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Implantology is one of the most modern methods which enables us to solve the problem of missing or removed tooth efficiently and reliably. Although the follow-up after treatment of the implant allows the patient’s life almost forgotten about once experienced the problem and does not require special care, the same implantation process can be both relatively simple and complex and include some or all of the following steps.
In most cases, the patient is willing to obtain the most detailed information on what and how will be performed during the initial consultation. Unfortunately, such information can only be provided in simplest of cases, when the patient’s bite is correct, and only one or several teeth are missing. In these cases the patient immediately gets acquainted with the proposed treatment and the time for surgical or therapeutic procedures can be estimated. However, often much more problems exist and they are more complex, requiring more in-depth analysis. In these cases, the patient’s teeth and mouth are scanned, the scans are retained and an additional consultation is planned in order to present the treatment plan.
It is required to have a panoramic radiograph. If it is missing, a panoramic X-ray or CT scan can be made directly at the clinic. What is the difference between those two? The panoramic radiograph is a two-dimensional shadow image of jaws and teeth. Computed tomography is a three-dimensional volumetric image that allows analysis of the jaw and teeth, where they like real can be turned in the right direction to see the desired section, select the segment of tissue of specific density. In terms of diagnosis, a panoramic radiograph and CT scan are like a car and a plane in the field of transport.
Dental radiograph (dental x-ray scan) – this simple method is applied the site of the problem – the causal teeth – are already identified. By means of this scan it is possible to see a very precise image of crowns and roots of one-two teeth. This scan is taken when the image on the panoramic scan is washed away or not sufficiently sharp to determine the processes unfolding around the tooth. Irradiation with this method is equal to the dose of the natural irradiation, obtained in half a day (5-7 microsieverts).
Panoramic radiograph is a scan, which is necessary for a good initial consultation. A good consultation is not practically possible without this scan and therefore the patients are required to have this radiograph, and if a patient does not have one, such a radiograph can be made directly in the clinic. A panoramic radiograph is a good reflection of all teeth, both jaws, upper maxillary sinuses and mandibular joints. This radiograph enables the doctor to evaluate the state of all teeth, the general state of periodontium, pathologic processes in the sinuses, passability of mandibular channels, position and form of the heads of joints. This radiograph is sufficient for the planned surgical tooth removal, regular implantation of one or several teeth. Irradiation with this method is equal to the dose of the natural irradiation, obtained over the period of four days (15-25 microsieverts).
Cone-beam computed tomography is a professional method which provides a 3D view of jaws and teeth. This procedure provides invaluable information for planning the implantation, reconstruction of bone tissue or sinus-lift surgery. 3D images enable the doctor to foresee all anatomical difficulties and obstacles, expected during the surgery, and if these are known, the surgery can be planned accurately and the obstacles can be avoided. Computed tomography is especially valuable, when it is necessary to decide, whether a patient needs bone grafting of his own bone tissue or application of artificial bone substitute would be sufficient, since this radiograph makes it possible to estimate the thickness of the bone, which it is not visible on a regular panoramic radiograph. Furthermore, while the implantation is being planned, the image of the section of jaw makes it possible to see the mandibular canal and localisation of the branch of trigeminal nerve. Having accurately measured its position, the possibility of damaging the nerve is practically excluded. Cone-beam computed tomography also enables the doctor to evaluate content of sinuses, which are, as a rule, invisible on a panoramic radiograph. Irradiation with this method is equal to the dose of the natural irradiation, obtained over the period of 15-20 days (75-120 microsiverts).
Spiral computed tomography is a CT scan, which is achieved by means of a medical CT scanner. Its resolution is even better than of a cone-beam computed tomography, but its application for dentistry purposes becomes less frequent, since cone-beam computed tomography provides lower irradiation levels. Irradiation with this method is equal to the dose of the natural irradiation, obtained over the course of 150-200 days (700-1100 microsiverts).
