From this article you will learn:
- dental implantation: types and prices on a turnkey basis (for 2017),
- implant placement techniques
- dental implantation - contraindications and possible complications.
Dental implantation consists in implanting special dental implants into the jaw bone tissue, which then serve as the basis for subsequent fixed prosthetics with crowns and bridges, or can be used as an additional factor in fixing removable dentures.
Dental implants are shaped like a tooth root (Fig. 1). They are made from biocompatible materials: most often from titanium, less often from ceramics or an alloy of titanium and zirconium dioxide. Below you can see the rating of the most technologically advanced and reliable implants, as well as get acquainted with the main methods of implantation.
The best implant models: statistics
Product popularity statistics, as a rule, speak quite clearly about its quality. We deliberately took the statistics of the popularity of different implant models not in Russia, but in Europe and the USA - for one simple reason. The fact is that their statistics are many times larger. In Germany alone, more than 1 million implants are installed in 1 year (which is many times more than in Russia).
In addition, we deliberately focus on the choice of implantologists, because they approach the choice of an implantation system consciously, and it is extremely important for them to receive positive results from their work. Patient reviews are always more subjective for the reason that the patient cannot distinguish what caused the unsuccessful implantation - doctor's mistakes or insufficient quality of the implant.
Most Popular Implant Models in the USA –
Implant models most popular in Europe –
Important : NobelBiocare ® , Straumann ® and AstraTech ® are well represented among the leaders of this rating in Russia. But as you will see below in the section "Price Dental Implants" - the models of these implants are not budget. The cost of turnkey tooth implantation with these implant models will start at least from 70,000 rubles. Implants from Israeli manufacturers (manufactured under the brands MIS and AlphaBio), which we will also discuss below, are distinguished by a more affordable price.
Implantation Reviews and Clinical Studies –
Numerous clinical studies show that success in implantation (i.e. the achievement of engraftment of the implant to the bone) is achieved in 95-98% of cases. Moreover, the percentage of successful operations in the lower jaw is higher than in the upper jaw. The latter is due to the fact that the bone tissue of the upper jaw is softer and more porous, and therefore it is more difficult to achieve good primary stability of implants in it. But it is precisely the tight contact between the implant and the bone at the engraftment stage that is one of the most important conditions for the success of the operation.
Thus, rejection occurs only in 2-5% of cases. And most often this happens for two reasons: firstly, in patients at risk (heavy smokers, hypertensive patients, patients with chronic diseases). The second main reason is the mistakes of the implant surgeon when planning and performing the operation, including violation of asepsis rules, rules for working with bone tissue and gums around the implant...
Dental implantation - types of operation methods
There are several classifications of implantation techniques, but the classification that takes into account the timing of implant loading is considered generally accepted (the term “implant loading” means the timing of prosthetics). There are 3 types of load on the implant -
–in this case, the crown or bridge is fixed immediately after the implant is placed, or within the first 72 hours after the operation. The implantation technique in which early prosthetics is used is called the one-stage implantation technique. The advantage of this technique is that you get a fixed bridge or crown immediately. The temporary prosthesis will be made of metal-plastic or plastic. –
in this case, prosthetics is carried out 6-8 weeks after the installation of the implant. Unlike the previous technique, permanent prosthetics with metal-ceramic or ceramic crowns are immediately used here. This technique is not often used, because. it requires ideal bone conditions (volume and density), and it is also desirable to use only more expensive implant models with an ultra-hydrophilic surface. –
late loading is used in the classic implantation technique. This is the most common implantation technique and may involve one-stage or two-stage surgery. Prosthetics is usually carried out 3 months after implant installation, or 6 months later (if the doctor performed bone grafting in parallel with the implant installation).
In this article we will talk about the main methods of implantation used in dental clinics (the term "load on the implant" means the timing of prosthetics) -
Technique 1 - Immediate dental implantation
This is the fastest dental implantation, which implies immediate loading of the implant. Thus, the crown is fixed on the implant either immediately after the operation or within the first 72 hours. That is why patients often call this method the term "express dental implantation", but the implantologists themselves use the names - "immediate dental implantation" or "immediate loading protocol implantation".
Immediate implantation is used in both partial and complete absence of teeth. In addition, with this technique, not only classical implants, but also basal-type implants (which do not require bone grafting if there is insufficient bone volume at the implantation site) can be used.
With partial absence of teeth -
Immediate dental implantation - feedback from implantologists suggests that this method is especially suitable for restoring single missing front teeth. Its advantage is that after the end of the implantation operation, a temporary plastic crown will be immediately fixed on the implant. Thus, you will not have an aesthetic defect, and you will be able to smile normally during the entire period of implant healing to the bone.
One-time dental implantation: photo
1)
first stage: installation of an implant with a temporary crown -
2) second stage: permanent prosthetics (after 8 weeks) -
The second main indication for simultaneous implantation with partial absence of teeth is the absence of three or more teeth in a row. However, in this case, only basal-type implants, such as Roott Basal or Roott Compressive, can be used. Within 72 hours after the operation, a non-removable metal-plastic bridge will be fixed on the implants, which can immediately be chewed normally. After 1 year, metal-plastic can be replaced with cermet.
With complete absence of teeth
For simultaneous implantation in the complete absence of teeth, implants of both the basal type (basal implantation technique) and classical (All-on-4 and All-on-6 implantation techniques) can be used.
Basal implantation technique: video
Technique 2 - Two-stage dental implantation
This is the most reliable method of implantation, with the fewest cases of implant rejection. Prosthetics with this technique is usually carried out after 3 months, but if bone grafting was performed in parallel, after 6 months. The term "two-stage dental implantation" suggests that the surgical intervention will be divided into 2 stages (see photo and video below).
- During the first stage –
you will be implanted into the bone, the upper part of the implant will be closed with a cap screw, and then the mucous membrane will be tightly sutured over the implant. Thus, engraftment will occur under the mucosa tightly sutured over the implant. - During the second stage –
at the end of the engraftment period (3 or 6 months), you will be assigned to a second minor operation, during which a small hole is made in the mucous membrane above the implant, the cap screw is unscrewed and the gum shaper is screwed in instead. The latter is necessary to form a gum contour around the implant before starting prosthetics, and 14 days after that, it will be possible to start prosthetics on the implant.
Clinical Case #1(two-stage technique) -
1)
first stage of surgery:
2) second stage of surgical intervention + prosthetics:
Two-stage dental implantation: reviews
This is the most reliable type of implantation, because. the implant is completely isolated from the bacteria of the oral cavity by a tightly sutured mucosa over it - throughout the entire period of engraftment of the implant to the bone (the period of osseointegration). Accordingly, there is a very low risk of developing peri-implantitis. But the downside is that the patient needs to go through a second minor surgical intervention, which is unnecessary discomfort for the patient.
A 2-stage operation should be preferred if –
- If late loading of the implant is planned (after 3-6 months).
- : if you smoke, then this is one of the 2 safest implant methods that can be used in smokers (the second is the basal implant method).
- With a high concentration of pathogenic bacteria in the oral cavity: with irregular oral hygiene, with chronic inflammation of the gums, chronic tonsillitis, etc.
- If you are planning a large volume of bone grafting or the use of a barrier membrane for guided bone regeneration.
- If you have thin gums (less than 2 mm thick) and therefore you need to increase the volume of the soft tissues of the gums around the implant, for example, by replanting a mucous flap taken from the palate. With thin gums, this is done so that there is no subsequent gingival recession and exposure of the implant neck.
Two-stage dental implantation: operation video
3. One-stage dental implantation -
One-stage dental implantation (not to be confused with one-stage implantation, in which the operation and prosthetics are performed in 1 visit) - involves a surgical intervention in only 1 stage. After the implant is installed, the mucous membrane above it is not tightly sutured, but a gum former screwed into the implant will protrude from under it. The purpose of this is to form a soft tissue contour around the implant even at the stage of its engraftment to the bone.
Therefore, after the engraftment of the implant is completed, the doctor immediately proceeds to prosthetics, because the gum contour has already been formed. And for this you only need to unscrew the cap sticking out above the mucous membrane. There are only two advantages to a single-stage operation. Firstly, this saves 2 weeks of time, which, with a two-stage operation, is needed to prepare the gums for prosthetics. The second plus is a little more psychological comfort due to the lack of unnecessary surgery.
One-stage dental implantation: a clinical case
1)
surgical placement of an implant (together with a gingiva former):
2) prosthetics 4 months after surgery:
One-stage dental implantation: reviews
in general, this is a fairly effective and safe technique, which is especially often used when early implant loading is planned (6-8 weeks after surgery). However, with a one-stage operation, there is always a slightly greater risk of bacterial infection, ie. development of peri-implantitis. This is due to the fact that the zone of osseointegration is not completely isolated from the aggressive bacterial environment of the oral cavity due to the presence of a healing abutment protruding through the mucosa.
Accordingly, this technique is contraindicated in patients with irregular oral hygiene, with chronic inflammatory diseases of the gums, tonsils. The second big minus is that it cannot be used in smokers, in patients with a reduced immune status (in particular, with compensated diabetes mellitus).
One-stage dental implantation: video
How is the subsequent prosthetics performed? –
To install a crown on an implant, you first need to insert a special adapter into the latter - an abutment. The latter is something like a stump of a tooth turned under the crown. When prosthetics with metal-ceramic crowns, an abutment made of titanium is used. When prosthetics with ceramic crowns, only ceramic abutments can be used (otherwise the metal will shine through the ceramic crown, giving it a bluish color).
Examples of titanium and ceramic abutments -
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