1. BASICS OF IMPLANTOLOGY
Implantology is a branch of dentistry which has contributed in a large part to the development of the dental medicine, to the satisfaction of the patients. It is, in fact, a combinatory discipline of oral surgery, periodontology and dental prosthetics. The beginnings of the science of implantology can be traced down to more than fifty years ago when the first dental implants were installed. Nowadays, it is, most definitely, the most developed branch of dental medicine which is developing even very quickly. The implantology offers solutions for all kinds of anodontia (toothlessness). Implants are installed in case one or more teeth are missing, anodontia or in case of people who are not satisfied with their denture. If you want to improve the quality of your life, natural chewing and biting function, and improve the aesthetic impression, teeth implants are the only worthy replacement for your natural teeth.
What is a dental implant?
Dental implants are titanium (bio-compatible material) replacements that are surgically installed into the bone tissue of the upper or lower jaw (the procedure can be long or short, but completely painless), which serve as a replacement of the natural root and carry the future prosthetic replacement. Implant instalment is a painless routine procedure conducted under a local anaesthesia. Depending on the type of implants and the length of the procedure, there are also other kinds of anaesthesia that can be used (see under Sedation). Once the implants have grown into the bone (osseointegration), implant represents the replacement root which serves as a basis of other prosthetics, even as a better one than the natural tooth. Upon the instalment of the implant, it can receive a fixed zirconium or ceramic prosthetic replacement which ensures a stable connection between the implant and prosthetic replacement; it can further receive a crown or bridge or even a denture.
Who can install the dental implants?
The implantology is recommended for everyone from twenty (when the development of the jaws and facial bones has already finished) to the elder age. An ideal patient is a patient of good health, both the general and dental one. People with chronic diseases, with high blood pressure, diabetes or similar conditions can only become a patient if their disease is under medical control. If the preparations are carefully done the complications occur rarely. There is a possibility of infections in the case of a bad oral hygiene, right after the procedure or within the first month. It can happen that the body rejects the implants, but it is a rare occurrence. Smokers, however, represent a risky group where the chances of success are reduced for 10 to 20 per cent, as a consequence of the toxic influence of nicotine and high temperature in the mouth during the phase of healing, but also as a consequence of tar settling due to a bad oral hygiene. A big problem, especially in the healing phase, is Peri-implantitis – an inflammatory process similar to periodontitis which can affect the soft and hard tissue surrounding the dental implants. Besides maintaining the perfect oral hygiene and going to the regular check-ups at the dentist, another possible treatment of this lesion is Helbo Laser system which effectively resolves the problem with the bacteria even in the most difficult situations.
2. PHASES OF IMPLANTOLOGIC PROCEDURE
(a) RTG diagnostics, analysis and the planning of the treatment
First, it is necessary to do a detailed diagnostics (2D ortopantomogram, CT 3D) and a detailed examination of the oral cavity just as the condition of the jaw bone. Only with CBCT 3D device it is possible to make a detailed plan of the implant procedure since it offers us a 3D image, a layered representation ( a bone cross-section up to 0.5 mm) and simple image editing. After an elaborated analysis of the planned procedure the dentist suggests a corresponding implant therapy to the patient.
(b) Surgical implant instalment within a single appointment
The very procedure of implant instalment in the bone structure is done in a single visit to the dental studio under the anaesthesia, quickly and painlessly.
(c) Osseointegration – attachment of the implant to the bone cells
It takes at least two to three months for the completion of the process of osseointegration, and sometimes even more. The patient, however, has a temporary prosthetic replacement which serves until the permanent prosthetic is installed after the osseointegration period is over. Sometimes it is necessary to do an extra procedure of thickening the volume of the bone and gum tissue surrounding the implant in order to improve the safety and the quality of the implant itself, but also the aesthetics, especially in the front region.
The only accurate method which shows the complete attachment of the implant to the bone structure and the completion of the process of osseointegration is the method of measurement with OSSTELL ISQ. OSSTELL ISQ is a diagnostic device which helps to measure the stability of an implant and the degree of the integration of the implant to the bone. Moreover, it gives the doctor the opportunity to make the right decision about the optimal time for loading the implants. The implant stability measurement with Osstell is an entirely non-invasive and it is conductible in a matter of few seconds. A SmartPeg attachment is mounted on the implant (SEE PHOTO) which is activated by OSSTELL ISQ emitting magnetic pulses. These cause the SmartPeg to resonate with certain frequencies depending of the stability of the implant. The resonance is picked up by the Osstell ISQ meter and the numeric values are displayed on a screen. The higher the values, the implant stability is bigger. A precise stability measurement is a very important diagnostic method which enables a successful therapy. If the measured values are very low it means that the implant has not yet been integrated completely and it is necessary to wait a bit more before loading it.