One tooth is missing
Procedure:
After local anesthesia, the gums are uncovered and the implant is placed into the bone. The implant is sutured under the gums or a higher cap is placed onto it. The operation takes 10 to 20 minutes. If the implant is sutured under the gums, the procedure for establishing the healing cap is held 3-4 months after the implantation.
Is the procedure painful?
During the procedure, the patient does not feel pain. The patient may feel pressure at the operated area or discomfort during the preparation of the bone, just the same way as during any other dental procedure.
The postoperative period
After regular implantation the patient does not lose any ability to work and may come back to work the same day. However, we recommend having a rest on the day of implantation, chilling the area where the surgery was performed and giving up vigorous activities. It is recommended to avoid sports and intense physical activities 24 hours after the surgery.
Please refrain from smoking at least a week, or reduce the number of cigarettes smoked to a minimum.
Prescriptions
After implantation, the antibiotics are usually not prescribed. Instead, patients are usually prescribed a single dose of antibiotics. Painkillers are also prescribed which are useful on the day of surgery and the next day. Most patients specify that only 1-2 pills were necessary to soothe the pain, and then medications were no longer needed.
Doctor’s advice
If in a few days after implantation the pain gets worse, an unpleasant odor or redness of the gums occurs, a visit to the doctor must be made.
Financial expenses
This price of implantation does not include the production of a dental crown.
Implantation with bone augmentation is grafting of the bone with artificial bone tissue or patient’s own bone during implantation. This procedure is performed when despite the atrophy, the amount of the jawbone is sufficient enough to place the implant, however, the bone around the implant is very thin and in the end may become completely atrophied.
The causes of the jaw atrophy:
Cases when the implantation can be performed with bone augmentation:
Stages of implantation with bone augmentation:
Is the procedure painful?
During the procedure, the patient does not feel pain. The patient may feel pressure in the operated area or discomfort during the preparation of the bone, likewise any other dental procedure.
The postoperative period
After a regular procedure the patient does not lose ability to work, but some swelling can appear during two to three days, and in rare cases – a bruise. Usually the patient can return to work on the next day. On the day of surgery it is recommended to have a rest, chill the area where the surgery was performed, and to refuse more vigorous activity in order to avoid more active bleeding and increased swelling. It is recommended to avoid sports and intense physical activities for two to three days. Please refrain from smoking at least a week, or reduce the number of cigarettes smoked to one or two a day.
Prescriptions
After implantation with bone augmentation a course of broad-spectrum antibiotics is prescribed. Antibiotics are needed to reduce the risk of infectious complications, while blood circulation reaches the bone. Painkillers are also prescribed which are useful on the day of surgery and the next day. Most patients specify that only 1-2 pills were necessary to soothe the pain, and then medications were no longer needed.
Doctor’s advice:
If in a few days after implantation the pain gets worse, an unpleasant odor or redness of the gums occurs, a visit to the doctor must be made.
Financial expenses
This price of bone augmentation does not include the production of dental crowns and gingival plasty (when there is a lack of gums attached around the implant, it may be a necessary procedure).
Sinus lift surgery a surgery which is performed in order to increase the sinus floor by augmentation of the lower sinus wall with bone tissue substitute or patient’s own bone.
Sinus is a cavity within the upper jaw, which is connected with the nasal cavities and is lined with a mucous membrane.
Lowering of the sinus can be caused by:
In which cases the sinus-lift surgery is performed?
Is the sinus-lift surgery required?
If the implants are necessary, however, upon the assessment of the upper jaw, the doctor concludes that the sinuses have increased or lowered and the bone height to the sinus is too small to stabilise the implant, the sinus lift surgery is required.
Alternatives to sinus lift surgery
When the bone is 6 mm in height, and of good quality, it is possible to place short implants and expect the same success as the sinus lift surgery and long implant placement provide. However, the long-term results (> 10 years) of such treatment are not yet known.
