Types of implants for insufficient bone tissue. An important stage of treatment: bone augmentation during dental implantation. Bone grafting: what's the catch

The essence of bone tissue augmentation is to restore the bone at the site of atrophy. Dental implants often require similar procedure: in the absence of a tooth, the bone does not receive a normal load, gradually dies off and after a while becomes thinner so that the pin literally has nowhere to put it. In order for implantation to become possible, bone tissue must be restored. Bone augmentation during dental implants

Why does bone die

There are five main causes of bone atrophy:

• no load on the bone after tooth extraction. The tooth root creates a load on the jawbone, keeping it “in good shape”. To greatly simplify the situation, we can say that after the loss of the tooth root, there is nothing to hold the bone, and the need to maintain a certain amount of tissue simply disappears;
• infectious diseases. Ostitis (inflammation of the bone) and periostitis (inflammation of the periosteum) often cause tissue atrophy;
• age-related changes;
• jaw trauma;
• poor quality dentures. Bone atrophy often leads to improper distribution of the load on prostheses, especially removable ones.

Adentia(absence of teeth) is always accompanied by a decrease in bone tissue, which, in turn, leads to a displacement of existing teeth towards the formed void and malocclusion.

Bone atrophy is a serious problem, fraught with extremely backfire, such as:

• violation of chewing function;
• change in the shape of the face (for example, a characteristic contour mandible and sunken lips in people with complete edentulous one or both jaws);
• difficult articulation.

Fortunately, today doctors have many ways to restore lost bone tissue.

Methods of bone augmentation for dental implants

Bone grafting, first of all, for successful implantation tooth. For secure fixation pin requires at least 1 mm of bone tissue. Installing an implant in an insufficiently thick and dense bone layer threatens to further accelerate the process of tissue atrophy. Also, recovery procedures are indicated for jaw injuries and the loss of a large amount of bone tissue as a result of inflammation.

Currently, there are several technologies for restoring lost tissue - the so-called osteoplasty:

• transplantation of bone blocks;
• guided bone regeneration;
• sinus lift.

Each technique has its pros and cons, features and contraindications.

Bone block transplant

This method was developed very first. Its essence lies in the transplantation of a piece of bone in the area of ​​atrophy; Previously, animal bones or donor tissues were used for this purpose, but due to the low survival rate from the use of someone else's biological material currently rejected.

Today for transplantation is taken patient's own bone material(usually straight from the jaw; in rare cases- from the thigh); this technique provides easy and almost one hundred percent engraftment. This process is called autotransplantation.

AT recent times in transplantation, artificial bone substitutes - alloplasts - are increasingly being used. They take root almost without problems, are reliable, their use does not give complications.

The operation is carried out according to the following scheme:

• first, the gum is cut and raised on the "donor" jaw, from where a piece of bone is removed;
• the future transplant is given the desired shape;
• through the hole in the jaw, the graft is placed in the area of ​​the lost bone and attached with special biocompatible screws;
• the gaps are filled with bone chips, the transplant area itself is closed with a special membrane, after which the gum is sutured.

The advantages of such an operation are reliability and predictability of the result– the layer of bone tissue turns out to be quite thick, the survival rate during autotransplantation is very high, there is practically no risk of rejection.

Of the shortcomings - transplanted material takes root for a long time, on average 6 to 8 months; the possibility of simultaneous installation of the implant is excluded, as this increases the risk of rejection of both the implant itself and the bone block; with insufficient integration of the transplanted block with the bone tissue, the flank can be detached from the jaw - the risk of such a complication is small, but still there.

Contraindications for bone block transplantation

• acute infectious diseases;
• blood diseases;
• oncological diseases;
• diabetes;
• period of pregnancy and lactation.

Guided bone regeneration

The method of guided bone regeneration is used in a situation where very little time has passed after tooth extraction. It consists in covering the hole extracted tooth a special protective membrane made of biocompatible material.

The meaning of this procedure is to protect the tooth socket from the growth of soft tissues of the gums into it, which grow very quickly and penetrate into the bone tissue, preventing it from recovering. Under the protection of the membrane, the bone regenerates naturally. Often to speed up the process additional bone tissue is implanted into the hole or allograft.

The advantages of this operation are low trauma and low degree stress for the body. Unfortunately, it has many more disadvantages:

• high risk of membrane rejection;
• risk of rejection of transplanted bone tissue;
• low efficiency of the procedure due to the structural features of the extended tissue. The fact is that such tissue does not have its own cortical plate and is much worse supplied with blood than the “natural” bone, which is why it tends to partially decrease. It is not always meaningful to restore one's own atrophied tissues in this way, in addition, the extension will have to be carried out “with a margin”.

Contraindications for the operation are exactly the same as for bone block transplantation - acute infections, blood diseases, oncological diseases, immunodeficiency states, diabetes.

Sinus lift

Sinus lifting is a low-traumatic bone tissue restoration technology. However, it can only be used on the upper jaw, as it includes manipulation of the maxillary sinuses.

