Introduction of implantation into a dental clinic from scratch

Why implantation?

All methods of dental prosthetics prior to implantation negatively affect the condition of the oral cavity in the future, often causing premature wear and loss of teeth. In particular, the manufacture of bridge-like prostheses - bridges, as they are also called - requires the depulpation and preparation of two, and sometimes three, teeth to replace just one lost tooth.

Such radical treatment, to put it mildly, is not beneficial for the jaw system and leads to overload of the supporting units with further root inflammation and tooth loss. At the same time, the average service life of “bridges” is 6-7 years.

The situation with removable dentures is even more complicated: for any removable device, the support is the gums and bone tissue of the jaw, which, in principle, is not adapted to a full chewing load. As a result, a chronic inflammatory process develops, and the bone atrophies and dissolves.

Contraindications for implantation

Before performing an implantation procedure, the dentist must check the patient for possible contraindications. They are divided into several varieties.

Absolutes include the following:

• blood diseases;
• if there are malignant tumors;
• with immune pathology;
• if there are diseases of the central nervous system;
• if bisphosphonates are taken orally;
• in the presence of lupus erythematosus, rheumatoid arthritis, rheumatism, scleroderma;
• if you have tuberculosis;
• if there is recurrent stomatitis or pemphigus;
• if the function of the masticatory muscles is impaired;
• diabetics.

Relative contraindications include the following:

• Lack of oral sanitation.
• Poor oral hygiene (this is a good reason to prescribe removable dentures).
• For gingivitis.
• If there is marginal periodontitis.
• For pathological bites.
• For diseases of the temporomandibular joint.
• If there is severe atrophy or damage to bone tissue.
• If the patient smokes, drinks alcohol and drugs.
• When pregnant.

General contraindications consist of the following:

• Surgical reasons for refraining from any intervention.
• Contraindications to pain medications (negative tolerance to anesthesia).
• Certain somatic diseases that may be affected by the procedure (these include endocarditis and other heart diseases, rheumatism, etc.).
• Certain treatment methods can have an impact on the regeneration and preservation of the dental element after installation, on the tissue surrounding the dental element (if various types of depressants, anticoagulants, cytostatics and other agents are used).
• Diseases of the central nervous system.
• Distress syndrome (severe and prolonged stress, which is caused by all sorts of reasons).
• If there is exhaustion of the body.
• Poor oral hygiene (this is a good reason to prescribe removable dentures).

Local contraindications consist of the following:

• unsatisfactory tendency to oral hygiene;
• insufficient presence of bone tissue or its inappropriate structure;
• unsatisfactory distance to the maxillary and nasal sinuses.

Temporary contraindications include the following:

• acute diseases;
• rehabilitation and health stages;
• pregnant condition;
• addiction;
• condition after irradiation (the implantation procedure can be done after a year).

What to prepare for

Dental implantation is a technique that does not have the disadvantages of previous generations of prostheses. Implantologists consider it as the only way to restore lost teeth that does not harm the health of the oral cavity and has an unlimited (usually lifelong) service life.

Important! No other prosthetic method provides such high aesthetics as implantation.

But it should be taken into account that dental implantation is not a simple procedure during which an implant is simply inserted in place of the missing unit. The future tooth (more precisely, its root) must have a certain size, the proper position and direction, and a strictly defined inclination are selected for it.

In addition, it is necessary to restore all the tissue surrounding the tooth - and, first of all, bone tissue and gums. It is this comprehensive approach that allows us to achieve reliability, impeccable aesthetics, and durability of implant treatment.

Implantation is a slow process, except for one-stage implantation, as well as the “all on 4” and “all on 6” techniques. Treatment usually involves several stages, despite the common name of "two-stage" surgery.

Treatment always begins with diagnosis, which is the first and, perhaps, the most important stage that determines its outcome. Based on the results of the preliminary examination, a decision is made on implantation technology, types of implants, and the details of the upcoming operation are thought out.

Important! It is necessary to prepare for the fact that during the implantation process you will have to go through several stages. A standard scheme applies to all patients, so we have prepared a detailed description of each stage of dental implantation.

Types of surgical templates for dental implantation

During the installation of orthopedic structures, the following templates are used:

• With fixation on bone tissue. To install this design, special microscrews are used. Such a surgical template is fixed to the edentulous jaw, which contributes to increased precision of the procedure and allows you to choose the area with the remaining bone as a support. In the process of this manipulation, patchwork components are used;
• Using nearby healthy organs as support. In order to attach the model, elements located in the dental arch during the surgical operation are used. This is a suitable option for people with partial absence of teeth. Recommended if it is not possible to use the flapless method;
• With fixation on soft tissues. The gingival mucosa is used as an anchor for the frame. This template is indispensable if there is an absolute lack of teeth in the jaw. Most often used as part of non-invasive intervention.

Stage 1: diagnosis

It may take some time to choose a clinic and an implantologist, since this is one of the key points in the whole story. In addition, you need to get to know the orthopedist and, if necessary, the therapist - these doctors will also take part in the process of implantological treatment. If everything is satisfactory, then before implantation an examination is carried out by a surgeon.

He will tell you whether it is possible in principle to place an implant in this patient, and will develop further treatment tactics based on the following data:

• general oral health;
• the presence and condition of neighboring teeth and gums, which are located next to the future implant root;
• bite;
• hygiene quality;
• financial capabilities of the patient.

The price is usually included in the total cost of treatment, which is carried out in most clinics on a turnkey basis. The doctor will announce the approximate cost, the final price is determined after diagnostic testing and consultation with an orthopedist. If a patient needs the help of a physician, hygienist or periodontist, then their services should be considered.

Diagnostics includes instrumental and laboratory studies, without which surgery is impossible. These examinations are necessary to exclude a number of complications after the introduction of implant rods and achieve extremely good treatment results.

How is 3D implantation performed?

The surgeon fixes the template in the patient’s mouth and places the implants exactly according to it. Flap surgery is not required: the doctor makes only small punctures in the gum, the diameter of which corresponds to the size of the implants. Thus, the traumatism of the operation is minimized, the gums do not need to be sutured, and there is no risk of developing inflammation with good oral hygiene. Implantation is performed under local anesthesia. It takes 10 minutes to install one implant. The possible error does not exceed 20 microns.

