Course of implant insertion
Implant surgery. If a tooth is lost, replacement is recommended, as soon as possible. If we wait with the restoration, bone loss is inevitable and delay of the implant placement will result in loss of the bone mass. The root of the extracted tooth can be replaced in the same session (immediate implantation, straight after extraction) or 6 weeks after the extraction (immediate-delayed) or at 4 month after the extraction of the tooth (delayed). The surface of the implants contains specially designed microscopical pores that will be occupied by the growing bone cells.
Prior to implantation, a medical questionnaire and a consent form will have to be completed by the patient. The medical questionnare obtains information about the general health and the previous dental history of the patient. The medical questionnaire covers history of oral diseases, current medications and questions regarding the overall health. This allows the identification of the contraindicting and risk factors. A subsequent clinical and radiological examination is required before the insertion of any foreign material (implants).We inform the patient about the possible inconvenience of the intervention. The dental implant can be considered as a tooth root, so it is called as artificial root, as well. Prior to drilling the bone a gum flap is prepared or alternatively a flapless approach can be executed. After the drilling the hole the implant is screwed into the bone. Majority of the implants are placed under local anesthesia.
One stage procedure is convenient for patients heving enough gingival thickness. With this procedure the implant is set into the jawbone and a healing abutment closes the implant. The gum flap does not cover the implant. The foreign body is exposed to the oral cavity. No need for the liberalization of implant.
A two-stage procedure is used for replacing teeth when there is no need for an immediate cosmetic solution. With this approach, the implant is placed into the jawbone and covered with a cover-screw and with the gum flap. The foriegn body is not exposed to the mouth.
The implant is set into a fresh extraction socket. The immeditae implantation can be a one-stage or a two-stage procedure similar to the implant set to the mature intact bone. If after a trauma the tooth needs to be extracted, usually the one-stage implantation can be made. After a minimal invasive surgical extraction of the tooth and in case of a high primary stability a one-piece implant or a temporary abutment can be used with a temporary acrylic crown. This is an immediate aesthetic restoration.
3D navigated implantation
The demand for more accurate implantation has driven the development of 3D navigation implantation system. 3D planning softwares are suitable for viewing soft tissues in different colors in real sizes. The planning program allows the virtual positioning of the implants in 3D. Based on the planning a surgical template is made, which is fixed at the beginning of the operation. At the planned sites, a bore is made through the gum and the implant is screwed in. This method avoids making a flap. Dental implantation with the navigation system is the most advanced and accurate implantation procedure. This will allow an optimal prosthetic restoration.
The advantages of navigated implantation for the patients:
- precise setting of the implant
- the implantation is made according to a pre-planned way, based on the prosthetic restoration
- we can support the patient in decision making by showing the end
- shorter surgical time
- the operation is simple and safe and also minimal invasive enhancing a fast healing
- it enable the precise planning of the implant placement prior to the operation
- In some cases this method can avoid bone grafting
All on four
In some cases with substantial bone loss, it is possible to make a 12-unit bridge on four implants without bone augmentation. The two lateral implants are placed not perpendicularly to the ridge, but at an oblique angle. The two mesial implants will be implanted in the vertical direction as usual. After surgery, without a healing period or delay, temporary bridges can be made. After the bone integration the permanent bridge will be fitted.
Upper bridge on four implants with screws.
Loading of implants
Implant supported restorations (crowns, bridges, removable restorations) can be fitted on the implants, which load the implants passing the chewing forces on the implants. The fixation of implant-prosthetic restotation can be carried out by screws (screw retained crown), or with adhesive material (cement- retained crown). Even the removable prosthesis is more stable if it is supported by the implants (implant retained dentures). The retainer can be for example a locator. In case of edentulism implant-prosthetic rehabilitation provides an esthetically pleasing and functionally efficient rehabilitation of the mouth. Transformation the patient’s smile and appearance improvs the quality of life.
If a crown is set on the implant immediately after the implantation it causes the loading of the implant with the chewing forces. The hardness and the shape of the crown influence the transfer of loading forces. This treatment is called immediate loading of implants. Acrylic crowns are most commonly used. In an ideal case, after the tooth extraction, an implant is inserted into the socket, and a crown can be fitted, resulting in immediate loading (the patient will not even have one minute without teeth). However, this procedure requires an non-inflammed (sound) surrounding with sufficient bone quality. If the crown is not in contact with the opposing tooth, the implant will be loaded only during chewing.