WHAT IS IMPLANTOLOGY
Implants are a permanent solution for tooth loss
Implantology is the fastest growing branch of dental medicine. Implants are used to replace one or more lost teeth in the upper or lower jaw. The installed implants represent a replacement for the tooth root, and pass through the process of osteointegration (fusion with the jawbone) over a period of 3 to 6 months. During the osteointegration period of the implant, the patient is not toothless and instead wears a temporary replacement that ensures the aesthetics and function of the tooth until the final prosthetic is completed. The final prosthetic can be a single crown on the implant, a bridge on the implant or a prosthetic on the implant. Installation of the implant into the bone helps also to retain the quantity of bone inthe alveolar arch, as it stimulates the bone similar to the natural tooth, and does not lead to bone resorption, which is a consequence of tooth loss.
- Permanent solution
- Complete return of tooth function
- Natural and beautiful tooth appearance
- Improved appearance of the whole face
- Prevention of bone loss
- Regular maintenance
In cases of one missing tooth in a jaw where the neighbouring teeth are healthy, an implant is recommended to avoid any abrasion of the neighbouring healthy teeth. A crown is then placed on this implant.
People who wear full dentures are often faced with the problem of inadequate adhesion of the dentures, which can be resolved by making a prosthetic on implants. To retain the upper prosthetic in a completely toothless jaw, four implants are usually enough, while two implants should suffice for the lower prosthetic in a completely toothless jaw. Full prosthetics on implants contribute to higher patient satisfaction in comparison with conventional dentures. These prosthetics are more aesthetically pleasing, more stable and making chewing easier, with fewer functional limitations, easier cleaning and clearer speech.
Implants can be loaded immediately (immediately after their installation) or conventionally (following the period of osteointegration). Research has shown that conventional loading has shown a somewhat better survival rate for the implants in the mouth.
The implants we use in our daily operations are constructed of high quality, resistant, biocompatible titanium, and the installation procedure is completely painless, achieved through the use of local anaesthetic.
The precondition for the installation of implants isan adequate quantity and quality of bone, which is verified by panoramic x-ray and CT scans of the mouth before the planned therapy. If there is reduced amount of bone, it is possible to perform bone augmentation and sinus lifting.
What is bone augmentation?
The loss of teeth results in the atrophy of bone that is no longer stimulated through chewing via the tooth root. The volume of bone is reduced and there is not sufficient space to install the implant. Bone resorption is faster if the extracted teeth also suffered from inflammatory processes around the root, as that infection further destroyed the bone. Every implant must have sufficient amount of bone around it to support and stabilise it, and prevent the retraction of the gums around the implant, resulting in subsequent aesthetic problems, such as when the implant becomes visible through the membranes. Bone augmentation is a surgical procedure used to replace lost bone. In order to replace bone volume, it is possible to use artificially produced bone of synthetic or animal origin, or the patient's own bone (autologous bone), which is taken either intraorally (from the lower jaw) or extraorally (from the hip), reduced in size and then built into the site where it is lacking. Using the patient's own bone is the golden standard in bone augmentation, since that bone has the best potential for installation and for increasing volume. In that case, it is necessary to surgically remove a sufficient quantity of bone to be installed at the site where it is lacking. To compensate for small and medium sized bone defects, artificially produced bone of synthetic or animal origin is usually used. The oral surgery specialist will decide on the method of bone augmentation. The healing of the bone and soft tissues after augmentation can be more successful by also applying the patient’s own growth factor using the PRF method (platelet rich fibrin) or by installing a biomembrane for the stabilisation of clots and bone replacement. The PRF method is based on the isolation of platelet rich fibrin from the patient's own blood, and applying that extract to the surgical area. In this way, the platelets release the growth factor, which stimulates the formation of new blood vessels and the growth of new bone. This method is harmless since only the patient's filtered blood is used, to facilitate the healing process. The installed materials are gradually resorbed and the bone is remodelled and a new, strong bone mass is formed. Augmentation is performed under local anaesthesia and is completely painless. After the procedure, it is necessary to wait for the bone to heal (about eight months), before continuing with the installation of the implant.
What is a sinus lift?
Where the bone is lacking in the side sections of the upper jaw, the raising of the floor of the maxillary sinus (sinus lift) is indicated. This isan oral surgery procedure in which the lifting of the sinus floor is combined with bone augmentation, so as to ensure sufficient space for the installation of the implant. The sinus lift is performed under local anaesthesia, and is completely painless.