With atrophy of the bone tissue of the upper jaw, the space of the nasal sinuses (sinuses) expands due to the decreasing bone. The essence of the sinus lift method is elevation of the sinus wall and the growth of new bone tissue under it.

Sinus lift surgery is open, in which a hole is made in the wall maxillary sinus, and closed, in which the bone bed itself is prepared. Closed surgery is performed more frequently, is less traumatic and carries a lower risk of complications. Open sinus lift is performed in extremely rare cases.

In both cases, the technology itself is almost the same. The main steps of the operation are as follows:

• the bone tissue is perforated and the membrane covering the sinuses from the inside is carefully peeled off with a special tool;
• the space between the membrane and the bone expands, and osteoplastic material is introduced into it;
• the bone window is closed, during the operation of the closed type, the mucous membrane is sutured.

After insertion under the membrane, the osteoplastic material should be integrated into the bone tissue. If the integration went without problems, a pin is inserted into the resulting bone layer.

The advantages of this operation are low trauma(with closed sinus lift), reliable engraftment of osteoplasts, low risks of rejection, high quality of augmented tissue.

The main disadvantages are inability to build up a layer of tissue more than 2 mm. Also, this method is not suitable for restoring a large volume of bone - in the absence of two or more teeth (and a corresponding degree of atrophy), sinus lifting is useless.

Contraindications for sinus lift are the same as for other bone restoration operations, however, there are several specific ones - chronic diseases nasopharynx, curvature and anomalies of the nasal septum, polyps in the maxillary sinus and frequent runny nose. Also, a serious limitation to the procedure can be the habit of smoking.

Materials for transplantation

As you can see, all three techniques use grafts that replace bone tissue - filling voids, as in a bone graft or sinus lift, or stimulating the growth of one's own bone, as in augmentation. There are five types of grafts used in dentistry:

• autogenous - represent bone material taken from the patient himself;
• allogeneic - donor material that has undergone preliminary processing;
• xenogenic - based on animal material (namely, bovine bones);
• combined - a combination of autogenous and xenogenic materials in a ratio of 1: 1; efficient and safe way rapid bone growth;
• alloplasty - artificial bone substitutes.

The most effective is the use of pure autograft and a combination of auto- and xenografts. These materials show top scores in terms of speed and quality.

Conclusion

Bone atrophy is an unpleasant and unsafe consequence of tooth extraction, fraught with serious complications. It is better to prevent it immediately by installing implants. However, this possibility is not always available. Fortunately, even if bone resorption has already begun, there are technologies to reliably restore lost tissue.

Quite often, dentists and their patients have to deal with bone growth during dental implantation. Price, reviews and detailed description procedures are provided below.

This happens when a person has thought too long about whether to install implants. During the absence of dental units hard tissue atrophies too quickly, which leads to the need for bone grafting.

About the lack of bone tissue in a patient

As soon as the tooth fell out or was removed, a natural and irreversible process begins - tissue atrophy. Doctors say that already in a year of the absence of a dental unit, resorption reaches a maximum.

If the patient needs to implant an implant in order to restore the integrity of the row, then the lack of natural bone will become a significant obstacle. It is believed that for high-quality implantation, at least 10 mm of a solid base is needed.

And when it is not enough, you have to use the procedure of bone grafting. In this case, a special operation is performed, in which the bone is built up in the right amount. This procedure significantly increases the recovery time of the dentition, but it provides a high-quality and lasting result.

A very important point - so that there are no unpleasant complications, you should choose good clinic, an experienced doctor and adhere to absolutely all the rules of preparation for the operation.

Why is the procedure necessary?

In the absence of bone tissue, it is necessary to build it up. And this applies not only to cases of subsequent implantation, but is also done to solve other problems:

• For a sufficiently reliable fixation of the implant, if the bone is shorter than the artificial rod.
• To prevent the displacement of teeth, their loosening, loss and other pathologies of the dentition.
• Prevent distortion of facial expressions and articulation.
• Restore chewing function, which will inevitably occur with atrophy.
• Prevent facial contours from being distorted due to jaw reduction.

Doctors allocate the following benefits process when artificial bone material is added or it is built up in another way:

1. Complete restoration of all jaw functions, even if atrophy has reached a large volume.
2. Makes affordable high-quality implantation, in which the rods will hold for a long time and reliably.
3. Comes back attractive appearance gums, and after prosthetics, and the entire dentition.
4. Following the rehabilitation period, there is a complete disappearance of all the inconveniences that accompanied tooth loss and bone atrophy.

True, there are some disadvantages of the procedure, such as a long recovery phase, the operation process itself, partial restrictions for this time. Building and increasing bone tissue is a complex long-term and always joint work of the patient and the doctor. Only with coordinated actions can everything be achieved positive effects and expected result.

