In the previous block, I considered all those general questions that, as a rule, arise in a patient before making a decision on the use of dental implant technology. Suppose you have now decided that you have no other way than to the implantologist. Now it's time to talk about the operation itself. installation of a dental implant, about how it goes, is it possible to put an implant simultaneously with tooth extraction, what is surgical template how long do you have to wait to find out whether the implant has "taken root" ...
In general, we will continue to create F.A.Q. on dental implantation.
1. How is the implant placement procedure performed?
Despite the fact that some patients still imagine dental implantation as something very complicated and bloody, it can be said for sure that the installation of dental implants today is an absolutely routine predictable surgical procedure. In some cases, tooth extraction can be longer and more difficult. Despite the fact that many people have had their teeth removed at least once in their lives, the inexplicable fear of implantation still remains. Why? Probably because a person tends to be afraid of something unfamiliar. That is why it is worth talking about how the standard implant installation procedure goes. Just in case, for impressionable readers, I will avoid naturalism in matters of surgery, so we will limit ourselves to diagrams and animations.
So the implantation of the tooth, I must say, is very simple. This is easy to verify by viewing a short schematic animation example.
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All this takes an experienced doctor 15-20 minutes of working time. With a stuck wisdom tooth, the surgeon sometimes has to mess around much longer.
It should be noted that during the installation of the implant, it is very important that the surgeon use good modern equipment and not too old drills for drilling. Lack of cooling, sloppy work, use of blunt tools (they need to be updated quite often) - all this can lead to failure, i.e. The "screw" simply does not integrate into the bone. If there was a "rejection" of the implant even before its prosthetics, then almost certainly a mistake was made somewhere. With rare exceptions.
2. How to behave before and after dental implant surgery? Memo.
Despite all the harmlessness, the installation of an implant is still an operation. Even in the treatment of banal caries, many patients, just sitting down in the dentist's chair, are already dreaming of jumping out of it as soon as possible, forgetting their things and everything in the world, just to quickly be outside the walls of the office. This is instead of asking in detail and remembering how to behave after a date with the dentist. Therefore, if the surgeon did not take care to hand over the leaflet in advance, then already at home the questions “and what to do with this happiness now?” begin. Is it allowed to eat, drink, smoke, brush teeth around the wound, etc. But let's start in order.
What to do before dental implants?
A couple of hours before the operation, it is worth eating a little (if the operation is in the morning - a light breakfast with sweet tea, if in the afternoon - a light lunch instead of a 3-course dinner). It is categorically not recommended to come to the reception hungry, so as not to collapse into a swoon even at the stage of “freezing” the operation area. Of course, no one feels sorry for ammonia, and it’s not very possible to really fall while lying on an armchair. But still, once again, the medical staff should not be nervous.
If you consider yourself to be a “nervous” type of patient, you are afraid of everything, you are terribly nervous for any medical reason, then it will not be superfluous to take something sedative, at least a banal “valerian” in any form, 30-40 minutes before the “X” hour . In no case do not relieve tension before the operation with alcohol. In especially severe cases, it is worth consulting with your doctor about taking stronger sedatives. Or, as an option, discuss with the surgeon the possibility of performing the operation under sedation (i.e., in a semi-conscious state under the influence of special anesthetic drugs). Of course, if you are impressionable, then you should not look at photos and videos of “live” operations on the eve of the operation. On the contrary, it is worth being distracted as much as possible, having a good night's sleep in order to come to the doctor's appointment in a cheerful and cheerful mood.
In some cases, shortly before the day of surgery, you should start taking antibiotics and antihistamines (to reduce postoperative discomfort). This is not always necessary, and your surgeon should tell you about this in advance.
It is advisable to brush your teeth well before taking it. Do not take time from the surgeon to do it for you.
What to do after dental implantation?
Immediately after the operation, you should take 1 tablet of pain medication, and 1 more at night. Other medicines (antibiotics, antihistamines) - at the discretion of the doctor. Not in all cases their reception is necessary. I would even say, basically they are not needed.