Clinical case StomArtStudio Leonardo, doctor Vasiliev Leonid Alekseevich

Instrumental studies – tomography and x-ray

They are performed on all patients, regardless of the chosen implantation technology. Based on the data obtained, the issue of the types of implants and the methodology of the implantation operation itself will be decided.

An X-ray is taken selectively, precisely in the part of the jaw where implants are planned to be installed. Using it, the doctor evaluates the condition and location of the roots of the teeth, near which the implant should be installed. The price of such a photo starts from 700 rubles.

A panoramic photograph is needed for any type of prosthetics, and implantation is no exception. Otherwise, it is called an orthopantogram and is performed to take into account the characteristics of the bite and the condition of the bone tissue. All this is of great importance, since a strong foundation is extremely important for the implant root.

The price of a 3D image - orthopantogram - from 1500 rubles.

But the most important study at the diagnostic stage is CT - computed tomography. Without it, not a single dental implantation operation is performed, and neither an X-ray nor an orthopantogram can replace it.

Computed tomography is the most expensive examination at the diagnostic stage, the price of which starts from 3,000 rubles. Based on its results, the quality of bone tissue is assessed, the sites for installing implants and their type are selected. It is the tomogram that allows the implantologist to conclude that bone grafting is necessary if there is insufficient bone volume.

Modern medical centers where implantation operations are performed are equipped with high-precision equipment and use navigation programs. All this makes it possible to plan the course of treatment in detail and even show its future results to the patient!

How to choose an implant brand?

Technical base

Another criterion when choosing where to install dental implants is the presence of its own technical laboratory. The implant is in the gum, no one sees it, but the crown or artificial jaw is in plain sight. It is important not only to ensure high functional properties of the prosthesis, but also its aesthetic appearance. Third-party technicians will never put in as much effort, select a shade, or grind out small details as much as those who work in the center.

Installing dental implants is the job of the doctor, prosthetics is the responsibility of the technician.

Lab tests

The diagnostic stage before implantation necessarily includes a general and detailed blood test. This is a must for everyone. Certain categories of patients will need to provide the results of hormone tests (usually women) and other specific laboratory tests if there are concomitant pathologies.

A number of diseases are a relative contraindication for surgery to install implants, and then a preliminary consultation with a specialist is necessary. If necessary, before implantation, the condition is corrected to acceptable levels (for example, in the case of diabetes).

The price of sample collection services may vary and depends not only on the number of studies. Many tests are done in district clinics, and will be free if referred by a doctor. Thanks to this approach, diagnostic costs can be significantly reduced.

At the diagnostic stage, all patient data is collected, and based on the information obtained, the optimal method of dental implantation and type of implants are selected. After agreeing on the finished plan with the client, we begin to implement it. Next begins the stage of preparation for the implantation operation.

How do dental centers save?

Clinics for which reputation is less important than immediate income save on us, the patients. They do this using different tricks.

Sterility

When we go to the dentist, we assume that everything around us is sterile, the surfaces have been treated, and the instruments have just come out of the autoclave. As for the tools, this is usually the case, but everything else! We almost added some antiseptic, wiped the surfaces not 4 times, but 2 times, you see, and saved a pretty penny. Yes, and the processing of instruments can be normal, or it can be carried out according to the “Anti-AIDS”, “Anti-Hepatitis” system..

Sterilization in ROOTT clinics using the “Anti-AIDS” and “Anti-hepatitis” systems

Antiseptics

According to the rules, the type of antiseptic must be changed every six months. This is where social responsibility comes into play. Some centers do this even more often, while others don’t bother at all. The main thing is that it’s cheap, and if the flora becomes resistant, it will probably carry through. It is almost impossible to prove the fact of infection in dentistry.

Tools

Responsible clinics use disposable instruments wherever possible. Reusable ones undergo double disinfection. But the irresponsible ones try to save on both. They are much more likely to become infected. For implantation, sterility is especially important. The slightest infection can nullify the doctor’s efforts. It's good if there is a guarantee for the work. Only in such centers it is usually absent.

Materials

Once in dentistry, where they work with dozens of brands, it is difficult to be sure that cheaper materials, and even instruments, are not used in more expensive systems. High-end clinics prefer selected brands and certainly will not use Chinese materials when working with Swiss implants. Global manufacturers supply them in sets. Everything is provided there - tools, materials. Everything is verified and confirmed by certificates of conformity. Relationships with the brand are long-term; no one will risk them because of imaginary benefits.

Stage 2: preparatory

Details of the preparatory stage may vary significantly for different patients due to differences in the condition of the oral cavity in general and the jaw bone tissue in particular. Most people planning to have implants require dental hygiene.

Sanitation is carried out with the aim of eliminating bacterial plaque from the surface of tooth enamel, since a successful implantation operation requires, if not sterility, then maximum cleanliness of the oral cavity. The presence of pathogenic microflora can provoke the development of inflammation, which should be avoided at any stage of implantation.

Hygienic cleaning is done using ultrasound when there is existing tartar, soft plaque is removed using Air Flow technology. The price of such reorganization is from 6,000 rubles.

At the preparatory stage before implantation, it may also be necessary to remove teeth, treat caries and periodontitis. The price of each procedure is calculated separately.

But the most serious step before installing implants may be bone grafting surgery. Very often it is impossible to do without it due to a lack of bone due to its resorption - resorption, natural loss. Bone volume can be greatly reduced if a tooth is lost or removed long ago, or due to individual characteristics.

As a rule, bone grafting is performed in the case of classical two-stage implantation, which places high demands on the quality of the jaw bone tissue. In addition, bone grafting is almost always necessary for patients who have lost teeth a year or more ago. During this period, the bone undergoes rarefaction and becomes brittle, which creates certain difficulties with fixation of implant roots.

There are several methods for performing bone grafting, or osteoplasty, using different materials. Therefore, the price will depend on the selected operation technology. There are 3 options in total:

• sinus lift;
• directed regeneration;
• autotransplantation.

SURGICAL KITS

The instruments used at the surgical stage of implantation are produced in sets.

The set is ergonomic in design and universal. The arrangement of the tools in the set is intuitive for simple and convenient installation of implants.

The instruments are fixed in the box using silicone holders. The box can be made of plastic and steel. Steel and plastic boxes can be sterilized in an autoclave.

