Installation of implants at a high level of development of modern dentistry is no more difficult than a simple tooth extraction. Depending on the condition of the jaw bone tissue, clinical indicators and the general condition of the patient, one-stage or two-stage implantation can be applied.
Dental practice shows that in most cases a multi-level technique is used, which includes a basic set of standard steps.
Planning and preparation
The purpose of this stage is completely identify possible contraindications and establish a detailed clinical picture. For this, a number of surveys are carried out:
- computed tomography;
- radiography;
- general and biochemical analysis of blood.
After that, the dentist determines a plan for further procedures and treats concomitant diseases and.
Compensation for a jawbone defect
Photo: sinus lifting scheme
After a detailed sanitation, the oral cavity is ready for the installation of the implant (pin). When installing an artificial root, the condition and quality of the jaw bone is of great importance.
Full-fledged implants can only be installed in bone of standard density and size.. If the root is absent for a long time, then part of the alveolar process becomes thinner.
In this case, restoration of bone tissue is indicated by one of the following methods:
- tissue regeneration (sinus lift). It is produced by introducing a synthetic bone substitute into the alveolar cavity. Shown only for the upper jaw. The installation of the pin in this case is possible no earlier than after 5 months;
- transplantation of an autogenous type graft (bone chips or blocks). It is the most effective method for bone restoration. An artificial root is installed only after 6 months;
- splitting the jaw bone to widen it. This method allows the implantation of a metal root immediately after plastic surgery.
In some cases, the restoration of the jaw bone may take longer than planned (from 8 months to 1 year).
There are implants that can be placed without additional alveolar bone augmentation, even if it is only 4 mm wide.
Classical technique
The classical method of implanting an artificial root type is carried out in several stages and differs in the complexity of the procedures. But, despite this, this technique is popular, as it allows you to install pins even for a single replacement of multi-rooted teeth.
Implantation of an implant by this method is a long process that lasts from 3 to 6 months. Prosthetics can begin only after the complete implantation of the metal root.
Stage of implant placement
The implantation of the pin is performed in the dentist's office and takes about 40-60 minutes.. For installation, use a two-stage. In some cases, general anesthesia may be used.
Thereby the procedure is absolutely painless and does not cause any discomfort. Implant placement consists of four stages:
1. Excision of the gums and periosteum
Before the excision procedure, a thorough aseptic processing of the oral surface is carried out. First, a patchwork incision is made on the soft tissue of the alveolar ridge of the gums.
After that, the mucous and periosteal tissues are peeled off, exposing the jawbone. Often, a conventional scalpel is used to cut soft tissues, but laser excision is preferable. This method is less traumatic and relieves blood loss.
2. Formation of the bed
Depending on the technologies used, marking of the implant site may be required to form the recess. To do this, a mark is placed on the exposed part of the bone using a spherical type cutter.
According to the set mark with a 2 mm drill, a length equal to the height of the metal rod is drilled deep into the bone. Drilling depth is controlled by a depth gauge.
After obtaining the required length, a phased expansion of the bed is carried out with an increase in the diameter of the drill by a maximum of 0.5 mm. Finally, a thread is formed on the walls of the canal, which will ensure the adhesion of the implant to the bone.
For screw type models, taps are used, and for cylindrical types, a cutter or reamer is used.
To ensure high drilling accuracy, the dentist uses individual templates, which are pre-made on a plaster model. The formed bed is carefully cleaned, dried and treated with an aseptic solution.
3. Implant placement
Cylindrical implants are installed with a slight interference with a special tool and a surgical hammer. Screw models are installed in the prepared bed using a screwing device.
The pin is installed below the edge of the alveolar ridge by at least 0.5 mm. After that, the instrument is removed, and a plug is screwed onto the artificial root with a dental screwdriver. It will prevent tissue from growing into the cavity of the installed pin.
When a gap is formed at the installation site, it is filled with osteoinductive or osteoconductive material. In some cases, both the first and second types of materials are used.
After that, a membrane can be applied, which is removed after about 20 days.
In some dental clinics, implants are treated with a special coating that contains a medicinal component. It helps to relieve inflammation in the surrounding tissues and the fusion of metal and bone.
4. Soft tissue suturing
Photo: screwed-in implant before gum suturing procedure
After the plug is screwed in, the periosteal and mucosal tissue flaps are placed in the reverse position, completely covering the implant with the plug. The wound surface is tightly sutured with interrupted-type surgical sutures, which are removed after about a week.
The installation of the implant can be carried out immediately after the surgical operation of tooth extraction into the natural bed. This will save you from additional trauma to the gum tissues.
Inserting the Healing Abutment
This element is an important part of the whole structure, since with its help the gum takes on a natural look. The gum former is installed only after the metal root has completely fused with the jawbone.
Since the lower jaw has a high bone density, osseointegration takes place on it faster, but not earlier than after a couple of months. On the upper jaw, ingrowth takes at least 3 months. Sometimes these terms differ, and the implantation of the implant can last about 6 months or more.
Before screwing in the shaper, the dentist determines the quality of the implantation of the pin using an x-ray image. The position of the implant is checked with a special probe or visually when the mucous tissue is detached.
The installation of the shaper is carried out in several steps:
- incision with a perforator of the soft tissues of the gingival crest;
- detachment of mucoperiosteal flaps, with exposure of the upper edge of the implant;
- unscrewing the plug with a dental screwdriver;
- screwing in the gingiva former;
- soft tissue suturing.
After the shaper is installed, within 1-2 weeks the gum forms a pocket around it with elevated natural edges. Due to this, with the further installation of an artificial crown, the fusion of the gingival margin with the lower part of the tooth looks natural.
There are implants that are installed immediately with the abutment, so there is no need for a shaper.
Abutment installation
Two weeks after the shaper is screwed in, the abutment is installed. The procedure for installing it is quite simple: the shaper is unscrewed and an abutment is installed in its place.
After that, the main work on installing the artificial root is completed and it remains only to carry out the prosthetics of the crowns, which are installed directly on the abutment - this is the final orthopedic stage of the entire procedure.
Basal technique
Basal (single-stage) implantation, unlike the classical technique, takes only several visits with an interval of 2-4 days. In this case, the implant and abutment are used as a one-piece construction.
After a detailed examination, individual implants and temporary crowns are made. Installation by the basal method depends on the type of implanted pins.
Insertion procedure for core implants:
- on the alveolar ridge, a puncture is made with a special tool in the tissues of the gums and jaw. The depression reaches the basal (deep) layers of bone tissue and is controlled by a depth gauge;
- a metal rod is inserted into the resulting canal, leaving the abutment above the gum surface.
Procedure for placing T-shaped implants:
- for implantation, an incision is made in the lateral part of the gum;
- produce exfoliation of the mucous and periosteal tissue, opening the bone part;
- the shape of the pin is modeled in the depth of the bone with a special tool;
- install an implant;
- the flap is returned to its place and interrupted surgical sutures are applied.
With the basal method, the installation of temporary crowns is carried out after 3-5 days. After that, the chewing function is fully restored, due to which the implant implantation is accelerated.
This technique makes it possible to install implants to restore a large number of teeth.
Despite some similarities, implantation methods differ. Their difference is not only in cost, but also in the time of installation and engraftment of the implant.
Only a dentist will help determine the method, having studied in detail all the contraindications and indications.
The following video shows in detail the procedure for express dental implantation with a closed sinus lift:
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