A dental implant is a well established method of supporting one or more false teeth. It is a titanium screw that can replace the root of a failed tooth in either lower or upper jaw. Strict adherence to a prescribed treatment plan is very important to achieve and maintain a long lasting aesthetic result and effective performance of dental implants.
The treatment process
1. Your dentist will arrange for a number of diagnostic tests. This includes a CT scan that produces a highly detailed 3D image and determines the position, shape, size and structure of the various parts and structures in your mouth. Because the test provides such a wealth of information, it is one of the key tools of diagnostics in modern dentistry.
Three-dimensional image of jaw structure
2. Once the diagnostic tests have been performed, we move on to the assessment of the relative procedure risk. This takes into account your expectations, height of the smile line, biotype of the surrounding gum tissue, shape of the existing teeth and those that are being restored, the amount and shape of available bone and soft tissues.
3. When the treatment details have been determined, a wax model is produced showing the desired position of the nearby gum tissue, the shape of the crown(s) and periodontal papillae. The model is then used to create a surgical template. This procedure allows the doctor to accurately identify and create dental implant(s) for each patient.
4. The next stage involves the fitting of dental implants and/or restoration of bone tissue/gums.
5. After some time, the second surgical stage is undertaken which involves treatment of the gum tissue or installment of an abutment.
6. When the surgical procedures are completed, the area with aesthetic significance is covered with a temporary crown.
7. A permanent crown is manufactured once all of the above stages have been completed
Implant abutment crown
Strict adherence to a treatment plan allows dental implants to aesthetically rehabilitate the edentulous (toothless section) with a long lasting results.
Selection of an implant system
Currently, there are hundreds of dental implant systems available to a patient. However, many implants enter the market without sufficient clinical documentation, scientific data and, in some instances, manufacturing companies may commence their clinical trials after selling their implants.
Results of long-term clinical studies (performed for more than 10 years after implant placement) officially determined a list of "big five" implant manufacturers that produce more than 85-95% of the world's denture implants: Straumann, Biomet3i, Dentsply/Friadent, Astra Tech and Nobel Biocare.
When choosing an implant system, we are guided by the following parameters:
- manufacture's participation in scientific research
- the latest technology and practical results
- precise fit
- attachment using a QuickSeat® system which produces an audible signal and tactile "click" during installing or when taking an impression of the abutment module, which signifies the correct fit and stability
- deep (4mm) landing of internal connections
- thick coronal implant wall (which prevents implant fractures)
- unique feature of the connection – zero residual voltage (which reduces the risk of implent fractures and abutment unwinding).
A unique feature of the implant-abutment
The surface of an implant NanoTite™ implant surface is based on the OSSEOTITE® surface which has been successfully used in implanotology for more than 10 years. The combination of OSSEOTITE® surface and the technology of discrete disposition of calcium phosphate crystals (CaP) create a more complex surface topography that makes the maximum use of calcium phosphate's biological benefits. This technology is the key to a favourable response by a patient to a dental implant and improves the predictability of clinical results. Pre-clinical studies have shown a significant increase in the rate and degree of osseointegration (survival) of NanoTite™ implants compared to all other implants present on the market. This type of dental implants may be preferable in the following cases:
- immediate and early loading (crown fitting)
- one-stage implantation (implantation immediately after tooth extraction)
- in aesthetically important areas where maintenance of the bone tissue is of great significance
- implantation in the areas with poor bone quality
- implantation in the areas that require short or wide implants.
Replacement of a single tooth with a dental implant. Aesthetics One of the biggest challenges today is considered to be the replacement of a single tooth with a dental implant in an area visible to the patient and others (front upper teeth that can be seen while talking, chewing and smiling). Previously and about 20 years ago, the main objective of a dental implant was the osseointegration (engraftment of the implant). However, these days, an implant's ability to perform this task is unquestionable and the expected life of an implant is estimated in decades. The challenge today is to meet the patients' expectations of not only having a long-term functioning prosthetic implant, but also having an implant with a natural appearance, especially in a visible area. Implantation in this part (the anterior maxilla) is a task of a medium to high complexity. The International Team for Implantology has set a clear definition of the aesthetic standards required of implant-supported restorations: "Aesthetic prosthetic implant is considered one that is in harmony with perioral facial structures of the patient. Implants should be surrounded by healthy gums, which in thickness, color and contour are no different from the gums in the area of the adjacent teeth. Prosthetic design should mimic natural teeth in color, shape, surface nature, size and optical properties." This is the precise description of a well executed procedure. Therefore, we assess the aesthetic risk of the procedure before it is undertaken. The factors that allow us to estimate the aesthetic potential of the planned implant structures are:
- patient's expectations (how justified your expectations are)
- smoking (patients who smoked more than 10 cigarettes per day are at risk)
- height of the smile line (the extent to which teeth and gums are visible when chewing, talking and smiling)
Height of the smile line. The higher the smile line, the higher the aesthetic risk
- width and height of the surrounding bone and soft tissues (the larger the defect, the more difficult it is to achieve a good aesthetic result)
Large vertical defect in the location of the removed tooth
- somatic diseases;
- presence of periodontitis;
- the level of self-care and willingness to cooperate
Having determined the overall risk, we move on to analysing the likelihood of an unfavorable outcome. We then plan the process of replacing the tooth with a dental implant.