A photo

Bone augmentation options for dental implants

Depending on the condition of the bone, the health of the patient, the expected result and the practical skills of the doctor, various procedures can be performed:

1. Guided tissue regeneration, otherwise NTR. In the process of NTR, the doctor implants a special membrane. It is made of biocompatible material and promotes natural tissue growth. Such a membrane may or may not be resorbable. After its installation, the surface of the wound is sutured and waiting certain period until the bone grows to the desired size.
2. Bone block grafting. When transplanting a bone block, most often a piece of the patient's own bone is used. Usually it is taken from the chin. It turns out two wounds, which is considered a disadvantage of the procedure. But such a transplant takes root better and rejections do not happen with it. This bone is screwed with special screws to the right place, compacted with chips or granules and sutured with a membrane. It is she who will not allow them to be washed out and will contribute to rapid regeneration. Another disadvantage of bone block implantation is the duration and the procedure several times. After all, initially they make two injuries, and then they also perform an additional operation to remove the membrane and implant the pin.

Whichever of the options for bone grafting is chosen, the operation goes through certain stages, for which the patient must be mentally prepared:

• Mandatory health examination, setting the degree of atrophy using x-rays. Taking blood samples with extended interpretation. After all, the operation should be carried out only in the absence of any contraindications.
• Anesthesia. Most often, local anesthesia is chosen, but in rare cases hypersensitivity or the susceptibility of the patient, the doctor can choose and light general anesthesia.
• An incision is made in the periosteal flap, which exposes the rest of the natural bone. In this case, the doctor can additionally diagnose the condition and size of atrophy. Accordingly, desired material for building and its adequate amount.
• Then the procedure itself takes place, which will differ depending on the chosen method of plastic surgery.
• After all the manipulations, the doctor is obliged to sew up the bone with the installed components and secure the wound. For this procedure, absorbable sutures are most often used, so removing the sutures will be unnecessary.

If the operation was successful, the rehabilitation period will last up to a month. The first week is also necessary to drink painkillers and anti-inflammatory drugs.

Sinus lift

This is the most popular procedure, which is carried out in two ways - open and closed. Which one is better to choose, the doctor decides based on the diagnosis of the condition of the bone tissue.

In this case, a mechanical lifting of the maxillary sinus is performed so that the necessary tissue can be built up under it. But this method is used only if you need to increase it by 1-2 mm, no more. Also a limitation for closed operation is the absence of more than two teeth in a row.

Otherwise, either open procedure, or a completely different method of bone grafting is chosen.

Indications for a sinus lift are:

• The absence of any pathologies at the site of the procedure.
• The presence of a certain amount of bone tissue to perform the necessary manipulations.
• When diagnosing the patient's health, nothing was found that could provoke complications after the operation.

It is also important to make sure that the patient does not have the following problems:

1. The presence of several partitions in the sinuses themselves.
2. Polyps in the corresponding zone.
3. Constant runny nose for various reasons.
4. Sinusitis in any form.
5. Broken or weak bone.
6. Previous surgical interventions in .
7. Bad habits in the patient in the form of frequent smoking.

Open

Open sinus lift complex operation which is only made in extreme cases. Carry out the following manipulations:

• The doctor drills a hole in the wall of the maxillary sinus, trying not to touch the mucosa.
• The shell itself is raised to the desired height.
• All the opened space is filled with a special material that will stimulate the growth of bone tissue.
• The wound is closed and sutured, returning to its place everything that was moved during the operation.

Only over time, when the tissue has grown to right size perform implantation.

Closed

The closed sinus lift turns out to be completely different, in which the direct installation of implants becomes available simultaneously with the implantation of tissue. The procedure is convenient in that it is carried out in one go. The following stages are distinguished:

1. Initially, the bone bed is prepared, where the rod for the implant will be installed. Its size should not reach the maxillary sinus by 1-2 mm.
2. With the help of a special tool and light tapping, the doctor moves the desired fragment inward, thereby raising the mucosa to the required height.
3. The osteoplastic material is introduced through the created hole and at the same time the implant shaft is installed.

While the tissues are healing and the gum is forming, the patient may be offered to use plastic temporary structures that mimic the dentition for that period until permanent implants are created and installed.

Although this procedure is considered to be simpler, more accessible and less traumatic for the patient, nevertheless, if it is carried out incorrectly, some unpleasant consequences may occur:

• Damage to the sinus, leading to a chronic runny nose.
• Possible sinking of the entire structure deep into, followed by its forced removal.
• The occurrence of inflammation in the maxillary region, which will have to be cured and only then produced repeated procedure implantation.

• Give up smoking.
• Restrain when sneezing and coughing, try not to do this, and also do not blow your nose intensively.
• Avoid colds as they lead to serious complications.
• Refuse for the period of rehabilitation from solid, cold and hot food.
• Do not go to the bathhouse or sauna, dive under water or engage in any sports where there is a possibility of injury.
• Do not travel by air.

What materials are used?

In each of the variants of such plastics, grafts are used. They can be:

• The patient's bone tissue taken from any healthy part of the body. They choose the rib, the ilium, but most often they use outgrowths or tubercles of the upper jaw, as well as a small area of ​​\u200b\u200bthe chin.
• Allograft - taken from a donor, which is another person. Although usually for these purposes they take a cadaveric bone, which is additionally processed. Such a transplant takes longer and more difficult to take root, but any risks are almost eliminated.
• Xenograft - hard tissue of animal origin. This is a more affordable option, but healing can also be delayed.
• Alloplasts - artificial materials that can completely replace living tissue, while they take root well and rarely cause rejection. For these purposes, hydroxyapatite and any of its derivatives are used.

