Dental implantation

Dental implantation

implantation

When is it recommended?

Implant restorations are recommended for one or more missing teeth or for complete tooth loss if you want to avoid grinding down the teeth bordering the gap or having a removable denture. Another advantage of implantation over traditional tooth replacements is that it avoids the need to wear removable dentures or allows for more stable wearing of removable dentures when a fixed replacement is not possible. Implantation is a surgical procedure, is longer and requires multiple treatments.

Implantation requires good oral hygiene and enough bone supply to allow the placement of an implant of the right size to withstand the chewing forces placed on it. Exclusion factors include heavy smoking, untreated diabetes, and long-term use of bisphosphonate-type osteoporosis medication.

What can we expect in the long term?

Life expectancy is increasing with technical and surgical advances in implantation; it is mainly influenced by the type of implant, oral hygiene, individual biology and proper planning and execution of the surgery. The average life expectancy is like or longer than that of bridgework on the patient’s own tooth, averaging 15 years. 

Signs of damage to implant restorations include mobility of bridges and crowns, gingivitis, extensive gum loss and bone resorption around implants. Treatment options: bridges, crowns, implant replacement, if necessary, periodontal, regenerative surgery around implants.

Treatment procedure

Step 1:
Planning

Panoramic X-ray or CBCT. Based on the imaging, planning the appropriate implant sizes and placement of implants.

Step 2:
Surgery

Types of surgery:
Surgery with exploration

In this case, the gum is surgically opened, a hole is made in the bone to place the implant with the screw and then the gum is closed. Suture harvesting is done one week after surgery; if bone grafting was done with the implantation, it is done 10-14 days later.

Surgery without exploration

This is the recommended method for larger amounts of bone. Performed by more experienced surgeons. Surgery without gum exposure has a faster healing time, fewer post-operative complaints (swelling, pain) and in most cases no sutures are needed. In such cases, the use of preoperative templates (guide systems) is recommended.

Surgery with guide systems

Before surgery, a surgical template is prepared based on a CBCT scan, which predetermines the location, size and depth of the holes to be made. The template is placed on the patient’s jawbone during surgery. The surgical template guides the doctor’s drill, so that the hole is drilled precisely in the pre-designed location. The implant is then inserted through the template into the pre-drilled hole.

A template-less implant navigation system is being introduced, where the location, position, and size of the implants to be inserted are predetermined on a CBCT scan taken before surgery and the drill hole design and position of the surgeon can be continuously monitored on the screen during surgery. This method does not require the preparation and use of a surgical template prepared by a technician.

The advantages of navigation methods are that they are more accurate, safer than traditional implantation procedures, there are fewer expected complications, and the technician can make a more accurate replacement later. Another advantage is that a temporary replacement can be prepared before the surgery because we know where the implants will be placed and, if they are stable enough, we can place them immediately after surgery.
Disadvantage: more preparation and more expensive procedure.

Step 3
Tooth replacement

For all three types of surgery, a distinction is made between immediate loading and late loading, the so-called two-stage implant technique.

Immediate tooth replacement

In this case, the prosthesis to be worn can be prepared within one to two weeks after implantation – in the case of surgery with navigation system, even before the operation. This is possible if the implant is firmly fixed in the bone. The advantage is that the patient does not have to wait long, but statistics show that the risk of losing the implant is 10-20% higher.

Late loading

In the first phase, only the implantation is done, then it takes 3-6 months to ossify and integrate, and then the final replacement is placed. In the intermediate healing period, the patient wears a temporary replacement.
These can be as follows:
partial or complete removable dentures, temporary bridges, if the own teeth are being ground down,
temporary single-phase implants placed in the bone alongside the permanent implants to hold the temporary bridges during the healing period.

Types of implants
Single-phase implant

Placed as a temporary implant until the final tooth replacement planned for the two-phase implant is completed. In this type, the bone part and the abutment are in one piece. It can also be used to make an existing removable denture more stable.

Two-stage implant

One part of the implant is placed in the bone and the other part is the abutment, which is placed in a hole with threads on the sides inside the implant and fixed with a through-bolt.

What should I look out for in the long term?

Generally speaking, the implantation success rate is 97-98 percent. The average rate of implant loss is 2-3%, mainly due to poor oral hygiene, inflammation of mucous membranes with reduced immunity due to diabetes, or mechanical impact.
In the long term after implantation, attention should be paid to increased oral hygiene, six-monthly or yearly check-ups, professional scaling.