Prosthetics using the classical method or implantation, which is better?

Methods of restoring teeth Requirements for methods Pros and cons of implantation Removable denture or implant Clasp denture or implantation Bridge denture or implant Comparison - which is better to choose Which will last longer Which is cheaper Doctor's opinion

The loss of even one tooth is accompanied by changes in the functionality of the entire row. Neighboring teeth become crooked and move towards the missing one. Bone loss begins in the empty area. There is no need to talk about impaired chewing function or psychological discomfort. In this case, implantation and classic prosthetics will help restore your smile. But it is dental implantation that completely solves the problem of functionality and aesthetics of the dentition. This is a physiological, durable method of prosthetics.

Removable dentures: the fastest and cheapest way to replace teeth

Removable dentures are products with a soft or hard base that imitates the mucous membrane of the oral cavity, and artificial teeth. They can be partial or complete, that is, replace a segment of the dentition or the entire jaw. A partial removable denture has special hooks - metal made of clasp wire (clasp-based denture) or plastic, which cling to the teeth, and a complete removable denture is fixed in the oral cavity due to the valve zone.

It is believed that removable dentures are now hopelessly outdated, but they have their advantages, thanks to which this solution is still in demand.

A)

Perhaps their most important advantage is the price. The cost of a removable denture depends on the material and the number of teeth being restored, however, even the most expensive removable denture costs several times less than a similar design on implants.

b)

Typically, such prostheses are manufactured within 2 weeks and do not require surgical intervention, unlike implantation. It is no secret that most patients try to avoid any surgical interventions and often choose removable dentures for this very reason.

c)

If 40-50 years ago removable dentures did not look very natural, then modern solutions (silicone removable dentures, orthopedic structures using composite teeth and individual options for coloring the base of a removable denture) can satisfy even the most demanding patient.

Content

• Consequences
• Advantages and disadvantages of implantation
• Advantages and disadvantages of prosthetics
• What is better to choose
• Benefits of Dental Implants

Dental implantation and prosthetics are modern methods of restoring missing teeth. Choosing the best one is not an easy task, because each has its own disadvantages and advantages. First you need to study the problem, undergo an examination, and only draw conclusions based on the data obtained.

Disadvantages of removable dentures

• With functionality and convenience, things are much worse. If we take the entire row of natural teeth to be 100% efficient at chewing food, then a complete removable denture (due to its design features) will allow us to achieve only 30% of the maximum capabilities.
• Another big problem with a complete removable plate denture is the unsatisfactory fixation of the prosthesis in the oral cavity. Even a properly made complete removable plate denture will not always stay well in the mouth when speaking and chewing. Also, such a prosthesis can lead to impaired diction and overlap of tactile and temperature receptors.
• A removable denture requires constant and regular correction. Food getting under the denture, the need for constant cleaning and treatment, the sensation of a foreign body in the oral cavity - this is not a complete list of problems that arise in patients who choose removable dentures.
• It is important to understand that any removable dentures without implants will not stop the process of bone tissue atrophy, which inevitably occurs after the loss of a natural tooth. Only an implantation procedure can stop bone loss.

What are implants made of?

Commercially pure titanium is most often used for the production of implants. A distinctive feature of this high-strength material is its ability to take root without problems. The titanium rod of the implant is not rejected by the body, since it is not perceived by it as a foreign body. The only contraindication for use is individual intolerance to titanium. In this case, implants are made from other materials.

Sometimes implants are made of zirconium dioxide. The advantage is that dioxide implants do not show through the gum mucosa, which sometimes happens with titanium ones. But the main disadvantage of zirconium dioxide is the poor adherence of implants to jaw tissue and the difficulty of subsequent processing of the implant rod, therefore implants made from it are not often used in dentistry.

Possibilities of a conditionally removable denture supported by natural teeth

A fixed bridge supported by your own teeth will help replace 1 to 4 missing teeth in a row. The undoubted advantage of such dentures is a better restoration of chewing function compared to removable dentures, the absence of discomfort and good aesthetic characteristics. Bridges do not need to be maintained or adjusted: up to a certain point, the patient may not notice them at all. Of course, this design will also cost significantly less than an implant-supported prosthesis. But there are some nuances here too.

✔

With a classic bridge, only a few teeth can be restored, because the supporting teeth also need to be taken into account. For example, to replace 1 tooth, the patient is given a prosthesis on 2 supporting teeth.

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Abutment teeth (even completely healthy ones) must be ground down for crowns.

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In this case, the tissues surrounding the tooth, the so-called periodontium, have an increased chewing function, taking on the load of the missing tooth. Over a long period of operation, the reserve forces of the periodontium of the supporting teeth will weaken, which, as a consequence, sooner or later will lead to their loss. That is why the service life of bridges, as a rule, does not exceed 7-10 years.