Depending on the size of the procedure, the sinus lift can be large or small. When there is about 2 mm of bone missing to install the implant, then a small sinus lift is performed, where the raising of the floor of the maximally sinus and bone augmentation are performed simultaneously with the installation of the implant. The procedure is performed using a technique called osteotomy, named after the instrument used to raise the membrane of the maxillary sinus. After the small sinus lift, it is necessary to wait for the period of osteointegration of the implant with the bone to be completed (about six months), and only then can the implant be loaded with the prosthetic (crown, bridge).
A large sinus lift is performed when a larger volume of bone is lacking, and is performed using the side procedure. Occasionally, it is also possible to install the implant at the same time, though if there is a lot of bone missing, it is recommended that the sinus lift be performed first, and the implant later. In that case, 6 to 8 months should pass before the implant can be installed, otherwise there can be a risk of complications and failure of the procedure. The oral surgery specialist will decide on the type of procedure you need, based on your scans.
What are the possible complications with the sinus lift?
The sinus lift has a high success rate, and complications are not common during this procedure, though they are possible. Complications can arise during the performance of the sinus lift, or following the procedure. While lifting the sinus, it is possible for the membrane of the maxillary sinus to burst. The thickness of the sinus membrane differs from patient to patient. If the membrane should burst, the oral surgeon can use a number of techniques to repair the defect and to prevent any subsequent complications, such as sinus infection caused by the entry of materials for bone replacement into the sinus cavity.
After sinus lifting, minor swelling is possible and should go away after a few days. Sinus infections are also possible due to various causes, such as the penetration of an infection from the nasal cavity, penetration of the implant or bone material through the membrane, or performance of the procedure on sinuses that are not healthy. The precondition for performing the sinus lift is having healthy sinuses, and if they patient has previous sinus conditions, it is necessary to consult with an ear, nose and throat doctor before having this procedure.
All-on-4
The All-on-4 implant system is a form of implant prosthetic rehabilitation for completely toothless upper or lower jaws. The All-on-4 method is not new, and has been well known and successfully used in clinical practice for years. Once the teeth are lost, over time, the jaw bone loses a portion of its bone density. If sufficient bone is retained, then the recommendation is that a larger number of implants should be installed, as there are then more supports for the prosthetic. However, in certain patients with insufficient bone quantity or poor bone quality, few implants can be installed to support the prosthetic. If the client is a suitable candidate for the All-on-4 system, just four implants (two axial and two slanted implants, as determined by the oral surgeon at the time of installation) is enough to support the entire tooth arch. Once the implants are installed into the jaw, the client receives a temporary fixed prosthetic the same day, or just a few days later. Three months later, the final permanent prosthetic can be installed. In this way, the period of toothlessness is reduced to a minimum, which ensures increased client satisfaction. This is possible due to the concept of immediate loading of the implants at the time of their installation into the bone, meaning that it is not necessary to wait for the period of osteointegration to be completed before the implant can be loaded with the prosthetic. The All-on-4 method offers numerous advantages: it avoids surgical procedures such as sinus lifting and bone augmentation in the upper jaw, which reduces recovery time and procedure cost; clients who have long been toothless and have little remaining bone can finally receive a fixed prosthetic; just four implants are needed, which contributes to the stability of the prosthetic in the mouth, giving the client the feeling of natural teeth, without the fear of instability or falling out as is the case with dentures. Also, the prosthetic is affixed using screws, and can easily be removed by the dentist to examine and repair as needed. Maintaining oral hygiene of these types of prosthetics is also very easy using a toothbrush and toothpaste, and a water shower or floss around the implants. With the proper oral hygiene around the implants, they can last a lifetime, and only the prosthetic is replaced as needed.
The price of the All-on-4 method is lower than the price of installing a larger number of implants in the jaw, and the price of additional oral surgery procedures. This makes this method of fixed prosthetics on implants more available to a wider number of clients.
IMPLANTOLOGY FAQ
A dental implant is a titanium screw that is shaped similar to the tooth root. The dental implant is surgically installed into the bone of the upper or lower jaw, based on the previously defined treatment plan. Two to six months after the implant is installed into the bone, the prosthetic can be affixed onto the implant, as the implant serves as the base for a crown, bridge or prosthetic.
1.
The first clinical exam includes a detailed overview and analysis of the existing state of the teeth. The clinical exam also includes a detailed analysis of the jaw x-rays (orthopantomogram). In planning treatment, it is necessary to consider the clinical condition in the mouth, the patient’s desires and expectations, and the patient’s budget. Given all these factors, the proposed treatment options are presented to the patient. In order to completely understand the therapeutic options, we present the situation to the patient using a detailed analysis of the intraoral photographs of the teeth and using demonstration models.