(d) Laser implant opening and the final phase – taking impression and making the final prosthetic replacement for implants
With Laser we can immediately make the impression, which is a lot more comfortable for the patient and saves both the patient’s and doctor’s time. You can read more about the prosthetic rehabilitation and the type of work in the chapter “Types of works on implants”.
(e) Regular check-up
The actual check-up begins before the very implant procedure as arranged with the staff of the dental studio. Once the implants are installed it is essential to take care of keeping your mouth clean. The oral hygiene is maintained with the use of special liquid preparations and gels, which we will suggest to the patient, and with special soft brushes for the post-operative period. Every patient gets a code conduct to respect before and after each procedure with the clearly explained rules of behaving and maintaining the oral hygiene. After the patient has been explained what kind of the temporary and permanent job is to be done, the professional staff of the studio educate the patient about the very procedure, first demonstrating it on a phantom head, and later in the patient’s mouth focused on the job itself. At the beginning, every month, and later once or twice a year, it is necessary to do a check-up and a RTG image. The dentist – surgeon controls the condition of the implant and the bone around it, soft tissue, oral hygiene, plaque and the condition of the very superstructure. Everything is written in an Implant Passport – a document which contains all the information from the beginning of the surgery, type of implants, upgrade, temporary and permanent prosthetic replacements on the implants, dates of check-ups, possible changes, etc. The patient has the greatest responsibility for the successful and long-term outcome of the implant-prosthetic treatment. A careful oral hygiene is the top priority since the dental plaque forms calculus which leads to the inflammation and gum tissue and bone recession on the place where the implant is installed. It all leads to the implant exposure and, in certain cases, to the implant loss.
3. PROSTHETIC REPLACEMENTS ON THE IMPLANTS
Once the implants are installed, the patient can get a fixed replacement on the implants or a mobile denture secured on the implants, depending on the number of the lost teeth.
ONE TOOTH MISSING: If you have only one tooth missing, the implant is the best solution since in that case we conserve the surrounding healthy teeth which would have to be drilled if you were to install a classic bridge. Also, the implant represents a long-term solution of a higher quality than a classic bridge.
MORE TEETH MISSING ON ONE SIDE: If you have more than one tooth missing, we do bridges on the implants, where the implants serve as the support for the bridges. They are the most natural replacement for your natural teeth. In this way, we avoid the mobile prosthetic solutions and preserve the natural teeth. At the same time, the patients get a more natural and more comfortable replacement which functions as the natural teeth, which helps with one’s self-confidence and personal satisfaction.
ALL TEETH MISSING: Many patients who have lost all of their teeth in the lower jaw cannot wear a classic denture.
For these patients we recommend coverdenture (overdenture) with two installed implants in the front region on which the special abutments are placed (Locator or Ball Abutment) whose main aim is to stabilize the denture and make it highly functional.
Patients whose bone structure is weak and who do not fulfil the conditions for getting the implants in the lateral dental region are recommended to get a Hybrid denture with a super-construction on four implants. These kind of dentures are firm, stable and notably smaller than a classic mobile denture, and, conveniently, can be removed when they need to be cleaned.
Fixed bridge on the implants
Sometimes, when doing the fixed restorations it is possible to reduce the number of implants, and sometimes it is necessary to do additional bone regeneration and increase the number of implants.
CIRCULAR BRIDGE ON 6 IMPLANTS / ALL-ON-6: This type of work is most often done in the upper jaw where the maxilla bones are softer.
ALL-ON-4: This is a relatively new method which comprises the making of a fixed prosthesis containing from 10 to 12 teeth, fixedly placed in the anterior maxilla on four implants. This method is particularly advisable to the patients who do not have enough bone structure in the lateral dental region for a classic implant instalment. In this way, it is possible to fixedly rehabilitate the condition of a complete anodontia, without having to do additional bone regeneration (augmentation). All-on-four enables us to make quick fixed temporary bridges the very same day and the patient will get fixed teeth in a time period from 12 to 24 hours. The procedure is called immediate loading implant procedure. These teeth, both aesthetically and functionally, imitate our natural teeth perfectly. After three to four months the final prosthetic replacement is made which is placed on the implants. The concept of immediate loading can be applied when replacing one, more or all teeth in the jaw. Still, this technique is not applicable to every patient and to every situation. Our expert team takes care of your teeth and they guarantee top quality.
