Tooth implant placement: how to choose the right implant

Everyone knows that teeth are made up of the hardest tissues inherent in the human body. Enamel contains up to 98% of inorganic substances and is the most mineralized, and, therefore, the most durable "building material" of man. Dentin in its composition has a slightly smaller amount of inorganic, but also has the right to be called a physically very stable substance. The third place in strength is cement, which covers the root of the tooth. Despite the fact that the teeth have a very strong structure, in fact they are very vulnerable to injuries, inflammatory and destructive processes. Take for example caries, this disease easily leads to the destruction of powerful tooth tissues. It is also worth mentioning about periodontal diseases, in the progressive course of which a person can lose perfectly healthy teeth. And, finally, a trauma to the teeth. At any age, under any circumstances, a person may lose one or more teeth due to accidental circumstances. When a person realizes that a lost tooth needs to be restored, the question before him is what to put, the bridge or the implant?

What's better? Implant or bridge on the teeth?

It should be noted right away that this question sounds too abstract to give a concrete answer to it. The fact is that both for the bridge and implant there are indications and contraindications.

A solid bridged prosthesis is indicated for defects of dentition with a length of 3-4 teeth in the frontal area or 2-3 teeth in the side region. That is, if there are no 3-4 front teeth or 2-3 lateral teeth, then you can put a bridge. But, it should be noted that far from all situations you can adhere to these rules. This is due to the fact that they are designed for healthy teeth. If a person has periodontal disease, it should be borne in mind that teeth can lose a significant part of their chewing power (often this figure is higher than 50%). In this regard, supporting teeth will require more. And at the advanced stages of periodontitis and periodontitis prosthetics with the help of a bridge prosthesis is completely contraindicated.

An important role is played by the age of a person. Bridge bridges are recommended to be installed from 17-18 years. At an earlier age, this is undesirable, because a rigid joint of teeth can restrain jaw growth in the period of active development. One must immediately say about single implants. They also can not be installed in childhood, because during the growth of the jaw implants will cause deformation of the dentition. Therefore, teeth implants to children are strictly contraindicated.

When prosthetics with bridges, certain requirements must be taken into account. First, there should be no end defects in the dentition. That is, on both sides of the missing teeth should be located supporting teeth. Secondly, the clinical crowns of teeth that are selected as a support should be high enough to fix the structure. If the teeth are severely worn out or destroyed, they must first be restored with pin structures.

Pay attention to the tilt of the supporting teeth. If the slope of the teeth is insignificant, then they can be used as a support. But, if they are excessively inclined, then there are two problems. The first - if the teeth are tilted in different directions, then the prosthesis can not be put on. It will be necessary to remove a very large layer of dentin, in order to achieve the parallelism of supporting teeth. The second problem is that the inclined tooth is less stable than the upright one. Nature has created a tooth so that it best perceives the load that goes along its longitudinal axis. And for this, the tooth should stand more or less vertically.

The advantage of bridges in front of implants is that when a bridge is installed, there is no need for surgical interventions on the bone, antibiotics and other radical interventions. It should also be noted that the installation of the bridge is approximately 2 times cheaper than the installation of a single implant. And if the bridge replaces two teeth, then the difference in price increases.

Benefits

The advantages of implants can be said for a long time. Their main advantage is the high ability to withstand the chewing load. If the teeth can break at any time and begin to tilt, the titanium implants will stand still.

The next advantage is the absence of bone atrophy in the place of the lost tooth. If the chewing load is directed to the bone, then the processes of atrophy will not occur. It is necessary to pay attention to the fact that even with a large degree of bone loss with the help of osteoplastic materials and implants, it is possible to restore the necessary bite height and create an imitation of living teeth with all surrounding structures (gingival papilla, etc.).

When a person does not have a tooth at all and the state of complete adentia comes, the choice remains small: either a complete removable prosthesis or implants. It is unlikely that a person who has the physical and financial capacity to install implants will prefer to wear removable dentures. After all, the quality of life when using strong, non-removable structures is much higher. Therefore, if you doubt whether it is worthwhile to put dental implants, then the answer will be simple - if possible, then put it.

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Disadvantages

The disadvantages of implants are only their cost. A good implant, along with the installation, will cost about $ 500-800, whereas a metal-ceramic bridge can be put up for $ 250, in a clinic of the same level. If we evaluate the situation more deeply, then it is likely that the high price is compensated by the durability and reliability of the structure. Therefore, this factor can be called a reasonable investment in the health of teeth, joint and the whole body.