The kits are available in three standard composition options, but, at the request of the doctor, changes can be made to any kit, or the kit can be completed according to individual preferences.

A box made of plastic or stainless steel with a set of instruments for both the surgical and orthopedic stages. Keys: - torque wrench; — three implant guides for a torque wrench (short and long for a small platform, short for a large platform); - five hex keys for a torque wrench; - a square wrench for a torque wrench.

Pointed cutter. Two depth gauges. Six drill bits. Steel bath.

Steel or plastic box with a standard set of tools, for working with all types of implants with two-stage installation:

Keys: - reversible key with lock for implant guides; — three implant guides for the reversing key (short and long for the small platform, short for the large platform); — three implant guides for the contra-angle handpiece (short and long for the small platform, short for the large platform); - two hex hand wrenches, long and short.

Cutters: - spherical; - bone. — three cutters for Short implants. — two cutters for implants Maximum.

Four depth gauges. Ten drill bits. Steel bath.

Steel box size: 180x100x45 mm.

Mini starter kit in a plastic or steel box, optimal for installing Leader series implants:

Keys: - reversible key with lock for implant guides; — three implant guides (short and long for the small platform, short for the large platform); - manual hex wrench.

Pointed cutter. Two depth gauges. Six drill bits. Steel bath.

Boxing size: 155x95x45 mm.

Disinfection should be carried out during full immersion:

- titanium products in a 1% chloramine solution, or a 3% formaldehyde solution for 30 minutes; - stainless steel products in a 3% solution of hydrogen peroxide with 0.5% detergent (Progress, Lotus, Astra) for 80 minutes.

Pre-sterilization cleaning of products is carried out with 3% Biolot washing solution in the following sequence:

— preliminary rinsing under running water for 0.5 + 0.1 minutes; — soaking in a washing solution at t 50 + 5C° for 15 + 1 minutes with full immersion; — washing each product in a washing solution for 0.5 + 1 minutes; — rinsing under running water for 3 + 1 minutes; — rinsing with distilled water for 0.5 + 1 min.; - drying with hot air at a temperature of 85 + 5C° until moisture is completely removed.

To carry out sterilization:

titanium products: - by steam method at a temperature of 132C° and an excess pressure of 2 bar for 20 minutes; — steam method at a temperature of 120C° and an excess pressure of 1 bar for 45 minutes; - by air method at 180C° for 60 minutes; - by air method at 160C° for 150 minutes;

stainless steel products: - by steam method at a temperature of 132C° and an excess pressure of 2 bar for 20 minutes; — by steam method at a temperature of 120C° and an excess pressure of 1 bar for 45 minutes.

Sinus lift

Sinus lift or subantral augmentation surgery before implantation can only be performed on the upper jaw. Its essence is to raise the lower septum of the maxillary sinus in order to increase the space of the alveolar ridge. The space thus freed is filled with bone tissue.

On a note! Sinus lifting is scientifically called subantral augmentation.

If there are no contraindications, the implantologist can combine sinus lifting with the installation of implants. Otherwise, the latter are placed in the jaw bone 3-6 months after the subantral augmentation surgery.

Sinus lifting can be open or closed, and its price depends on the chosen method. Open operations are estimated at the amount of 40,000 rubles, closed ones - from 20,000 rubles. It is important to know that this cost does not include the price of the bone material itself.

Currently, dental implantation is a valuable method of treating edentulism, which is actively used due to the extensive list of indications, predictability of results and durability of the structures used. Bone grafting and modern osteoplastic materials play an important role in its development.

Dental implantation is considered one of the most promising areas of modern dentistry. Despite the rapid development of dentistry, the number of people suffering from edentia continues to increase around the world. Although the loss of individual teeth, especially in the lateral parts of the jaws, does not lead to the formation of serious functional and aesthetic defects, any disruption of the dentition can potentially affect a person’s quality of life.

The most common consequences of adentia include overload of the surrounding periodontal fibers, changes in bite, pathological increase in the mobility of adjacent healthy teeth and their destruction as a result of functional overload. Separately, the literature mentions complications from the temporomandibular joint, which suffers due to abnormal load distribution.

Bone atrophy, which occurs a certain time after tooth loss, creates additional difficulties in subsequent prosthetics. Timely dental implantation restores the natural or close to natural load on the underlying tissues, preventing bone tissue atrophy.

The prognosis for the functioning of dental implants depends on their interaction with the surrounding bone tissue. The issue of osseointegration of dental implants is of great scientific and practical interest today. Partial or complete absence of teeth is always accompanied by signs of atrophy of the jaw bone tissue, which in at least 30% of cases is an indication for eliminating the deficit in alveolar bone volume.

Augmentation using an autogenous block graft is one of the most common and effective methods of bone tissue regeneration. One of the factors that makes it possible to reduce the rate of “subsidence” of the graft, in addition to its strong fixation and optimization of surface structures, is considered to be a differentiated approach to the selection of the graft itself, depending on the clinical situation.

Considering the availability of various methods of osteoplasty of defects in the alveolar processes of the jaws and the variety of osteoplastic materials, there is no unambiguous solution to the problem of atrophy. Planning the osteoplasty method and choosing a specific graft depend on determining the degree of bone resorption, the nature and size of the bone defect.

Computed tomography of the jaws has an important diagnostic value when planning dental implantation. In addition to the main task, that is, assessing the anatomy, using CT it is possible to determine the type of bone tissue and select surgical treatment protocols, predict the timing of osseointegration.

Prosthetics on dental implants is the most modern method of restoring dentition in edentulous cases. However, the main problem that dentists increasingly have to face when planning dental implantation is the insufficient quantity and poor quality of bone in the area of ​​intended implantation.

Choosing a method for restoring alveolar bone

To solve the problem of bone atrophy, various methods have been proposed at different times: installing implants bypassing the maxillary sinus, using subperiosteal implants, implantation with perforation of the bottom of the maxillary sinus, etc.

Today, many researchers agree that the optimal solution for restoring the vertical volume and thickness of the alveolar bone when it is atrophied is the use of the patient’s own bone.

Autografting is the “gold standard” for organ and tissue restoration due to structural conformity, lack of immune response, and the presence of progenitor cells in the autologous bone graft. However, due to the insufficient availability of autologous bone and additional complications during material collection, this controversial method is not widely used.

