Dental 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 strongest "building material" of a person. Dentin has a slightly smaller amount of inorganic substances in its composition, but also has the right to be called a physically very stable substance. In third place in terms of strength is cement, which covers the root of the tooth. Despite the fact that teeth have a very strong structure, in fact, they are very vulnerable to injuries, inflammatory and destructive processes. Take caries, for example, this disease easily leads to the destruction of powerful tooth tissues. It is also worth mentioning periodontal diseases, with a progressive course of which a person can lose completely healthy teeth. And, finally, dental injuries. At any age, under any circumstances, a person can lose one or more teeth due to accidental circumstances. When a person understands that a lost tooth needs to be restored, he faces the question of what to put, a bridge or an implant?

What is better? An implant or a dental bridge?

It is worth noting right away that this question sounds too abstract to give a specific answer. The fact is that both a bridge prosthesis and an implant have their own indications and contraindications.

A cast bridge prosthesis is indicated for defects of the dental arches extending 3-4 teeth in the frontal area or 2-3 teeth in the lateral area. That is, if 3-4 front teeth or 2-3 lateral teeth are missing, a bridge can be installed. However, it should be noted that these rules cannot be followed in all situations. This is due to the fact that they are designed for healthy teeth. If a person has periodontal disease, it should be taken into account that the teeth can lose a significant part of their chewing force (often this figure is higher than 50%). In this regard, a larger number of supporting teeth will be required. And at advanced stages of periodontitis and periodontosis, prosthetics using a bridge prosthesis is completely contraindicated.

A person's age plays a major role. Bridge prostheses are recommended to be installed from the age of 17-18. It is not advisable to do this at an earlier age, because the rigid connection of the teeth can restrain the jaw growth during the period of active development. It is necessary to immediately say about single implants. They also cannot be installed in childhood, since during the process of jaw growth, the implants will cause deformation of the dental arches. Therefore, dental implants are strictly contraindicated for children.

When using bridge prosthetics, certain requirements should be taken into account. Firstly, there should be no terminal defects of the dental arches. That is, there should be supporting teeth on both sides of the missing teeth. Secondly, the clinical crowns of the teeth that are chosen as a support should be high enough to fix the structure. If the teeth are heavily worn or destroyed, they must first be restored with pin structures.

It is worth paying attention to the tilt of the supporting teeth. If the tilt of the teeth is insignificant, then they can be used as a support. But if they are tilted excessively, then two problems arise. The first is that if the teeth are tilted in different directions, then the prosthesis will not be possible to put on. It will be necessary to remove a very large layer of dentin to achieve parallelism of the supporting teeth. The second problem is that a tilted tooth is less stable than an upright one. Nature created the tooth in such a way that it best absorbs the load that goes along its longitudinal axis. And for this, the tooth must stand more or less vertically.

The advantage of bridge prostheses over implants is that when installing a bridge, no surgical interventions on the bone, antibiotics or other radical interventions are required. It is also worth noting that installing a bridge prosthesis is approximately 2 times cheaper than installing one implant. And if the bridge replaces two teeth, the difference in price increases.

Advantages

The advantages of implants can be discussed at length. Their main advantage is their high ability to withstand chewing loads. If teeth can break at any moment and begin to tilt, then 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 atrophy processes will not occur. It is worth paying attention to the fact that even with a large degree of bone loss, with the help of bone plastic 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 has no teeth left at all and a state of complete adentia sets in, the choice is limited: either a complete removable denture or implants. It is unlikely that a person who has the physical and financial ability to install implants will prefer to wear removable dentures. After all, the quality of life with durable non-removable structures is much higher. Therefore, if you doubt whether it is worth installing dental implants, the answer is simple - if possible, then install them.

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Flaws

The only disadvantage of implants is their cost. A good implant together with installation will cost about $500-800, while a metal-ceramic bridge can be installed for $250, in a clinic of the same level. If you evaluate the situation more deeply, it is quite likely that the high price is compensated by the durability and reliability of the design. Therefore, this factor can rather be called a reasonable investment in the health of teeth, joints and the whole body.

The next relative disadvantage of implants is their intolerance to trauma. If you imagine that a person gets a dental trauma with a bridge on the teeth, then most likely he will lose the supporting teeth and the structure itself. But when the impact falls on the area of the implants, the consequences can be very serious. If the intraosseous part of the implant is thick and long, then the implant can break off together with the bone during trauma. After this, there will be no place to screw the implant again. For this reason, some athletes and people working in dangerous conditions (hockey players, race car drivers, boxers, etc.) prefer removable dentures instead of implants.