Any defects in the bone and / or soft tissues, if present, must be removed or addressed prior to or simultaneously with the implantation process. During the radiological examination, a surgical template made of wax is prepared. The template is used during the surgery to assist with the installation of the dental implant.
Following the attachment of the dental implant, a temporary construction is prepared and fixed to the dental impant for a certain period of time ranging from several weeks to several months. The following are the options for an ideal temporary implant structure that replaces a single tooth:
1. Prosthetic bridge.
If the adjacent teeth are to be covered with crowns, a temporary bridge will provide excellent function and aesthetics.
2. Fixed prosthesis made of fiber reinforced plastics.
If the patient's bite permits, it is possible to attach a crown with wings that stick to the palatal (inner) surfaces of adjacent teeth.
Fixed prosthesis made of fiber reinforced plastics
3. Orthodontic fixation.
If the patient is simultaneously undergoing an orthodontic treatment (braces), we can fix the crown to the arc.
The crown can be fixed in a mouthguard produced in a thermal vacuum apparatus.
5. A removable partial denture.
This is a detachable design supported by the roof of the mouth and adjacent teeth.
A removable partial denture
The choice of the implant installation procedure depends on the circumstance of each patient. The possible timelines are:
- replacement of a tooth with a dental implant may be done immediately after the tooth extraction; or
- implantation may take place 5-6 weeks after the tooth extraction; or
- implantation may take place 4-6 months after the tooth extraction.
In any of the above three cases, a permanent construction may be fixed either immediately or three months following the placement of the implant.
The surgeon will make the decision as to the most appropriate timeline and method on a case by case basis.
Typical implant surgery follows the following steps: an incision is made to remove soft tissue, exposing the bone, under a local anesthesia. The implant is inserted into the jawbone, covered with soft tissue and sutured.
The fusion of the implant with the bone takes approximately 3 months. In the meantime, a temporary prosthesis is used to cover the implant. Twelve weeks after the operation, the second surgical stage takes place over 14 days and aims to establish sufficient gum tissue.
The next step involves the fixing of a provisional (temporary) crown that assists with the forming of the gingival contour. The temporary crown must remain in place for about 3 months, following which a dental technician will create a permanent construction (crown).
Teeth 11 and 21 are removed due to a significant loss of hard dental tissue
Installation of two dental implants in the area of teeth 11 and 21
Transfers are fixed and used to take impressions to fabricate temporary restorations
Temporary structures are fixed to enable the surrounding soft tissue to form
Soft tissue has formed and ready for the fixing of permanent crowns
Permanent solid ceramic restorations (crowns) have been attached
The process described above is a summary of the modern protocol for the replacement of a single tooth with a dental implant. The temporary crown attached to the implant can be made of cement or ceramic with a screw fixation. The permanent crown can be manufactured from an all-ceramic or ceramic-metal material with a screw or cement fixation. The type of prosthesis is choosen by a dentist, taking into account the depth of the implant platform and its tilt axis.
Implantation in case of a partial loss of teeth
Implantation in the event of a partial loss of teeth has its own certain characteristics and requirements. During the planning stage, it is important to take into account the number of missing teeth and the degree of atrophy of the alveolar bone (the area that previously housed the missing teeth). Before implantation, a surgical template is made and used to correctly positioned the implants.
Surgical template in the mouth area
With the loss of 7-8 molars, it is recommended that one implant is introduced; in case of the loss of 6-8 molars - between 1-2 implants are recommended; absence of 5th to the 8th molars - 2-3 dental implants are used; and between the 4th and the 8th – three implants. Implants are installed at a distance of 1.5 mm between the implant and the adjacent tooth and 3 mm between the implants themselves.
Optimal distance between implants and teeth
The alveolar bone should have a thickness of 6.7 mm and the height of anatomically relevant area should be not less than 8 mm. Where necessary, the volume of the bone tissue can be increased. It is not recommended that one orthopedic construction is used to connect teeth and implants, as this may lead to a short lifespam of the implants. Implantation for a partial loss of teeth is usually accompanied by medical sedation.
"Clinic of Aesthetic Dentistry" performs dental oral surgeries of any complexity. For more details, please visit our website at www.kes.com.ua or call us on 044-230-83-88.