Dental implantation of teeth: features, advantages and disadvantages. What are implants? Ways to install dental implants

Dental implantation is a surgical intervention that allows you to restore lost functions. dental system. In research medical centers constantly developing innovative technologies. As a result, a generation of new implants and a special technology for processing the intraosseous surface were created.

The practice of applying innovative developments describes a trend towards an increase in the probability of a positive outcome, a decrease in survival time foreign body in the body.

What is dental implantation?

Dental implantation of teeth is an innovative technology for implanting artificial roots into the lower or upper jaw arch. The design of the device consists of a titanium screw and. serve as supports for fixation in the full replacement of lost units, or for fastening.

A titanium screw is a part that is surgically implanted into the jaw. It performs the function of the root system.

The abutment is installed inside the titanium screw after its osseointegration (engraftment). He is outer part, imitating a turned tooth. A specialist already installs an orthopedic product on it for temporary or permanent use.

Today, the production of implants is carried out in many countries. These are products of Swiss, German, Israeli, American, Korean campaigns. All of them are used in modern dental implantation, they have their own differences and, accordingly, different prices.

Indications and contraindications for dental implantation

Any surgical intervention is carried out as needed. Indications and contraindications for dental implantation are determined by the doctor after the diagnosis, studying the patient's history.

• With single defects of the dentition. The technology allows you to restore the missing link, while maintaining the health of neighboring units.
• When defects are included, implantation is also recommended.
• With end defects, the technology makes it possible to create a support for.
• With complete adentia - the absence of all teeth on the jaw arch.
• If you want to achieve a good aesthetic effect.

Contraindications to dental implantation are divided into absolute and relative. In the first case, the procedure is categorically contraindicated.

When planning an operation, the specialist should exclude the following factors:

• Bruxism, macroglossia.
• Open form of tuberculosis.
• Serious ailments of the cardiovascular system.
• Violations in the work of the protective functions of the body (weakening of the immune system due to the presence of hypoplasia, severe forms systemic lupus erythematosus).
• Disruptions in the endocrine system - diabetes 1 degree, hyperthyroidism.
• Diseases of the hematopoietic organs.
• Diseases of the peripheral and central nervous system.
• The presence of malignant tumors.
• Diagnosis of HIV infection, sexually transmitted diseases.

Relative contraindications are factors that indicate significant risks of achieving a favorable treatment outcome with this particular technology. They may also indicate that before the operation it is necessary to take special measures precautions.

Relative contraindications to dental implantation include:

• Postponed heart attack, stroke.
• Serious disruption of the endocrine system - stage 2 diabetes, the presence of climacteric syndrome, mild forms of hyper- and hypothyroidism.
• Infectious diseases of bone tissue (osteomyelitis).
• The presence of allergic reactions that do not require hormonal treatment.
• Diagnosing an unsatisfactory condition oral cavity and the periodontium in particular.
• Pathological bite.
• Diagnosis of precancerous condition of oral tissues.
• The presence of TMJ dysfunction syndrome.
• If the patient has metal implants in other organs.
• The formation of cancerous tumors.
• Infectious chronic diseases.
• The period of bearing a child.

Pros and cons

When planning any type of treatment, it is necessary to study all the advantages and disadvantages of the technology. Comparison of these factors will determine the feasibility of surgical intervention.

Advantages of the procedure:

• A person receives a wonderful aesthetic result. All artificial units will look as natural as possible.
• Comfort in operation. There is no need to remove and install prostheses in the oral cavity. The patient does not feel the difference between implants and native teeth.
• Long service life.
• The use of technology allows you to maintain the health of neighboring teeth in a row. There is no need to prepare tissues of supporting units.
• The design allows you to replace the crown part. If necessary, the old product can be replaced with a new single prosthesis.

Having decided to resort to the restoration of dentition defects with the help of implantation, it is necessary to familiarize yourself with the disadvantages of the procedure:

• There is a risk, however slight, that the artificial root will not take root in the jaw.
• To extend the life of the structure, it is necessary to regularly carry out professional hygiene procedures for cleaning the oral cavity from deposits,.
• The disadvantages of dental implantation of teeth include the duration of the procedure. Sometimes the whole process can take up to 6 months.
• Financial aspect. The procedure is the most expensive way to restore lost teeth.

Stages of dental implantation

The implantation operation is carried out sequentially. Sometimes it takes a significant amount of time to complete. This is due individual characteristics organism and the complexity of the operation.

Planning

It is carried out to assess the patient's health status. For this purpose, modern radiographic and computer research. If necessary, elimination, treatment of detected ailments is carried out. A plan of the stages of the implantation itself is drawn up.