Video: about bone growth.

How much does the operation cost?

The price for such a complex procedure will largely depend on both the clinic itself and the chosen method of plastic surgery. In addition, the cost may also include all the materials used, as well as the implantation procedure, if it is carried out simultaneously with the sinus lift, for example.

Focusing on the prices of Moscow private clinics, average cost varies from 150 to 450 dollars for the operation itself. But you can also find various promotions, Special offers and discounts. More important in this case not the price, but the quality of the doctor's work.

The need to increase bone tissue during implantation turns for many patients into a failure of this method of restoring teeth. Why this happens is easy to guess, because osteoplastic surgery is almost always associated with additional expenses, with rather complicated rehabilitation, possible risks and loss of precious time, with the inability to get a dream smile right away. In addition, sometimes doctors also give a “stop” - if there are not a large number of teeth, they simply refuse implantation due to the fact that bone grafting along the entire row is too difficult and expensive. So patients return to removable dentures again.

Fortunately, today there are methods of implantation that allow you to do without building up bone tissue or are carried out in conjunction with this procedure. It is behind them professional dentists see the future, and patients choose such methods of dental restoration with increasing confidence. But there are still a number of questions that a person far from medicine would like to get answers to. We will help you understand all the nuances of this topic in detail.

Why does jaw bone atrophy?

As is known, anatomical features the structures of the maxillofacial apparatus suggest that each of us has two jaws - the upper and lower. On each of them, 14 (or 16 with “eights”) teeth erupt in a permanent bite. Ideally, a person manages to avoid their loss until the end of his life, but in most cases, many still have to face the loss of one or more elements of the dentition. Moreover, there is an alarming trend - already people of 30-40 years old are faced with partial, multiple and even complete adentia, not to mention those patients whose age is over 60 years.

Interesting! The WHO European Office emphasizes that it is committed to minimizing the situation of edentulism around the world. It is planned to increase the level by 2020 dental health so that the number toothless people on the planet did not exceed 1%, and about 90% of people had full-fledged (natural or restored prosthetic structures) dentitions.

So, with the loss of at least one unit of the dentition, the bone tissue located in this area ceases to be involved and loaded with “working” teeth that take part in biting, gnawing, grinding food. It remains “not destiny” and gradually begins to atrophy, thin out. The same thing happens when a person wears removable dentures or fixed bridges for a long time. Moreover, even in the presence of teeth, atrophy of the tissues surrounding them can occur - this situation occurs with inflammation of the periodontium, with diseases of periodontitis and periodontal disease.

When you can not do without building up bone tissue

It's simple: the longer after tooth extraction you do not solve the problem, the more likely that you will have to go through the procedure of bone augmentation for implantation in the future. But not only the time factor plays a role here, but also the method of treatment and restoration of teeth that you have been shown.

For example, the classical implant implantation protocol in almost all cases, without exception, places very high demands on the quality of bone tissue, and if it is not enough, then you will have to resort to surgery, then recover up to six months before the doctor implants the implants directly. You will also have to wait if you have been shown a tooth extraction - an implant cannot be implanted in its place until the hole heals.

Important! Outwardly, the changes that occur with bone tissue are invisible to humans and do not directly cause problems. But when deciding to finally restore teeth by implantation, until recently, many had difficulties: the classic two-stage approach could not be implemented until the bone had the necessary volume and height to securely fix the implants in it. With a lack of bone tissue with this approach, they would simply fall out, loosen in best case. At worst, when installing them, the doctor could injure the sinuses in the upper jaw or hurt ternary nerve on the bottom. After all, there are few bones and these anatomically important elements are now very close.

That is why, when referring to the standard, classical method of implantation, patients have no other choice but to turn first to the procedures for increasing the dentary bone for implantation. This saves the situation and eliminates some problems, for example, wearing removable dentures further. But the path to a beautiful and perfect smile is quite thorny: you have to wait a long time, pay a lot. Constant fixed prosthesis in this case, the patient does not receive it at all soon - after 8, or even more months after the initial visit to the doctor. Also, despite the fact that such a protocol can restore any number of teeth, it is still more rational to use it if there are 1-2 defects due to the financial component.

What to do for those who do not want to wait or have more serious problems (inflammatory process, chronic diseases), a history of multiple adentia, or are all teeth missing in the mouth? Today, such patients have the opportunity to get results in a matter of days and hours thanks to fundamentally different innovative methods implantation, but we will discuss them a little later.

Bone grafting: what's the catch

Bone augmentation before implantation becomes a stumbling block for many patients, because most of them do not want to face several uncomfortable moments:

• time and money: procedures will need to be paid separately from the implant itself. With the classical approach prerequisite for further implantation of implants, there is a rehabilitation period - a period of 3 to 6 months, allocated for the healing of bone structures after the intervention and for recovery,

• possible complications: most often, complications frighten patients who need to restore teeth in the upper jaw. The fact is that here in the immediate vicinity are the maxillary sinuses, which can be injured during the sinus lift, which will lead to the appearance of a chronic inflammatory process in this area, the occurrence of sinusitis or even meningitis.

