Implantology

Implantology

Implantology

Tips on implants

Are you thinking about installing implants or have you decided to go for this intervention?

In dentistry, implants are increasingly used after tooth loss. Implant treatment proved to be a stable, functional and successful measure in the long term, in addition to providing high quality comfort for patients.

More detailed explanations regarding treatment methods, materials and system of implants can vary significantly from patient to patient. For this reason, all is clarified only through a personal interview with a doctor who specializes in implantation (meaning dentist, oral surgeon, maxillofacial surgeon).

General considerations

Implants can compensate for individual teeth or a greater number of missing teeth. In addition, they can form a mounting system for large fixed dental appliances (bridges) or dental appliances that are removable (dentures).

Structure of implants

The structure of the implant consists of the following components:

  • body of the implant, which is implanted in the bone
  • upgrading parts (columns, abutments) for fixing the teeth on the very implant and
  • crown or structure for fixing dentures

There is a difference between two-piece and one-piece implants. In two-piece implants, the implant body and the upgrade are separated. When it comes to one-piece implants, the coupling element, i.e. the upgrade and the implant are made of one element.

Two-piece implants are used much more often since in this case it is ensured that the implant is not burdened in the healing phase.

Implant materials

As a base material for dental implants, highly purified titan is used. This material is particularly advantageous in relation to tissue (biocompatible), and it forms a secure and solid connection with the bone (osseointegration). From the biological point of view, it behaves neutrally and does not cause any allergic reactions or reactions to foreign bodies.

Indications and prerequisites for the installation of dental implants

Dental implants are used to compensate for missing teeth. Therefore, it is theoretically possible that each missing tooth be compensated for by implants. In the case of loss of some teeth, this is certainly practical, while in the case of partial or complete loss of teeth, this is not necessary. As for the fixed bridges, whether in the upper or lower jaw, 4-6 implants are enough, and sometimes 8, depending on the structure of the bone and the implant position.

When it comes to anchoring of complete dentures in the lower jaw, implants with ball attachments (clasps) are used. The prosthesis is then “buttoned” to the implant and used, and after the meal it can be washed and returned into the mouth.

  • Indications for implantation
  • Implant of a single tooth
  • Closing the major toothless regions
  • End of the dental arch. Compensation of nonexistent molars.
  • Significantly reduced number of remaining teeth
  • Complete edentulism

Prerequisites for performing implantation

  • Good bone volume for implant fixation
  • Enough space for prosthetic upgrade (crown)
  • Good oral hygiene
  • Completed development of the jaw

The method of treatment depends on the condition of teeth in the mouth and is determined by the attending physician when planning the installation of implants.

Contraindications

Medical reasons which do not favor the placement of implants (contraindications) are circumstances that either make such a procedure impossible (absolute contraindication), or they lead to the possibility of specific hazards (relative contraindication).

General medical contraindications

  • Cigarette smoking
  • Drugs that affect bone metabolism, such as bisphosphonates
  • Untreated or poorly controlled diabetes (diabetes mellitus)
  • Reduced immune defense of the body caused either by disease or by drugs
  • Severe cardiovascular illnesses
  • Generalized diseases of the connective tissue or the bones (for example, rheumatic diseases)
  • Certain psychiatric illnesses

In smokers, the long-term success is smaller and therefore implantologists cannot provide any guarantees regarding the success of implantation to smokers.

Locally conditioned contraindications

  • Insufficient volume of existing bone: bone upgrade (augmentation)
  • Bad quality of the bone: adequate implantation technique (a method which makes the bone more dense)
  • Vulnerability of important structures (nerve branches or roots of adjacent teeth): adequate implantation technique, an implant of suitable size and specific methods of imaging, if necessary, application of computer techniques
  • Jaw bone disease, oral cavity mucous membrane disease or tooth supporting apparatus disease: treatment of the underlying disease
  • Unfavorable bite relations (such as too little space for the crown), if necessary, applying the method in orthodontics or surgical procedure
  • Teeth grinding (bruxism): therapeutic rail
  • Incomplete jaw development: waiting

A whole series of local, biological-anatomic or functional circumstances may jeopardize the success of implant treatment. Such circumstances do not generally exclude performing implantation but they often require adequate preparation. Thus, careful examination and determination of the state before treatment is one of the prerequisites.

Advantage of implants

  • After tooth extraction, the bone is broken down because it is not stimulated by the tooth. The implant continues to stimulate the bone so that the degradation is reduced to the minimum biological flow
  • Saves healthy teeth from grinding in order to bridge edentulous fields.
  • Very good therapy for tooth loss due to gum disease (periodontitis)
  • Routine procedure which is substantially free of risk
  • Secured biocompatibility (little chance of rejection of the implant)
  • Cost-effective therapy, mainly due to long life span.

