Implantation and gum augmentation

Dental implantation is gaining popularity with each passing day among different population groups. This is due to the fact that this method of teeth replacement is quite reliable, because it was invented a few dozen years ago. During this time, scientists conducted thousands of scientific studies, invented a lot of implant systems, a large number of patients were examined many years after the treatment. This allowed to fully analyze the possibilities of this field of dentistry, to combine all the information among themselves and create a single set of specific data. Thanks to these data it became known that implants take root in more than 90% of cases. Also, numerous studies helped determine the most durable types of implants, which were intraosseous. Moreover, to date, many surgical and orthopedic treatment protocols have been invented that allow for the operation with the maximum preservation of soft tissues and bone, and prosthetics - with the achievement of ideal aesthetics and function. Thus, it can be concluded that implantation is not a "know-how", but a proven method of dental rehabilitation for years.

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Indications for the procedure

Indications for implantation are any defects in the dentition up to complete adentia. That is, it does not 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 explained by the individuality of each case. For example, a woman of 75 years with hypertension of the second degree and many other somatic pathologies wishes to undergo a course of total implantation. 

[2], [3], [4], [5]

Technique of the gum augmentation

The method of implantation is determined at the planning stage of treatment. This is due to the fact that the type of implantation is selected strictly individually. It takes into account the age, health status of the patient, his occupation and psychological state. For example, if a young, relatively healthy person wants to immediately restore a lost tooth and perform express implantation, then such a plan can be implemented. However, if a person is in adulthood, has chronic periodontal disease, suffers from somatic pathologies, then he needs to conduct special training: eliminate all pathological processes, achieve a state of remission and perform a two-stage implantation. This classic method is more reliable and consistent, which allows you to control first engraftment of the implant, and then the formation of the mucosa.

Traditional two-stage implantation involves the separation of the treatment course into separate stages. The first stage is osseointegration. In this period, the mucosal dissection is performed, the implant bed is bored into the bone and immersed in it. After that, the implant is covered with a flap of the mucous membrane and tightly sewn. The next 3-4 months there is a period of osseointegration. At this time, the bone tissue in the area of the implant is subject to structural changes. In the first weeks after implantation, the bone tissue undergoes minor destructive processes. This is due to the fact that when drilling a bone, the cutter destroys the layer of osteocytes (bone cells) with which it has been in contact. Consequently, the marginal sphere of the bone begins to necrotize. However, no matter how paradoxical it may sound, but in this case necrosis is a normal process that disappears after a short time. He is replaced by active osseointegration. During this phase, several control X-rays are taken to make sure that the engraftment occurs without deviations. After 3-5 months, the mucosa over the implant is cut, a plug is unscrewed from the implant and a gingiva former is installed.

It is very interesting that most people know what the implant looks like, but have no idea what the gum former is and what role it plays in implantation. In fact, its task is no less important than any other element of the design. The gum formulator is a part that is attached to the implant after its 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 "fouling" the structure. The gingivator during implantation is healed for 2-3 weeks. Given the good ability of the mucosa to grow and restore, the installation of this element for such a period is considered quite sufficient. After extraction of the shaper, an abutment is placed in the implant. From this moment begins the orthopedic stage of treatment. That is, the task of the implantologist is to screw in the implant, check its integration and perform the gingival enlargement. And the task of the orthopedist (prosthetist) is to give the gums a natural appearance and aesthetic outlines. As already mentioned, the orthopedic stage begins with the installation of the abutment. This part serves as the stump of the tooth. That is, it is a metal copy of a tooth that has been turned under the crown. A temporary plastic crown is placed on the abutment, after which the mucosa begins to acquire a more physiological appearance. The stage of temporary restorations is very important for the overall result of the treatment. It allows the mucosa to adapt to new conditions and create such an abutment of the gum to the crown, which will not differ from the contour of the gums of the "real" teeth. In addition, temporary crowns allow a person to get used to new appearance, smile parameters, features of diction and chewing in new conditions. Also important is the opinion of close people (parents, spouses, friends) who can express their criticism only if the permanent crowns are not yet made and you can easily make any changes. The patient uses temporary crowns for several months and only after complete adaptation of the gums is he made permanent designs. Thus, gum formation during implantation occurs only at the stage of temporary restorations. Permanent prostheses are fixed under the condition of fully adapted mucous membrane. Ceramic crowns in form are copies of temporary, but they have better physical characteristics. Permanent prostheses are not erased, are more durable, reproduce micro and macrorelief of teeth. They also have optimal optical characteristics (color, brightness, contrast, transparency, etc.), which at times improves the aesthetics of the teeth.