Surgical stage

An artificial root is implanted into the bone. At this stage of treatment, additional manipulations are possible to eliminate degeneration changes in tissues. This is especially necessary in cases where it is planned to replace a long-lost unit. Then comes the turn of the installation of the abutment.

Crown installation

The final orthopedic stage involves the installation of a dental crown, bridge elements or. As a result, the patient receives a full restoration of lost chewing functions and a beautiful aesthetic appearance.

Operation algorithm

Depending on the number of implanted roots, the procedure lasts from half an hour to several hours and looks like this:

1. Application .
2. Insertion of an artificial root into the bone.
3. Wound suturing.

Removal of sutures after dental implantation occurs on the 7-10th day. If necessary, a micro-operation is carried out for the purpose of installation. After 2 weeks, it is removed, and an abutment is fixed in its place.

Engraftment period

Osseointegration due to the biocompatibility of titanium with the body is achieved in 96% of cases. The artificial root takes root mandible about 2-4 months. On the top row, the process is somewhat delayed (no more than six months).

The specialist evaluates the result at the time of testing for the mobility of the artificial root. In this case, there is no pain. Conducting percussion should respond with a ringing knock. All this indicates successful osseointegration of the implant.

List of errors that provoke complications

The use of modern technologies in dental implantation, equipment and instruments minimizes the possibility of making mistakes at the time of treatment.

However, they meet, and here are the reasons for this:

• Violated surgical protocol.
• The rules of antisepsis and asepsis are not observed.
• Anatomical features were not taken into account.
• There was an error in choosing the anesthetic.
• Negligence when working with the tissues of the alveolar process.
• The drills were not cooled or their rotation speed was exceeded.
• The distance between dental structures was not taken into account.
• The duration of the procedure did not correspond to the amount of work being done.

All these errors can lead to the following complications:

• Soreness, swelling of soft tissues.
• Mobility of the implant in the bone.
• Exposure of the cervical zone of the tooth.
• Fracture or loss of a dental implant.

The use of laser in dental implantation

The development of methods of conducting the operation does not stand still. modern medicine successfully uses laser ray in treatment. In the procedure for implanting an artificial root, the laser replaces the scalpel.

This approach has a number of advantages:

• The pain of the operation is reduced.
• Increased manipulation accuracy.
• Reduced implant placement time.
• Reduces the likelihood of inflammatory processes to a minimum.

Choosing the method of the operation, the specialist is guided by the presence of indications and contraindications to.

Lifetime

Specialists guarantee a long period of operation of artificial roots.

To do this, you need to follow a few simple recommendations:

• Keep the oral cavity in a satisfactory condition. Visit the dentist's office twice a year.
• Do not overload structures.

Subject to compliance with all protocols during implantation and fabrication orthopedic structures the service life of products reaches 25 years.

Implantation is the most advanced way to restore the lost functions of the chewing apparatus. Despite the maximum automation of processes at all stages, the quality of treatment largely depends on the professionalism of the doctor. The choice of clinic and doctor must be approached with all responsibility.

Dental implantation is a rather complex and multi-stage procedure. But of course the result is worth it. A high-quality implant should be made of titanium and have high strength. In this case, the body will not reject it and allergic reactions will not occur.

The process of prosthetics takes place in several stages:

• a screw is inserted with the help of a surgical intervention;
• an abutment is installed (connects the implant and the prosthesis);
• making a prosthesis and attaching it to an implant. Already at this stage, the teeth have a natural appearance.

More recently, people wearing removable dentures felt great discomfort. Eating and even ordinary communication could lower the self-esteem of such people. Nowadays, they can combine convenience, comfort and aesthetics. Despite this, the use of prostheses brings with it a number of certain problems that are excluded during dental implantation.

The operation takes a relatively short time. If there are no teeth at all, then up to 6 screws can be inserted, but if some teeth are present, then, depending on the situation, their number may increase.

What are implants capable of? During production, specialists try to achieve the following goals:

• high strength;
• good cosmetic effect;
• low bone trauma.

Naturally, nothing is eternal, and dental implantation is no exception. There may be deformation and breakage. But not everything is so scary, as they are very easy to recover. Subject to the rules of hygiene and regular visits to the dentist, they can last for decades.