However, if the doctor is competent, then the procedure for him is quite simple - the patient can only trust and strictly follow all the recommendations.

Factors that made possible implantation without augmentation of the jawbone

It is worth noting that active development advanced technologies, 3D modeling, creation surgical templates, computed tomography brought great benefit and the development of implantology in general. Thanks to them, today doctors can offer their patients methods of one-stage dental implantation with immediate installation prosthesis, which in most cases allow you to completely do without building up bone tissue.

avoid this unpleasant procedure possible even when the patient has a pronounced degree of atrophy of bone structures, inflammatory processes and other circumstances in the anamnesis, which can complicate treatment and achieve the maximum positive result: smoking, elderly age, osteoporosis, HIV, chemotherapy in the past.

On a note! Implantation with immediate loading of the prosthesis and without bone augmentation is possible even when you have just had a tooth removed. The procedure is carried out in one step: an artificial root is immediately installed in the hole of the extracted tooth or next to it, and you go home with a prosthesis.

It is worth noting that, in general, immediate loading methods are most successfully practiced when patients need to restore a large number of teeth or solve the problem of complete adentia. Most importantly, with these methods of implantation, people really get new teeth, literally not looking up from work and communication in society. The entire treatment process takes 3 to 7 days. Now let's find out why there is no need for bone grafting with one-stage protocols.

1. Use of specific implant models

Experienced implantologists emphasize that not every implant is suitable for use in one-stage dental restoration protocols. Especially for these purposes, only certain models are suitable, which have strictly verified characteristics:

• fast survival in bone tissue: for this different manufacturers use special coatings. For example, the famous ones have TiUnite, and the hydrophilic surface contributes to the rapid development protective cells in bone tissue and its growth,
• active type of thread for strong adhesion of the bone to the implant,
• the ability to be installed at an angle: this is necessary precisely so that during implantation it is not necessary to resort to bone augmentation and not to touch the areas of the maxillary sinuses and nerves. The tooth implant in the lateral sections is fixed in such a way as to maximize the use of bone structures that are not subject to inflammation and atrophy. Due to the increase in the contact area, it is held tightly in the bone, does not fall out and does not loosen,
• the ability to solve the most difficult cases: a vivid example of this is the artificial roots of the brand, which are used for periodontitis and periodontal disease. They are covered with antibacterial coating, and also have one design feature - they are one-piece, their body is immersed in the hole of the extracted tooth, and the smooth neck is in contact with the mucosa. Thanks to these properties, a patient with inflamed gums may not worry about the rejection of structures or irritation of the inflamed mucosa, or the accumulation of plaque on the implant neck.

2. Careful treatment planning in advance

If the doctor tells you that he is ready to carry out the procedure, bypassing the stages of preparation for dental implantation, then you should think about changing the specialist. Perhaps you fell into the hands of a non-professional, because an experienced specialist who has the necessary knowledge of the anatomy of the maxillofacial system and owns the techniques of one-stage protocols will never allow this. Whether the procedure is carried out jointly with or without bone augmentation, but without fail, the doctor must require a CT scan of the jaw (or it will be done directly in dentistry) and general analysis blood. Also, if you have chronic diseases, the maxillofacial surgeon or implantologist has no right to start treatment without the recommendations of highly specialized specialists and their opinion on the state of health.

This data is needed by the doctor to work out the treatment process on computer equipment, using 3D technologies, to select the optimal implant models for you, to determine the place of their installation, to create surgical templates that allow you to reduce all possible risks from procedure to a minimum.

3. Fastening the prosthesis immediately

This is a prerequisite for the implementation of one-stage implantation methods. The doctor can immediately load the prosthesis within 4-6 hours to 3-5 days after the installation of artificial roots. It all depends on individual indicators. The prosthesis acts as a guarantee that the implants will loosen or fall out, it unites the entire system into a single whole.

And one more thing: no matter how long the prosthesis is installed, there is one thing important condition- this is the need to start the process of chewing food with new teeth without delay. You should not be afraid, since the design contains a metal base, which will not allow the implants to move even under loads. Also, so, you help run metabolic processes in the bone tissue, provide it with work and nutrition, due to which the engraftment process will take place quickly and almost imperceptibly.