It is also worth mentioning such a disadvantage of implants as the lack of shock absorption. If we talk about real teeth, they are suspended in the socket (hanging on the microligaments of the periodontium). When chewing or closing the teeth, they spring in the socket, thereby compensating for the chewing pressure. Due to this, the load on the joint and bones of the skull is transferred only partially. If we analyze the biomechanics of implants, they are overgrown with bone tissue, which eliminates their mobility. That is, when closing, there will be no shock absorption, which will lead to the spread of the load on the temporomandibular joint and bone sutures of the cranial bones. This problem is at the study stage and many manufacturers have already found a technological solution in the form of implants with a built-in 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 optimization stage.

Which implants to choose?

The high demand for implantation provokes the emergence of many manufacturing companies. Some of them have been on the market for decades, while others have appeared quite recently. It is impossible to say for sure which implants are better and which are worse. Each company diligently promotes its system, idea, and method. Their employees conduct all sorts of experiments that confirm the quality and reliability of their products. Commercial battles between dental implant manufacturers create confusion in the choice of systems. There is such an opinion among implantologists: “The best dental implants are those that the doctor has learned to work with perfectly.” That is, the concept of “best” and “worst” is a strictly subjective assessment.

Straumann (Straumann) are Swiss implants of the oldest company, which has been on the dental market for 63 years. Not every manufacturer can boast of such durability and maintenance of high quality of products. The advantage of this company is a lifetime guarantee on implants. But there is one nuance: Straumann can only guarantee the integrity of the system, but not the survival rate. Integration depends entirely on the person and his doctor. According to the manufacturer, more than 14 million Straumann implants have already been installed in the world, and this figure is growing rapidly. The only drawback of the system is the high price. Straumann is, if not the most expensive dental implants, then definitely among the three most expensive systems.

Another bright representative of Swiss implants is the Nobel Biocare company. They have been on the market for over 40 years, which makes them a little younger than the Straumann company. However, many implantologists, as well as representatives of the Nobel company themselves, claim that in terms of product quality, they are not inferior to other leading companies. The positive qualities of the Nobel Biocare systems are the production 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, the Nobel company produces individual crowns, veneers and bridge prostheses. Due to this, you can further improve the quality of the result.

Among Israeli implants, we can mention the company Alfa Bio, which has been on the market for over 25 years. Many implantologists appreciate the ease of use and ergonomics of these systems. Israel also offers implants from MIS and Adin, which also have optimal qualities for successful implantation. All of these Israeli implants are excellent inexpensive systems. They have a wide range of products and excellent technical support, which allows you to avoid many problems during the treatment process.

Ankylos is a high-quality German implant system that is approximately in the middle of the price list. It requires many years of experience and precision from the doctor. Like the 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 manufacture thousands of types of all kinds of implants. Due to the lack of long-term research, the quality of the systems sometimes suffers. However, some Korean factories that manufacture relatively cheap dental implants can boast of quite 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. This company also fights hard for leadership in the global commercial arena of implantology. An excellent, high-quality system that is definitely worth attention. According to the manufacturer, the guarantee for the implant is 5 years. An interesting feature of the warranty obligations is that the manufacturer is ready to replace the implant free of charge if it does not take root. Although the company's employees say that this happens extremely rarely.

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

Indications for the procedure

Many people idealize implants, believing that they can replace a tooth in any clinical situation. However, implants, like any prosthesis, have indications, contraindications, advantages and disadvantages.

If we evaluate the ability of implants to replace teeth, then the range of their capabilities is wider than that of bridge prostheses. This is due to the fact that when performing prosthetics with "bridges", the doctor must adapt to the current state of the teeth. When performing implantation, the dentist can initially create conditions for successful prosthetics. By assessing and correcting the condition and amount 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 in place of each missing tooth (according to the principle of "one tooth - one implant") or to install implants "every other one". In the latter case, every second missing tooth is replaced. If this scheme is chosen, then bridge prostheses will be installed on the implants. It is worth saying here that the same orthopedic structure is installed on the implants as on the teeth, but with support on the implants, a more stable state of the prosthesis is achieved.

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Preparation

Before "screwing in" implants, special preoperative preparation should be done. It consists of a thorough examination of all remaining teeth and other structures in the oral cavity (tongue, gums, oropharynx, etc.). A complete sanitation of the oral cavity should be carried out. Teeth that are subject to treatment should be treated. If this is not possible, then they are removed. All inflammatory processes in the oral cavity are eliminated, chronic diseases are transferred to a state of remission or stabilization.

A necessary procedure is a computer tomography analysis, which will evaluate the condition of the bone tissue. Since people sometimes have intraosseous benign and malignant neoplasms, this method allows for timely detection and treatment of the identified pathologies.