The next relative disadvantage of implants is their intolerance to injuries. If you imagine that a person is injured by teeth in the presence of a bridge on the teeth, then most likely he will lose supporting teeth and the actual construction. But, when the impact falls on the area of the implants, the consequences can be very serious. If the intra-osseous part of the implant is thick and long, then trauma can lead to a fracture of the implant along with the bone. After that, the implant will no longer be re-screwed, where. For this reason, some athletes and people working in dangerous conditions (hockey players, car racers, boxers, etc.) prefer removable dentures instead of implants.

It is also worth mentioning about such a shortage of implants, as the absence of depreciation. If we talk about real teeth, then they are in a hole in a suspended state (hang on the micro-bonds of periodontal). When chewing or closing of teeth occurs, they spring in the hole, thereby compensating for the chewing pressure. Due to this, the load on the joint and skull bones is transmitted only partially. If you analyze the biomechanics of implants, they become overgrown with bone tissue, which excludes their mobility. That is, when closing, there will be no depreciation, which will lead to a spread of the load on the temporomandibular joint and bone seams of the cranial bones. This problem is at the research stage and many manufacturers have already found a technological solution in the form of implants with an integrated shock absorber. However, their design is complex, and the cost is even higher than that of conventional implants. Therefore, we can say that such systems are still at the stage of optimization.

What implants to choose?

The great demand for implantation provokes the emergence of a multitude of manufacturing companies. Some of them are on the market for more than a dozen years, and some have appeared quite recently. Which implants are better and which are worse, it is definitely impossible to say. Each company diligently promotes its system, idea and methodology. Their employees conduct all sorts of experiments that confirm the quality and reliability of their products. Commercial battles of manufacturers of dental implants create confusion in the choice of systems. Among implantologists there is such an opinion: "The best dental implants are those with which the doctor has learned to work in perfection". That is, the concept of "best" and "worst" is strictly a subjective assessment.

Straumann (Strauman) is a Swiss implant of the oldest company that has existed in the dental market for 63 years. This persistence and maintenance of high quality products can not boast of every manufacturer. The advantage of this company is a lifetime guarantee for implants. But here there is one nuance: Straumann can guarantee only the integrity of the system, but in no way the survival rate. Integration is completely dependent on the person and his doctor. According to the manufacturer, more than 14 million Strauuman implants are already installed in the world, and this indicator is growing rapidly. The only drawback of the system is the high price. Strauman is, if not the most expensive dental implants, then exactly included in the top three most expensive systems.

Nobel Biocare is another outstanding representative of Swiss implants. They have been on the market for more than 40 years, which makes them slightly younger than Straumann. However, many implantologists, like Nobel itself, claim that they are not inferior to other leading companies in terms of product quality. The positive qualities of Nobel Biocare systems are the manufacture of individual abutments (the connecting part between the crown and the intraosseous part of the implant). This allows you to create the most functional and aesthetic restoration. Moreover, Nobel produces individual crowns, veneers and bridges. This can further improve the quality of the result.

Among Israeli implants, mention can be made of Alfa Bio, which has been on the market for more than 25 years. Many implantologists appreciate the convenience of work and the ergonomics of these systems. Israel also offers implants from MIS and Adin, which also have the optimum qualities for successful implantation. All these Israeli implants are excellent inexpensive systems. They have a rich assortment of products and excellent technical support, which avoids many problems in the treatment process.

Ankylos is a quality German implant system, which is roughly in the middle of the price list. Requires a doctor of many years of experience and accuracy of work. Like previous companies, Ankylos has an excellent range of products and excellent information support.

Most Korean companies are focused on manufacturing budget implant systems. There are many similar companies on the market that produce thousands of kinds of all kinds of implants. In the absence of years of research, the quality of systems sometimes suffers. However, some Korean factories that manufacture relatively inexpensive teeth implants can boast of a rather high quality. An example is the company Dentium, which offers a large selection of systems and components.

French implants Anthogyr are the leader in the French market of dental products. Also, this company is fiercely struggling for leadership in the world commercial arena of implantology. Excellent, high-quality system, which is definitely worth attention. According to the manufacturer, the implant warranty is 5 years. An interesting feature of the warranty is that the manufacturer is ready to replace the implant free of charge, if it does not take root. Although company employees say that this happens very rarely.