Training

Preparatory measures take place in several stages:

• sanitation of the oral cavity;
• training sessions on hygiene measures;
• immobilization of moving teeth;
• measures to eliminate traumatic occlusion, as well as leveling the surface;
• teeth grinding;
• if there is a risk of nerve exposure, depulpation is performed;
• drug therapy (antibacterial agents, vitamins, immunostimulants, as well as agents that strengthen the body's resistance). Antibiotics reduce the risk of developing inflammatory processes, therefore, immediately before the procedure, a course of antibiotic therapy is performed.

Indications

Indications for the procedure are the following conditions:

• single deformities of the dentition;
• defects in which it is possible to make fixed prosthetics;
• the complete absence of teeth, in which it is possible to fix a removable prosthesis well or to carry out fixed prosthetics.

Implantation or traditional prosthetics

Implantation has a number of significant advantages and benefits:

• defects are eliminated without turning healthy teeth that are nearby;
• no need to wear removable dentures;
• fixed dentures can be much longer;
• can be used even with total absence teeth;
• Implants allow you to save bone in the place where the tooth has already been lost. This is very valuable, because if the bone does not perform its functions, it will quickly atrophy and can be lost;
• the chewing process in percentage terms is many times higher than in traditional prosthetics;
• even with atrophy of the lower jaw, effective orthopedic treatment can be carried out;
• the likelihood of bone resorption is minimized;
• long service life;
• look and feel like your own teeth.

If speak about pricing policy, then the opponents of this procedure cite the cost as an argument in favor of what is better to choose traditional method prosthetics.

It is safe to say that the price is directly proportional to the quality. The procedure requires certain skills, expensive tools, as well as highly qualified training. This is not a restoration and a crown, so the implant should last a lifetime.

Types of implants

Based on the results diagnostic study choose the appropriate implant size and shape. Previously, the implantologist had at his disposal one model, which was selected, but now you can choose the right model for almost every patient. All this became possible thanks to the measures that are carried out on the eve of the procedure: the volume of the bone is restored, as well as the mucous membrane in the place where the material will be directly implanted.

Implants are classified as follows:

• screw;
• cylindrical;
• mucosal;
• intramucosal;
• transosseous;
• subperiosteal;
• transdental.

Let's take a closer look at the most common varieties.

screw

They differ in such important characteristics:

• good fixation;
• the possibility of removal by rotation in the opposite direction;
• the possibility of implementing a functional load;
• good support for bone tissue due to the fact that its outer area is larger.

Cylindrical

Installation of this type of implant is quick, simple and relatively painless. There is a uniform distribution of functional loads on the bone tissue.

By coating with titanium plasma, outside surface increases within the bone.

If we talk about the shortcomings, then the duration of the procedure is quite long, because of which the bone heats up, and can also be damaged due to pressure. As a result, an attempt at prosthetics may fail.

Also, implants are divided depending on the shape:

• root-shaped. Applied with a sufficient amount of bone. If there is not enough space, then in some cases, doctors build up bone mass, after which they proceed directly to the procedure;
• combined. Larger materials can be used for severe defects;
• plate. Effective even with narrow bones. Implementation over a long distance is possible. Due to this, the validity period is increased significantly;
• intramucosal. It can be called a unique species, since in this case it is possible not to embed into the bone. Helps stabilize dentures;
• subperiosteal. Even with thinned bone tissue, they have a good result. It would not be an exaggeration to say that this is a piece of jewelry. Despite its openwork and subtlety, it affects a large area and is firmly held;
• stabilized. Traumatization of the mucous membrane is reduced to almost zero due to the installation of the material through upper part tooth root. Healing is easier and faster. Also, the root does not lengthen, but also strengthens;
• mini implants. They can be attributed to the innovations of implantology. Made using high quality titanium. The method is simple and fast. They stabilize the prosthesis, and also contribute not only to temporary, but also to permanent fixation. The prosthesis can be installed immediately, and the price cannot but please. In addition, the technique itself is simple and is performed under local anesthesia.

Contraindications

As with any procedure, dental implantation has a number of contraindications:

• pathology hematopoietic system(poor blood clotting);
• high blood pressure;
• violations in the work of the pancreas (diabetes mellitus);
• pathology of the nervous system;
• deformed bite;
• ischemia of the heart;
• periodontal disease;
• any chronic diseases in the acute stage;
• immunodeficiency syndrome;
• periodontitis;
• periodontal disease;
• stomatitis;
• caries;
• osteopathy;
• mental disorders;
• oncology.

Process description

The procedure implies a responsible approach of both the dentist and the patient. Even before surgery, you should carefully follow the doctor's instructions regarding oral hygiene. The presence of microbial plaque and tartar can adversely affect the result of prosthetics.