As a result, a two-stage implantation can last about a year. Man gradually approaches the desired result. Naturally, this kind of treatment is more reliable and easier for the doctor, because during the year the implantologist and orthopedist have the opportunity to imbue with the characteristics of the patient's body and more carefully conduct treatment.

The popularity of express implantation is growing every day. This is due primarily to the marketing work of private dental clinics. They entice people in that they guarantee the restoration of the lost tooth in just a few days. Having considered the superficial information about two-stage implantation, it is possible to imagine what an enormous amount of work the implantologist and orthopedist perform with express implantation in a short period of time. The first visit is performed by diagnosis and treatment planning. During the second visit, the patient is screwed in with the abutment together with the abutment (for express implantation they are made as an integral structure). After this, an impression is made or scanning of the oral cavity is performed, and the following day temporary structures are fixed. At this stage, each doctor, depending on his working protocol, chooses the period of use of temporary restorations. It is desirable that the patient has the opportunity to get used to them and evaluate their shape. But often specialists fix the permanent crowns as early as possible in order to justify the patient's temporary advantages of express implantation. This can be done only if the doctor is confident in his abilities. This factor is very important, because during the treatment simultaneously there is a load on the implant, osseointegration and partial bone resorption (due to the load). Together with partial bone resorption, a certain loss of soft tissues also occurs. If all these processes are not taken into account, then a breach of the gingival abutment and the absence of the gingival papilla will be observed around the crown. In this restoration will look very unattractive and between the teeth will be determined by the so-called "black triangles"

How does the gum look after implantation?

The appearance of the gum after implantation does not depend on the technique of the operation. First of all, the aesthetics of the gum is associated with the quality of the implantation. If the treatment course is implemented at the highest level, then the gum will have a pale pink shade. Its contour will be located symmetrically with the contour of the gum of the opposite side. The gingival papilla will fill the entire space between the crown and the adjacent teeth. If the color of the artificial crown, its shape and dimensions correspond to the rest of the teeth, then after treatment no one will distinguish the "living" tooth from the implant. And, this applies not only to people not related to dentistry. Quality work can be so accurately chosen for the shape of the face, muscle tone, skin color, that even a specialist will not always determine the presence of an artificial crown on the implant. Moreover, the implant and restoration performed at the highest level will allow to provide aesthetics and design function not only for the first two or three years, but also for the next ten years with appropriate care for the condition of the oral cavity and the body as a whole.

Contraindications to the procedure

It should be noted that at this age the surgical operation is extremely undesirable. Moreover, the body of an elderly person no longer possesses such an active detoxification and regenerating function as at a young age. Therefore, taking antibiotics, analgesics, anti-inflammatory drugs, injections of anesthetic solutions - all this will negatively affect the health status of the elderly person.

It is also worth noting that implantation is unacceptable in childhood. Constant reorganization of the jaw bone, teething, characterizes the child's tooth-jaw system as a dynamic structure. Therefore, the implant, being a stationary element, can delay the growth of the jaws, lead to incorrect and incomplete teething.

Persons with decompensated forms of diabetes mellitus, immunodeficiencies of different 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.