Russian dental implants are rapidly gaining popularity among domestic specialists. Examples may be companies such as Rusimplant, Inno, LIKO, NIKO. It is worth noting that some Russian implants are made in Korea. However, manufacturers claim that the quality from the place of manufacture does not suffer in any way.

Indications for the procedure

Many people idealize implants, believing that they can replace the tooth in any clinical situation. However, implants as well as any prostheses have indications, contraindications, advantages and disadvantages.

If we assess the ability of implants to replace teeth, then the range of their possibilities is wider than that of bridges. This is due to the fact that with the "bridges" prosthetics the doctor must adjust to the current state of the teeth. When carrying out implantation, the dentist can initially create conditions for successful prosthetics. Assessing and correcting the condition and quantity of bone tissue and mucous membrane, the doctor has the opportunity to create an optimal aesthetic and functional design. Moreover, during implantation, the dentist and the patient have a choice: to install an implant (on the principle of "one tooth - one implant") at the site of each missing tooth or to install implants "through one". In the latter case every second missing tooth is replaced. If such a scheme is chosen, bridges will be installed on the implants. Here it is worth saying that the implants are equipped with the same orthopedic design as the teeth, but when resting on the implants, a more stable condition of the prosthesis is achieved.

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

Preparation

Before the "twist" implants should undergo special preoperative preparation. It consists in a thorough examination of all the remaining teeth and other formations of the oral cavity (tongue, gums, oropharynx, etc.). A full sanation of the oral cavity should be carried out. Teeth that are to be treated should be treated. If this is not possible, then the removal is performed. All inflammatory processes in the oral cavity are eliminated, chronic diseases are transferred to a state of remission or stabilization.

The necessary procedure is the analysis of computed tomography, which will assess the state of bone tissue. Since sometimes intraosseous benign and malignant neoplasms are encountered in humans, this method allows finding and carrying out treatment of the revealed pathologies in time.

Very often, an internal bone buildup called sine lift is required. This is a surgical operation, which consists in raising the bottom of the maxillary sinus in order to increase the volume of bone tissue in the mette of the future implant. If you do not go into details and subtleties of various types of sinus-lifting, the essence is approximately this: in the area of the missing tooth, surgical access to the maxillary sinus is created. When a doctor drills the bone of the alveolar process, it "rests" on the bottom of the maxillary sinus. After this, the surgeon lifts the mucous membrane and places bone substance in the released space. By the way, very often bone growth is used to build a bone, which was obtained when drilling a jaw. At the same visit, you can screw in implants in this area. Thus, the implant is installed immediately after the extraction of the tooth. The operation is performed under local anesthesia, so the question: "Is it painful to put an implant?", The answer will be negative.

Any doctor will tell you that implantation should be planned before the tooth is removed. It means not at the time when the tooth is healthy, but at the moment when you already understand that the tooth will have to be removed. This approach is necessary in order to shorten the period of implantation. When the tooth is removed, the bony hole (alveolus) remains empty. More precisely, it contains only a blood clot, which is the basis for the formation of new bone tissue. It should be noted that this process lasts more than one month. But, if after removing the tooth immediately put the bone substance in the hole of the tooth and close it with a biological membrane, you can get a hard and structured bone much faster.

In the narrow alveolar process, the splitting operation is used. The essence of the intervention is to saw the alveolar process into two parts and place the bone substance in the cutting zone. After this, the wound is closed with a membrane and sutured.

In some cases, the method of bone autotransplantation is used. With a lack of bone, it can be obtained by taking from other massive structural (eg, from the pelvic bone, chin).

[6], [7], [8], [9], [10], [11]

Technique Tooth implant placement: how to choose the right implant

At the moment, there are several effective techniques for implantation. Among them, one-stage and two-stage implantation are singled out. Immediately it is worth saying that these methods have been invented for a long time, but discussions about which of them are better actively conducted so far. The fact is that each of the techniques has its advantages. In order to better understand them, you should consider each of the techniques in more detail. Since the classical is two-stage implantation, it should be considered first.