If possible, in the first hours after the operation, it is worth applying cold to the injured area from the outside. This will greatly reduce the likelihood of swelling and bruising.
Try not to drive immediately after the operation, and do not plan any work associated with increased attention.
The first few days after the operation, serious physical exertion, hypothermia, overheating (bath, sauna, hot bath) should be avoided.
Try to carefully observe oral hygiene, but it is necessary to wield a toothbrush in the operation area without fanaticism. Despite the fact that during implantation, the surgical wound is almost always sutured and it is quite difficult to damage anything, nevertheless, you need to be very careful. In addition to the standard brushing of teeth, it is worth rinsing your mouth with mild antiseptics for the first few days, for example, 0.05% chlorhexidine solution. Keep in mind that prolonged use of this drug gives the appearance of a grayish-brown plaque on the teeth, which, however, is then removed without much difficulty. In the first 3-4 days after brushing and rinsing the teeth, it is good to lubricate the gum at the site of the operation with an ointment that accelerates its healing (for example, Solcoseryl dental adhesive paste or Asepta adhesive balm).
Try to choose a more forgiving diet without coarse solids for the first few days.
To prevent edema, try not to sleep at night on the side where the operation was performed during the first couple of days. It also costs more to be in an upright position, sitting and lying less. Try to keep your head above the rest of your body.
Do not forget that usually after 7-10 days you need to come to the doctor for an examination and removal of stitches.
In any circumstances, you should not independently conduct an audit of the site of the operation with your fingers, toothpicks and other improvised means.
In these cases, it is worth calling a doctor or showing up for an unscheduled examination:
If after 2-3 days the pain in the implantation area does not go away, if there are signs of an increase in pulsating acute pain, sharp pain when touching the operation site with the tongue.
If you continue to bleed several hours after surgery
If after a few hours the feeling of numbness in the area of operation does not completely disappear (especially in cases of implants in the lower jaw).
3. What is a surgical template for implantation? Why is he already? Is it included in the cost of the operation?
A surgical template is a special device for the correct installation of implants, which is usually made by an orthopedic dentist at the stage of planning the operation. In fact, the task of any surgeon performing an implantation operation comes down to the correct protocol installation of the “screw”. But after all, an implant is not an end in itself, it is only an intermediate stage of prosthetics. Those. on the implant placed by the surgeon, you still need to somehow put a crown or some other structure. And here it is very important that the implant not only “grown” to the bone, but also stood correctly. What does right mean? In the right place, at the right slope, at the right depth… ie. it should not just be put "by the eye" of the implantologist, but oriented in a certain way. Because later it may turn out that the implantologist has his own “eye”, and the prosthetist has his own. Here, just so that both doctors, working in conjunction for a single result, understand each other, a template is necessary. It most often looks like a kind of removable prosthesis.
This is what one of the variants of the surgical template looks like. During the operation, the implantologist will position it in exactly the same way and will no longer be able to place the implant crookedly and in the wrong place where the orthopedist needs.
To make it, the prosthetist must take impressions in advance and clearly plan the position of future crowns, so that later it does not turn out that the implants are not right and not there. This is especially important when carrying out large works, when a large number of implants are placed, and the surgeon does not have any reference points in the form of adjacent teeth at all. A template is also very important in anterior surgery when it comes to achieving maximum aesthetics. If there is a template, the surgeon applies it to the operation area during the operation, and then it will no longer be necessary to guess how to orient the implant in 3D space.
The surgical template, as a rule, is not included in the cost of the operation, since, despite everything written above, it is far from needed in 100% of cases.
And now I want to show a clear example of what results can be obtained in the absence of planning for the installation of implants.
This photo shows the sad result of an illiterate installation of implants. A young girl lost her front teeth due to an injury and the surgeon decided to put implants in her without planning treatment by an orthopedist. Just a couple of weeks after the prosthesis, the patient realized that with such teeth she could not smile normally. The result of the treatment is absolutely disastrous from the point of view of aesthetics, although both implants "take root" perfectly.
