Implant surgery

Implant surgery Dr. Paraschivescu

   Dental implants are Titanium or Zirconium made devices that are surgically inserted into the jawbone in order to replace one or more missing teeth. The aim of dental implants is to support a dental prosthesis (crown, bridge, removable dentures) but they may be used as an orthodontic anchor (in order to align and straighten teeth).

 

   The basis for any dental implants is a biologic process called osseointegration where materials, such as titanium and zirconium, form an intimate bond to bone. The average healing time required for osseointegration varies from 3 to 8 months, although, in some particular circumstances, one must wait a longer time. After the completion of the integration process, an abutment is attached to the implant. The abutment will hold the dental prosthesis.

 

   Implantology aims at the functional rehabilitation of a patient affected by total or partial edentulism, by the mean of dental implants. Lately, implantology has experienced a spectacular development: new surgical techniques appear, new materials are developed and new rehabilitation methods are devised, all aimed at increasing the quality and success rate of dental implants.

   The main goal of dental implants is the proper replacement of the missing teeth, considering the following most important aspects:

 

   Mastication or chewing process

   Mastication is the most important dental process. When an implant restoration is planned, it is vital to rehabilitate this process as closely as possible to natural teeth, so that the patient will adapt very quickly to the new restoration. The chewing forces are transferred to the surrounding bone just as in the case of natural teeth. Comparatively, when the traditional denture is designed, some of the chewing forces are passed to the supportive gums and, as this is not the normal way, it takes longer to get used to a removable denture.

 

   Aesthetics

   Restoring aesthetics is for many patients the most important goal. The general aesthetic of an implant supported reconstruction is great. A dental implant restores a lost tooth so that it looks feels, fits and functions almost like a natural tooth.

 

   Speech

   The normal speech can be affected when front teeth are missing. It is well known that these teeth have an important role in some consonants pronunciation.  With dental implants, which function almost like natural teeth, the adaptation process is a lot shortened.

Dental implant
Dental implant
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   Advantages

   The great advantage of a dental implant is that it replaces the missing tooth in the most natural way possible.

 

  • Dental implants reduce the load on the remaining oral structures

 

  • There is no need to prepare adjacent teeth for conventional restorations

 

single tooth gap : if a traditional dental bridge is designed, the preparation of the adjacent teeth is required

 

 

single tooth gap : if an implant supported crown is manufactured, the adjacent teeth remain untouched

 

  • Dental implants preserve bone and significantly reduce bone resorption that results in loss of jawbone height.

 

  • Better chewing and speaking     

 

   Disadvantages

   If there are no general or local contraindications, dental implants have few drawbacks.

 

   Success rate

   Because of constant developments in the field of implantology, the success rate of dental implants has continually and constantly risen. In optimal conditions the successful rate of an implant is reported to be around 93-98 %. The most important factors that can influence the success rate of dental implants:

 

  • The quality and quantity of the available bone: Implants placed in thicker, stronger bone have a higher success rate. The quality and quantity of the bone can be improved using different procedures (bone augmentation, sinus lift,etc)

 

  • Case difficulty: higher success rate is associated with younger age and non-complex cases (like single tooth replacement, with good quality bone present).

 

  • Oral hygiene and compliance with postoperative instructions and general maintenance: The success rate of dental implants will enormously drop if these measures are not properly conducted.

 

  • Surgeon’s quality and experience

 

   INDICATIONS, CONTRAINDICATIONS

 

   Indications

   Dental implants can successfully restore all forms of partial edentulism and complete edentulism

   Single unit toothless gap with healthy adjacent teeth:  an implant supported crown is the best treatment option

 

   Partial edentulism with the back (posterior) tooth missing: these conditions imply

the absence of several posterior teeth (molars and/or premolars) on one or both sides of the dental arch

(Kennedy class 1 or Kennedy class 2).

 

   Complete edentulism: when all teeth are missing, the only traditional solution available is a full removable denture. Implant supported prosthesis (either fixed or removable) offer better speech, chewing and stability if compared with the classic ones. Normally, one should insert a minimum of 6 implants on the upper edentulous jaw and 4 on the lower one.

 

   Other situations when dental implants can be indicated: patients who cannot tolerate a removable restoration (removable denture), patients with high aesthetic and/or functional demands.

 

 

 

      Contraindications

 

General contraindications

 

   Absolute contraindications. Some serious general conditions make anesthesia, surgical procedures and the overall placement inadvisable:

  • Heart diseases affecting the valves, recent infarcts, severe cardiac insufficiency, cardiomyopathy

  • Active cancer, certain bone diseases (osteomalacia, Paget's disease, brittle bones syndrome, etc.)

  • Certain immunological diseases, immunosuppressant treatments, clinical AIDS, awaiting an organ transplant

  • Certain mental diseases

  • Strongly irradiated jaw bones (radiotherapy treatment)

  • Treatments of osteoporosis or some cancers by bisphosphonates, although, in present days, even such cases could be solved by the mean of implants.

 

   Relative contraindications. Other situations will be evaluated on a case-by-case basis.

  • Diabetes (particularly insulin-dependent)

  • Angina pectoris (angina)

  • Significant consumption of tobacco

  • Certain mental diseases

  • Certain auto-immunes diseases

  • Drug and alcohol dependency

  • Pregnancy

  • Age - children: not before the jaw bones have stopped growing (in general 17-18 years).

Local contraindications: some conditions or physiological changes, usually inside the mouth cavity, may temporary prevent the placement of dental implants. Most of the times, these conditions can be remedied before the implants are inserted in the jawbone.

 

  • The alveolar bone where the implants would be positioned, shows chronic infections, has an inadequate structure or an insufficient height or width.  The dental implant must be always surrounded by healthy bone tissue.

 

  • Important anatomical structures such as the maxillary sinus, the inferior alveolar nerve (located inside the mandible), have an abnormal position that can interfere with the dental implants. Adjunctive surgical procedures have to be performed before the placement of dental implants. These procedures aim to increase the amount of bone, so more bone is available to support the implants.

 

  • Some local diseases of the oral mucosa or alveolar bone can temporary prevent the placement of dental implants until the conditions are treated.

 

  • Hypersensitivity or other allergic reactions;

 

  • Poor oral hygiene.

 

  • Bruxism or involuntary grinding of the teeth.

     

     

case 1, IIIrd class edentations
case 2, IIIrd class edentation, implant insertion with left maxillary sinus augmentation
case 3, mandibular class III edentation
case 4, maxilar and mandibular class I edentation
case 5, mandibular class III edentation
case 6, mandibular edentulism.
case 7, maxillary class II edentation
case 8, maxillary class I edentation
case 9, maxillary total edentulism
case 10, class III edentation
case 11, maxillary bilateral class I
case 12, maxilar and mandibular clas
case 13, mandibular class III
case 14, mandibular class III edentation. Zyrconia implant placement
case 15, maxillary class III edentation. Left maxillary sinus augmentation with simultaneous implant
case 16, mandibular class II edentation
case 17, maxillary total edentulism,
case 18, mandibular class II edentation
case 19, maxillary total edentulism
case 20, class II edentation