Two-stage implantation involves the use of special collapsible implants. They have an intra-osseous part, a gum former and an abutment. After planning the treatment, the surgeon cuts the gum, drills the bone with a special device called a physiodisperser. With it, you can monitor the force and speed of the drill. This helps prevent bone overheating, wedging of the drill in the bone tissue and other undesirable moments. When the implant bed is formed, the intra-osseous part of the implant is screwed into it. This detail is completely immersed in the bone and after suturing the gums it is not visible. This stage is called - osteointegration, or "implant engraftment". Although the term "engraftment" is not entirely correct. After all, the titanium implant is a bioinert material, and the body does not react to it in any way. The essence of osseointegration is that the titanium screw simply fills with bone. As a result, the carving of the implant and all its grooves are filled with a new bone tissue. As you can see, the mechanism of integration is simple, so it's not difficult to understand how a tooth implant is implanted. After the implant is integrated, the gum is again cut and the gingiva former is inserted into it. In appearance, this element resembles a cylindrical head, which is designed to build up soft gum tissue. This is a very important stage that determines the aesthetic characteristics of an artificial tooth. After a few weeks, the gingiva former is dismantled and a temporary crown is installed instead. If the previous element was used to obtain the volume of soft tissues, the crown is designed to create and refine the gingival contour and the interdental papilla. After a few weeks, the temporary crown is changed to a permanent one, which is made of a ceramic mass. In the process of two-stage implantation there is a clear sequence of the stages of the implantation of the tooth. Although the duration of treatment is quite large, it makes it possible to perform and monitor each period qualitatively.

Single-stage implantation is performed in the "express" mode. That is, after planning the treatment, the gum is cut, the implant is screwed in, the temporary, and then the permanent crown is fixed. Thus, the treatment consists of 2-3 visits, and the stages of implantation of the tooth are significantly compressed. The mechanism of "engraftment" is somewhat different from osseointegration with a two-stage method. This is due primarily to the fact that with a one-step technique on the implant immediately put on the crown, which takes on the chewing load. Due to this, a voltage is created in the contact area of the implant with bone, which can slow down the engrafting processes. Also, with a one-step implantation, it is more difficult to monitor the gums around the crown.

One-stage implantation is very popular among people. Managers of private clinics have worked hard on this. If the administrator of the clinic asks: "How long does the tooth implant last?", They will proudly reply: "Do not exceed a week!". Everyone wants to restore the appearance and function of chewing as quickly as possible. However, it is worthwhile to know that the "immediate load" technique is an aerobatics for an implantologist, and not every doctor will be able to fully implement this technique. Moreover, such work usually costs more than a two-stage implantation. If the clinic offers quick, cheap and high-quality implantation, then one of these three items will definitely not be available.

Contraindications to the procedure

With the help of modern implantation, absolutely any missing tooth can be replaced. Thus, it is possible to install an implant of the front tooth, chewing gum and even an implant of wisdom tooth. With success, both implants of the upper teeth and lower ones are installed. Moreover, dental implants are installed with a complete absence of teeth, which allows a person to return the usefulness of the chewing system.

However, despite the amazing possibilities of implants, they are not always shown. There is a whole list of relative contraindications, which prohibits placing implants. Relative they are called for the reason that everything depends on the specific case. For example, in diabetes mellitus, implants are contraindicated. But, if a person monitors his state of health, keeps diabetes in a state of compensation, then the prosthetics will be successful. The same applies to drug addicts who have been treated and have not used narcotic substances for a long time. Contraindications are various blood diseases, which do not allow for a full surgical intervention. People with pathologies of the nervous system can use prosthetics on implants only after the conclusion of a psychiatrist. It is also worth mentioning that the installation of a tooth implant in pregnancy is not recommended. This is due not to the fact that they "do not get accustomed", fall out, etc. On the contrary, the implant is more likely to integrate ("get accustomed") and orthopedic treatment will be successful. But, whether the remaining period of pregnancy will pass successfully, whether a child will be born healthy - nobody can answer these questions. It should be understood that the implantation course consists of surgical and orthopedic interventions. In addition to a long-term stay in the dental clinic, a huge medical burden falls on the pregnant woman's body, which includes antibiotics, anti-inflammatory, anesthetics, analgesics, keratoplastic agents, vitamins and other medications. Therefore, the implantation of teeth during pregnancy is an extremely unpredictable, dangerous and irrational solution. In the list of contraindications are also many systemic diseases of connective tissue, such as systemic lupus erythematosus, rheumatism and scleroderma.