The success of this manipulation depends on the technique and type of osteoplastic material used. When planning autotransplantation, we must not forget about the morphospecificity of tissues, that is, that at the cellular level the same tissue in different organs has a different structure, cellular composition, physiological activity and reactivity.

In the past, the anatomical features of the facial skeleton significantly limited the use of dental implantation, but modern approaches to bone grafting, the sinus lift procedure, and the ability to transpose critical vascular and nervous structures have expanded the possibilities of dentistry.

The choice of method of surgical preparation of jaws for dental implantation is associated with the characteristics of a particular site. This must be taken into account when planning the procedure to avoid complications and maximize the likelihood of success.

Particular attention should be paid to nearby anatomical structures, interaction with which may affect the outcome of treatment. For example, Rosenquist et al indicated that in 20% of cases, the inferior alveolar nerve forms a loop in the mesial region that projects forward by up to 1 mm. Therefore, during surgery it is necessary to avoid injury to the inferior alveolar and mental nerves.

Despite these well-known studies, implantologists have to take risks in 35% of cases when installing dental implants. However, this can lead to injury to the anterior branch of the inferior alveolar nerve and the occurrence of temporary hyperesthesia or paresthesia, which should be remembered in advance, especially if there are teeth nearby.

In addition, during bone preparation, perforation of the mucous membrane of the maxillary sinus often occurs. However, animal studies have shown that the prediction of the degree of osseointegration during the first year after the procedure does not depend on the fact of perforation of the sinus mucosa.

The ability to fully use implants during operation does not always correspond to the biomechanical characteristics of the bone tissue in the area of ​​implantation. For this reason, many authors believe that it is desirable to move away from the use of additional surgical interventions and to minimize any invasive manipulations to increase bone volume.

Data from modern research

In general, the prognosis for the functioning of all implants depends on their interaction with the surrounding bone tissue. In modern dentistry, the issue of osseointegration of dental implants is of great scientific and practical interest.

Atrophy of the alveolar processes of the jaws is an irreversible process, so the more time passes after tooth extraction, the more pronounced bone atrophy is. In the jaw bones, vertical resorption of bone tissue predominates over horizontal resorption, and atrophy of the lower jaw occurs much more intensely than that of the upper jaw.

Despite the numerous medical and scientific achievements, there are still a number of unsolved problems in dental implantology. Great difficulties with ridge atrophy arise due to insufficient volume of bone tissue to fix the structure.

Therefore, it is proposed to perform operations using osteoplastic materials in the form of inlays, onlays, split flaps or intraosseous implants, as well as using demineralized bone in various forms.

It has been proven that when preparing a patient with significant atrophy of the jaw bone tissue, operations using membrane technology and osteostimulating drugs are needed, that is, the use of the method of so-called directed tissue regeneration.

Guided bone regeneration using a membrane was first reported by Hurley et al in 1959. The principle of guided bone tissue regeneration using membrane technology has been successfully used in clinical implantology for the preliminary increase in the volume of atrophied alveolar bone, in two-stage implantation surgery, when using a subperiosteal implant, and even in adolescents in the treatment of jaw deformities.

An X-ray study of the results of using membrane technology in dental implantology showed that in 81% of cases there is an increase in bone tissue. In particular, it is possible to dramatically increase the width of the alveolar bone and its height.

For this purpose, membrane technology is used very effectively in combination with hydroxyapatite, autologous bone, allogeneic or xenogeneic osteoplastic materials. As an alternative to a subperiosteal implant, these materials are successfully used in operations for local elevation of the maxillary sinus floor.

Among surgical interventions aimed at increasing the volume of bone tissue of the upper jaw, sinus lifting deserves great attention. The modern technique of classical sinus lift, subantral augmentation, was developed in the USA.

Linkov successfully installed dental implants using this technique back in the early 60s of the last century. Hilt Tatum and Boyne devoted their work to further improving the technique in the 1970s. In 1978, at the annual meeting of the American Academy of Dental Implantology, Tatum reported to the dental community about his unique 3-year experience with anthroplasty.

Currently, work to improve the method of increasing the volume of bone tissue in case of atrophy of the alveolar process of the upper jaw continues, as evidenced by numerous domestic and foreign publications.

The main goal of sinus lift surgery is to create optimal conditions for inserting implants. In this case, implants should not pierce the mucous membrane of the bottom of the maxillary sinus, since this can lead to an acute and then chronic inflammatory process in the maxillary sinus.

When determining the possibility of simultaneous implantation, the height and structure of the bone tissue in the area of ​​the bottom of the maxillary sinus are of decisive importance. Today, these data, with a certain degree of error, can be obtained by preoperative computed tomography examination.

Selection of osteoplastic materials

The literature contains data on the long-term results of plastic surgery of the maxillary sinus floor using various osteoplastic materials. Based on their origin, materials used in surgical dentistry for bone tissue restoration are divided into autogenous, allogeneic and xenogeneic.

There is a huge number of materials proposed by various authors for plastic surgery of bone defects. Among surgeons who perform bone grafting, there remains a tendency to use autogenous bone material.

Material for autoplasty can be obtained from the ilium, as well as from the tibia, from the chin and from the ramus of the mandible.

The popularity of the method can be partly explained by the emergence of new data on the presence of substances in the bone substance that regulate osteogenetic processes (growth factors). Factors that first initiate the bone regeneration cascade include platelet-derived growth factors PDGF and TGF-beta.

The use of growth factors is indicated for severe atrophy of the upper jaw, during sinus lifting. The combination of growth factors with resorbable carriers significantly increases the efficiency of targeted tissue regeneration.

Experiments and clinical practice have confirmed the high effectiveness of various materials containing hydroxyapatite in reparative osteogenesis in the treatment of jaw bone defects. However, the most important property of hydroxyapatite was its biocompatibility, which allowed it to be used to coat implants and stimulate osseointegration.

In combination with hydroxyapatite and purified fibrillar collagen, it was possible to successfully increase the height of the atrophied alveolar process for the next implantation operation. Most often, surgeons use hydroxyapatite, which is easily resorbed, as well as demineralized lyophilized allogeneic bone and autogenous bone, and less often xenogeneic osteoplastic materials to increase bone volume.