Stages of the sinus lift procedure:
It is useful to know:
Doctor’s recommendations:
With the loss of the molar teeth of the upper jaw, be sure to consult your doctor immediately. With time the quality and height of the jaw is changing rapidly, sinuses expand and decrease, at the same time reducing the height of the bone. Then the possibility of placing an implant without sinus lift surgery is very low.
Grafting of the bone block is a transplantation of a patient’s own bone block at the area of resorbed jaw bone. A piece of bone is taken from the lower jaw or chin and is placed in the area of defect. This procedure is performed when the jaw is severely damaged, the width and height have changed and it is not possible to perform implantation.
Reasons of jaw destruction:
When is the bone block transplantation performed?
Is it necessary to perform the transplantation of bone block?
If your jaw is severely disrupted in a course of many years after teeth loss, but there is still a need for implantation, then it is necessary to perform the transplantation of bone block. Quite often it is possible to apply simple methods with the use of the artificial bone, but there are cases when the transplantation of one’s own bone is necessary.
Stages of the bone block grafting:
What happens to the area from which the bone tissue was taken?
After the surgery:
It is useful to know:
In which cases bone grafting is not recommended?
Doctor’s recommendations:
The transplantation of bone block is required only in severe or post-traumatic cases. In the course of time the quality, height and width of jaw is decreasing rapidly. Then the possibility to place implants is low. It is recommended to consult a doctor immediately after the tooth loss, as in such cases a regular implantation is sufficient and the timely restored quantity of teeth allows avoiding extra financial expenses and expenditures of time, plus the procedure is much simpler.
Tooth transplantation is the process of placing the forming tooth bud into the space of a missing tooth. The transplanted tooth bud forms and grows as a new full-fledged tooth. Tooth transplantation procedure can be performed when the space in the jaw is large enough and the size of a tooth bud is sufficient (visible on a radiograph).
The reasons of not grown or not fully grown teeth:
– Congenital pathology, when one or more tooth buds are missing, is not a rare phenomenon. If a bud is missing, the tooth is missing, too
– Trauma which leads to the loss of one or more teeth
– Tooth is removed due to deep caries, fracture or severe inflammation.
How to solve this problem?
– Solution for adults whose tooth did not grow in childhood is implantation, whereby the missing tooth in a few months is replaced by an artificial tooth.
– Titanium implants cannot be placed for children, as jaw growth has not stopped yet and the implants “migrate”.
– Implantation is only possible from the age of 18. Due to a missing tooth (especially the front tooth), the child may experience discomfort, while dentures are not comfortable and contribute to the destruction of the bone, which further complicates implantation in adulthood. Thus, the best solution for a child is tooth transplantation. Once the tooth is transplanted, the jaws grow and form, and the tooth is growing along with them.
At what age transplantation of a tooth bud can be performed?
– In childhood and adolescence, the results of transplantation are the best, because at this time the roots and buds of the permanent teeth are not fully formed.
– Tooth transplantation in adulthood can be performed, however, no teeth buds – the teeth are already fully formed, and as a result the transplanted teeth are not always full-fledged.
What a tooth bud is?
– Tooth bud consists of a follicle, which contains the emerging tooth. Firstly, the tooth crown is formed, secondly – the root, and lastly – the root tip.
– During formation of the tooth bud, the crown is visible out of the follicle, then the roots, and as the apex closes, the follicle disappears, hence the teeth, are so to say, born out of the follicle.
Which tooth buds can be transplanted?
– It is best to transplant tooth buds, the roots of which have already begun to form, but have not yet fully formed (when they are surrounded by the follicle)
– Transplanted tooth settles in a new place and the roots continue to develop in the follicle, which become with already formed roots is transplanted, and not the tooth bud, it usually settles, but due entirely formed root tips, blood vessels cannot enter, therefore, the tooth needs to become not alive before transplantation (root canal treatment)
– If not a tooth bud but a tooth is transplanted, and the tooth often fuses with the bone not via the periodontal ligament (semi-flexible connective tissue), but directly with the bone (stationary), and in this case it is impossible to move the tooth orthodontically and the roots eventually start to collapse (root resorption develops)
Tooth buds of which teeth can be transplanted?