It all starts with the fact that it is extremely necessary to undergo an examination. If the patient has contraindications, then the procedure cannot be performed. If the diagnosis showed that everything is fine, then the dentist conducts his additional research and finds out if there are problems directly with the teeth. If such problems exist, they must be resolved before the procedure.

First, the surgeon must drill a hole into which the implants will be screwed. It lasts about 60 minutes and is performed under local anesthesia.

Then, for some time, it happens differently for everyone, everything should heal, and the implant itself should be firmly rooted in the bone. As a rule, this lasts for several months, and if it comes to upper jaw, then up to six months. During this period, you need to monitor your diet.

When this stage is completed, the surgeon moves on to the next stage of the procedure. Within 30 minutes, the screws that were installed at the first stage are changed to subscriptions. At this stage, healing occurs much faster - for 6-7 days.

The final stage of the procedure is the actual creation of the prosthesis. This will require a jaw impression. After special adjustment and processing, it becomes the patient's new teeth. During such a multi-stage procedure, the teeth look natural, and the smile will only emphasize the beauty of the teeth.

oral care

The diet includes the use of soft and liquid food, it is good if it is pureed. Doctors also prescribe antibiotic therapy, as well as analgesic drugs. Brush your teeth very gently, a brush with soft bristles will do. Additionally, you can also rinse your mouth with an antiseptic solution. hygiene care should be not only in the morning, but also in the evening. Saliva has antibacterial properties, and saliva secretion is significantly reduced in the evening. Such procedures should be carried out using a mirror and good lighting.

Given all of the above, you can make a confident choice in favor of dental implants!

Classification of dental implants

1. By types of implantation:
- Endodonto-endossal implantation. Such implantation is carried out with mobile or significantly damaged teeth by inserting screw or pin-shaped implants through the root of the tooth into the underlying bone tissue.
- Endossal implantation. Fixation of the implant is carried out by integrating the “root” part of the implant into the bone tissue. Intraosseous implantation the most common efficient view implantation. Any intraosseous implant consists of an intraosseous (root) part, a neck (to which the gingival mucosa is attached) and a supraconstruction (a head protruding into the oral cavity). Most often, this part is called an abutment. Implants can be collapsible, i.e. with screw fixation of the head to the root part.
- Subperiosteal implantation. Subperiosteal implants are a metal frame with supports protruding into the oral cavity, made from a cast from the jaw bone tissue and placed under the periosteum. Subperiosteal implantation is usually used when intraosseous implantation is not possible due to insufficient height of the alveolar part of the jaw.
- Intramucosal implantation. Intramucosal implants mushroom-shaped protrusions on the inside of the basis of a complete removable denture, which, when it is applied, enter the corresponding recesses in the mucosa. These depressions are formed surgically.
- Submucosal implantation. It involves the introduction of a magnet under the mucous membrane of the transitional fold of the oral cavity and the corresponding location in the base of the removable prosthesis of the magnet of the opposite pole.
- Transosseous implantation. Transosseous implants are used for severe atrophy of the lower jaw; their intraosseous part passes through the thickness of the jaw in the intermental region and is fixed on the basal edge of the jaw.

2. According to the material of the implant:
- Biotolerant: stainless steel, chromium-cobalt alloy.
- Bioinert: titanium, zirconium, gold, corundum ceramics, glassy carbon, titanium nickelide.
- Bioactive: coatings of metal implants with hydroxyapatite, tricalcium phosphate ceramics, etc.
Currently, biotolerant materials are almost never used in implantology, because they are surrounded in the body by a thick fibrous capsule and cannot ensure long-term success. The most common material for dental implants is titanium.

3. According to the shape of the intraosseous implant (basic forms):
- plate;
- screw;
- cylindrical;
- in the 4th form of a natural tooth;
- with steps;
- with cortical overlays;
- tubular, etc.
With all the variety of implant shapes and design features, most of them have a porous coating with a pore size of 50–250 µm. Commonly known by results experimental studies that porosity contributes to the biocompatibility of the material with porous bone tissue. In addition, the formation of osteogenic tissue in the pores of the implant contributes to its mechanical retention in the jaw. In this regard, it should be noted that a porous titanium nickelide alloy with through permeability is promising.

