WHAT IS IMPLANTOLOGY
Implants are a permanent solution for tooth loss
Implantology is the fastest growing branch of dental medicine. Implants are used to replace one or more lost teeth in the upper or lower jaw. The installed implants represent a replacement for the tooth root, and pass through the process of osteointegration (fusion with the jawbone) over a period of 3 to 6 months. During the osteointegration period of the implant, the patient is not toothless and instead wears a temporary replacement that ensures the aesthetics and function of the tooth until the final prosthetic is completed. The final prosthetic can be a single crown on the implant, a bridge on the implant or a prosthetic on the implant. Installation of the implant into the bone helps also to retain the quantity of bone inthe alveolar arch, as it stimulates the bone similar to the natural tooth, and does not lead to bone resorption, which is a consequence of tooth loss.
In cases of one missing tooth in a jaw where the neighbouring teeth are healthy, an implant is recommended to avoid any abrasion of the neighbouring healthy teeth. A crown is then placed on this implant.
People who wear full dentures are often faced with the problem of inadequate adhesion of the dentures, which can be resolved by making a prosthetic on implants. To retain the upper prosthetic in a completely toothless jaw, four implants are usually enough, while two implants should suffice for the lower prosthetic in a completely toothless jaw. Full prosthetics on implants contribute to higher patient satisfaction in comparison with conventional dentures. These prosthetics are more aesthetically pleasing, more stable and making chewing easier, with fewer functional limitations, easier cleaning and clearer speech.
Implants can be loaded immediately (immediately after their installation) or conventionally (following the period of osteointegration). Research has shown that conventional loading has shown a somewhat better survival rate for the implants in the mouth.
The implants we use in our daily operations are constructed of high quality, resistant, biocompatible titanium, and the installation procedure is completely painless, achieved through the use of local anaesthetic.
The precondition for the installation of implants isan adequate quantity and quality of bone, which is verified by panoramic x-ray and CT scans of the mouth before the planned therapy. If there is reduced amount of bone, it is possible to perform bone augmentation and sinus lifting.
What is bone augmentation?
The loss of teeth results in the atrophy of bone that is no longer stimulated through chewing via the tooth root. The volume of bone is reduced and there is not sufficient space to install the implant. Bone resorption is faster if the extracted teeth also suffered from inflammatory processes around the root, as that infection further destroyed the bone. Every implant must have sufficient amount of bone around it to support and stabilise it, and prevent the retraction of the gums around the implant, resulting in subsequent aesthetic problems, such as when the implant becomes visible through the membranes. Bone augmentation is a surgical procedure used to replace lost bone. In order to replace bone volume, it is possible to use artificially produced bone of synthetic or animal origin, or the patient's own bone (autologous bone), which is taken either intraorally (from the lower jaw) or extraorally (from the hip), reduced in size and then built into the site where it is lacking. Using the patient's own bone is the golden standard in bone augmentation, since that bone has the best potential for installation and for increasing volume. In that case, it is necessary to surgically remove a sufficient quantity of bone to be installed at the site where it is lacking. To compensate for small and medium sized bone defects, artificially produced bone of synthetic or animal origin is usually used. The oral surgery specialist will decide on the method of bone augmentation. The healing of the bone and soft tissues after augmentation can be more successful by also applying the patient’s own growth factor using the PRF method (platelet rich fibrin) or by installing a biomembrane for the stabilisation of clots and bone replacement. The PRF method is based on the isolation of platelet rich fibrin from the patient's own blood, and applying that extract to the surgical area. In this way, the platelets release the growth factor, which stimulates the formation of new blood vessels and the growth of new bone. This method is harmless since only the patient's filtered blood is used, to facilitate the healing process. The installed materials are gradually resorbed and the bone is remodelled and a new, strong bone mass is formed. Augmentation is performed under local anaesthesia and is completely painless. After the procedure, it is necessary to wait for the bone to heal (about eight months), before continuing with the installation of the implant.
What is a sinus lift?