The reasons for this result are clearly visible here. The implants were placed according to the scheme "as the surgeon's right hand itched". They are installed at different angles, at different depths, without taking into account the need to form the correct gingival contour. At the same time, an implant system was used, which has limitations in the possibilities of prosthetics, so it is impossible to rectify the situation with crowns. Unfortunately, in this case, the only option to fix everything is the removal of implants, bone grafting and re-implantation.
After the removal of the implants, the patient was made a banal temporary removable prosthesis (the so-called "birdie"), the aesthetics of which is much better than previously installed crowns on implants.
4. How long after implant placement do I need to walk before final prosthetics? What to do if the time has come for prosthetics, but you need to somehow delay this moment?
To the frequent question “how long will the implant take root”, there is no unequivocal answer for all situations in medicine (well, this is such a field of knowledge, nothing is ever 100% here). Everything is individual and depends on several factors, the main of which is the quality of the patient's bone. If it is dense and there is more than enough of it, then sometimes you don’t need to wait for anything. Immediately after the operation, you can carry out the so-called. "immediate load", i.e. put a temporary crown on the implant (I will tell you more about immediate and delayed loading). If the patient had little bone, it is loose, then the time for delaying the moment of permanent prosthetics increases. And here it must be said that in the upper jaw the bone is always looser than in the lower. Therefore, on average, the waiting times are always shorter at the bottom (usually 2-3 months) than at the top (4-6 months).
What to do if the deadline for prosthetics has already come up, but there is no opportunity to put crowns (well, for example, due to a local financial crisis in your wallet separately)? It is quite easy to delay the stage of prosthetics painlessly for a couple of months. If even then you are not ready, then you need to install at least temporary plastic crowns on the implants. This will not be very expensive, but it will save you from irreversible bone loss around the implant. After all, the process of chewing with a crown transfers the load on the bone through it and the “screw”, which allows the latter to function normally. Without a load, it will begin to atrophy, and don’t go to a fortuneteller. This means that the money spent on implantation can fly into the pipe. With temporary crowns, it will be possible to walk for quite a long time, but you need to remember to visit an orthopedic dentist every 3-4 months for follow-up examinations. Well, in general, of course, it is worthwhile to calculate all your strength in advance so as not to lead to such situations.
5. How long to wait to find out if the implant has healed?
The final answer to this question can only be given by an autopsy ... Do not be alarmed, this is not about a pathologist, but only about an implant. The fact is that all methods for assessing osseointegration (this is what “engraftment” is called in the language of dentists) available to most practitioners are completely subjective. Usually, an x-ray is used for this purpose to assess the condition of the bone around the implant. But he will show only obvious problems, due to serious mistakes made by the surgeon during the operation. Also, some dentists determine the degree of “maturity” of the implant using percussion, just like when choosing a watermelon.
When checking the osseointegration of the implant, the surgeon taps on it, trying to determine by the sound (dull or voiced) how tightly the "screw" is fixed in the bone tissue. In much the same way, we try to figure out the degree of maturity of a watermelon in the market without cutting it.
But far from everyone has a conservatory education or at least a couple of "musician" classes, and therefore this method cannot be called 100% objective.
Of the more or less objective methods for assessing the degree of implant osseointegration, there are special devices that are based, in general, on the same principle as the implantologist when trying to determine the degree of maturity of the “screw” by ear. In this case, the device does the same and gives the doctor some numbers that show the degree of stability of the implant in the bone. Although, as far as I know, such devices are still not widely used.
Device "Periotest" for determining the degree of mobility of the implant
So how do things work in practice? Most often, everything is determined at the time of opening the implant and installing a gum shaper * (or abutment) into it. If, when it is screwed-untwisted, the implant stands rooted to the spot, then it’s good. If it scrolls under load, you will have to remove it and reinstall it again.
This completes the first part. To be continued…
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