Autologous bone has the advantage of not causing a rejection reaction and ensuring optimal timing of osseointegration with the implant. However, the volume of donor bone in the oral cavity is limited; taking an autograft extraorally is associated with additional surgical trauma and the involvement of specialists from related medical fields.

The disadvantages of using allogeneic and synthetic osteoplastic materials include a possible immune response, infection, low strength, long resorption period and insufficient primary stability of dental implants installed in the sinus lift area.

Literature data and some original studies indicate the possibility of using porous titanium for subantral augmentation. At the present stage of development of dental implantology, it is relevant to expand the indications for the use of porous titanium, including its use in reconstructing the bottom of the maxillary sinus for further dental implantation.

The use of a combined augmentation technique using xenogeneic bone minerals-osteoconductors and morphogenetic proteins obtained by fractionating the patient’s blood is also promising.

What to consider when preparing jaws for dental implantation

Unintentional premature loading of the implant leads to its failure. Sometimes implant loss can occur immediately after the second surgical stage of implantation as a result of an incorrectly manufactured and fixed temporary prosthetic device.

Later implant loss is usually due to overload caused by insufficient implant length, as well as inadequate prosthetic designs and improper interocclusal relationships.

An important condition for the long-term functioning of a dental implant is its biomechanical properties (tolerance). Along with other factors influencing the success of implants, prosthetic design planning is also important.

To avoid implant disintegration, it is important to assess the occlusal load that the prosthetic structure must withstand. If there are defects in the dentition (three teeth or more), it is recommended to install the appropriate number of implants not along one straight line connecting them, but in the form of a triangle. This will avoid bending the implants, unscrewing and breaking the screws that secure the abutments.

It has been mathematically determined that the optimal distribution of the functional load on the implant should be parallel to the axis of the implant. Many mathematical studies prove that the magnitude and direction of the acting force can be adjusted using the relief of the occlusal surface, namely the degree of expression of the tubercles of artificial teeth.

Thus, the functioning of a dental implant depends not only on the surgical preparation of the jaws for implantation, but also on the structure of the orthopedic structure, the location of the implant in relation to the antagonist teeth, neighboring teeth and the distribution of the chewing load.

Autotransplantation (autologous transplantation)

Another type of bone grafting performed before implantation. It is essentially a self-transplant since the recipient is his own donor. A similar technique is used for extensive burns, when areas of the patient’s healthy skin are transferred to the burned areas.

A similar technology is widely used by implantologists. During surgery, bone blocks taken from the patient are implanted into the jaw bone. The recovery period after installing implants using autologous transplantation is quite long and can last up to six months.

Implantation of implant roots is possible after completion of osseointegration, after 6 months. The asking price is at least 50,000 rubles.

How are implant templates made?

Templates are created automatically using special 3D printers. This is another new technology that has found application in dentistry. To create a template, the data obtained from 3D planning is digitally transferred to a printing machine, and an acrylic tray is produced.

The printer creates it in full accordance with the given program - without errors or deviations from the plan. This allows you to avoid the notorious “human factor” associated with insufficient experience or mistakes of the dental technician.

Stage 3: installation of implants

If bone grafting was performed, then the stage of dental implantation itself proceeds six months after the healing of the jaw tissue and successful integration of the bone. Surgical treatment for implantation of implant roots, in turn, is also divided into several stages, including:

• Stage 1 – pain relief. The type of anesthesia is planned at the diagnostic stage, and its choice depends on the scope of the intervention. When installing 1-2 titanium rods into the jaw, local anesthesia is usually given. If there are more, implantation may require general anesthesia or sedation;
• Stage 2 – incision of the gums and periosteum to gain access to the surgical field;
• Stage 3 – drilling a hole for the implant root in exact accordance with its dimensions and forming notches on the walls of the hole for better fixation of the future tooth in the jaw. The prepared hole is treated with an antiseptic, dried, after which the implantologist begins to screw in the implant itself;
• Stage 4 – installation of a plug to prevent tissue from growing inside the implant root;
• Stage 5 – suturing the gums and suturing. Implantation is complete.

On a note! Implant sedation is often chosen by patients who experience panic attacks before dental treatment. It is also indicated for people with heart disease and hypertension. Sedation is a safer alternative to general anesthesia, which is advisable to use for multiple dental implantations and bone grafting.

After the implants are installed, the patient is under the supervision of a doctor for some time, who at the same time instructs him regarding further treatment and care. If there are no signs of complications, after a couple of hours the person goes home, where he takes medications to speed up the healing of the gums and stimulate the osseointegration of the implant roots. In addition, he is given a leaflet with recommendations regarding oral hygiene after implantation.

The sutures after implantation are usually removed after a week, then a temporary crown can be installed. The price of the main stage largely depends on the type of implants.

In the online store Stomatorg you can buy everything you need for implantology

It should be noted that implantation does not forgive even minimal savings. All components are important here, from accurate diagnostics to the availability of high-quality consumables and tools. Without special and reliable equipment, even the most competent dentist will not be able to perform his work at the highest level. Our online store Stomatorg offers you a wide range of products from such well-known manufacturers as Anthogyr

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Our company presents products for implantology that guarantee a long service life. All instruments and consumables presented in the online store have been repeatedly tested by professional dental clinics during their work and are in demand in world dentistry.

Implant placement is a procedure that involves inserting a foreign body into the patient's bone. Therefore, it is important that the implants take root, serving the patient for a long time, without creating even minimal discomfort. Naturally, such work is a complex process. Here, not only the doctor’s experience and diagnosis of the problem, but also the availability of special tools play a significant role. We offer you: abutments, an orthopedic set, a physiotherapy clinic, bone material and much more, which will ensure an effective result and the provision of prompt, safe and high-quality services - dental implantation.

The lack of necessary tools and technical problems can create all sorts of complications and errors. To avoid such problems, it is very important to purchase high-quality components that facilitate effective and quick implantation. When purchasing tools and consumables, pay attention to the manufacturer; it is best to give preference to trusted companies, such as Antogir. From us you can buy tools and materials that meet all norms and standards, in accordance with your needs and preferences. Experienced managers will help you make the right choice by providing the maximum information about the products you are interested in. Also, our online store differs from competitors - affordable prices. Our product is purchased by a considerable number of dental clinics that care about their clients and try to provide high-quality services.