[12], [13], [14]

Complications after the procedure

During the course of implantation, a lot of surgical and therapeutic manipulations are performed. And the more these events, the higher the likelihood of various complications. If the situation is globally assessed, the complications can occur even at the stage of anesthesia (with a vessel injury) or in the form of an allergic reaction to antibiotics, which are often prescribed before implantation. But this does not mean that implantation is painful, scary and dangerous. This means that all diagnostic procedures must be performed beforehand. If the doctor said to pass the list of tests, then this must be done. Saving on diagnostics means putting the entire treatment at risk. Often people do not want to talk about some diseases of other organs. But in this case it is also worthwhile to understand - you come to a medical institution where the doctor will interfere with the work of your body. If a specialist does not fully appreciate your physical condition, errors and complications may well arise.

After implantation, in some cases, a peri-implantitis occurs. In fact, this is the state in which the implant does not take root and is rejected. The peri-implantitis clinic is quite bright: a person complains of pain, swelling, suppuration and bleeding from the gums after the implantation of the tooth. The general condition of the body (fever, headache and other symptoms of intoxication) can be disturbed. On the radiographic picture, signs of rejection of a tooth implant are determined: bone resorption around the structure. When periimplantit is not always shown the removal of the structure. Most often enough surgical cleaning of the implant surface, drug therapy, occupational hygiene and physiotherapy. But sometimes it is still necessary to remove the implant together with the construction that rests on it. In this case, the person will have to go through all the stages of implantation anew or choose another method of prosthetics.

How often do implants fail?

This issue stands out in a separate section, because this is the main reason for people to refuse implantation. People panically fear to contact implants because of the probability of their rejection. This phenomenon usually spreads on the principle of word of mouth when people tell each other: "I have an acquaintance whose implant has not caught on! A month later the implant fell out! ". The most interesting thing is that in such dialogs the name of the implants, their cost, the qualification of the doctor and the type of implantation are not mentioned. After all, if you understand, the reason in 99% of cases lies somewhere on the surface. Very cheap dental implants (often copies and fakes), insufficient doctor qualifications, implantation with disregard for contraindications, lack of preparation for implantation - all this can cause implant rejection. If all of these requirements are met, then the implant will survive in 98-99%. Moreover, such statistics are observed not only in the elite Straumann systems. Budget Korean and Russian implants are as well integrated into bones. The main thing is to create conditions for integration. Everything else will make the body.

Care after the procedure

Regardless of the method by which the implants were installed, it must be understood that they require careful and regular care. How to care for dental implants after installation, should tell the doctor before the treatment. Buy the necessary hygiene products, learn the proper method of cleaning teeth - it's all advisable to do before the implantation. For everyday care is recommended to buy toothpaste, which combines medicinal herbs and micronutrients. This will simultaneously affect the condition of the gums and hard tissues of the remaining teeth. Also useful are dental brushes, which allow you to thoroughly clean the interdental spaces. In general, it is necessary to clean implants of teeth as well as real teeth. Every six months you should visit a dentist for professional hygiene. It is very important to understand that hygiene after implantation is the basis of its well-being. It does not matter which implant you install, large or small, ceramic or titanium. Whether it is from adamantium, poor hygiene will bring its result, and this time you can lose not only the tooth, but also the integrity of bone tissue. Therefore, one should take seriously the doctor's instructions and do not be lazy to spend time and energy on your health.

It is also worth noting that the body needs restoration after the installation of dental implants. Surgical and medicamentous interventions adversely affect the operation of many organs and systems. Therefore, the next six months, you need to carefully monitor your health. We must try not to allow hypothermia and the appearance of acute inflammatory processes. The shelf life of dental implants is unlimited, but their life is limited by the patient who does not follow the doctor's instructions.

[15], [16], [17], [18]

Reviews

On the Internet, reviews about dental implants should not always be taken seriously. First, many people tend to complain and blame anyone for their problems, but not themselves. For example, a person installed implants "express" method and began to enjoy the results. Forgetting that the integration of the implant is still in the process, the patient begins to consume alcohol and ignore the doctor's prescription. After an expensive system is discarded after a few months, the patient begins to blame the doctor, write negative comments on the Internet and deal with legal proceedings. In some cases, the reviews are written for the purpose of advertising a clinic that specializes in implantation. To form an opinion on this procedure, it is best to visit one of the clinics, talk with a doctor and ask all the questions. In the process of a short dialogue with a professional doctor, all the myths about implantation will dissipate and you will have a motivation to perform qualitative and effective treatment.