[6], [7], [8], [9]

Consequences after the procedure

Implantation is a fairly serious intervention, so there is always a risk of complications and negative consequences. If we talk about the proper implantation, then during it there can be complications, which are typical for many unsuccessful surgical operations. Some complications arise from the fact that the patient did not report any systemic pathologies. Other troubles may arise due to inadequately carried out patient diagnosis and treatment planning. If we talk about common complications for the surgical sphere, then they include an allergic reaction to anesthetics, bleeding, fainting, collapse, hypertensive crisis, attacks of bronchial asthma, epilepsy, stenocardia. Having looked at the list of the listed states it is easy to understand that most of them can be avoided by informing the doctor about the existing disease. For example, hypertension, bronchial asthma, epilepsy and angina pectoris are those pathologies in which a person necessarily consults a doctor and receives a medical opinion. The patient may not know about the allergic reaction to anesthetics and antibiotics, so allergic tests must be performed before the operation. Bleeding can occur both in diseases of the blood, vessels, and for other reasons. For example, the individual anatomy of a person can suggest such an arrangement of blood vessels, which is not characteristic of most people. On this basis, the surgeon can accidentally damage the artery or vein. The same situation can happen if you do not know the anatomy of the human body. Complex tooth extraction before implantation increases the likelihood of uncontrolled bleeding. Fainting, collapse and increased pressure can occur suddenly with a person of any age and sex. The reason for this may be a fear of surgical interventions, pain syndrome with poor-quality anesthesia, or weak vascular tone. In any case, these situations take place during surgical interventions. The appearance of these complications does not cause confusion for an experienced surgeon. This is due to the fact that such conditions occur regularly, there is a clear protocol of action for their relief, and for patients these conditions have no physical consequences.

Mucositis and peri-implantitis

These complications should be highlighted in a special section, as they are considered specific for implantation. In the presence of their teeth, a person usually has three most common problems: caries, periodontitis and periodontitis. After implantation, the probability of losing an artificial tooth still remains. The cause of these consequences is periimlantitis - inflammation of the bone around the integrated implant.

The prevalence of peri-implantitis ranges from 2% to 43% of cases. It is very interesting that the implant engrafts in 95-99% of cases, and the surrounding bone tissue becomes inflamed with a probability of up to 43%. This is due to the fact that the period of osseointegration is controlled by a physician, which regularly conducts professional oral hygiene. During the course of treatment, the patient understands all the responsibility that lies with him. Also important is the motivation of a person to get an aesthetic and functional result quickly. When more than six months pass since the installation of permanent restorations, people begin to treat implants with less care. Gradually, the amount of hygiene products begins to be limited to toothpaste and a brush, and the cleaning time is reduced to a minimum. As a result, the infection gradually penetrates into the area between the abutment and gum, which causes mucositis - a superficial inflammation of the gums around the implant. Mucositis resembles gingivitis in some way: in the area of the crown there is inflammation of the gum, which is accompanied by soreness, swelling, itching and bleeding. From the pockets, purulent contents can be released. The given situation though clinically bright enough, however at timely reference to the doctor inflammatory process can be completely liquidated.

If the patient does not seek specialized care for mucositis, the disease can go to peri-implantitis. In this case the inflammation passes to the bone tissue around the implant. In the beginning, the lesion can have a local form, and eventually affects all the bone tissue around the implant. This condition without qualified intervention leads to the mobility of the implant and its loss. If this happens, then the entire treatment will have to start again. First of all, it is necessary to eliminate the inflammatory process in the bone. Then it is necessary to carry out plastic surgery of bone tissue to obtain the required volume. And only after that it will be possible to begin the first stage of the actual implantation. It should be noted right away that old crowns and implants can not be reused. Despite their very high cost, after extraction from the bone, they can be left only as a souvenir and motivation for oral hygiene. Even careful handling of the implant will not allow it to be reused. This is due to its unique surface, which is treated with various acids and sandblasters to produce a rough surface. If even a minimal amount of pathogenic microorganisms remains in the implant cavities, the peri-implantitis with a high probability of recurrence. Therefore, it is rational to use a new, completely sterile design and not to repeat previous mistakes.

[10], [11]

Recession of gums after 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 installation negatively affects the condition of the gums. Rather, this effect is due to the natural loss of soft tissues after tooth extraction. By the way, the same processes occur with bone tissue. These are completely physiological processes that must be amenable to surgical correction. Most often, the volume of recession varies within 1-2 mm, however, in some cases, these indicators may be more significant, which looks like a splitting of the gum. To restore the aesthetic and barrier properties of the gum is performed by her plastic. The operation is performed under local anesthesia. Depending on the area and localization of the defect, the method of substitution is chosen. The specialist determines the most suitable donor place in the oral cavity and takes a transplant from it. This tissue is moved to the defect area and stitches are applied.