Risks of implantation

Deciding for or against the application of implants is surely often accompanied by the concern that complications can occur (for example, loss of implant) within the therapeutic application of implant. Implant therapy is one of the interventions that are characterized by low risk.

The risk of premature loss of implant in uncomplicated conditions is 5%. Individual risk for the patient can be well assessed after a thorough examination by the attending physician. Thus, the problems deriving from the specific anatomical circumstances can largely be avoided (for example, nerve injury, the neighboring tooth, the opening of the nasal cavity or the jaw javity).

Postoperative complications

In order to avoid the occurrence of postoperative complications (interference in the healing process), you as a patient can be of significant help to minimize the risks. In the following text, you will find important information in this regard.

LATE COMPLICATIONS
They are rare and mostly related to chronic infection. The frequency, however, is increased in patients with certain common disease.

PERIIMPLANTITIS
Periimplantitis is a disease which can occur in patients with a built-in implant. Periodontal disease is similar to natural teeth periodontosis.

As is the case with natural teeth, implants with dental crowns also cause deposits. If these deposits are not thoroughly eliminated, gum inflammation (gingivitis) occurs. Periimplant gingivitis calms down and disappears after the removal of deposits which have caused it.

If deposits are not carefully removed, the inflammation in the further course also spreads to the bone. The bone therefore continues to disintegrate due to periimplantitis. The implant starts to come loose. If you do not undertake timely treatment, this can lead to the loss of the implant. Precisely in order to prevent periimplantitis, one should devote great care in maintaining optimal oral hygiene.

LOSS OF IMPLANT
The loss of the implant is rare, but a disappointing outcome. The resulting bone defect can be closed again by the re-created bone. In this case, implantation can be repeated.

Procedure – implantation

Before implantation, one should provide optimum hygiene of the oral cavity and, if possible, stop smoking. Gingival inflammation and diabetes should continue to be treated. Treatment of dental caries should be completed. Insufficient bone volume requires augmentation.

Bone upgrade (augmentation)

If there is not enough bone mass at the desired point, the patient’s bone, the material which replaces the bone or the two elements together are applied. After that, there is a natural turnover of the bone in the jaw bone that can be loaded. In this case, prophylactic administration of antibiotics is often recommended in order to prevent possible bacterial inflammation.

Preparations for dental treatment

Prior to implantation, the oral cavity is disinfected by means of an antiseptic elution solution. Prophylactic use of antibiotics is recommended before and, if necessary, in the course of the implantation procedure. Thereby, possible bacterial inflammation which can lead to loss of the implant is prevented, as well as the occurrence of bacteremia (transient presence of bacteria in the blood).

Dental surgery (implantation)

The implant, as a kind of “artificial tooth root” is installed in the jawbone, mainly with local anesthesia. The mucous membranes are cut at the planned point and sets aside. Bearing of the implant in the bone is gradually processed (a hole is made into which the implant is anchored) according to the established length of the implant and its diameter. Preparation is carried out using a rotary instrument (drill) at low engine speeds with constant cooling by a saline solution in order to avoid overheating of the bone. The implant is placed and the seam of the gingiva is set. Healing of the wound is, under normal conditions, completed after ten days (recommended removing of stitches).

Length of the healing of implants without loading the bone depends primarily on the quality of the bone.

Average healing time is 3-6 months depending on the position of the jaw and bone quality.

In some cases, there is a technique of immediate loading, i.e. setting the implant and setting the crown without waiting.

After healing of the implant, the gums are formed around the implant so that it can be accessed and appropriate measures can be taken to create a definite compensation (crowns, dentures). The waiting time for the final work depends on the size and complexity of the case, but it ranges from one week up to one month.

Subsequent treatments and maintenance of implants

Immediately after placing the implant, the site of operation should not be burdened. Too intensive cleaning procedures (e.g. hard toothbrush) should also be avoided directly at the level of the seam wherein the remaining teeth must be very carefully cleaned. Prevention of infection in the first hours after surgery plays a key role. Mouthwashes based on chlorhexidine are available as additional protection.

Later, dental implants must be regularly controlled because of the danger of infection. Timely detection of infection is easier to treat than advanced infections that led to the degradation of the jaw bones.

For this reason, it is necessary that the attending physician controls the state of dental implants every 3-6 months. In addition to the usual good oral hygiene which comprises a toothbrush, dental floss and optionally a mouthwash, it is necessary to use brushes, which clean the interdental spaces.

Loss of implants

The loss of the implant is often associated with inadequate oral hygiene. Sometimes, however, this is caused by individual factors (e.g. smoking), or changes in the general state of health of the patient.

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