Prosthesis Implantation

Accurate diagnosis and thorough examination are required for a successful dental implant placement procedure.

Prosthesis Implantation

The loss of one or more teeth for any reason (congenital, trauma, chronical diseases, tumors) affects the oral health negatively and this leads to disorders in the digestion, the phonetics, the aesthetics .
The most modern way to restore the lost teeth is placing a dental implant.
The word “implant” originates from the Latin name plantum and means grafting. It is inserted in the jaw. It replaces lost teeth and serves for support of the artificial crowns, dental bridges and other types of prosthesis.

Due to the great accomplishments and the less complications, the placement of implants gains popularity worldwide. These accomplishments are result of constant scientific researches, examinations.

It is necessary for the surgeon to have the required qualification in the maxillofacial surgery, the prosthetics, the parodontology and enough clinical experience with technical skills.


Classification of the implants

1. According to the shape (root shape, screw shape, blade shape

2. According to the material (titanium - TINI, bio ceramic)

3. According to the surface (flat and polished, rugged retentions)

4. According to the type of implantation (immediate loading, late loading)

5. According to the implantation method (one stage, two stage)

6. According to the level of insertion in the bone (spongiosis, bi cortical)

The most common type being implanted is the screwable intraoral titanium implant.


Types of implantation

1. Conventional implantation:

A classical universal method is the two-staged implantation with later loading, where the implant is placed in the spongiosis bone (the soft bone).In this method we need to wait at least 3-5 months - the period needed for osteointegration (ossification).

Stages in implantation:

1st stage after taking the anamnesis and an intraoral clinical examination and a x-ray photo the patient is ready to start implantation . It is made with local anesthesia. By making a flap in the soft tissues the implant is placed (screwed) in the spongiosis (the soft bone) and stitched.
2nd stage: after 4-6 months - a gingiva –forming element is placed over the implant , so that it forms the gum above it.
3rd stage:10-15 days after the second stage an impression is taken . The dental technicians start to construct the bridge/crown over the implant.
4th stage: placing the abutment and the construction over the implant , adjusting and fixing them.

Advantages:

1 - Possibility for placement a single implant or several implants in any area of the jaw.
2 - Possibility for construction of single crowns over the implants, which gives a highly aesthetic effect.

Disadvantages:

1 - It is necessary to have enough bone for implantation.
2 - the implant is placed only into the spongious bone. The period for osteointegration is too long.
3 – when the bone is not enough , bone augmentation is needed and this prolongs the waiting period.

2. One-staged implantation with immediate loading (Immediate loading implantation; Strategic Implantation ):
/directly inserted in the bone through the gum , immediately after the extraction of the tooth/.

An innovative method, in which the implant is inserted directly through the gum in the compact bone (hard bone), without waiting for the period of osteointegration.

Stages of treatment:

Unlike the abovementioned stages, in the two-staged implantation with two-part implants it is important to be clarified, that here it is necessary for a detailed plan to be made as well as to get accustomed to the characteristics and the anatomy of the jaw. That is why, sometimes it is necessary an additional x-ray diagnostics to be made and CBCT to be done (3 D a x-ray examination);

1st stage: under local anesthesia, the implant is put directly through the gum (without a flap). The primary stability in the bone has to be verified.
2nd stage: Immediately after the placement of the implants the orthopedic stage starts ( taking an impression and send it to the dental laboratory).
3rd stage: 2 days after the second stage is the metal try of the bridge construction (an additional mediate stage for the precise design of the metal-ceramic construction).
4th stage: 1 day after the third stage is the final adjusting of the the completed metal-ceramic crown (bridge) - it is placed and fixed above the implants.

Advantages:

1 - it is not necessary to have enough bone in width or height for implantation, because those types of implants have bi - cortical anchorage in the hard bone.
2 - the advanced bone atrophy (the melting of the bone) is not a contraindication for implantation with strategic implants.
3 - patients at older age and those with accompanying general diseases (osteoporosis, diabetes) can be also implanted.
4 - options for placement immediately after the extraction of broken teeth/tooth directly in the alveolus and their anchorage deep in the healthy bone;
5 - the patients with advanced chronical periodontitis are no longer contraindicating for the placement of those implants.
6 - the specific design and processing of their smooth surface gives them an advantage consisting of an impossibility of the microorganisms to migrate and to be a reason for peri-implantation.
7 - the waiting time after the placement of the implants (the period of osteointegration) is being reduced and respectively their loading with the prosthetic construction.

Disadvantages:

1 - after the teeth extraction a natural closure (retraction) of the gums (gingivae) is in order and later the bone melts, which results in outcropping of specific segments from the construction, which does not have optimal aesthetic qualities.
2 - for greater stability of the immediate implants, it is preferred those implants to be placed and tied under one construction (splinted) above three implants.


Warranty of the prosthesis implants:

The correctly placed and positioned implant in the teeth raw and the well osteointegrated in the bone one or the anchored directly in the hard healthy bone one cannot be rejected from the organism for life….with the condition for strictly hygiene norms to be followed for the oral cavity. That is way the regular clinical control examinations with x-ray controls for finding of present microorganisms (peri-implantitis) are mandatory, they also help for finding preliminary contacts with antagonists or superior contact above the tooth implant.


Specialists Prosthesis Implantation

Dr. Ghassan Mohamed

Dr. Ghassan Mohamed

Specialist-dentist, oral surgeon and implantologist in Sofia, one of the best dentists in implantology and oral surgery.

EDUCATION Dr. Ghassan Mohamed started his higher education in 1986 at the Faculty of Dental Medicine in the Medical University – Sofia. In 1992, he a ...

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