Very often, internal bone augmentation is required, which is called sinus lifting. This is a surgical operation that involves lifting the bottom of the maxillary sinus in order to increase the volume of bone tissue in the place of the future implant. Without going into details and subtleties of various types of sinus lifting, the essence is approximately as follows: in the area of the missing tooth, surgical access to the maxillary sinus is created. When the 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 freed space. By the way, very often the bone chips that were obtained during jaw drilling are used for bone augmentation. During the same visit, implants can be screwed into this area. Thus, the installation of the implant occurs immediately after tooth extraction. The operation is performed under local anesthesia, so the answer to the question: “Is it painful to have an implant placed?” will be negative.

Any doctor will tell you that implantation should be planned before tooth extraction. This does not mean when the tooth is healthy, but when you already understand that the tooth will have to be extracted. This approach is necessary to reduce the implantation time. When a tooth is extracted, the bone socket (alveolus) remains empty. More precisely, it contains only a blood clot, which is the basis for the formation of new bone tissue. It is worth noting that this process lasts for more than one month. But if, after tooth extraction, you immediately place bone substance in the tooth socket and cover it with a biological membrane, you can get a hard and structured bone much faster.

In case of a narrow alveolar process, an operation of its splitting is used. The essence of the intervention consists in sawing the alveolar process into two parts and placing bone substance in the sawing zone. After that, the wound is closed with a membrane and sutured.

In some cases, the method of bone autotransplantation is used. If there is a lack of bone, it can be obtained by taking it from other massive structures (for example, from the pelvic bone, chin).

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Technique Dental implant placement: how to choose the right implant

At the moment, there are several effective methods of performing implantation. Among them, one-stage and two-stage implantation are distinguished. It is worth saying right away that these methods were invented quite a long time ago, but discussions about which of them is better are still actively ongoing. The fact is that each of the methods has its own advantages. In order to better understand them, each of the methods should be considered in more detail. Since two-stage implantation is classic, it should be considered first.

Two-stage implantation involves the use of special disassemblable implants. They have an intraosseous 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 physiodispenser. It can be used to control the force and speed of the drill. This helps prevent bone overheating, jamming of the drill in the bone tissue and other undesirable moments. When the bed for the implant is formed, the intraosseous part of the implant is screwed into it. This part is completely immersed in the bone and is not visible after the gum is sutured. This stage is called osseointegration, or "implant engraftment". Although the term "engraftment" is not entirely correct. After all, a 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 is simply overgrown with bone. As a result, the implant thread and all its recesses are filled with new bone tissue. As you can see, the integration mechanism is quite simple, so it is not difficult to understand how a dental implant takes root. After the implant has integrated, the gum is cut again and a gum former is installed in it. In appearance, this element resembles a cylindrical head, which is designed to build up soft gum tissue. This is a very important stage, which determines the aesthetic indicators of the artificial tooth. After a few weeks, the gum former is dismantled and a temporary crown is installed instead. If the previous element was used to obtain the volume of soft tissue, then the crown is designed to create and refine the gum contour and interdental papilla. After a few weeks, the temporary crown is replaced with a permanent one, which is made of ceramic mass. During the two-stage implantation, a clear sequence of stages of installing a dental implant occurs. Although the duration of treatment is quite long, this makes it possible to qualitatively perform and control each period.

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

One-stage implantation is very popular among people. Managers of private clinics have worked hard on this. If you ask the clinic administrator: "How long does it take to install a dental implant?", they will proudly answer: "No more than a week!" Every person wants to restore the appearance and chewing function as quickly as possible. However, it is worth knowing that the "immediate loading" method is the highest level of skill for an implantologist, and not every doctor will be able to implement this technique to the fullest extent. Moreover, such work usually costs more than two-stage implantation. If a clinic offers fast, cheap and high-quality implantation, then one of these three points will definitely be missing.

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 a front tooth, a chewing tooth, and even an implant of a wisdom tooth. Both upper and lower tooth implants are successfully installed. Moreover, dental implants are installed in the complete absence of teeth, which allows a person to restore the full functionality of the chewing system.

However, despite the amazing capabilities of implants, they are not always indicated. There is a whole list of relative contraindications that prohibit the installation of implants. They are called relative because everything depends on the specific case. For example, implants are contraindicated in diabetes. But if a person monitors his health, keeps diabetes in a state of compensation, then prosthetics will be quite successful. The same applies to drug addicts who have undergone treatment and have not used drugs for a long time. Contraindications include various blood diseases that do not allow for full-fledged surgical intervention. People with pathologies of the nervous system can use prosthetics on implants only after a conclusion from a psychiatrist. It is also worth mentioning that it is highly inadvisable to install a dental implant during pregnancy. This is not due to the fact that they “will not take root”, fall out, etc. Quite the contrary, the implant is highly likely to integrate (“take root”) and orthopedic treatment will be successful. But whether the remaining period of pregnancy will be successful, whether the child will be born healthy - no one can answer these questions. It is important to understand that the implantation course consists of surgical and orthopedic interventions. In addition to many hours spent in a dental clinic, the pregnant woman's body is subjected to a huge drug load, which includes antibiotics, anti-inflammatory drugs, anesthetics, analgesics, keratoplastic agents, vitamins and other drugs. Therefore, performing dental implantation during pregnancy is an extremely unpredictable, dangerous and irrational decision. The list of contraindications also includes many systemic diseases of connective tissue such as systemic lupus erythematosus, rheumatism and scleroderma.

