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For patients

What means the dental implant treatment?

 

A dental implant is an artificial root made of titanium or zircon. It is implanted in a jaw bone and supports artificial teeth.  In many cases dental implants placement allows to get rid of dentures and to achieve stable fit of fixed dentures, to restore existing dental defects without peeling of healthy teeth for making bridges.

 

The dental implant treatment is a highly specialized method of dental care which has its own indications and contraindications. Only after detailed examination doctor can conclude the possibility of such interference. Main precondition for implants placement is appropriate availability amount of bone tissue. Therefore recently, in cases of bone lack, the dental implant treatment was not possible. Typically this situation was observed in lateral parts of an upper jaw (maxillary sinuses) and lateral parts of a lower jaw (mandible proximity of a nerve).  

 

Today this problem is solved by various bone grafting methods.

 

An X-ray examination (orthopantomography) makes preliminary conclusions about the quality and usefulness of bone tissue for implant placement. A computer tomography is appropriate for planning implant surgery, it becomes more accessible and safe.

 

Modern implants are made of titanium which is biologically compatible with bone and other mouth tissues. It is used for many years in the implant dentistry and in orthopedic surgery (broken bones connection, femoral bone prosthesis etc.). Another group is zirconium implants based on white zirconium oxide. But unlike titanium implants which are used for over 40 years, these implants require additional scientific developments.

 

The dental implant treatment surgery can be used depending on the clinical situation in a dental office, using local anesthesia or in specialized clinic under the general anesthesia with anesthesiologists presence.      

 

There are classic two-step, one-step or direct dental implant treatment.

 

Two-step dental implant treatment is considered as a classic one and is conducted in two stages with an interval of 5-6 months on a upper jaw and 2-3 months on a lower jaw. Implants which were placed in a bone are “in reserve” under a gums for this period. Researches which were conducted over the last 20 years show how during this time implant fouls by a bone (osseointegration). It gives the successful result in 98% cases and respectively 2% of implants which are “not settled down”. After 3-6 months comes the second step of the dental implant treatment which means the eternal implant structure (stumps or abutments). A stump (abutment) is covered with a temporary crown which may come into a contact with teeth of another jaw (with occlusion pressure) or without it (without occlusion pressure). Temporary crowns with occlusion pressure are placed mainly in case of complete teeth absence replacement.

 

One-step dental implant treatment is conducted in case of appropriate titanium implants primary fixation or in case of titanium implants placement in which this implant or abutment is presented by one structure. Usually after implant placement a temporary crown is fixed. After 4-6 months this crown is replaced for a permanent one.      

 

Direct dental implant treatment is an implant placement immediately after tooth extraction, directly into a tooth hole. The possibility of the direct dental implant treatment a doctor determines after a consultation and an x-ray examination.

 

 

INDICATIONS AND CONTRAINDICATIONS FOR THE DENTAL IMPLANT TREATMENT

 

If implants are properly inserted, wounds will heal quickly. There are two groups of general medical contraindications: “danger factors” or “high danger factors”.

 

High danger factors of complications while implants placing.

 

Serious uncontrolled systemic diseases, such as rheumatoid arthritis, endocrine disorders or violation of bone structure, such as osteomalacia or osteopsatiroz (osteogenesis imperfecta – so-called “a glass bone”). But osteoporosis is not a contraindication for dental implant treatment [Baxter & Fattore 1993; Dao et al. 1993].

 

Patients with weakened immune system which is a result of viral infection (VI) or treatment of certain medications (corticosteroids, cancer chemotherapy or other immunosuppressors) demonstrates weakening ability for wound healing and inadequate reaction of the immune system.

 

People who abuse alcohol, drugs and patients with mental disorders are not responsible concerning proper treatment regime compliance and implants care, because they do not cooperate with doctors [Hogenius et. al. 1992].

 

Risk factors during dental implant treatment, in case of complications.

 

Diabetes. Serious forms of diabetes, especially teenage diabetes (type 1), are considered as risk factors. But to patients with the controlled diabetes (type 2) the implantation therapy is not forbidden. However, implantation therapy is not denied for patients with controlled diabetes (type 2) [Shernoff et al. 1994; Oikarinen et al. 1995]. But it should be mentioned that the risk of implants loss for those who have diabetes will be constant for their all lifetime.

 

Predisposition for bleeding during the hemorrhagic diathesis or medically substantiated violations of blood coagulation also are considered as risk factors during the implantation therapy.

 

Previously irradiated bone. Radiation therapy can lead to fibrosis and vascular thrombosis with subsequent tissue destruction and chronic incurable wounds [Epstein et  al. 1997; Wong et. al. 1997]. Therefore an irradiated bone is considered to be a risk factor. But after some period it would be possible to conduct radiation therapy [Esser & Wagner 1997; Jisander  et al. 1997; Granstroem & Tjellstroem 1997].

 

Intensive smoking negatively affects on the long-term prognosis during the dental implant treatment. But according to some authors there is some risk for smokers for implant loss. This situation is observed during the first year after dental implant treatment [Bain & Mao 1993; Gorman et al. 1994; Bain 1996; Haas et al. 1996; Lindquist et al. 1996; K.Moy et al. 2005].

 

Allergic reaction on titanium. Titanium has the highest biocompatibility among metals to a human body. It is used successfully in the dental implant treatment and in other medical spheres. But for patients who have hypersensitivity to metals it is possible to install implants with zirconium oxide.

There are some local preconditions for dental implant treatment: infection of dentoalveolar system diseases should be absent and there should be healthy bone shape in the implantation hole. Local contraindications include temporary contraindications and local risk factors.

 

Temporary contraindications:

 

Unsatisfactory hygiene of an oral cavity, lack of a patient motivation and collaboration with a doctor.

 

Insufficient bone volume in an implantation hole belongs to the temporary contraindications, because there are a lot bone reconstruction methods. Using these methods before or in a process of the dental implant treatment there is a possibility to conduct structured alveolar crest [Buser et al. 1994; Buser et al. 1996; von Arx et al. 1998; von Arx & Kurt 1998].

Uncontrolled periodontitis should be stabilized before conducting the dental implant treatment. Periodontal treatment and appropriate oral care methods should exclude possible infection of the implantation area of teeth affected by periodontitis [Mombelli & Long 1992; Meffert 1993; Mombelli 1993; Cune & de Puffer 1996; Gouvoussis et al.1997].

 

Local risk factors:

 

Erosive or cystic diseases of oral cavity mucosa. For example, pemphigoid – the local contraindications to place dental implants due to their autoimmune origin. Usually they require local or systemic therapy which suppressed the immune system [Weinberg et al. 1997].

 

Xerostomia (dry mouth effect) can be caused by long-term medical therapy or by autoimmune diseases and is often diagnosed in elderly patients [Wu & Ship 1993; Navazesh et al. 1996]. Reduced salivation is also seen as a local risk factor, because saliva contains active antimicrobial components and makes a cleaning effect.

 

Bruxism (night teeth gnashing) related with a high risk of implants loss, such as implant fracture or loss of an osseointegration [Perel 1994; Rangert et al. 1995].

 

Therefore, during a prosthetic construction producing which is supported by an implant, the great role play treatment conducted in detail and based on the x-ray data. Each patient who needs the implantation therapy requires a detailed analysis concerning indications and contraindications. For this reason the consultation is necessary.