High-quality tooth implantation is full reconstruction of the chewing function and no complications during and after the surgery.
The most frequent complication is peri-implantitis (inflammation of tissues around the implant).
Peri-implantitis can present due to many reasons, for example:
- bone overheating. When an implant is placed without a physiodispenser (the drill is not cooled, which causes bone overheating)
- insufficient oral hygiene implant overloading. It is caused by incorrect implant placement in the bone.
Complications during or after implantation can be caused by the dental surgeon’s affecting anatomic formations on the upper and lower jaws. For example, when placing an implant on the upper jaw, one can “miss” and insert the implant directly into the maxillary sinus. Of course, there is a way out of this situation: to remove this implant and place a bigger but shorter implant.
Other complications can occur, for example, when placing an implant on the lower jaw and affecting (or compressing) the mandibular nerve. In this situation the patient has strong pain syndromes. Here again it is necessary to remove the implant. But the most terrible thing is that implant placement with damaging the nerve causes dumbness of chin and cheek, which can last for a long time, sometimes years.
Beside the mandibular nerve, when placing an implant in the lower jaw, there is a risk of damaging the sublingual artery. The bleeding after damaging the sublingual artery is intensive and difficult to stop. But the worst thing is that the artery is difficult to catch because when it breaks it contracts and literally flies into the sublingual area.
All these cases can occur due to incorrect diagnostics and planning of implantation, when the doctor did not study carefully the patient’s CT scan and did not make a correct plan.
What does high-quality dental implantation consist of?
- Diagnostics and planning of implantation.
- Preparation for implantation.
- Post-surgical period.
Diagnostics and planning of implantation
- Patient’s examination to see the absent teeth we are going to implant.
- X-ray diagnostics. Previously, it included a spot X-ray shot or an orthopantomogram. The disadvantage of these shots is their error of up to 8 mm. In other words, on a panorama shot, if we take anatomic formations (the mandibular nerve, maxillary sinus), we cannot correctly choose an implant and correctly plan a surgery. When processing the CT shot, we have an error (depending on the tomograph) of 1 mm in average. And this millimetre enables us to plan high-quality implantation. In modern CT we can choose from a special implant base an implant of any size and diameter, from any manufacturer.
In general, dental clinics offer to choose from 2-4 implant manufacturers. But we can offer our patients implants from any manufacturer, as we do not attach to the manufacturer, but we first of all look at efficiency of a certain implant in every clinical case.
X-ray diagnostics stages:
- presence of bone presence of distance to important anatomic formations.
On a CT apparatus, we study the bone thickness and bone density and then decide whether we will use bone plastics.
Depending on the selected type of implantation we calculate the cost, which can differ markedly due to many reasons:
- implantation type
- dental implant type
- dental implant manufacturer
- related operations.
Example 1. Functional implantation. When, for instance, the seventh lower tooth (chewing tooth) is absent and an implant is necessary. The patient needs chewing, masticating food well. He is not so worried about aesthetics, as when speaking or smiling the tooth is not seen. But after tooth extraction there is a minimal bone defect, say, 4 mm of the bone is absent. We will suggest this patient an ordinary functional implantation, when a small puncture is made, an implant is placed and a crown is fixed.
Example 2. Functional and aesthetic work is when there is no upper fourth or fifth tooth which can be seen when smiling and we have little of the bone. But the patient wants the tooth to look like a “real” one, which cannot be seen in a smile as a non-natural tooth. If the CT scan shows that the bone is scarce, for example, 2-4 mm is absent, we use the following method: immediately with the implant, we add the absent bone volume, then the implant is placed and the crown is fixed.
Example 3. Aesthetic implantation with the middle tooth absent. In this case we make bone plastics, in 4 months we check in the second CT the bone volume we got. If it is still insufficient we add more bone and place an implant. Then we make a temporary crown and place it to form a gingiva of a future tooth. Afterwards, when replacing the temporary crown with a permanent one, we look at how much mucosa is missing and make mucosa plastics (we tighten it).
All these things are considered at the stage of diagnostics and implantation planning.
At the planning stage, very important is cooperation of the implantation surgeon with the orthopaedist, because the final goal is to get a tooth but not just an implant. The planning stage does not suggest that first the surgeon places an implant and the orthopaedist then adjusts to it – vice versa, first the orthopaedist plans crown placement and then the surgeon looks how to place an implant. It is a very important aspect of high-quality dental implantation.
Patient’s preparation for implantation
The second stage of successful implantation is patient’s preparation for implantation.
Dental implantation needs ideal oral hygiene. Of course, there should be no dental deposits (dental plaque, dental calculus). One should understand that all implantation types are very sensitive and exacting to patient’s oral hygiene.
All teeth must be treated, there must be no complex cavities, parodontitis, periodontitis, deep caries, pulpitis. If the first stage (diagnostics and planning) and the second stage (patient’s preparation) were made correctly, then possible complications will be minimised.
This is probably the most important stage which provides for successful implantation. To make a high-quality implantation, the doctor must be an experienced implantation surgeon. The doctor must have a license – a training certificate issued by the Ministry of Health of Ukraine.
A dental clinic must have a specially equipped dental surgery. It must be sterile and tiled (as tiles can be washed). There must be a pre-surgical room where a patient puts on sterile single-use clothes.
The dental surgery must have enough room for free staying of the surgeon and at least two assistants. What is better, the surgery should have enough room for comfortable work (if necessary) of 1-2 more doctors.
There must be special instruments: a physiodispenser, a piezotome, anaesthesiologist’s equipment, monitors, shadowless lights, videocameras for surgery recording, air ventilation and permanent quartz treatment apparatus (that allows people to stay in the room when it is switched on).
Most often, post-implantation complications are possible when a patient does not follow doctor’s recommendations. For example, when after implantation the patient takes antibiotics as the doctor advised and then drinks alcohol. This is inadmissible. Or after implantation and antibiotics, the patient went to the sauna – this is also inadmissible. Such cases often bring complications.
After teeth implantation, there is a clear protocol which must be followed by the patient, in particular: • it is necessary to take an anti-inflammatory drug for 6 days • antibiotics – for 5 days • 2 weeks later, it is necessary to take minerals, calcium drugs (for 1 month).
What do we have in the end?
Successful dental implantation is based on a number of important steps: accurate diagnostics and planning, good pre-surgical preparation, correctly performed implantation and observance of doctor’s post-surgical recommendations.