Our company offers a large selection of high-quality dental instruments and consumables for implantology: updated Lectra New furnace

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hydraulic press for crimping cuvettes PI.88.00
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wax refiner DIPPY NT light
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milling machine A2
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grinding motor BIP.2.00
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set of burs for therapy Composite Kit Blister
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surgical set Axiom
and much more. All products meet the highest requirements of modern dentistry. Our consultants will be able to provide you with qualified assistance and advice in the selection and purchase of dental equipment, tools, and materials that will allow you to equip your dental clinic with everything necessary and perform work efficiently and professionally.

The products of our online store are used in dentistry and have managed to confidently occupy the highest positions in the dentistry market, thanks to the trust and recognition of not only experienced doctors, but also clients who have received an amazing effect as a result. That's why you can trust us.

All company products have the necessary quality certificates. Using it, you will be sure that the implants will be able to take root and serve the person for many years. Naturally, to carry out a procedure such as implantation, special tools and consumables are required, which are intended for preparing the bone bed, installing the implant and all its components. When selecting such auxiliary items, you should be extremely careful and we will help you make the right choice.

Stage 4: rehabilitation after implant installation

The rehabilitation period is the time during which the implant root takes root in the patient’s own tissues. Only after osseointegration is completed can one proceed to the orthopedic stage and place permanent crowns.

It is impossible to shorten the healing time of implant roots, even if you take special calcium supplements and other medications. Depending on individual characteristics, it can average 3-6 months, although in most cases it takes at least six months.

The implantologist may recommend regular visits to the clinic to monitor the survival of the implant root (or roots). However, in the absence of discomfort and complications at the rehabilitation stage, the patient makes the next visit to the clinic at the very end. Next, a date is set for placing a gum former on the implant.

Implantation with laser

This method of implantation is the most advanced and technologically advanced. The operation is carried out practically, like the classic procedure, but instead of a scalpel, a laser is used to cut the gums. The percentage of engraftment is the highest and reaches almost 100 percent. Laser technology is used in the following situations:

• If the gum is cut and the dental implant is not installed immediately after healing.
• If the mucous membrane is re-opened, that is, with two-stage implantation.
• When the gum restoration process is carried out.

Implantation using a laser is carried out in several stages:

1. First, preparation is carried out, during which the weight of the future tooth is calculated. This is necessary in order to understand what kind of load the gums will experience. If the dentist believes that there may not be enough bone tissue to perform the operation, then a sinus lift is performed (bone tissue is built up).
2. Then the implant is inserted. But before this, a small incision is made using a laser; it is into this that the dental element will be inserted. It is implemented using high-tech and sensitive equipment - a physical dispensary. After implantation, sutures are placed on the laser-cut gum. Then a temporary crown is installed.
3. Next comes the recovery process. Depending on the characteristics of the human body, this process can take from two to six months. During this time, the dental element must grow together and become accustomed to the bone tissue.
4. After the implant has completely taken root, the second stage of laser implantation is carried out. Using a laser beam, the gums in the healed area are opened and a permanent crown is installed. It can be made of metal ceramics, metal-free ceramics, zirconium and titanium.

The main positive aspects of using this method are the following:

• Bleeding during the procedure is almost completely absent, since the gums are cut not with a scalpel, but with a laser beam. The laser beam instantly burns through the blood vessels. Due to the fact that there is no bleeding, there is no likelihood of inflammatory processes.
• The incision is made with a minimum length, on average it is made one centimeter long for each extracted tooth. The bone tissue is evaporated, so there is virtually no damage. The procedure is considered virtually non-traumatic, since this indicator is minimal. The tissues are restored and healed quite quickly. After installing a permanent prosthesis, you can return to your normal lifestyle and eat all foods.
• This operation using a laser takes a minimal amount of time. Within half an hour, the dentist makes an incision in the gum, implants a dental element and sutures the cut gum tissue.
• The procedure is completely sterile, since the laser beam has bactericidal properties.
• Side effects are practically absent completely. When using a scalpel, the dentist cannot guarantee that there will be no ingress of metallic dust. Metal particles can react with the surface of the implant, become electrified, and thus the patient will experience uncomfortable sensations. With the laser cutting method, this possibility is impossible.
• Anesthesia is used in minimal doses. Due to the minimal risk of injury and pain, a minimal amount of anesthetic is used to numb the incision site. In addition, it reduces the burden of drugs on the human body.
• Lack of psychological discomfort. From a psychological point of view, this operation is much easier, since it is not associated with bleeding gums. From the patient's point of view, cutting with a laser beam is less traumatic.
• The period of use of the implant is almost lifelong. The dental element is attached to the jaw very firmly, practically like a healthy tooth, therefore the period of use of the implant is very long.

The indications for the use of this laser method are practically no different from the indications for traditional implantation with a scalpel. An implant can be implanted using this method in any age category.

Stage 5: insertion of the healing abutment

This detail is necessary to give natural contours to the gums in the operated area. The former is screwed directly into the implant rod by cutting the soft tissue.

In essence, the plug is replaced, which is unscrewed, and a former is placed in its place in the implant channel. The manipulation is very simple and quite fast. An experienced implantologist performs it in a matter of minutes, maximum in half an hour, regardless of the type of implant. But an anesthetic injection is still given due to the incision of the mucous membrane.

This is where the main and most serious part of dental implantation ends, and after a week or two they move on to screwing in the abutment.

How is the oral cavity prepared?

Before dental implantation, regardless of how many teeth are planned to be restored, it is necessary to prepare the entire oral cavity. It is very important to eliminate any inflammatory processes, since their development is provoked by microbes and bacteria that can get into the hole and thereby cause inflammation of the tissues around the implant. That is why the oral cavity should be as sterile as possible.

Treatment of caries, pulpitis

All inflammatory processes of periodontal tissues, dental diseases (caries, pulpitis, periodontitis) and even ordinary deposits on the enamel are nothing more than bacteria. This means that during implantation, they can get inside the wound and cause tissue inflammation. The risk of developing peri-implantitis and rejection of the structure increases. Therefore, it is very important to treat the teeth that are directly adjacent to the defect area, as well as on the opposite jaw, so that the surgical area is sterile. If a large number of teeth are destroyed, then, of course, it is advisable to cure them all.