4. By the method of implantation:
- one-time;
- two-stage;
- immediate;
- remote.

In the first case, the implant is placed in the formed bone bed, the head of the implant protrudes into the oral cavity, and prosthetics begin in the first days after the operation. With the two-stage technique, only the root part of the implant is placed in the bone bed and the mucous membrane above it is sutured. Prosthetics begins after the implant head is attached, 2-3 months after the operation on the lower jaw and 4-6 months on the upper jaw.
Direct implantation is carried out simultaneously with the removal of the tooth into the alveolar socket. Due to the discrepancy between the implant and the hole size, such implantation is effective in a two-stage technique with a preliminary “engraftment” of the root part. Remote implantation is performed after a complete restructuring of the bone at the site of tooth extraction (on average, after 9 months). early implantation in various terms after tooth extraction is rarely carried out, because clinical experience shows less reliable results when implanted in the socket of an extracted tooth.

Indications for dental implantation

Currently, dental implants are considered alternative method prosthetics. From the point of view of the topography of the dentition defect, implantation is possible and indicated for any location and extent of the defect:
- in the absence of one tooth;
- with included defects in the dentition;
- with terminal defects of the dentition;
- in the complete absence of teeth.
The decisive factor in choosing the method of implantation is the patient's negative attitude towards removable dentures and the unwillingness to prepare intact teeth. The reason for the use of implants is also the lack of necessary conditions for secure fixation full or partial dentures. Implants are indicated in patients with intolerance to acrylates.

Contraindications for implantation

1. Absolute:
- chronic diseases of the body (tuberculosis, rheumatism, diabetes mellitus, stomatitis);
- blood diseases;
- diseases of the skeletal system that reduce bone reparation;
- diseases of the central and peripheral nervous system;
- decompensated diseases of the cardiovascular system;
- malignant tumors.

2. Relative:
- periodontitis;
- pathological bite;
- poor oral hygiene;
- precancerous diseases oral cavity;
- the presence of metal implants of other organs;
- diseases of the temporomandibular joint;
- bruxism.

Chronic inflammation of the periodontium and insufficient hygiene oral cavity will inevitably lead to chronic peri-implantitis; deformation of the dentition and pathology of the temporomandibular joint will contribute to the overload of the implant.
Targeted treatment of diseases prior to the implant operation makes implantation possible in many cases.
For intraosseous implantation, a specific contraindication is an insufficient amount of bone tissue at the site of the intended operation. To prevent bone tissue atrophy, it is necessary to keep at least 2 mm of bone on all sides of the implant during the implantation operation.

Examination of the patient before implantation

An assessment of the general state of health should be made up of anamnesis data, the results of a blood and urine test, and must be based on the conclusion of a local therapist or family doctor. In some cases, it is necessary to consult doctors of other specialties and conduct additional methods research.
Dental examination of the oral cavity consists of:
- study of dental history;
- clinical evaluation condition of the teeth, dentition, TMJ, oral mucosa, jaw ratio (occlusion);
- study of diagnostic models;
- x-ray examination dento-jaw system.

Prior to implantation, it is necessary to obtain a panoramic image of the jaws using plastic or wax templates with standard-sized regrowth-contrast pins or balls fixed in them. Such features are associated with the need to measure the distance from the top of the alveolar ridge to the mandibular canal, maxillary sinus and other anatomical structures. In some cases, targeted intraoral images are needed;
- measuring the thickness of the mucous membrane at the site of surgery and determining the width of the alveolar part of the jaw. Recently, computed tomography of the jaws has been used for these purposes;
- conducting biopotentiometry of oral tissues, especially in prosthetics and implantation using dissimilar metals.
As additional methods, gnathodynamometry, electromyography, doppler flowmetry, etc. can be used.