– In cases, where dental transplantation is considered for solving the problem of missing front tooth the tooth bud of a premolar is chosen. In order to avoid causing space, the teeth are shifted one towards another during the orthodontic treatment.
– When a molar or a premolar is missing, the situation is less complicated, as if a patient has the wisdom tooth buds (and most often one has them), it is necessary to wait until the buds of required size are formed and transplant those. The wisdom tooth buds do not have to be retained since the teeth of wisdom are more often removed than treated and sometimes even cause serious problems if their growth process is complicated.
What happens to the gap which occurs once the tooth bud is taken?
Certainly, a tooth is missing there and moving the tooth from one space to another while the amount of teeth remains the same might seem to be illogical.
In fact, some teeth are more important than other. For example, the front teeth play the most significant role as their loss causes social problems, too. The other teeth, such as premolars or molars, are important as well, however, their loss results in fewer social problems. In cases of overcrowded teeth and lack of space for alignment by means of braces, premolars are sacrificed. In cases, where dental transplantation is considered for solving the problem of missing front tooth the tooth bud of a premolar is chosen. In order to avoid causing space, the teeth are shifted one towards another during the orthodontic treatment.
What happens to the tooth bud after the transplantation?
The tooth is immobilised for about 10 days. After three months the orthodontic treatment begins and the tooth is moved from its original position to the targeted place.
What tests are required?
– Panoramic radiography of mouth
– Computed tomography (CT) – in cases when it is unclear on which side of the jaw the bud grows
Is the procedure painful?
During the procedure, the patient does not feel pain since local anesthetics are applied.
Stages of transplantation
The surgery lasts from 30 minutes to an hour, depending on whether the tooth bud extraction is complicated:
– Local anesthetic is applied
– Defective tooth is removed or if a tooth has been extracted a long time ago, a special site is formed in the bone for transplanting the tooth bud
– Gums are uncovered, and the tooth bud along with the follicle is extracted
– The tooth bud is settled and gums around it are sutured, and thus fixed in the new location
– In some cases, the tooth bud is attached to the adjacent teeth with a metal wire
Stitches are removed a week after, and after a few months orthodontic treatment begins and the tooth bud is being grown in a proper position.
Postoperative period
Like after the tooth extraction, some swelling after transplantation can be felt and noticed for several days. Pain is controlled with painkillers.
Prescriptions:
– A course of antibiotics is prescribed after the transplantation;
– Painkillers are also prescribed which will be useful on the day of surgery and the next day.
Doctor’s advice:
It is recommended to prevent the site where the tooth bud is transplanted from chewing so that the wound is not affected.
Possible consequences:
– The tooth bud can settle, the normal roots form and the tooth can become a fully-fledged tooth.
– The tooth bud may fuse with the jaw bone, and in that case it will become immovable and the change of its position would be impossible. This happens when the tooth bud is transplanted with roots which have almost formed, or when the tooth is transplanted which has already formed.
– The roots of the teeth can collapse, and in this case, longevity of the tooth is reduced.
– 95% of transplanted tooth buds settle and full-fledged teeth are formed, which makes this method of treatment successful and biologically sound, and allows to avoid future implantation.
A healing cap is a screw with which the soft tissues are formed in such a way that after prosthesis there would be contact between gums and ceramics, and it would look like a natural tooth. It can be placed immediately after implantation or 3-5 months later, after implantation. Healing caps come in different sizes, they can be selected according to the size of the implant.
Is the procedure painful?
This is quite a simple procedure, during which no pain is felt.
Stages in healing cap placement
Placement of a healing cap takes about 10 minutes:
Prescriptions
Only pain medication is prescribed after this procedure, but most patients do not feel pain.
Doctor’s advice:
If after a few days pain, swelling or red gums occur, it is advisable to consult a doctor who performed the procedure.
Financial expenses
The cost of a healing cap is included in the price of an implant.