Implant options that can be performed without bone grafting

As mentioned above, one-stage protocols are a chance to get new teeth quickly, economically, without bone grafting. In some cases, bone tissue growth can be directly carried out during dental implantation, i.e. together with it, this does not change the result when choosing one of the one-stage methods of treatment:

• or the solution of the problem with three implants: this solution was developed by Nobel especially for patients who have missing teeth in the lower jaw. And the secret of success is simple - these are three two-piece Trefoil implants (read as "Trefoil"), which are installed in the anterior part of the mandibular bone, and a template bar made on high-precision Procera equipment, taking into account the anatomy of the lower jaw and reducing the time for acquiring new teeth,

• solving the problem with four implants: there are several options. The first is which is higher than the previous technology, but there are more indications for treatment. The protocol was also developed by the Nobel company using the artificial roots of this brand. The second is from Straumann using the Roxolid model. Also in clinics, you may be offered other, more budgetary and less proven protocols for the implementation of this protocol. clinical research models, for example, Korean Osstem,
• solving the problem with six implants: this is the solution for patients who have preparatory stage showed moderate bone resorption. allows you to abandon the osteoplastic surgery, because six artificial roots in some cases - optimal amount supports for reliable support of the prosthesis and competent distribution of chewing load,
• solution the maximum number supports: the minimum with this approach is 8, and sometimes even 12-14 artificial roots, which an experienced specialist will offer to implant in a patient according to the protocol if he diagnoses severe bone atrophy or an inflammatory process in it. Also, the basal complex will be a real salvation and help for those who have contraindications to all of the above methods of treatment or complicating factors,
• solving the problem with long ones: we immediately make a reservation that the method is only suitable for patients with missing teeth on. But among it clear benefits indications for use can be noted: very strong bone atrophy. The advantage is that such long models (Nobel - Zygoma, Biomed, Noris Medical have them) are fixed not in the jaw, but directly in the cranial vaults and cheekbones. This in itself serves as a guarantor of high primary stability, plus the patient also receives the prosthesis immediately.

Implantation without bone grafting: advantages and disadvantages

The most important advantages: wide opportunities choice and a real chance to find a technique that suits your situation. Also this financial freedom– the price of the complexes may vary depending on the selected implant model, which is presented great amount. So there is plenty to choose from.

Complex approaches, in principle, are cheaper than the classical ones, since they allow you to save on bone grafting and gingival contour plastic procedures (the prosthesis in this case is already equipped with a beautiful gingival margin that covers the imperfections of your mucosa). Another plus is that this approach allows you to calculate all expenses in advance, because clinics that value their reputation offer a turnkey solution to the problem.

Well, the most important advantage is the ability to do without waiting and start eating, smiling right away. Here the patient does not need to find free minutes, he avoids unpleasant moments that are related to communications. Agree that if the treatment takes only a week, then there is no need to negotiate with colleagues about substitution at work or ask the boss for a long vacation, constantly asking for time off. The doctor will need to visit no more than 2-3 times.

As for the shortcomings, then they are here. Firstly, this is the absence in Russia of a large number of specialists who are really trained in all the intricacies of working on protocols for immediate loading and implantation without prior bone augmentation. Therefore, the patient, alas, always has the risk of running into a non-professional. You need to be very careful in choosing a specialist.

Secondly, this method of treatment requires high level self-control and discipline, diligence and from the patient himself. When deciding to restore teeth in this way, you need to clearly understand - if you do not follow all the doctor's instructions, break the rules rehabilitation period and treat the instructions negligently, then you will only have to blame yourself.

Video review of the patient about the operation

1 Iordanishvili A.K., Gaivoronskaya M.G., Soldatova L.N., Serikov A.A., Podberezkina L.A., Ponomarev A.A. Occlusion-caused diseases of the masticatory apparatus. Kursk scientific and practical bulletin "Man and his health", 2013

In this article, you can learn about new standards in dental implantation from an implantologist with a total work experience of more than 30 years. Alexander Pavlovich Akhtanin has been installing implants since 1996. Installed more than 20,000 implants. Passed the specialization in Boston, USA with the award of the title of Implant specialist.

Alexander Pavlovich, tell us what, in your opinion, is the key factor for successful implantation?

For many years, the key to successful implantation was the placement of long and thick implants. This was motivated by the fact that larger implants are more resistant to chewing loads. In turn, a large amount of bone tissue was required to install a thick implant. With its shortage, bone grafting was performed, sometimes in quite traumatic ways.

But, decades later, implantologists came to the conclusion that many complications occur just in those cases when it was decided to put a longer or thicker implant in a place where a smaller implant could have been dispensed with. For example, Straumann has shown evidence that complications occur 3.4 times more frequently with thicker implants than with standard-thickness implants or thin implants.

Tell us in more detail, what are the advantages for the patient of installing thinner and shorter implants?

Firstly, the implant installation procedure itself is less traumatic. After all, what larger size implant, the larger the hole for it needs to be made in the bone tissue. When installing a thinner implant, the bone tissue around it is maximally preserved, and it just depends on it whether the implant will last for many years. So why sacrifice your own bone for the sake of the size of the implant?

Secondly, the use of thin or short implants makes it possible to do without bone tissue augmentation, without sinus lifting. In addition to reducing the treatment time, reducing trauma, this reduces the risk of nerve damage in the lower jaw and the maxillary sinus in the upper. If you think you're taking a risk with a short or thin implant, don't forget that bone augmentation also comes with additional risks. Unfortunately, in medicine there are no methods with a 100% success rate.

For many patients, the placement of short or thin implants is the only way restore the lost dentition, especially in the complete absence of teeth.

Does this apply to thin and short implants of all companies?