Features of the operation

Surgical intervention during the formation of the intraosseous implant bed should not lead to overheating of the bone. In this regard, the preparation is carried out with low-speed drills (400 rpm) with mandatory cooling. operating field saline or distilled water. Modern cutting tool sets for implantology contain a number of sequentially used burs and cutters with internal cooling. The nature of the incision in the mucosa at the site of implantation, whether in the middle of the alveolar ridge or with an offset, is still under discussion.
With the introduction of a plate implant, a series of holes are formed along the top of the alveolar ridge, which are then connected with a fissure bur. The implant is easily driven into the bed with a slight "tightness". The mucous membrane around the implant is sutured. A few days later, a temporary or permanent prosthesis is made. When inserting cylindrical implants, cutters and drills are required that match the diameter of the implant; in the case of screw implants, instruments are required that form a screw thread in the bone tissue. Implantation requires analogues of implants, depth gauges; and with the two-stage technique, implant root plugs, screwdrivers, healing screws and other devices are also used. Sometimes pre-made plastic guide templates are used. The head of the implant is screwed in after 3-6 months using a conventional or round scalpel to open the mucous membrane.
Features of prosthetics on implants
Dental prosthesis design planning begins at the examination stage by determining the number and designs of implants that can be used in this patient in accordance with the size and configuration of the alveolar part of the jaw. Moratori put forward the thesis of "implant isotopy", according to which it is necessary to strive for a situation where the number of implants corresponds to the number of teeth being restored. He also emphasizes the possibility of using implants of different diameters and lengths in a patient (“implant multidimensionality”) depending on the amount of bone tissue.
In the absence of one tooth replaced by an implant, it is possible to manufacture artificial crown with obligatory approximal contact with natural teeth. In some cases, such a prosthesis will be more effective if a reliable connection with natural teeth is ensured using inlays, occlusal linings or adhesive systems such as "Ribbond". In this case, it is desirable to use an implant with an anti-rotation device (internal or external hexagon, etc.)
In the manufacture of bridges, it is often necessary to take into account the non-parallelism of the implants with the teeth that limit the defect. In cases where the tilt of the implant is expected in advance, an implant with a tilted head can be used. In modern implant systems, a screw connection of the implant head (suprastructure) with a cast bridge prosthesis is provided. The screw not only creates opportunities for imposing and fixing the prosthesis on tilted implants, but also allows you to save the implant in the event of a prosthesis breakage and to revise the state of the implant. It is desirable that the prosthesis has a locking connection with a natural abutment.
For a more even distribution of stresses, some implants use shock absorbers, for example, made of Teflon. However, real confirmation of their expediency in the clinic is not enough. It should be noted that from the point of view of stress distribution, the porous structure of the implant root is preferable to any other. This is confirmed by biomechanical studies through photo-optical and mathematical modeling. It is believed that the occlusal surface of the crown on the implant should be six times less than the total surface area of ​​the intraosseous part, because the ratio of the area of ​​the occlusal surface of the molar to the area of ​​its roots is 1:6. In most cases, it is necessary to simulate the narrowed occlusal surface of prostheses on implants. As for the facing materials (porcelain or plastic), there is still no consensus. However, there is no clear clinical evidence that porcelain contributes to implant overload due to impact loading. It is believed that under static conditions (grinding, bruxism) porcelain reduces the load on implants. It should be borne in mind that modern plastics and composite facing materials are much stronger and harder and approach the properties of porcelain. Some implantologists recommend in all cases to model the occlusal surface on implants 100 µm below the occlusal surface of the dentition, because. when chewing, natural teeth are displaced deep into the alveoli by this amount and overloading of the implant is possible.
The issue of designing occlusion for extensive and complete prostheses on implants is discussed in particular. "Protected occlusion" recommended: full contact chewing teeth in central occlusion and their deocclusion during extension and lateral movements of the tender jaw. Lingualized setting of teeth with an anterior guiding component involves the mortar-and-pestle closure of the low lingual tubercle of the upper molar with the shallow central fossa of the lower molar. The buccal tubercles do not enter into occlusion. This setting of the teeth unloads the implants, but is less natural, occlusal contacts are limited and chewing efficiency is less.
Complete absence of teeth fixed prosthesis with a lightweight frame can be used if there are six (in rare cases five) intraosseous implants. In other cases, removable dentures are made with telescopic, beam or lock fixation.
When prosthetics on implants, it is necessary to use analogues of implant heads when taking impressions and for work in a technical laboratory in order not to damage the clinical heads of implants.
The technology of electrospark milling significantly improves the accuracy of metal frames on implants. Due to the fact that most of the implants used are made of titanium, the casting of frameworks from this metal is increasingly being introduced.

Errors and complications of implantation

The causes of complications may be:
1. Incomplete examination of the patient.
2. Underestimation of contraindications to implantation.
3. Rough work of the surgeon during the formation of the implant bed.
4. Incorrect prosthetics.
5. Non-compliance with oral hygiene.

