Dental implant treatments
Shortly about dental implants:
Today dental implant treatments have become an integrant part of dental treatments. The replacement of the missing teeth with implants and dental medicine appeared at the same time. Until the recent past the implantation of these implants could be considered only some experimental activities because due to some unexplained biological and pathological conditions these interventions did not bring results. The first crucial breakthrough in implantology took place due to the biomaterials developed in the second part of the 1960’s. When they got implanted in the bone-tissue they presented osseointegration, i.e. they could integrate into the bone-tissue without using connective tissues. As far as long-term success is regarded we have to mention the important fact that the tissues of the gingiva create a biological closure around the part of the implant that is in the mouth, so it is protected against the harmful effects of the mouth.
Indications for dental implants:
Their use depends in fact on three factors:
- Better functional stability, more advantageous aesthetic look and it is more comfortable than traditional prostheses (in case of large edentulous areas the traditional method would not be very advantageous, but with the help of the implants we can realize a bridge)
- We don’t have to sacrifice healthy dental structures like in the case of the traditional prostheses (there is no need for the scraping of the teeth surrounding the edentulous area)
- For some disadvantageous clinical or anatomical reasons or for psychical reasons the patients cannot wear a traditional prosthesis
Temporary and definitive contraindications for dental implants:
- Surgical contraindications: acute diseases, fever, anticoagulant treatments
- Inadequate oral hygiene – but during the treatment we can motivate the patient in this regard
- The mandibles are not completely developed (17-18 years old)
- When there is an acute or subacute inflammation at the level of the implantation area
- For 2 years after the irradiation of the mandibles
- General contraindications for surgical interventions
- Alcoholism, smoking, drugs
- System diseases, immune system diseases
- Disadvantageous anatomical correlations
- Osteomyelitis of the jaws
- Chronic mucosa diseases – relative contraindication
What to do before the intervention:
At first we realize the patient’s case history and we exclude the contraindications. The next step is to examine the patient and identify the possible prosthetic solutions. We also examine the morphology of the jaws (bimanual examination). If we consider that we can realize the implantation, we perform some additional examinations:
Laboratory tests and general medical examination (if the patient’s case history contains some risk factors/diseases)
- panoramic radiography (orthopantomography – OPG): we obtain a more precise picture of the bone that is situated in the place of the implant and of its structure.
- Our clinic has a 3D CT of smaller volume developed for the examination of the craniocervical area and with the help of this machine we can obtain a more precise picture of the affected area (adequate bone structure, neighbouring anatomical structures etc.)
Inserting Denti Needle implant
Needle implants have small diameters, hence their name. The reduced diameter does not make possible to realize an internal thread in the implant, so these are one-piece implants, i.e. the body and the head of the implant represent one piece. After inserting this implant there is no need for a new surgical intervention because in the case of these implants the gingival closure takes place at the same time with the integration of the implant. As far as their head is regarded there are implants with conic or ball head design. The latter can be used only for the stabilization of the prosthesis. Their implantation is fast and simple, we usually use them when we have to replace lower incisors and there is not enough space between the existing teeth or when the alveolar crest is not thick enough and we don’t have the possibility or the patient doesn’t want us to perform a more expensive and more traumatic bone augmentation.
Inserting Denti Eco Line implant
The main object of the Denti implant – as an implant developed and owned by the Hungarians – was to realize a high-quality implant for the Hungarians that they can afford. The EcoLine implant – i.e. economical – is similar to a dental root, its diameters are the followings: 3.8, 4.3, 4.8, its length is 9.5, 11.5 and 13.5, it is very stable and is covered by TiO2. Besides economy they appreciate quality as well, so the implants are made by the German companies Meisinger and Komet and by the Italian company Dess which have more than 100 years of experience.
Inserting Denti Bone Level implant
The Bone Level implant is one of the premium products of the Dentisystem company that – besides the narrow apical part that assures its stability – also contains a conic internal closure of 6° that contributes to the hermetic closure of the microspace existing between the body and the head of the implant. The implant has a special platform switching head that contributes to a good gingival closure and a nice, aesthetic look. At the same time this system makes it possible to realize the „all on four” prosthesis supported by four implants called “Denti on 4”.