It is worth mentioning the company Straumann. They invented the material Roxolid, an alloy of titanium and zirconium. It has the same biocompatibility as pure titanium, but is many times stronger than it. Therefore, thin and short Straumann Roxolid implants can be used without bone augmentation and without sinus lift, being absolutely confident in the result.

It is important to note that Straumann Roxolid are NOT mini implants. They are classic implants from a more durable alloy (85% titanium, 15% zirconium).

It should also be noted the German implants Ankylos. They were originally designed in such a way that their standard implant is thinner than standard implants from other companies. But that doesn't stop him from holding on. heavy loads, which was proved at the University of Frankfurt in the course of a 20-year study. There is no difference between thick and thin, long and short implants. The most important thing is the presence of bone around the implant.

Thin Ankylos implants installed in 1992 (left), X-ray 20 years later (right) shows excellent bone condition around the implants

And what do European and American colleagues think about this?

Just they have not been afraid to put into practice short and thin implants for a long time. And they do it right! For example, our Italian colleague, president of a large implant association, conducted the following study. He installed two crowns on a Straumann Roxolid implant just 4 mm long! That is, he deliberately doubled the load on the implant. And what do you think, the success of implantation after 5 years was 95%. What can we say about if the work is done according to the protocol.

At one of the last meetings of ITI - the international association of implantologists - the undiscovered potential of thinner and shorter implants was actively discussed. Implantologists around the world are coming to the conclusion that it is better to avoid additional bone augmentation surgeries. After all, a patient does not come to us for us to perform a "cool operation" on him. He needs new teeth new smile and improve the quality of life. And for this, you can get by with smaller implants.

What is the difference between foreign dentistry and ours?

Communicating with our foreign colleagues, I draw your attention to the fact that in our country there are many more patients who already have all their teeth missing, or they need to be removed and implants installed. Accordingly, there are much more patients with bone tissue atrophy.

Is it possible to install short/thin implants in the complete absence of teeth?

Of course, sometimes this is the only way out for those who want to get a fixed structure on implants that completely imitates their own teeth. Without volumetric operations to increase bone tissue. But for this it is desirable to use Straumann Roxolid or Ankylos implants.

Another option is to install thin / short implants, but in more. If 6 implants are to be placed for a fixed jaw prosthesis, 8 short or thin ones can be placed as an alternative. This will evenly distribute the chewing load between them. The installation of an additional two implants is much less traumatic than bone augmentation procedures, and the cost of treatment is less or the same.

Tell me, can you still perform bone grafting and put a large implant?

Indeed, there is always a choice of what is best to do. Let's look at what problems arise during bone grafting.

Firstly, it is the traumatic nature of the procedure. The gold standard for bone grafting is the harvesting and grafting of the patient's own bone. The bone block is sawn off from the angle of the lower jaw, from the chin area, or completely outside the oral cavity ( ilium, edge). The more bone tissue you need to grow, the more surgical procedures must be transferred to the patient.

Second, duration. Bone augmentation procedures are often performed independently without implants. The total duration of treatment can be a year and a half.

Although they do not save on health, one cannot but say about the high cost. The cost of bone augmentation can cost as much as implantation followed by prosthetics.

But the main problem is that the grown bone tissue is different from your own. There is a risk of its resorption 2-3 years after the installation of implants. Then it turns out that the patient endured all these procedures in vain.

But this does not mean that you should completely abandon the procedures for increasing bone tissue.

Most often when it comes to sinus lift. His technique was worked out decades ago, so it really reliable procedure. When implanting in the complete absence of teeth, it is sometimes advisable to do a sinus lift with simultaneous installation of implants than to install them at an angle, bypassing the maxillary sinuses. But in each case, everything is decided individually.

It is also worth mentioning those cases when it is necessary to restore aesthetics after an injury. Without bone tissue augmentation, it is sometimes simply impossible to create a beautiful gingival contour and, as a result, a beautiful smile.

Describe cases from practice when short/thin implants were placed.

The patient came to me with the need to implant the entire jaw. Periodontitis has led to the loss of many teeth and bone atrophy. If we wanted to install standard implants, then it would be necessary to remove all the teeth, wait 3-4 months. Then perform bone grafting, wait the same amount, and then install the implants. Total duration treatment would be about one and a half years, during which she would use a removable prosthesis. Not the most comfortable thing in the world.

Instead, simultaneously with the extraction of teeth, short and thin implants were installed without sinus lifts, but in a larger quantity - 8 pieces. This was enough to install a fixed plastic prosthesis immediately after implantation. The whole procedure lasted about 2-3 hours. The patient was very pleased with her new smile!

The last question, what are the prospects this method implantation?

To date, the successful use of thin and short implants without bone augmentation is a proven fact. Let's keep up with new trends in implantology.

Quite often, in the course of preparing for dental implantation, patients encounter a common problem - this is an insufficient amount of bone tissue or its atrophy. In such a situation, it is necessary to look for other methods to solve the problem, or the doctor prescribes a procedure to build up bone tissue.

How this happens, what are the reviews about the procedure and features, you will find out below.

What to do with a small amount of bone tissue?