Removing dental plaque

Cleaning before implantation is also a mandatory preparation step. As with tooth decay, plaque and tartar can cause inflammation. The cleaning is carried out deep, that is, deposits are necessarily removed from under the gums. Therefore, if there is a need, gum curettage is prescribed instead of the traditional hygiene complex.

Step 6: Abutment Installation

The abutment is screwed directly into the implant root; it is the abutment that is the connecting link between the implant and the crown/prosthesis. The abutment is installed 2 weeks after the former and is selected individually for each client.

For example, when implanting teeth in the smile area and thin gum tissue, it is recommended to install zirconium abutments, since titanium “spare parts” can negatively affect aesthetics.

Placement of the abutment completes the implantation procedure and treatment continues with the prosthodontist.

The need to use surgical guides

The production of surgical templates is not carried out in all situations that arise in implantology practice. If several teeth are missing in the chewing area, there is no need to use the above tools. But when it is necessary to perform more complex procedures involving the fixation of a large number of dental structures, a surgical template is an indispensable device for dental implantation , since they allow you to clearly define the area for the location of future titanium structures.

In addition, the guides described above can be used when it is necessary to restore teeth in the frontal area, when achieving perfect aesthetics is a priority. However, in this case, much depends on the level of professionalism of the surgeon.

If there is a situation of bone deficiency, a surgical template for implantation often avoids osteoplasty (sinus lift). Thanks to it, the installation of dental implants can be performed in an area that is resistant to increased stress.

Stage 7: prosthetics

After 1-2 weeks from the installation of the abutment, impressions of the teeth and jaws can be made. Crowns can be made from absolutely any material, but ceramic products are more suitable for front teeth. Implant roots in the area of ​​chewing teeth are complemented by metal-ceramic or zirconium crowns.

The price of prosthetics varies depending on its type, since both crowns and removable, as well as conditionally removable dentures are placed on implants. In addition, the cost is affected by the material they are made of.

On a note! Zirconium is the most expensive, but also the most reliable material, which has high strength and excellent aesthetic qualities.

Making a surgical template for dental implantation

The procedure for obtaining the above device involves the participation of several specialists: an experienced surgeon, an orthopedist and a dentist. The process of making templates is carried out in several successive steps, which we will discuss below:

• Preparation. Includes diagnostic procedures, CT scanning, as well as a mandatory assessment of the clinical situation. The need to obtain it is determined not only by the choice of a suitable orthopedic design, but also by the precise determination of the location of the implant;
• Obtaining an impression. Thanks to the use of modern scanning devices, which include 3Shape, it is possible to obtain an impression of the jaw in digital format and instantly transfer it to the laboratory to create a prosthesis;
• Modeling in 3D format. Based on the use of a modern computer application, which allows you to simulate the method of performing surgical intervention, determines the location of future dental structures;
• Template production. It is carried out either in laboratory conditions or using CAD/CAM equipment. The first option involves the participation of a specialist, the second allows you to obtain a template using computer technology and a large-scale printing device.

Life after implantation

Once the implants have settled in and the crowns have been placed, it is important to properly care for them in order to maintain the results for as long as possible. The rules for caring for teeth with implant roots are standard, but with some peculiarities.

Firstly, you should use a brush with medium-hard bristles to avoid traumatizing the mucous membranes and ensure high-quality cleansing of new teeth. An implantologist or orthopedist will advise which paste is best to choose.

Secondly, it is advisable to rinse your mouth after every meal, but alcohol-based rinses are not suitable for this due to their ability to dry out the mucous membranes. A person with installed implants should have dental floss and an irrigator in their arsenal.

On a note! Insufficiently careful care of teeth on implants can shorten their service life and even lead to rejection.

Implantologists

Most importantly, make sure that the implantologist is not a visiting specialist, but is part of the clinic’s staff. If a doctor is here today and there tomorrow, it will be difficult for you to get an appointment, and simply track his movements from clinic to clinic. In addition, visiting consultants are little concerned about the prestige of the dental center; they do not have close connections with doctors from other departments and technicians.

Education also plays a role. Not only the basic ones received many years ago, but constantly updated. Is the doctor certified to work with a specific brand? How long has it been since she took courses and attended trainings? Implantology is akin to programming - you get distracted for a while and that’s it, you can’t catch up. Simply placing a dental implant is not enough these days; you need to use current techniques with a high percentage of engraftment.

One-stage, instantaneous implantation

Dental implantation of teeth can be not only two-stage, but also one-stage, one-step. If you choose one of these procedures, the installation of implants will take much less time, at least due to the absence of the need to build up bone before implantation.

In one stage, implantation is performed in two cases: with satisfactory bone condition and the use of special types of implants. During surgery, the implant is installed, and a temporary crown is immediately placed.

Unlike one-stage implantation, one-stage implantation involves the simultaneous removal of a tooth and the introduction of an implant into the same hole. But, like one-stage, one-stage implantation is performed with immediate loading, that is, after installing the implant, an abutment is immediately screwed onto it and a temporary prosthesis is placed.

Important! A temporary prosthesis on an implant can be replaced with a permanent structure after six months.

Classic one-stage implantation is also called non-surgical express implantation. It has a number of advantages, since the client:

• saves time - implants are installed in one visit to the doctor;
• saves money - the final cost of one-stage implantation is lower than classical two-stage implantation;
• obtains excellent aesthetics even in the absence of most teeth - and in the case of complete edentia, a dazzling smile can be achieved within 3 days;
• recovers quickly after installation of implants, and with a lower risk of infection, swelling and other complications, since simultaneous implantation is performed without an incision or stitches.

Thus, implantation in one visit to the dentist is the best solution, since it allows you to do without bone augmentation, which means saving time, money and preserving your own bone tissue in the area of ​​the implant root.

Tools for dental implantation list

Practice shows that preparing the operating table and printing out sterile instruments and kits should begin only when the patient has already arrived and has finally confirmed his consent to the operation, and not in advance!
On the morning of the operation, be sure to check the functionality of all equipment (aspirator, physiodispenser, operating light, etc.).

Proper, ergonomic organization of the workplace allows you not only to significantly save time (without wasting it on unnecessary and sometimes simply meaningless body movements), but also to work for a long time without getting tired. Believe me, this is extremely important, especially when over time you begin to do more complex and lengthy operations!

Of course, there are different ways to cover the operating table and place instruments on it. As an example, I will give a layout that I have been using for many years and which contains a certain sequence of actions.