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Complications after the procedure

During the implantation course, many surgical and therapeutic manipulations are performed. And the more of these procedures, the higher the probability of various complications. If you assess the situation globally, complications can manifest themselves already at the stage of anesthesia (in case of 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 take a list of tests, then this must be done. Saving on diagnostics means jeopardizing the entire treatment. Often people do not want to talk about some diseases of other organs. But in this case, it is also worth understanding - you come to a medical institution where the doctor will interfere with the work of your body. If the specialist does not fully assess your physical condition, then mistakes and complications may well arise.

In some cases, peri-implantitis occurs after implantation. In fact, this is a condition in which the implant does not take root and is rejected. The clinical picture of peri-implantitis is quite vivid: a person complains of pain, swelling, suppuration and bleeding from the gums after the installation of a dental implant. The general condition of the body may be disturbed (fever, headache and other symptoms of intoxication). An X-ray image shows signs of dental implant rejection: bone resorption around the structure. With peri-implantitis, removal of the structure is not always indicated. Most often, surgical cleaning of the implant surface, drug therapy, professional hygiene and physiotherapy are sufficient. But sometimes it is still necessary to remove the implant together with the structure that rests on it. In this case, a person will have to go through all the stages of implantation again or choose another method of prosthetics.

How often do implants fail?

This issue is highlighted in a separate section because it is the main reason why people refuse implantation. People are terrified of dealing with implants because of the possibility of their rejection. This phenomenon usually spreads by word of mouth, when people tell each other: “I have a friend whose implant did not take root! The implant fell out after just a month!” The most interesting thing is that such dialogues do not mention the name of the implants, their cost, the doctor’s qualifications and the type of implantation. After all, if you look into it, the reason in 99% of cases lies somewhere on the surface. Very cheap dental implants (often copies and fakes), insufficient qualifications of the doctor, implantation with ignoring contraindications, lack of preparation for implantation - all this can cause implant rejection. If all of the above requirements are met, the implant will take root in 98-99%. Moreover, such statistics are observed not only with elite Straumann systems. Budget Korean and Russian implants integrate into bones with the same success. The main thing is to create conditions for integration. The body will do the rest.

Care after the procedure

Regardless of the method by which the implants were installed, it is important to understand that they require careful and regular care. The doctor should tell you how to care for dental implants after installation even before the treatment begins. Buy the necessary hygiene products, master the correct technique for brushing your teeth - it is advisable to do all this before implantation. For daily care, it is recommended to buy a toothpaste that combines medicinal herbs and microelements. This will simultaneously affect the condition of the gums and hard tissues of the remaining teeth. Dental brushes are also useful, which allow you to thoroughly clean the interdental spaces. In general, dental implants must be cleaned in the same way as real teeth. Every six months, you should visit the 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 what kind of implant you install, large or small, ceramic or titanium. Even if it is made of adamantium, poor hygiene will bring its result, and this time you can lose not only a tooth, but also the integrity of bone tissue. Therefore, you should take the doctor's instructions seriously and not be lazy in spending time and effort on your health.

It is also worth understanding that the body needs to recover after the installation of dental implants. Surgical and medicinal interventions adversely affect the functioning of many organs and systems. Therefore, for the next six months, you need to very carefully monitor your health. You need to try to avoid hypothermia and the occurrence of acute inflammatory processes. The shelf life of dental implants is unlimited, but their service life is limited by the patient himself, who does not follow the doctor's instructions.

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Reviews

Online reviews of dental implants should not always be taken seriously. Firstly, many people tend to complain and blame anyone but themselves for their problems. For example, a person installed implants using the “express” method and began to enjoy the results. Forgetting that the implant integration is still in the process, the patient begins to drink alcohol and ignore the doctor’s orders. After the expensive system is rejected after a few months, the patient begins to blame the doctor, write negative comments on the Internet and engage in litigation. In some cases, reviews are written to advertise a clinic that specializes in implantation. To form an opinion about this procedure, it is best to visit one of the clinics, talk to the doctor and ask all the questions. During a short dialogue with a professional doctor, all myths about implantation will be dispelled and you will be motivated to undergo high-quality and effective treatment.