Where the bone is lacking in the side sections of the upper jaw, the raising of the floor of the maxillary sinus (sinus lift) is indicated. This isan oral surgery procedure in which the lifting of the sinus floor is combined with bone augmentation, so as to ensure sufficient space for the installation of the implant. The sinus lift is performed under local anaesthesia, and is completely painless.
Depending on the size of the procedure, the sinus lift can be large or small. When there is about 2 mm of bone missing to install the implant, then a small sinus lift is performed, where the raising of the floor of the maximally sinus and bone augmentation are performed simultaneously with the installation of the implant. The procedure is performed using a technique called osteotomy, named after the instrument used to raise the membrane of the maxillary sinus. After the small sinus lift, it is necessary to wait for the period of osteointegration of the implant with the bone to be completed (about six months), and only then can the implant be loaded with the prosthetic (crown, bridge).
A large sinus lift is performed when a larger volume of bone is lacking, and is performed using the side procedure. Occasionally, it is also possible to install the implant at the same time, though if there is a lot of bone missing, it is recommended that the sinus lift be performed first, and the implant later. In that case, 6 to 8 months should pass before the implant can be installed, otherwise there can be a risk of complications and failure of the procedure. The oral surgery specialist will decide on the type of procedure you need, based on your scans.
What are the possible complications with the sinus lift?
The sinus lift has a high success rate, and complications are not common during this procedure, though they are possible. Complications can arise during the performance of the sinus lift, or following the procedure. While lifting the sinus, it is possible for the membrane of the maxillary sinus to burst. The thickness of the sinus membrane differs from patient to patient. If the membrane should burst, the oral surgeon can use a number of techniques to repair the defect and to prevent any subsequent complications, such as sinus infection caused by the entry of materials for bone replacement into the sinus cavity.
After sinus lifting, minor swelling is possible and should go away after a few days. Sinus infections are also possible due to various causes, such as the penetration of an infection from the nasal cavity, penetration of the implant or bone material through the membrane, or performance of the procedure on sinuses that are not healthy. The precondition for performing the sinus lift is having healthy sinuses, and if they patient has previous sinus conditions, it is necessary to consult with an ear, nose and throat doctor before having this procedure.
The All-on-4 implant system is a form of implant prosthetic rehabilitation for completely toothless upper or lower jaws. The All-on-4 method is not new, and has been well known and successfully used in clinical practice for years. Once the teeth are lost, over time, the jaw bone loses a portion of its bone density. If sufficient bone is retained, then the recommendation is that a larger number of implants should be installed, as there are then more supports for the prosthetic. However, in certain patients with insufficient bone quantity or poor bone quality, few implants can be installed to support the prosthetic. If the client is a suitable candidate for the All-on-4 system, just four implants (two axial and two slanted implants, as determined by the oral surgeon at the time of installation) is enough to support the entire tooth arch. Once the implants are installed into the jaw, the client receives a temporary fixed prosthetic the same day, or just a few days later. Three months later, the final permanent prosthetic can be installed. In this way, the period of toothlessness is reduced to a minimum, which ensures increased client satisfaction. This is possible due to the concept of immediate loading of the implants at the time of their installation into the bone, meaning that it is not necessary to wait for the period of osteointegration to be completed before the implant can be loaded with the prosthetic. The All-on-4 method offers numerous advantages: it avoids surgical procedures such as sinus lifting and bone augmentation in the upper jaw, which reduces recovery time and procedure cost; clients who have long been toothless and have little remaining bone can finally receive a fixed prosthetic; just four implants are needed, which contributes to the stability of the prosthetic in the mouth, giving the client the feeling of natural teeth, without the fear of instability or falling out as is the case with dentures. Also, the prosthetic is affixed using screws, and can easily be removed by the dentist to examine and repair as needed. Maintaining oral hygiene of these types of prosthetics is also very easy using a toothbrush and toothpaste, and a water shower or floss around the implants. With the proper oral hygiene around the implants, they can last a lifetime, and only the prosthetic is replaced as needed.
The price of the All-on-4 method is lower than the price of installing a larger number of implants in the jaw, and the price of additional oral surgery procedures. This makes this method of fixed prosthetics on implants more available to a wider number of clients.