Dental implantation
Dental implantation is a procedure for implanting implants into the bone tissue of the patient's jaw with subsequent prosthetics with crowns, bridges, or conditionally removable prostheses. An implant is a pre-prepared artificial structure that is inserted into the jaw tissue for subsequent prosthetics. Implants are designed to replace the roots of lost teeth, which allows the dentition to be restored in the future.
The problem of implantation in modern dentistry remains highly relevant. So, according to the data provided by the WHO, acquired and congenital adentia is one of the widespread diseases of the dentoalveolar system and is on a par with caries and periodontal pathologies. Only in Russia, according to various sources, 45-75% of people need orthopedic treatment, and in the world up to 75% of the population suffers from this problem. In recent years, an increasing number of young and mature people suffer from partial adentia.
According to statistics, 86% of patients in dental offices prefer non-removable dental structures. It is dental implantation that allows for fairly predictable success, which has been confirmed by more than two decades of clinical studies. Indeed, implantation itself never acts as a primary therapeutic measure. In this regard, the risks of complications are minimal.
There are many types of dental implants, but they all have the same structure and consist of a head, neck and body.
Content:
- Types of dental implantation
- Implant surgery planning
- Possible complications after dental implantation
- Contraindications to dental implantation
Types of dental implantation
There are the following types of dental implantation: classical implantation, one-stage implantation, basal implantation and implantation according to the “all-on-4” technique. Each of these types of implantation has its own characteristics, advantages and disadvantages.
Classic dental implantation
It is the classical implantation that is the most demanded type of implantation among patients. Classic implantation is carried out in two successive stages.
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The first stage is surgical. An implant is inserted into the subgingival part, directly into the bone. When this procedure is completed, the patient will have to wait from 1 month to six months. During this time, the implant will grow together with the bone.
The operation of its introduction is as follows: the mucous membrane of the gums is cut to expose the surface of the bone tissue, after which a hole is made in it for the implant. It is performed using a physiological dispenser and special drills. An implant is screwed into the resulting hole, and the cut mucosa is sutured.
During this process, it is important to ensure that the bone is not exposed to too much heat, as this will provoke an inflammatory process (peri-implantitis) and lead to the implant being rejected. To prevent overheating while drilling the bone, it is constantly and intensively cooled with saline.
Sometimes the surgical stage of implantation can be extended for another 1 to 6 months. This is required if the bones are of insufficient height or width. This problem most often occurs in patients who lost their teeth a long time ago and is explained by bone atrophy without chewing load on it. To remedy the situation, the doctor will augment the alveolar bone using the bone grafting technique using bone mass (natural or artificial).
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The second stage of classical implantation is prosthetics. Above the installed implant, the mucous membrane is cut again and a structure is screwed into it, which forms the gum, gives it the desired contour. The engraftment process takes 14 days. After another 1 week, an abutment will be installed in the implant, then the doctor will make a crown and fix it on it using a screw thread or using cements.
The advantages of classical implantation are as follows:
- A rational approach to performing the procedure. The phased installation allows the body to adapt to the foreign body, and the rod is securely anchored in the jaw bone.
- The design of the tooth is collapsible, and it is not difficult to replace the crown. This is easy and does not require removal of the implant.
- The teeth adjacent to the implant will not suffer. They do not need to be ground, pulped or sanded.
- In 99% of cases, the implant itself will serve the patient for the rest of his life. Only the crown or other prostheses fixed on it will need to be changed as needed.
- The load applied to the implant is evenly distributed over the entire jaw. In the same way, the load distribution from the natural tooth root would occur.
- With the help of classical implantation, you can install both a single tooth and all lost teeth.
- Both chewing and front teeth are subject to restoration.
The disadvantages of classical implantation include:
- A long period of time for treatment.
- The emergence of possible difficulties that appear in patients who have delayed the implantation of the implant for more than 1 month. As mentioned above, bone atrophy significantly lengthens the implantation procedure and leads to certain technological difficulties.
- There is a likelihood of a violation of the appearance of the gums.
- The presence of an extensive list of contraindications.
- Risk of foreign body rejection.