Sinus lift: costs, bone substitute and membrane
On the lateral parts of the upper maxillary we often find a bone of which height is inadequate for the implant we wish to insert. In these cases we have to perform sinus lifting. Through this technique we can increase the volume of the bone material in the following way: during the intervention we create a small lateral window in the maxillary sinus – by lifting the mucosa of the maxillary sinus – and through this window we insert in the created space the synthetic bone mixed with the patient’s own bone, after that we cover all these by a resorbable collagen membrane fixed with microscrews and finally we close the lobe. During the osteogenesis between the granules of the synthetic bone appears an own bone that surrounds these granules and after a period of 6-9 months it will be able to support the masticatory pressure. This intervention is advantageous in the case when in the maxilla there are many edentulous spaces and there is no adequate bone material in order to insert the implants. In this case using the traditional restoration methods we could realize only a plate-supported prosthesis that would cover a part of the palate or the whole palate and this wouldn’t be comfortable for the patient because it would cover a part of the taste buds and the patient would not feel tastes. Also there wouldn’t be enough space for the tongue, so at the beginning the patient couldn’t speak so well. The disadvantage of the intervention is that it cannot be performed in the case of a chronic sinusitis or if the maxillary sinus has already been operated.
Augmentation and restoration of the atrophic alveolar ridge/edentulous area: costs, bone substitute, memebrane and screws
After loosing some teeth the alveolar process can become so thin or it can be so reduced that the remained bone-tissue doesn’t make it possible or makes it very hard to perform a dental implant treatment. In the year following the loss of the teeth there will take place a fast osseous atrophy and if the patient waits more than five years, the implantation will not be possible anymore. In these cases the replacement of the missing teeth can take place using some bioactive materials or an autologous bone-tissue, otherwise the chances for survival of the implants decrease and it becomes difficult to realize a prosthesis. According to the direction of the bone resorption we need to realize a horizontal or a vertical augmentation in order to replace the missing bone-tissue. In this case we need to thicken or to heighten the bone in order to obtain an adequate quantity of bone-tissue and to be able to perform the dental implant treatment. During the augmentation – that can take place when we insert the implants if there is an adequate osseous material that can assure the primary stability of the implant, or it can take place separately – we fix the mixture of bone substitute and own bone to the bone using some resorbable or non-resorbable screws, and this will be the initial skeleton of the bone that will appear during the osteogenesis. The osteogenesis lasts 6-9 months, during this period the implant cannot be loaded.
Augmentation of attached gingiva
It can happen that after exploring the implant there is not enough attached gingiva surrounding the implant that would be necessary for the epithelial cuff. There are some cases when we discover the lack of the attached gingiva at neck of the existing teeth. In these cases we also need to augmentate the missing keratinized gingiva. In order to perform this intervention we can choose between two possibilities: in order to remediate the defect we can use sterilized and lyophilized animal tissues (Geistlich-Mucograft) or we can obtain connective tissue from the palate. In the case of the first method – which is more simple because we only have one surgical area – we insert collagen matrix (for ex. Mucograft) that feeds on the surrounding keratinized gingiva and on the periosteum situated under it and it becomes populated by the cells of the neighbouring area and it turns into keratinized gingiva. Its disadvantage is that it is not suitable for thickening the gingiva. The second possibility is that we obtain the connective tissue from the patient’s palate and we stitch it to the adequate place. The disadvantage of this method is that the patient will have two wounds in his/her mouth and at the beginnig these can make food consumption difficult.
Obtaining A-PRF (fibrin matrix) from the patient’s own blood via centrifugation
PRF is in fact a platelet rich fibrin, a so-called Platelet-Rich Plasma. During the process at first we draw some blood from the patient, we centrifugate and sedimentate it in order to obtain PRF. Being inserted in the wound the PRF helps and speeds wound healing up and it contributes to the improvement of the quality of the new, regenerated bone. First of all we use it for sinus lifting together with some bioceramics used for bone augmentation, but it can also be used for the augmentation of the atrophied alveolar crest and for after-extraction bone augmentation in order to prevent the resorption of the alveolar bone.