If the volume of tissue in the upper jaw is reduced, then during implantation of teeth there is a high risk of damage to the maxillary sinus. Implants are longer than the bone, all this can increase the risk of maxillary sinus rupture and infection. As a result, it appears chronic runny nose or sinusitis.

Problems with the upper jaw can be solved in this way:

• implantation of teeth without tissue build-up;
• a sinus lift operation is performed;
• with atrophy of the bone tissue of the lower jaw, the doctor is often faced with the fact that the mandibular nerve is located too close, and damage to it can lead to loss of all or all language sensitivity, the lower part of the face and problems with pronunciation or swallowing.

And in order to build up the bone tissue of the lower jaw, the following is done:

• an implant is implanted in the anterior jaw, but this extension is possible only in the presence of complete jaw adentia and is used to fix the prosthesis;
• the implant is placed next to the nerve;
• the position of the nerve changes;
• dental implantation is performed with increasing tissue on the lower jaw.

To implant a titanium structure, the tissue must have sufficient width and height. It is on this that the stability of the position of the implant and the duration of its use depend.

If the patient decides to perform dental implantation without the need for bone augmentation, then the prerequisite here is that the tissue height should be a maximum of millimeters in height.

The indication for bone augmentation is a small amount of fabrics. In this case, insufficiency in each individual case is calculated individually. For example:

• if implantation is performed in the anterior maxillary region and subsequent fixation of removable dentures is planned, then bone grafting is not required;
• if it is necessary to carry out fixed prosthetics, and there is not enough bone tissue, then in this case bone augmentation is required.

This plastic is necessary measure also due to the fact that uncompensated bone atrophy leads to the following consequences:

• pathological displacement of the teeth, which can lead to their loosening and loss;
• facial expressions, articulation and speech are distorted;
• chewing function is disturbed, which provokes problems with the digestive organs;
• the contour of the face is distorted, wrinkles appear and the lips sink.

Therefore, bone grafting atrophic changes bone tissue is a vital necessity.

Bone augmentation methods

Thanks to modern technologies to restore bone tissue, implantation can be performed anywhere in the bone no matter what condition it is in. Now there are extension methods such as:

• bone regeneration;
• plastic;
• sinus lifting;
• transplantation of bone blocks.

Guided Type Bone Regeneration

During this procedure, bone grafting is performed in the form of a membrane, which has a high degree of biocompatibility and helps to form bone tissue. The membrane is made based on collagen fibers, it may or may not dissolve. And after the membrane is implanted, the wounded surface is sutured. And only after the formation of bone tissue, implantation is performed.

After the tooth is removed, a large hole remains in its place. And when an implant is placed, in order to better fix it in the bone tissue, sometimes doctors use bone tissue.

Bone grafting and its application

But bone grafting is practiced somewhat less frequently. Bone augmented by graft in the following way:

• the bone tissue is planted, it is taken from the area of ​​the lower jaw (near the chin) or the upper one behind the wisdom teeth;
• a fragment of bone tissue after implantation is fixed with titanium screws;
• After about six months, the screws are removed and the implantation procedure is performed.
• The procedure itself is carried out in this way:
• the gum is cut;
• with special tools, the bone tissue is split and moved apart;
• osteoplastic material is immersed into the resulting cavity;
• the graft is fixed with titanium screws;
• intermediate defects are filled with osteoplastic chips;
• a membrane is applied, and the gum is sutured.

What is a sinus lift?

This concept implies increase in volume while lifting the maxillary sinus. This method of building up tooth tissue is used in such cases:

Sinus lift is divided into open and closed.

Open operation

Operation open type quite complex, and it is prescribed for severe bone deficiency on the sides upper jaws. It runs like this:

• a small hole is made outside the wall of the sinus so that the mucous membrane is not affected;
• the mucous membrane is raised to the required height;
• the resulting free space is filled with a special material for building;
• partially, the tissue and mucous membrane, exfoliated before, is returned back and sutured.

After some time, the desired volume of bone is formed, then implantation is performed.

Performing a closed sinus lift

This operation is used during implantation, when there is no only 1-2 mm of bone tissue is enough in height. It includes the following steps:

Pros and cons of a sinus lift

The advantages of this extension method are as follows:

• tissue volume can be restored;
• with the help of a closed type of operation, it is possible to build up bone tissue with a minimum of trauma;
• you can get new teeth that fully replace the real ones.

But if the operation was unsuccessful, then, according to reviews, the following consequences may occur:

• the nasal sinus is damaged, this in the future provokes the appearance of a chronic runny nose;
• the design sinks deep into the maxillary sinus, so it will need to be removed;
• sinus inflammation may develop.

And the period after surgery and rehabilitation of the patient can take a very long time. The patient will have to comply with a number of requirements for a certain time, such as not coughing or sneezing, so the implant or artificial bone may fall out.

• eat hard, hot or cold;
• go to the sauna or bath;
• perform heavy physical activity;
• dive;
• drink liquid through a straw;
• use air transport.

What is used for extensions

To restore lost bone volume using a special transplant. For this purpose, the following materials are used: