Dental implantation is a reconstruction of lost or extracted teeth by screwing in a dental implant into a jawbone. It is an invaluable opportunity for a person to have robust dental substitutes resembling the natural teeth.
Implantology is one of the contemporary methods, empowering to solve the problem of a missing or extracted tooth effectively and reliably. Even though after completion of treatment, in the further life of the patient allows to nearly forgetting the problem experienced long time ago, and does not require any special care, the implantation process itself can be relatively both complicated and straightforward when treatment takes an extended period, starting from bone augmentation, sinus lift procedures, and finishing with prosthodontics.
What to do if the teeth are lost, or before extraction of teeth:
- Initial consultation: first, registering for an initial consultation with an oral surgeon is recommended;
- Presentation of the treatment plan: if during the initial consultation, it turns out that the patient’s situation is more complex and more in-depth analysis is necessary, the patient is registered for the presentation of the treatment plan.
- Radiological examination: for patients who address the clinic for implantation or complicated tooth extraction need to have a radiological examination done.
Start of treatment
Professional oral hygiene (removal of plaque) is the starting point of the entire process. Any planned treatment must be performed after this stage. The work that must be done is a clean oral cavity. It’s a pity, but the treatment usually commences from “cleansing” of the mouth from teeth with a poor prognosis, i.e., teeth whose chance of standing for five years is close to zero. Why is it necessary to remove them instead of keeping them in service for a few more years? Finance stands as the biggest argument. If teeth with a poor prognosis will be left in the mouth and the patient’s teeth will be restored, or if implants or prosthesis is installed, the treatment plan will be executed. Still, after a few years, when the poor prognosis teeth will be lost, a question will arise: what to do now, when implants and prostheses are installed, and surgery next to them seems undesirable, however, those poor prognosis teeth need to be replaced with the new ones. In such a case, there are two choices, first – installing implants into their place, and that’s not the best option because there may not be enough of bone left in their place; therefore we cannot choose; or, secondly – do not install implants, but to restore the missing teeth with bridges. In such a case, it would be necessary to cut off the recently manufactured dentures from the adjacent teeth or implants, and produce the new ones, larger, and covering the areas of extracted teeth. In any case, the patient loses financially, because in one case, he must pay for additional implants and prosthodontics. In another case, he loses recently manufactured dentures and pays for the new ones again. For this reason, we propose clearing the mouth from teeth with poor prognosis at the start of treatment, or, if they are left in the mouth, then it could be done for purposes of temporary prosthodontics or for the purposes of fixation of the temporary denture. iii. Temporary prosthodontics. Once the teeth with a poor prognosis are extracted, the patients must return to social life. For this to happen, they must be granted an opportunity to chew and smile. Temporary dentures are manufactured for this purpose. They can be non-removable (bridges) or removable (partial or complete plates). The dentures are worn for 2-3 months until the jaws heal completely after the extraction of teeth.
Dental implantation
The implantation itself is an uncomplicated and painless procedure, no matter how many teeth are being implanted at once – one or fourteen. The surgery is performed with local anesthesia and takes for about 10 minutes for one implant. If bone augmentation is necessary, the surgery extends for a few more minutes. Incision is made on the gums, they are separated from the bone, hole of needed diameter and depth is drilled, implant is screwed into it, bone graft is added if necessary, then the implant is sutured airtight, or healing abutment is screwed on the implant, and the gums are only stitched around it. The naturalization of an implant is anticipated for 3-4 months. During this period, the patient feels nothing, so it shows that there is no problem. In our practice, about 99,4% of implants have naturalized for the first time. Six implants out of thousand fail to naturalize for different reasons: error of a surgical work, patient’s bone peculiarities, systemic diseases. The failed implant is removed, and, after waiting for a few months, a new implant is screwed into the same place or nearby. Of course, the additional surgery and the implant cost nothing for the patient.
Implantation and bone restoration
Once the teeth are extracted, and the jaws heal up, the width of their processes is assessed, i. e., is the width enough for implantation. In many cases, when the teeth were just recently extracted, the processes of the jaws do not deteriorate and can be easily implanted after a few months. After the more extended period passes, the processes thin out, become pointy. In such a case, implantation becomes more complicated. The choice must be made between the two possible methods:
- Bone transplantation from another area of the jaw in instances where the jaw is so thin that if the implant were screwed in, it would get fully exposed.
- Or it can be implantation with instantaneous bone augmentation in cases when the jaw is narrowed down, but an implant can still be screwed in, and its exposed neck can be covered with a small amount of bone tissue.
If bone transplantation is chosen, mostly it is taken from the branch of the mandible, by accessing it from the mouth side. After the bone is transplanted, it is necessary to wait for approximately four months before it naturalizes, and then the implantation can be performed.
Implantation and sinus lift surgery
In cases where sinuses of the maxilla are lowered, and the remaining height of the bone is < 4 mm, such type of surgery is performed. During the surgery, the bone graft is added to the floor of the sinuses. After the surgery, a 6-month waiting period follows, and then implantation is performed. This surgery can be combined with bone transplantation or with implantation if the remaining height up to the sinus is 4-8mm.
Implantation and gingivoplasty or vestibuloplasty
In certain cases, when a substantial amount of bone has been augmented, or in instances where the bone tissue has been lost for a long time, a lack of fixed gums of good quality is typical. The implant or augmented body in such cases is covered by mobile mucosa of the cheek, which is of poor quality, not suitable to be near the neck of an implant because of its mobility. The purpose of gingivoplasty or vestibuloplasty is the creation of a stable mucosa around the necks of implants. The mucosa of the cheek is incised, layered off and pushed deeper, an open wound is left near the implant, and soon an immobile mucosa forms in that area. This ensures the longevity of the implant.
Attachment of healing abutments after implantation
3-4 months later, after the implant was screwed in, a control radiogram is performed, and, if there are no foci of bone destruction near the implant, it will be exposed, and prosthesis will be placed. After local anesthesia is applied, a small incision is made above the implant, the gums are parted, the implant is located, and after the covering screw is removed, a healing abutment, around which parted gums lie flat, is screwed on. This procedure lasts for 1-2 minutes.
Prosthodontics after implantation
Permanent dentures can be made right away for areas of molars. After measuring them precisely in the mouth, they are cemented or fixated with the screws. For aesthetic purposes, for the area of frontal teeth, a temporary plastic tooth or teeth are made, so the contour of gums would settle around them. Only then they are replaced with ceramic dentures. In the opposite case, it would be challenging to predict at what height the gums would settle after the prosthodontics. After the prosthodontics procedure, the patient must visit the oral hygienist every four months. It is imperative during the first year so that the occurrence of an early problem or inflammation near the implant can be prevented.