- The high cost of the procedure.
- Difficult postoperative period with pain, swelling, dysfunction of chewing.
One-stage dental implantation
One-stage dental implantation is an alternative procedure to the classical method. Its main feature is that the rod will be inserted into the bone tissue immediately after tooth extraction. The operation is carried out quickly and in one visit to the dental office the patient gets rid of an unnecessary tooth and gets an implant that replaces the diseased root. In this case, it is possible to avoid additional surgical intervention for cutting the gums.
One-stage implantation can be performed if the tooth tissues are healthy and the bone tissue of the alveoli is strong.
Advantages of one-stage implantation:
- The procedure is minimally invasive.
- The recovery period is much shorter than with classical implantation.
- The installation of the tooth is carried out in a ready-made hole, so no additional incisions are required.
- High doses of anesthesia will not be needed during and after the procedure.
- The procedure for tooth extraction and implant placement takes only a few hours.
- Both the implant and the crown will be installed in just one visit to the dentist.
- Immediate implants can act as a base for bridges, clasp prostheses and crowns.
Disadvantages of one-time implantation:
- To be able to install a denture, there must be enough space in the gum after the extraction of the tooth.
- Healthy teeth should be located next to the extracted tooth. They will take on the load and allow the implant to take root better.
- The risk of rejection of the structure exists even after a long time after the installation of the implant.
- Due to the fact that the fixation of such an implant is not entirely reliable, there is a risk of its displacement during chewing.
Basal dental implantation
Basal implantation of teeth or express implantation is a rather complex manipulation, during which titanium rods are inserted much deeper than with classical implantation. For its implementation, special implants are used, which are implanted into the basal bone of the jaw, and not into its alveolar process. The basal bone lies deeper, it is more durable and does not tend to atrophy. The procedure will take 1 to 5 days to complete.
Due to the special form of the thread on the implant, a high degree of stability of the implanted structure is guaranteed immediately after its insertion. Such installations can be prosthetic after 1-5 days.
The injection most often takes place through a small puncture in the mucous membrane and through a small hole in the bone. There is no need to drill out impressive amounts of bone tissue. The special shape of the implants allows it to be installed even if the bone thickness would not be enough for the classical technology.
The advantages of basal implantation are as follows:
- Minimal tissue trauma.
- Rapid recovery of chewing ability. The term can be less than a week.
- The prosthetics procedure does not require any incisions or sutures, which significantly shortens the recovery period.
- Since the patient is allowed to chew almost immediately after the operation, metabolic processes do not have time to slow down. This, in turn, accelerates the survival rate of the prosthesis.
- In the overwhelming majority of cases, there is no need for bone augmentation in case of its atrophy.
- Fewer contraindications for surgery. So the procedure, due to its low trauma, can be recommended for people with hepatitis, HIV, diabetes mellitus, and elderly patients.
The disadvantages of basal implantation are as follows:
- It is recommended to restore at least three teeth in a row using this method. As a rule, one tooth is not restored using the basal technique.
- The dental specialist must undergo additional training in this particular dental implantation technique.
All - on - 4
"All in four" is a modern dental implantation procedure in which the prosthesis will be held on only four implants.
Indications for the use of this technique can be:
- Complete absence of teeth on both jaws;
- Severe atrophy of bone tissue, accompanied by periodontal disease and periodontitis (there is no possibility of using classical implantation);
- Removal of dentures as a result of tooth decay under them.
To perform the technique, you will need to implant two implants in the anterior part of the jaw and two in the area where the chewing teeth are located. The implantation angle is 45 ° C.
The technique is gentle, allows you to install a lightweight prosthesis on implanted posts and does not take a long time to recover.
The advantages of the all-in-four technique:
- The cost of treatment will not be high, since only 4 implants are required to install a prosthesis in the complete absence of the dentition.
- High reliability of fixation.
- The chewing load on the bone will be evenly distributed.
- Due to the insertion angle of 45 ° C, the implant can be installed even in partially atrophied bone without a procedure for its augmentation.
Disadvantages of the "all in four" technique:
- Massive prostheses for such implants are not fixed.