Always purchase only a complete set of surgical instruments, being wary of the so-called starter instruments, which are greatly reduced in range and quantity. According to the “sandwich law”, already in one of the first operations, when you have almost installed the implant, you will see that you are missing some extension or adapter from the complete surgical set.

After the operating table is set, your assistant prepares the physiodispenser: removes sterile saline solution from the refrigerator, hangs it on the bracket and installs the peristaltic pump tubing system; opens the sterile package with the micromotor and connects the tube coming from the perestaltic pump to the handpiece.

Now the operating room is ready and the patient can be seated in a chair. Cover the patient with a sterile sheet, and a regular medical cap can be placed on the head. Treat your facial skin with a disinfectant antiseptic solution.

Octenisept→ is an excellent product for treating facial skin before surgery. The solution is colorless and does not cause skin irritation at all. Just remember to cover the patient’s eyes with your hand when treating with this spray, because... it contains alcohol.

You can begin the operation.

1. Needle holder, scissors, suture material.
2. Metal cup for bone and osteoplastic materials and auxiliary instruments (curettage spoon CM2/4, excavator, probe, eye tweezers).
3. Dental tweezers and retractors for tongue and soft tissues.
4. A complete surgical set of drills, cutters and instruments for installing dental implants.
5. Tweezers, scalpel and set of raspators.
6. Assistant's tools: retractor hooks and titanium aspirator.

To cool cutting instruments (burs, cutters, drills) at the time of preparation, it is necessary to use cold sterile saline solution. I hope there is no need to explain why it is sterile. Why saline solution? In previous years, various antiseptic solutions, antibiotic solutions, etc. were used throughout the world to cool cutting instruments during dental implantation. As a result of numerous studies, it was found that saline solution is the most optimal, because does not have any irritating or resorptive effect on the bone. Why cold? Because lowering the temperature of the cutting tool additionally protects the bone from possible thermal injury. The saline solution must be stored in the refrigerator and installed on the physiodispenser immediately before the operation, and not in advance.

The entire bone-cutting instrument must rotate much slower than is customary in normal dental practice. The highest speeds (1500–2000 rpm) are set for Lindemann cutters (photo 2.3-4) when forming the primary drilling direction and for surgical spherical burs, which remove fragments of connective tissue remaining on the bone and directly adjacent to the operation area.

For all other cutters and burs, set the rotation speed in the range of 400–800 rpm. Moreover, the larger the diameter of the drill used, the lower the speed of its rotation. There is a scheme according to which bone preparation begins with a Lindemann cutter (or a small spherical bur) at a speed of 1500–2000 rpm (there is no need to try to drill the bone as deep as possible with these tools, it is enough to perforate the cortical layer and go deeper into the cancellous layer by only 3–5 mm ). Then, when moving to a drill with a diameter of 2–2.2 mm, set the speed to 700–800 rpm and with each subsequent drill increasing the diameter, the rotation speed is reduced by 100 revolutions. Do not forget that the entire cutting tool loses its properties during operation, and friction and heating of the bone increases. Therefore, all burs, cutters, trephines, etc. needs to be changed periodically (cutters for bone preparation are changed on average after 40–60 implants are installed).

To ensure low speed rotation of the bur with high power, as a rule, handpieces with a reduction gear are used. The most universal tips have a reduction of 16:1 and 20:1 (photo 2.3-7).

We have decided that we will use saline solution as a coolant. Salt, even in small quantities contained in the solution, leads to increased wear of the tip and its corrosion, so it is preferable, firstly, to use tips specially created for surgery (from special durable and corrosion-resistant alloys), and, secondly, After each operation, it is imperative to treat and lubricate them (for example, in the Assistin apparatus).

Specialized surgical handpieces always have a hole for installing an additional Kirschner system tube (photo 2.3-8) (for drills with internal irrigation). The best irrigation option is a combination of internal and external cooling.

The use of external cooling only with intermittent bone preparation is common implantology practice. It is absolutely forbidden to work only with internal cooling of instruments!

As a rule, all physiodispensers have the ability to regulate the speed (volume) of saline supply. Forget about her! Always set the feed speed (volume) to maximum!

Time costs

For each client, the total implantation time will be slightly different, but in general we can guide you in terms of time and indicate approximate time costs.

1 day is a consultation with a surgeon who specializes in dental implantation.

Diagnostics before implantation will take 7 days (on average) - tests, CT scans and x-rays. All this can theoretically be completed in 1 day, but in practice it often takes longer to wait for test results.

It will take some time for filling, removal and hygienic cleaning of teeth. It is impossible to predict the exact timing here.

From 3 months to a year and a half - it will be required for the implanted bone and implant rods to heal, and for the installation of a former with an abutment. Crowns and dentures are made in approximately 2 weeks.

An exact implantation plan with all the necessary diagnostic tests and dental services, including their cost, can be obtained from your doctor.

What guarantees does the patient receive?

No matter what dentistry website you visit, there will be a lot of promises there. You can get confused. Or see the words “lifetime warranty” and decide – this is what you need. There is no need to rush, because there are different guarantees.

Implant warranty

It is she who will most likely end up with a lifelong sentence. All well-known manufacturers provide a lifetime warranty on their implants. Knowing that the pin will not rust, fall apart or oxidize is certainly nice. What happens if the implant does not take root? There are clinics that undertake reinstallation of the implant in case of rejection. Implantation is a complex, multi-stage process and I would like to be sure of the quality at all stages

Doctors' work guarantee

Here everything is not so rosy. Only dental centers that are confident in the professionalism of their implantologists and value their reputation take on such obligations. Only highly qualified doctors can deliver high-quality implants. Typically, warranties for doctors' work are not as long as for products. On average, this is 1, maximum 2 years. It is important to understand that the clinic bears responsibility under the contract in case of trouble. A large center will be in its place in 2 or 3 years, but a tiny dentistry can close at any time. Along with it, warranty obligations will disappear.

Licenses and certificates

A clinic where an implant can be installed must have a license for this type of activity. Certificates confirming partnerships with supplier companies protect against counterfeiting. Doctors are awarded certificates upon completion of training on working with a specific brand. Typically, dental centers are proud of their achievements and display documents for public viewing. If certificates and licenses are not visible, something is wrong with the clinic.