Complications may occur on different stages patient treatment.
- During the implantation operation, it is possible to injure adjacent anatomical structures (mandibular neurovascular bundle, maxillary sinus). In this case, you should refrain from implantation; in some cases, a smaller implant can be used by closing the perforation with osteotropic materials. The burn of the bone tissue at the time of the formation of the implant bed manifests itself in subsequent periods and is expressed in the absence or incomplete integration.
- After the operation, it is possible to develop varying degrees of inflammation in the tissues surrounding the implant. As a rule, it is advisable to prescribe a complex of anti-inflammatory drugs. If, before the start of permanent prosthetics, due to a burn of bone tissue or inflammation in the tissues, the implant is mobile more than I degree, it cannot be counted on for its long-term functioning. Sometimes it is advisable to remove such an implant and perform reimplantation after a complete bone remodeling at the surgical site.
- After prosthetics, as a complication, rapid loosening of the implant, the appearance of clinical signs of inflammation in the peri-implant mucosa (para-implantitis), the formation of peri-implant pockets and peri-implantitis are possible. This is due to implant overload or poor oral hygiene. At incorrect prosthetics the concentration of pressure on the bone tissue leads to its resorption. The lack of attachment of the gingival epithelium to the implant neck is a weak point of any implant; normally, the mucosal cuff covers the implant and has healthy look, but the histological picture in any case shows signs of irritation and chronic inflammation of the tissue. In this regard, each patient should be registered not only with an orthopedist, but also with a periodontist, who must periodically carry out professional cleaning implants and oral cavity and carry out periodontal treatment if necessary.
For subperiosteal implants, a typical complication is exposure of the framework due to inaccurate matching with the underlying bone and further inflammation.

1. "Russian Dental Journal" (special issue) No. 2−2000.
2. “Economics and management in dentistry” No. 1-2000.
3. Olesova V.N., Rozhkovsky V.M., Olesov A.E., Aksamentov A.D.: Fundamentals of dental implantation. Guidelines of the Ministry of Health of the Russian Federation FU Medbioekstrem, Institute for Advanced Studies FU Medbioekstrem.

Source newspaper “Dentistry Today” No. 3, 2000

People who need dental prosthetics often ask questions: dental implantation of teeth - what is it, what is the price of the procedure and is there positive reviews about her?

To date, dental implantation is becoming an increasingly popular area in modern dentistry, as it allows you to restore the lost chewing function, eliminate cosmetic defect and does not require any special care after full engraftment of the artificial structure.

Dental implantation - what is it?

Dental implantation is the replacement of the roots of a lost tooth with artificial implants. The implant is a construction of a titanium screw and an abutment. A screw is a part that is directly implanted into the bone. (literally from English - support) is attached to the screw and serves as the basis for fixing the future prosthesis or crown.

Why is dental implantation necessary? If one or more teeth are missing, bone the jaw in this place begins to gradually become thinner, since there is no chewing load on it. When implanting an artificial root, the load is maintained and the jaw does not undergo any changes.

Indications and contraindications

Like any other surgical intervention, dental implantation is not performed simply at the request of the patient. There are strict indications for its implementation:

• single defects of the dentition;
• included defects, that is, the lack of one or more teeth in the middle of the dentition;
• single or double sided end defects- loss of chewing teeth;
• complete absence of teeth;
• inability to use removable dentures due to an increased gag reflex, individual intolerance to the plastics from which they are made, or due to the specifics of the profession;
• the desire to achieve a satisfactory aesthetic effect.

Contraindications to the procedure can be divided into absolute and relative. If there are absolute ones, manipulation cannot be carried out, since it can lead to undesirable side reactions or simply be ineffective.

• lack of anatomical conditions for the integration of the implant and the formation of the prosthesis (violation of the bone structure or structure of the jaw);
• infectious process (tuberculosis, viral hepatitis in the active phase, etc.);
• diseases of the hematopoietic system (leukemia, severe anemia, agranulocytosis);
• some neurological and mental illnesses;
• autoimmune and systemic diseases(scleroderma, systemic lupus erythematosus, autoimmune thyroiditis);
• congenital or acquired immunodeficiency;
• pregnancy;
• chronic alcoholism, drug addiction;
• malignant neoplasms, radiation or chemotherapy in the last 10 years.

Types of methods

In dentistry, several options for implantation are used:

1. Intramucosal - the introduction of push-button structures into the mucous membrane of the gums.
2. Submucosal - first, a magnet of one pole is placed under the mucosa, and then the basis of a removable prosthesis is installed - a magnet of the opposite pole;
3. Subperiosteal - integration under the periosteum of a metal frame formed from a cast of the jaw with supporting parts protruding into the mouth. This method is relevant when it is impossible to carry out intraosseous due to the low alveolar part of the jaw.
4. Endodonto-endoosseous - the introduction of an implant-pin through the tooth root into the bone tissue. Recommended for .
5. Intraosseous - a collapsible or non-collapsible implant is fixed directly in the bone tissue.
6. Transosseous - relevant with a significant decrease in the lower jaw: the implant penetrates through the entire jaw and is attached to its base.

Operation methods:

1. Classic surgical.
2. Laser.

Advantages laser technique It consists in minimal tissue trauma and, accordingly, in faster healing.