- There is a risk of developing rejection, which exists with other techniques of performing the operation.
Read more: Dental implants - types, how they put, how long do they serve?
Implant surgery planning
The more carefully the patient and the doctor approach the planning of implantation, the higher the chances of success of the upcoming procedure. Deficiencies and mistakes made at this stage can lead to the need for either re-intervention or re-prosthetics.
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Orthopedic planning. At this stage, the doctor and the patient are determined with the type of future prosthesis. Perhaps they will opt for a crown or a bridge. In the absence of teeth, it is recommended to use a conditionally removable denture, which holds much better on implants.
Based on the type of the future prosthesis, the doctor will determine how many implants will need to be implanted in the patient:
- If there is no 1 tooth, then 1 implant is implanted;
- If there are no from 1 to 3 teeth, then 2-3 implants are implanted;
- If a conditionally removable prosthesis is installed, then up to 4 implants will be needed for one jaw;
- If there are no teeth at all, then up to 10 implants can be implanted into one jaw (this number is used when installing a non-removable horseshoe-shaped bridge).
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Surgical planning stage. The stage of surgical planning avoids mistakes during the operation itself. Therefore, the doctor must know exactly where the patient's mandibular nerve is located, where the maxillary sinus is located, what is the thickness of the bone between them and the site of the intended implantation.
When the bone is too narrow, augmentation will be required. At the same time, the doctor and the patient determine in one or two stages the procedure will take place. Bone density will have a significant impact on this.
As for determining the location of nerves, maxillary sinuses, bone thickness, in this regard, the maximum information can be obtained using a computed tomogram, which actively displaces X-ray examination and orthopantomogram.
Modern dentists are armed with special programs after loading into which the patient's CT scan results, an electronic three-dimensional planning of the operation takes place. This minimizes the risk of medical error, but it will cost a little more.
When preparing a patient for multiple implants, planning will include the process of making an acrylic plate, in which holes will be made at different angles. This is a very important procedure, since it allows you to choose the drilling angle not by eye, but taking into account how the patient's jaw will behave during the procedure.
Possible complications after dental implantation
Although the procedure for installing implants is quite safe, adverse health consequences are not excluded.
Doctors note the following possible complications after dental implantation:
- Rejection of the implant. When the rejection of the installed object occurred before the moment when the prosthetics was performed, then this may be a reaction of the patient's body to the implanted foreign body. However, one should not rule out a possible medical error made during installation. In the case when signs of rejection appear after the installation of the prosthesis, when the patient began to chew with it, this clearly indicates a medical blunder.
- Atrophic processes of the bone surrounding the implant. The failure of the performed procedure will be unambiguously indicated by a decrease in bone by more than 1 mm in the first year after the installation of the structure. The same applies to bone loss of 0.1 mm in the second and subsequent year after insertion.
- Peri-implantitis is a process characterized by inflammation of the mucous membrane with possible capture of the bone located around the implant. Most often, this inflammation develops due to infection. At risk are smokers, patients with diabetes mellitus, patients who violate the rules of oral hygiene, as well as those people who have too thin oral mucosa.
Early complications after the implantation procedure include:
- Pain syndrome, which is inevitable and always occurs after the effect of anesthesia is over. Normally, painful sensations persist for 1-2 days after the completion of the operation. The doctor will recommend the patient to take any pain relievers during this period. If pain persists for a longer period of time, then this may indicate the addition of inflammation, or injury to the nerve.
- Swelling of damaged tissues. The swelling increases on average three hours after the completion of the operation. After a week, the swelling should completely subside. If cold is applied to the damaged area in a timely manner, then it is possible to reduce tissue swelling. (read also: First aid for edema)
- Bleeding. If it is mild and bothers the patient only in the first days after the installation of the implant, then this is the norm. When bleeding continues for a longer period of time and tends to intensify, this may indicate vascular damage, which increases the risk of hematoma formation. The danger of hematomas is that wound suppuration and seam divergence are possible.
- Increased body temperature. Raising the mark on the thermometer to values of 37-37.5 ° C on the first day after installing the implant is normal. However, when this temperature persists for more than three days, then perhaps it indicates the onset of an inflammatory process.
