage of the collagen tissues, for example, scleroderma, dermatitis, etc.
- Disease, affecting the mucous membrane of the mouth rug; aphthous stomatitis, prone to relapses, Sjogren’s syndrome, lupus erythematosus, leukoplakia, etc.
Relative contraindications are:
- The presence of chronic diseases in the compensated stage.
- The patient’s age after 55 years.
- Bruxism the habit of grinding my teeth. If implantation is still performed, the patient will need to have to put on the night time special mouth guard.
- Diabetes type II diabetes is a relative contraindication, as in this disease, any wounds heal slower. However, if the patient chooses to execute the procedure, you should opt for basal implantation.
- The presence of harmful habits – alcohol, Smoking, drug abuse.
- The period of carrying a child on the time period to 4 months and after 8 months.
- The lactation period.
- Diseases of the peripheral nervous system.
- The presence of a metal prostheses in the heart, in the bones, and the spokes of Kirchner.
- People who have an increased risk of developing bacteremia, those who have already suffered a rheumatic fever and bacterial endocarditis.
- Taking drugs containing hormones. Treatment with immunosuppressive agents, the passage of chemotherapy.
Separately, you can select local contraindications for dental implantation:
- Chronic disease of the oral cavity that is prone to frequent relapses;
- A large tongue;
- Anatomical barriers – excessive bone atrophy, narrow alveolar process, etc.;
- Pathology of the temporomandibular joints;
- Some defects of the jaw;
- Progressive periodontal disease of chronic;
- Violation of oral hygiene of the mouth;
- The presence in the jaw remnants of the roots;
- The presence of cysts.