Options for the number of lost teeth

The method of restoration is determined depending on the number and location of lost teeth. Only the attending physician will answer the question of what to choose. The table shows general indications:

Pathology	Implants	Removable dentures	Dental bridges
1 tooth missing	Yes	yes, if the patient does not want to grind healthy crowns	Yes
Several teeth missing in a row	Yes	Yes	Yes
Scattered defects	Yes	depends on the length and location of defects	Yes
End defect	Yes	No	No
Completely edentulous	Yes	Yes	No

Why is implant-supported prosthesis considered the best solution?

I.

The dental implant method allows you to restore lost teeth using single crowns, bridges and full dentures supported by implants. Such a prosthesis, even in the absence of all teeth, completely restores chewing function.

II.

The implant completely replaces the root of a natural tooth: it receives the load from the crown and distributes it to the bone tissue, so that it does not undergo atrophy. Simply put, with the help of dental implants, the doctor restores the natural function of chewing to the fullest extent possible. Feedback from patients about implantation, especially from those who have previously used prostheses of other designs, will be positive in the vast majority of cases.

III.

The service life of an intraosseous dental implant (if its installation was carried out efficiently) is practically unlimited. We see patients who had implants installed more than 30 years ago. Particular attention should be paid to self-discipline and compliance with all rules of oral hygiene. The patient must understand that the presence of implants increases the requirements for daily hygiene (using not only a toothbrush, but also an irrigator) and implies regular (2 times a year) professional oral hygiene. Thus, the long-term functioning of implants is not only the competent work of the doctor, but also the responsible attitude of the patient himself to his health.

Survival and service life of implants

The healing time of implants is: on the upper jaw - from 6 months, on the lower jaw - from 3 months. Much here depends on the age of the patient, the quality of his bone tissue and the experience of the doctor installing the implants. But, if the implant is successfully implanted, it is almost impossible to remove it from the jaw.

A well-established implant will serve you for at least thirty years. If you follow your doctor's recommendations, the implant will last a lifetime. This refers to the part of the implant that is placed into the gum, the plate and abutment. The crown placed on the implant will have to be replaced, but it will last 10-15, or even 20 years.

How many implants are needed to install a prosthesis?

➢

Restoration of several teeth. It is optimal when implants replace every lost tooth. If 3 teeth are missing, we install 3 implants and replace each implant with a separate crown. We get maximum and natural restoration of chewing function and the best aesthetic result. It is possible to install 2 implants when replacing 3 lost teeth - this is already a bridge prosthesis. The chewing function is restored completely, but restoration of ideal aesthetic parameters can be difficult, as well as hygiene.

➢

Restoration of a completely toothless jaw

1. Conditionally removable and removable dentures on implants.
   When rehabilitating patients with complete edentia, it is not always possible to make a fixed dental prosthesis supported by implants. With prolonged absence of teeth and when using complete removable dentures, atrophy of the alveolar process and narrowing of the dentition occur. In the absence of the required volume of bone tissue and mucous membrane of the alveolar process, especially in the lateral parts of the jaws, implants as a support for a conditionally removable denture can be installed in the front part of the jaw. The base of such a prosthesis can imitate part of the mucous membrane, which creates an additional cosmetic effect. There are different types of fixation of conditionally removable plate prostheses supported by implants: a beam fixation system, fixation of the prosthesis on ball-shaped abutments, a telescopic system, etc.
2. Fixed dentures on implants.
   If there is a sufficient volume of bone tissue or if teeth are removed simultaneously with the installation of implants, it is possible to manufacture permanent structures on implants. These types of dentures have all the advantages over removable and conditionally removable dentures supported by implants.

• There is no need to remove the denture from the mouth after each meal.
• Reliable fixation of crowns in the oral cavity.
• The shape and size of crowns follow the anatomical shape and size of their teeth. In this case, the chewing load is evenly transferred to the bone tissue surrounding the implants, which allows 100% of the chewing function to be restored. All this makes implant-supported fixed prostheses comfortable and convenient for the patient, so adaptation to such designs occurs as quickly as possible.

In case of complete loss of teeth, prosthetics on dental implants can be carried out in different options.

1. “All on 4” is the most gentle technique with the installation of 4 implants and fixation of a fixed prosthesis on them. Surgical intervention in this case is minimal and is carried out using a special surgical template through a puncture of the mucous membrane in the area where the implant is installed.
2. Installation of 6-8 implants and subsequent prosthetics with a fixed prosthesis made of metal ceramics and zirconium dioxide.
3. Installation of 8 or more implants and fixation of fixed bridges or single crowns made of metal ceramics or zirconium dioxide on them. Today, dentistry has entered the age of digital technology and computerization. Advanced CAD/CAM systems allow you to achieve maximum speed and accuracy in the manufacture of implant-supported orthopedic structures.

Compromises in the cost of final treatment include the choice of the option of fixed prosthetics on implants made of different materials: this is the production of metal-ceramic structures, zirconium with veneer and all-zirconium structures.

To reduce the patient’s financial costs for the manufacture of implant-supported fixed dentures for a toothless jaw, you can consider the concept of patient rehabilitation “All on 4” and “All on 6”, as well as a shortened dentition.