- Seam divergence is another possible early complication after the dental implantation procedure. This can happen as a result of their improper application, due to mechanical trauma, or due to the onset of an inflammatory process.
- Numbness of the implant site. Normally, numbness should go away within a maximum of five hours after surgery is completed. In this case, it will be a consequence of the performed anesthesia. If the numbness persists for longer, it may indicate damage to the facial nerve that travels down the jaw. Therefore, this complication can occur only when the implant is placed in the lower jaw. The nerve heals for a long time - several months.
- Inflammation of the soft tissues can also be a complication dating back to the early period after implantation surgery.
If the patient discovers any symptoms that indicate the development of complications, it is necessary to immediately seek help from the attending dentist. The sooner they are diagnosed, the more chances that the treatment will be successful and the implant will be preserved.
Contraindications to dental implantation
Before starting treatment, an orthopedic dentist must determine the need, as well as the possibility of installing an implant in each specific case. After all, these structures are designed not only to perform the function of chewing and to improve the cosmetic effect, but also are a prophylactic agent in the fight against disorders in the dentition as a whole. Therefore, their installation must be reasonable and not harm the patient.
Contraindications to dental implantation are a very serious issue, since neglect of them can lead to the most serious consequences and increase the risks of an unfavorable completion of the implantation process.
All contraindications can be divided into two large groups: psycho-emotional and somatic.
Contraindications to dental implantation of the psychoemotional group are represented by various psychoses, depressive moods, hypochondria and psychopathy.
In turn, somatic contraindications can be either absolute or relative.
The absolute ones include:
- Any seropositive infections such as AIDS, tuberculosis, gonorrhea, etc.
- Diseases of the bone tissue of a systemic nature.
- Diseases of the endocrine sphere, such as: dysfunction of the adrenal glands, insufficient or excessive function of the parathyroid and thyroid glands, diabetes mellitus proceeding according to the first type.
- All systemic diseases of the blood and hematopoietic organs.
- The presence of chronic diseases of the cardiovascular system. So, dental implantation is prohibited for hypertension, arrhythmias and angina pectoris.
- Chronic diseases of the kidneys, liver and pulmonary system in a decompensated form.
- The presence of a malignant oncological disease.
- Systemic connective tissue diseases, diffuse damage to collagen tissues, for example, scleroderma, dermatoses, etc.
- Diseases affecting the mucous membrane of the mouth; aphthous stomatitis prone to relapses, Sjogren's syndrome, lupus erythematosus, leukoplakia, etc.
Relative contraindications are:
- The presence of a chronic disease in a compensated stage.
- The patient's age is after 55 years.
- Bruxism and jaw clenching. If the implantation is still carried out, then the patient will need to wear special mouth guards during the night's rest.
- Diabetes mellitus of the second type is a relative contraindication, since with this disease any wounds heal more slowly. However, if the patient decides to perform the procedure, then he should opt for basal implantation.
- The presence of bad habits - alcohol abuse, smoking, drug addiction.
- The period of bearing a child for periods up to 4 months and after 8 months.
- Breastfeeding period.
- Diseases of the peripheral nervous system.
- The presence of metal prostheses in the heart, bones, as well as Kirschner wires.
- People with an increased risk of bacteremia are those who have already had rheumatism and bacterial endocarditis.
- Taking medications containing hormones. Undergoing treatment with immunosuppressants, undergoing chemotherapy.
Separately, local contraindications to dental implantation can be distinguished:
- Gingivitis;
- Chronic diseases of the oral cavity, prone to frequent relapses;
- Increased tongue;
- Osteomyelitis;
- Anatomical obstacles - excessive atrophy of bone tissue, narrow alveolar ridge, etc.;
- Pathology of the temporomandibular joints;
- Some jaw defects;
- Chronic progressive periodontal disease;
- Violation of oral hygiene;
- The presence of root residues in the jaw;
- The presence of cysts.
The author of the article: Muravitsky Boris Viktorovich, dentist, especially for the website ayzdorov.ru