After the first examination and selection of the therapy option, we present the patient with the detailed protocol of treatment for the current state. The protocol includes extracting teeth that cannot be saved, cleaning plaque and polishing teeth to repair the existing teeth. If needed, temporary prosthetic replacements are installed on the same day, to enable patients to have normal function and aesthetics during the treatment procedure. If the clinical condition requires additional diagnostic examination, we recommend a precise three-dimensional scan (CT) of the lower jaw where the implants will be installed. The CT scan is necessary to precisely determine the quantity and quality of bone, and to determine the most optimal position for installation of the dental implant. The clinical findings, panoramic x-ray and CT scan enable us to develop a detailed therapy plan, which will include the decision on the number and distribution of implants, and any possible need for bone augmentation.
2.
The next phase is installation of the dental implants. The patient goes through preparations, consisting of rinsing out the mouth with antiseptic, and then anaesthetizing the area with a local anaesthetic. This is followed by the surgical installation of the implant (incision, revealing the bone ridge, preparation of the site for the implant, installation of the implant, suturing the wound, control x-ray). It can be emphasized that installation of the implant is not a painful process. Once the dental implants are installed, the patient receives detailed verbal and written instructions to ensure proper healing of the wound and successful osteointegration (fusion of the implant with the bone). The stitches are removed after seven days.
3.
Depending on the clinical condition, the next visit is two to six months after the implants are installed. The procedure includes opening the dental implants and installing certain anchors which helps the gums to heal and take proper shape.
4.
Once the anchors are installed, an impression is taken and sent to the dental laboratory for the creation of your prosthetic replacements.
5.
The next phase is a trial of the prosthetic and analysis of the prosthetic with the patient and the dental technician, in order to remedy any shortcomings.
6.
The final phase is the final installation of the prosthetic!
If you are missing one or more teeth or if you have difficulty chewing or speaking, then dental implants are the best solution for you. Also, if you have problems with poorly fitting or uncomfortable dentures, implants are a suitable treatment option.
Installing dental implants and prosthetics on the implants have been a treatment option and integral part of clinical practice in specialized clinics for over 40 years. With the use of sophisticated and renowned dental implant systems, at RepićDental Centre, you can be sure you will receive reliable and long-term results, both functionally and aesthetically.
Indications for the installation of dental implants are determined individually, based on each patient's clinic condition and their level of motivation. With the right decision to install dental implants, and with good maintenance of oral hygiene, the success rate of implant treatment is from 95 to 100%.
The installation of implants is not recommended for certain patients, including people under the age of 18 years, pregnant women, those with uncontrolled systematic diseases (diabetes, high blood pressure, immunological diseases), smokers (since smoking slows the healing of wounds), persons who have received radiation therapy in the head and neck region, and those who grind their teeth, as they can jeopardize the survival of the implant. These conditions, however, are relative contraindications for the installation of an implant, and the final decision will be made by the dentist, depending on the general condition of the patient and control of the disease.
Complications appear in a low percentage rate after the installation of implants, though they are possible. They include: rejection of the implant, damage to the nerves in the lower jaw, inflammation of the gums around the implant (periimplantitis), retraction of the gums, loss of interdental papilla.
In terms of price, dental implants are more expensive than other prosthetic solutions (bridges, dentures). However, dental implants are a longer-lasting solution than other prosthetics, and do not need to be replaced. Examining all the characteristics of dental implants, it could be concluded that they are the most effective solution to compensate for missing teeth.
Instructions for wound hygiene after a surgical procedure
After the installation of implants and prosthetic loading of implants, good oral hygiene is essential. Brush your implants and prosthetic replacements every day, and visit the dentist for a check-up at least twice a year. Professional tooth cleaning and plaque removal at the dental clinic is recommended at least twice a year.
- Take the first painkiller 30 minutes after the surgery, later as needed
- If the pain does not subside, please call us to book an appointment at +385 21796 241.
- Avoid using Aspirin, Andol or other medications containing acetylsalicylic acid, as this may cause extended bleeding.
- If you should see signs of bleeding, don't worry, this is normal.
- The gauze placed at the site of the procedure should remain pressed against the wound for at least 20 to 30 minutes
- Avoid rinsing out your mouth.
- Swelling may occur several hours after the surgical procedure.
- If you observe signs of swelling, place a cold compress against your cheek, alternating: 20 minutes cooling, 10 minutes pause.
- Sleep with your head in an elevated position.
- Soft foods are recommended
- Avoid hot foods
- Avoid physical activity and exposure to the sun for 48 to 72 hours after the procedure
