Prosthetics on implants

Indications for implant prosthetics

• The absence of one tooth, in the presence of adjacent healthy teeth.
• Absence of terminal chewing teeth.
• The therapist is forced to do his job by eye, this does not give an entirely accurate result.
• The absence of one or two supports for the installation of a bridge prosthesis.
• Complete absence of teeth (if the patient refuses or is unable to fit a removable denture for one reason or another).

Types of Implant Dentures

First of all, there are fixed and removable types of prosthetics.

There are two types of attachment among fixed types of prosthetics:

• on the cement,
  when the crown is attached to the abutment with a special prosthetic cement and it will be impossible to remove it without replacing the crown..

• screw, it is also called conditionally removable,
  when the entire structure: crown, abutment and implant – are connected with a special screw, and the doctor, if necessary, can disassemble the structure in the clinic..

The choice of attachment method is determined by the doctor and the patient.

Fixed implant prosthetics

Button-lock dentures

Once in this lock, the implant head is securely fixed, making it impossible for the prosthesis to shift during chewing or talking. In addition, it is quite easy to remove prostheses fixed in this way by yourself — it is enough to master one special movement.

Implant prosthetics with bar constructions

Similar to the previous method, three or more implants are initially inserted into the jaw bone, but a metal beam is inserted between them and an appropriately shaped recess is created in the base of the removable denture. This ensures that the prosthesis is securely fixed in the oral cavity and will not move during active jaw movement.

Mini Implant Dentures

In the case of mini-implants, very thin and small implants are used, which are placed with minimal surgery. The bone does not even have to be drilled, as the implant is simply screwed into it like a self-tapping screw. However, it should be borne in mind that the purpose of mini implants – is only to support removable prostheses, as they are not able to withstand the full masticatory load, and the main load is taken by the removable prosthesis.

Stages of implant prosthetics

Consultation

Visual assessment of the condition of the oral cavity, examination of the patient, the patient's medical history is clarified, what diseases have been acquired to this point. Whether there are any limitations or contraindications.

Diagnosis

A 3D computerized examination is performed so that we can see the jaw and teeth of the patient in volume. Impressions are made. It is mandatory to compare the image with impressions of the patient's teeth in order to plan the correct position of the implant, so that the crown is not only functional, but also aesthetically pleasing. Additional tests may be required. To rule out health problems that are contraindications for implantation.

Orthopedic planning

The choice of prosthetics techniques, implant models, and their number.

Based on the type of future prosthesis, the doctor will determine how many implants will need to be implanted in the patient:

• If 1 tooth is missing, 1 implant is implanted;
• If 1 to 3 teeth are missing, 1 to 3 implants are implanted;
• If a conventionally removable denture is placed, up to 4 implants will be needed for one jaw;
• If there are no teeth at all, it is possible to implant up to 10 implants in one jaw (this number is used when placing a fixed horseshoe bridge).

Surgical planning

The individual characteristics of the patient such as the passage of the mandibular nerve, the location of the maxillary sinus, the type and thickness of the jawbone are determined. If there is not enough bone tissue, which is often the case in patients who lost their teeth long ago, a bone grafting procedure or «sinus elevator is prescribed».

Surgical template

When preparing a patient for the implantation of several implants, planning will include the process of manufacturing a surgical template in which holes will be made at different angles. This is a very important procedure, as it allows you to choose the drilling angle not by eye, but taking into account how the patient's jaw will behave during the procedure.

Absolutely, we are talking about creating a surgical template if we are talking about terminal defects. There are situations when, even with single teeth, there is a need to install on a surgical template.

Bone augmentation

It is required if its volume is insufficient for implant placement (performed by grafting natural or artificial bone material). This procedure can last more than 1 month.

Gumplasty

A surgical procedure that is sometimes required when the gum contour changes, mainly due to bone atrophy.

The planning stage is important because it is designed to eliminate any errors that may occur in the subsequent stages of prosthetics, any unaccounted for little things lead to the fact that the implants do not take root and the procedure must be repeated.

Discussing a treatment plan

The doctor presents the patient with a treatment plan with clinical steps and prices. If possible, offers several treatment options.

Oral sanitation

• Treatment of teeth and gums, plaque and tartar removal, which helps to restore the natural color of enamel – this is needed to match the exact shade of dental crowns;
• Removal of problem teeth under local anesthesia, prescribing medications and giving recommendations for comfortable postoperative rehabilitation;
• The stage of healing the traumatized gum and rebuilding bone tissue in place of the extracted teeth. This may take 2-4 months;

Dental implants and prosthetics

Sometimes it is possible to place implants immediately on the day of tooth extraction, if anatomical features allow. Otherwise, the implant is placed on average 2-4 months later and a temporary removable prosthesis is placed for the period of implant placement: a temporary abutment and crown. The temporary prosthesis is made individually to the beginning of the implant surgery. At «Konfidencia» we use a temporary composite crown. It is based on a modeled tooth shape made on the basis of impressions of the patient's teeth.

As for the dentition with teeth to be extracted, an impression is made, a technical task is prepared for the technician with notes on the removal of specific teeth. The technician, taking into account the patient's anatomy, removes the teeth on the model and makes a prosthesis. This prosthesis can be used both immediately after the tooth extraction surgery and after the implants have already been placed. One or two more visits may be required to correct the denture so that it is comfortably fixed in the mouth.

The standard protocol is usually as follows: implants are placed, after which a temporary crown is placed, followed by a permanent prosthetic restoration after 2-3 months, depending on the clinical situation.

If orthodontic treatment has been performed, a permanent crown is placed 4-6 months after the orthodontic treatment has been completed.

If no orthodontic treatment has been performed, the temporary crown can stay in the mouth from 3 months to 6-8 months. After that, it is replaced with a permanent crown.

When it comes to front teeth prosthetics?

The most common indication is a single-stage loaded implantation. When a tooth is extracted, an implant is implanted, a temporary abutment and a crown are placed in one appointment. This is the aesthetic zone, this is the smile zone. If there are no foci of infection and there is enough bone tissue, we can plan such an operation.

Medical limitations to implantation

Medical restrictions on implantation are general: blood diseases, oncological diseases, mental disorders, severe thyroid diseases – all these will be specified and examined at the stage of consultation and diagnosis.

That is, before extracting a patient's tooth, doctors know exactly what design can be used to restore its absence.

Is implantation possible in pregnancy?

Impossible. Pregnancy and lactation – it is a stressful change of hormonal background in a woman's body. The density of bone tissue changes. In the same period there is also an increase in caries, associated with changes in calcium metabolism. Therefore, it is absolutely impossible to be implanted and prosthetics during this period. Implantation is planned after the patient has finished feeding.

Is implantation possible in older adults?

Most often with age there is a change in hormonal background, calcium metabolism changes. And the change in the level of thyroid hormone leads to the fact that bone density goes into the age category. After 65 – this is a risk zone, it is not a contraindication, but a risk zone. By 65, the patient has some other acquired disease that may be a contraindication to implantation. In such patients, the risk associated with this or that procedure increases.