In addition to the natural loss of the gum, it can be caused by aggressive tooth cleaning with a stiff brush, drinking hot drinks, smoking and other bad habits. After performing the gum plastic surgery, the patient is repeatedly provided with all the recommendations, information about the need for rational oral hygiene and possible consequences.

Care after the procedure

Care after implantation is no less important than the quality of the operation itself. Expensive implantation is like buying a car, it requires regular professional maintenance and self-care. Only if these conditions are met can we talk about the durability of the restoration.

The basic rules of care are to brush your teeth 2 times a day with medium-hard brushes. Pasta should be used on the advice of a dentist. If there is a tendency to inflammatory periodontal diseases, it is recommended to use a paste with herbs (for example, Parodontax, Blend-a-med "Herbal Collection", Colgate "Medicinal Herbs"). If a large number of seals are fixed on the teeth, then there is a tendency to carious lesions. For prophylaxis, it is necessary to use pastes with microelements (Blend-a-med "Anti-caries, Lacalut" Flour ", Sensodyne" Repair & Protect "). If inclinations to similar pathologies are not revealed, then it is desirable to combine the kinds of pastes with each other. In occasion of bleaching paste it is necessary to say that it can be used no more than once a week. With frequent use, its abrasive particles may adversely affect hard tooth tissues and soft gum tissue.

It is difficult to overestimate the benefits of dental floss and brush. They perfectly cope with cleaning the interdental spaces from the plaque. Before purchasing these hygiene products, it is recommended to consult a hygienist doctor. This will allow you to individually select the size of dental brushes, which will further increase the effectiveness of procedures.

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Reviews

Reviews about implantation and gum augmentation are mostly positive, because people often get a satisfactory result from implantation. However, it should be understood that every person has different opinions about successful treatment. Much depends on the personality psychotype and the patient's expectations. Some people believe that after the restoration of the aesthetics of a smile they will immediately start to like people, the problems will disappear and "everything will be different". In fact, after self-implantation, a person will really have more self-confidence, self-esteem will increase. But one should not take implantation as a new stage in the development of the personality and expect cardinal changes in life. It should be more rational to such things. After all, loved ones will definitely rejoice at the man who restored his teeth. And ill-wishers are likely to feel jealous that someone has the financial opportunity to undergo an expensive treatment to restore the aesthetics of the teeth.

Also, many patients consultants promise to "look like a star," "become like a queen," "make a Hollywood smile." These phrases marketers guarantee a knowingly impossible result. To fulfill their promises, the patient would have to be treated not only by the dentist, but also by other specialists. For example, many patients need to undergo a course of cosmetic procedures with an individual selection of hygiene products for the skin. People with postural problems should contact a postulologist for appropriate research. This will help to identify problem areas in the musculoskeletal system and correct posture and gait during therapy. If the patient is in a depressed state, is an introvert and a sociopath, then he needs to visit a doctor-psychotherapist. Changing attitudes to their problems, a person will begin to feel less emotional about minor troubles. Thus, after a complex interdisciplinary approach, a person can really appear before society in a completely new way. He will easily communicate in the team, confidently get acquainted with new people, leave after themselves a pleasant impression, smile and enjoy life.

It is also worth noting a group of people who have had an implant rejection. Very often such patients are inclined to talk about the lack of professionalism of doctors, low quality of medicine and expensive treatment. If you listen to such people, you can really believe that a man was cruelly deceived. But if you ask him a few questions, for example: "What are dental flosses?", "What kind of brush did you use?", "How often do you smoke?", "How many times did you go to the dentist after implantation?", It becomes clear who is to blame for complications after treatment.

In addition to negative feedback, one can also find the opposite situation. For example, a person received not the most qualitative treatment that could be carried out. But, the presence of teeth, the emergence of the opportunity to chew the food well became for the patient such a pleasant event that he wants to tell everyone around his impressions. In this case, patients who turn to the same clinic for an aesthetic result, can be disappointed. After all, their requirements are higher than in the previous case.

As a result, a person's feedback is not always a clear reflection of the quality of implantation. In such situations it is worthwhile to trust close people and competent doctors, from whom you consult.