Depending on the duration of the operation, implantation happens:

1. - one-stage installation of non-separable implants. At the same time, the likelihood of infection and impaired integration into bone tissue is higher.
2. Two-stage - classic version using collapsible structures. First, a titanium screw is installed, and after its engraftment, an abutment.
3. Immediate - the implant is directly installed in the socket of the extracted tooth without incisions and suturing. With this technique, the risk of infectious complications is higher.
4. Delayed - from the moment of tooth extraction to implantation, several months pass. This period is necessary for the healing of the hole when the risk of infection is high.

Stages

The operation of dental implantation is carried out in 4 stages.

• Training.
• Surgery.
• Orthopedics.
• recovery features.

Training

On the this stage the dentist collects information about the patient's diseases, about the presence of allergies (to determine the possible medical support for the operation), evaluates general state the patient and the state of his oral cavity. Plain radiography or computed tomography of the jaws is performed to determine the suitability of the bone for implant integration, as well as to exclude changes in the temporomandibular joint, maxillary sinus, mandibular canal.

If there are no contraindications for implantation, a treatment plan is drawn up, an agreement is concluded and direct preparation of the oral cavity for the upcoming manipulation begins:

• decayed and non-restorable teeth are removed;
• if necessary, previously installed orthopedic structures are updated;
• procedure is being carried out.

Then, based on the casts of the patient's dental system, a surgical model is made.

Surgery

Any operation begins with the provision of anesthesia. The technique of the operation depends on the chosen technique. One-stage implantation rarely given. In this case, a non-separable implant is immediately placed in the hole of the extracted tooth.

The two-stage version of the operation is considered a classic.

1. At the first stage, the screw is installed. First, a gum incision is made along the crest of the alveolar process of the jaw, the mucous membrane of the gums and the periosteum are exfoliated, and the place where the implant is inserted into the bone is marked. With the help of a thin drill (2.0–2.5 mm in diameter), the formation of a canal in the jaw begins, its depth depends on the size of the intraosseous part of the structure. The channel is gradually expanded, using drills of ever larger diameter and various shapes. Depending on the shape of the implant, it is either screwed into the canal or placed using special tools. A plug is temporarily placed in the hole into which the abutment will be inserted in the next step. Then the periosteum and mucosa are sewn into place, the wound is sutured. The sutures are removed about a week after surgery.
2. At the second stage of the operation, a micro-incision is made in the gum, through which the plug is unscrewed and removed. Then, a gum shaper is installed in this place, and after 2 weeks - an abutment.

Orthopedics

The orthopedic stage consists in the formation of the outer part of the “tooth”. To do this, casts of the dentition are taken, plaster copies of the teeth are made, which serve as samples for crowns or bridges. It is also possible to install removable structures.

Recovery features

Immediately after surgery, you must:

• 5-6 times a day apply ice to the face in the projection of the implant for 20 minutes;
• use a toothbrush with soft bristles;
• rinse your mouth often antiseptic solutions(up to 15 times a day);
• eat only sparing food: soft, pureed, not too hot.

Sometimes in postoperative period prescribe antibiotics to prevent infectious complications and dental adhesive paste - Solcoseryl. It is applied to the seams and promotes their faster healing.

For a full engraftment of a titanium structure on the upper jaw, no more than 6 months are required, on the lower - no more than 4. The rejection rate is no more than 4%. Evaluation of engraftment is carried out by testing the implant for mobility: when trying to move it, no unpleasant or painful sensations should occur. During percussion at the place of installation of the artificial root, a sonorous knock is normally determined. Within a few months after the operation, the patient should regularly come to see the dentist. If signs of rejection of the structure are detected, it is removed.

Possible complications of implantation:

• violation of the rules of asepsis and antisepsis;
• inadequate duration of the operation;
• wrong choice of anesthetic;
• inattention to individual anatomical features;
• improper use of surgical instruments (not cold instruments, too fast drilling);
• negligence in the dissection and suturing of gum tissue.

Video: dental implantation of teeth - step by step guide.

Price

The cost of dental implantation consists of the cost of each individual manipulation: anesthesia; implant placement; abutment fixation; prosthetics. Additional costs may be associated with the need for bone augmentation.

The average price for dental implantation in Moscow is about 30,000 rubles. About 25,000 rubles will need to be spent on prosthetics. Thus, the cost of implantation of one tooth on a turnkey basis will be approximately 50,000–60,000 rubles. With an increase in the number of prosthetic teeth, the price will increase accordingly, but for such cases in dental clinics are usually discounted.