What is a bridge

A bridge, or bridge-like prosthesis, is a traditional type of dental prosthetics in which crowns are fixed to supporting teeth. This is a one-piece structure that replaces one or more missing teeth (in a row). The structure is fixed on the supporting teeth.

Modern bridges are made of durable alloys or are presented in samples in which there is no metal at all. The durable frame is coated with a ceramic composition.

The following indications can be identified as recommendations for installation:

• absence of one or more teeth (partial edentia);
• lack of ability/desire to install permanent structures;
• diseases that are contraindications to implantation.

An undeniable advantage of bridges is their accessibility.

About the disadvantages of implantation

From the outside, implantation may seem like an ideal technique, and in many ways it is - with the exception of a few points. The disadvantage of implantation is not only the high price, but also limitations during the procedure. There are a number of contraindications in the presence of which dental implantation is not recommended or cannot be carried out in principle. In case of absolute contraindications, alternative methods remain the only option.

If a sufficient volume of bone tissue is preserved, prosthetics on dental implants does not present any difficulties and allows the patient to obtain the maximum expected functional result and better aesthetics.

In cases where the volume of bone tissue does not allow the installation of an implant, additional osteoplastic operations are required to restore it. In some cases, plastic surgery of the gingival margin may be required, especially if the patient has high aesthetic needs. In the postoperative period, soft tissue swelling and pain are possible.

If treatment is carried out according to the classic two-stage protocol, the implant is installed in the bone tissue, and sutures are placed on the mucous membrane above it. After surgery, the healing process (waiting for the implant to integrate into the bone) can take from several weeks to several months. Then the second stage, additional surgery, is performed. The implant is opened, the external parts are fixed on it, and the orthopedic stage of treatment begins, the manufacture of the actual dentures. Not everyone is ready to wait that long.

There are options for installing an implant during tooth extraction and immediate fixation of a temporary prosthesis on the installed implant. The choice of technique is made by the doctor, based on each specific case.

Contraindications

Regardless of the choice of prosthetics, a dental bridge and an implant have their contraindications. In the first case there are few of them:

• absence of more than four incisors, two premolars, and one molar in a row.
• malocclusion;
• severe forms of periodontal disease;
• abrasion of hard tooth tissues (pathological).

Implantation involves surgical intervention, therefore it has a large number of contraindications:

• chronic diseases (blood diseases, central nervous system damage, immune disorders, malignant neoplasms, type II diabetes mellitus, tuberculosis);
• pathology of the bone tissue of the jaw;
• disproportions in the distance between the sizes of the maxillary sinuses;
• bite pathologies;
• inflammatory gum diseases.

Some of the contraindications are relative and require medical supervision.

About implant brands and price differences

The most expensive implants are those made in Europe and the USA, but this does not mean that they have no alternative. We recommend paying attention to South Korean implants. Many are quite skeptical about products from Asia, but the medical industry of South Korea is not inferior to leading Western countries in terms of technological solutions. One of the best South Korean implant systems is Osstem. The company offers a wide range of implants and abutments that can solve the problem of partial and complete tooth loss in patients of various age and social groups. The possibility of 3D planning and the availability of special sets of tools for installing Osstem implants in conditions of bone deficiency makes it universal.

It is very important that the selected company producing implants has a distributor in your city who would not only sell this system, but also conduct courses, seminars, master classes and provide all the necessary technical support to doctors and patients. There is no need to save on your health by trusting systems that have not received a license and do not have official representation in Russia.

Implant shape

Observations show that the best shape is for implants made in the form of a threaded cone. This design allows you to change the angle of the implant during installation, which helps position the crown in a natural way.

The shape of the upper (coronal) part of the implant, otherwise called the neck, also plays an important role. The best option is an implant neck with grooves, shaped like an inverted cone. The bone tissue around such an implant will quickly grow, giving the tooth a natural appearance.

The role of the doctor in choosing a treatment method

Often, already at the first consultation, the patient categorically declares: “I need an implant!” It sounds so confident that it seems that only the lack of appropriate tools is keeping the patient from doing it himself.

Before receiving the right to treat patients, a doctor studies for 6 years, then for 2 years he can undergo highly specialized training. Every 5 years he goes to improve his qualifications, but in fact he studies all his life, constantly gaining new experience, skills and knowledge. What can be concluded? Only a doctor can draw up an optimal rehabilitation plan and carry out the necessary manipulations.

Before starting treatment, a comprehensive clinical and radiological examination is carried out, and if necessary, the patient is referred for consultations to doctors of related specialties. Not only the extent of the dental defect is assessed, but also the condition of each remaining tooth, the quantity and quality of bone tissue, and the presence and severity of the patient’s general diseases. Only then will it be possible to make a diagnosis and formulate a treatment plan. Of course, the patient should be fully informed about both the treatment plan and alternative methods.

In conclusion, we would like to advise patients who have not decided on the choice of treatment method and who have no serious contraindications to pay attention to dental implants.