ADVANTAGES OF THE “ALL-ON-FOUR” METHOD
COMPARISON WITH THE MOBILE REPLACEMENTS
One of the factors of the successful integration is the quantity of the bone in which the implant is installed. In the case the patient has not had his teeth for a couple of years, if he or she is wearing prosthetic replacements or if the patient is left with great defects after the extraction of the teeth, the volume of the needed bone structure is often very questionable. If this would be the case, it is necessary to perform different surgical procedures of bone augmentation by adding an artificial bone or bone block a couple of months before the implant instalment or during the instalment procedure; it all depends on the situation.
ALVEOLAR RIDGE PRESERVATION
It is the procedure of bone regeneration in which a replacement bone material is placed in the alveolar ridge of the extracted tooth. In this way, we create a better and safer foundation for the future implant instalment and we, also, reduce and prevent the biological bone loss after the extraction.
RECONSTRUCTION OF NARROW BONE RIDGE
It is a process of widening the narrow bone ridge by using different techniques and materials, depending on the situation. The most commonly used technique is the autologous bone graft technique, Split Crest system, SonicWeld Rx® and similar.
Guided bone regeneration is a procedure which utilizes barrier membranes, tissue-stimulating proteins or bioactive growth factors. Sometimes it is necessary to use a bone from other parts of the body or a synthetic bone. The aim of the guided bone regeneration is the stimulation of the body to create a new bone tissue or keep the space for a new bone. Furthermore, this surgical procedure helps the body to restore the tissue lost after a periodontal disease. Also, with this procedure other teeth in the jaw have bigger chances of remaining healthy, while the procedure itself reduces the possibility of the development of more serious heath complications connected to the periodontal disease. The denture will be more comfortable, so if you are thinking about getting the dental implants take this procedure into consideration. Sinus lift is a very effective way of bone regeneration when a patient has lost a larger number of teeth in the lateral, back region of the upper jaw. It is, in fact, a surgical procedure of lifting the floor of the upper sinus. The treatment begins with the opening of the gums at the border of the sinus. The treatment consists of raising the sinus membrane in order to insert the granules of the replacement material which eventually transforms into bone which enables the instalment of one or more implants DENTAL HUBE.
5. COMPUTER-GUIDED IMPLANTOLOGY
It is based on a 3D implant templates which enable us the implant instalment on those places where you cannot afford yourself to make a mistake. It is the method in which the dentist, patient and dental technician cooperate to make the plan for the making of the final product. The surgical procedure of the implant instalment is computer-planned: the entire procedure is conducted by utilizing a minimally invasive flapless surgical technique. In this programme it is possible to plan the complete procedure of the implant instalment, including their number, length, diameter and angulation, but also different replacements which serve as a support for the fixed prosthetic construction.
Protocol for preparing surgical template:
1. The first step is to make a CBCT 3D image of the jaw on the basis of which the therapy plan is made. 2. The software has the possibility of conversion of the DICOM file to 3D objects of jaw bone and radiological templates. The borders of the soft tissue and the surrounding teeth (if there is any), all vital structures (alveolar nerve, dental nerve, jaw sinus, etc.) are clearly indicated. 3. The therapy plan is forwarded to the factory, where a special surgical template is produced. With this template, the technician in the laboratory makes a temporary or even the permanent prosthetic supra-construction, using a wide spectre of replacements. 4. Finally, with the same template and with pre-prepared prosthetic replacement, the implants are being installed by utilizing a minimally invasive technique, which is, at the same time, very precise and safe. On average, the entire procedure of implant instalment lasts less than an hour. The patient gets implant(s) and prosthetic supra-construction. After the procedure there is no need for taking a sick leave and the patient is spared from the majority of inconveniences which normally follow the conventional implant instalment procedure. The total number of appointments is lesser than when undergoing the usual treatment. In that sense, there is another advantage for the surgeon: the operating room is less occupied, the number of possible mistakes is minimized, and, finally, the procedure gives the surgeon opportunity of a greater surgical and prosthetic preciseness.
FOR A MORE COMFORTABLE FEAR-FREE TREATMENT
Our dental team can make your more complicated procedures, even the surgical ones, easier by using the sedation.
Sedation does not mean a general anaesthesia! What we deal with here is a controlled conscious anaesthesia administered by a specialized anaesthetist during which the patient is wide awake and communicates with his or her surroundings, but does not feel any pain or discomfort.
Dental procedures can be a little long, but in that way, in a single appointment, even more complex and demanding procedures. This method is usually used with bigger procedures and it is the first choice, both for the patients and doctors since the doctor is more comfortable, while the patient feels safer, he or she is not afraid and does not feel any pain.