Dear friends, I am glad to welcome you again! We have already discussed a lot on the topic of wisdom teeth, , , , and even more so . I am very pleased that many of you liked the articles, but today I will continue the topic of implantation.
We all know that our people go to doctors in exceptional cases. Then when it's too late. Going to the dentist is no exception. Of course, this has little to do with Habr users, but I would like to tell you, and most importantly, show you how this can end.
So, let's begin!
What is everyone so afraid of? What is stopping them? Everyone has their own reason. If we talk about dentistry, then in my opinion the main two are the fear that it will hurt (or even more painful than now) and the fear that it will be expensive. They say it's better to spend this money on a vacation, a new car or ... 8PACK OrionX. Everyone's priorities are different.
But few people think that an untimely visit to the doctor can only aggravate the situation. Often, while you think “I’ll be patient and it will pass by itself,” the situation can worsen until serious complications appear, in which the only way out is to call an ambulance. But it also happens that many dental problems are asymptomatic and can only be detected by chance. This is how “it doesn’t hurt, okay”, later it comes to the point that none of the teeth can be saved and all of them have to be removed. And as we know, the larger the volume, the harder the work and the higher the cost. No matter what area it is. Therefore, it is extremely important to visit the dentist every six months in order to track all these “does not hurt” in a timely manner. Why six months? It is believed that within no more than six months, it is possible to detect and eliminate the problem even at the initial stages of its development.
Here is one example
The patient is quite sensitive to her teeth. As we can see, she was actively involved in the treatment and restoration of teeth. But time passes, and therefore, the service life of fillings, crowns and bridges has come to an end. In addition to the fact that your teeth deteriorate, problems can also begin with implants installed, as in this case. The second also needs to be removed. Not to mention the fact that some doctors still install plate implants without any indication. Which can break very easily, as in this case. And all why? Yes, because there was no comprehensive approach, treatment plan and vision of the situation. Tell me, why did they “shove” a thin plate here with such a width of the bone? But for sure before the operation the conditions were even better. Well, it's definitely not worse.
The only correct solution is to remove the plate implant. Although ... removal is putting it mildly. It will have to be cut out. What I mean? And I mean, YOU DRINK. After this word, somewhere on the horizon, Billy's doll on his bike begins to slowly but surely approach, and the ability to adequately perceive information slowly disappears, agree.
As we know, plate implants lack integration. This means they do not fuse / do not take root in the bone. They are held only mechanically. When forming a bed for the implant, a “trench” is made along the alveolar ridge, where this plate is placed in turn. Over time, bone tissue grows into the holes of this implant. And it turns out something like a castle. Therefore, it will not be possible to remove it in any other way than what I indicated above. You say, does the usual, cylindrical implant have to be removed in the same way? Akey, now compare the area of the wound when the plate is removed about 2 cm long, and the cylinder, on average 4,5 mm in diameter. There is a difference? Moreover, if for some reason there are problems with a cylindrical implant, then, as a rule, it either did not integrate (did not grow together with the bone), and therefore, you can get it with your fingers, or there was a critical loss of bone tissue around the implant, as in this case. Often, the work of a drill or an ultrasonic handpiece is minimized, as well as trauma after manipulation. Although, of course, this does not detract from the difficulties associated with restoring the volume of lost bone in this area. Since there is usually an impressive "hole".
So, after taking into account the results of the diagnosis, the consultation of the orthopedist and, importantly, the wishes of the patient (!), it was decided to remove all the teeth in the upper and lower jaws, including the previously installed implants. In addition to the record, I left it for dessert.
Do you think that's all? Can we start? No matter how! At this stage, new fears begin, such as - “What?! Remove everything at once?!”, “Will I survive at all?”, “How will I then chew with my gums?”
In fact, there is nothing dangerous in this. Nothing threatens your health and even more so your life. Moreover, no one will let you leave the clinic without teeth. Before removal, casts of the jaws are taken without fail by an orthopedist, and after that, complete removable dentures are made by a technician in the laboratory. After the work gets to the clinic, the patient is recorded for tooth extraction, and then immediately for fitting and delivery of the structure in the form of temporary prostheses. This means that just as you came to the clinic with your teeth, you will leave with your teeth.
Before and after removal:
Temporary removable prosthesis, tried on immediately after tooth extraction:
Before proceeding with implantation, about 2 months should pass until the wound is completely healed. It makes no sense to wait longer than this period, the bone will not grow from this, but the decrease in its volume will be more and more pronounced over time. The jaw, of course, will not resolve, but with a long absence of a tooth, and therefore, a load in a particular area, the bone tissue slowly begins to decrease. The longer the recovery is delayed, the worse the conditions will be by the time of implantation. This means that the likelihood and need for bone grafting will only increase.
Well, two months behind and it's time to start implantation! But how to install implants if there is not a single tooth? What to focus on so that they stand exactly and in their place? We can't just place them anyway. To avoid this:
Therefore, a surgical template is used. A special mouthguard, which is very similar to a sports mouthguard, with only one condition: holes are made in it in the area of the teeth that will be implanted in the future. This is required so that the surgeon can understand exactly where the implant should be. Below is a positional template that serves only for markup:
In the case of this patient, the production of a separate surgical template is not required. The orthopedist, using cutters, forms similar holes in the temporary prosthesis itself, which will serve as a template. After the operation is performed, the same doctor will close up these holes with a special material and it will be possible to continue using the prosthesis until the permanent construction is made. And no, putting it in a glass of water before bed will be unnecessary.
In the panoramic image below in the middle, contrasting “white cylinders” are clearly visible, this is exactly the same material that closed the holes in the upper removable denture. The prosthesis itself is not radiopaque, so it is not visible in the picture.
Well, for dessert. Behold! Here it is, creation! This is what I was talking about, a plate implant with holes in it, into which bone tissue has grown. Well, a broken "pin", which was one of the supports for the bridge.
What happened to the other support, you ask? Drumroll. Your teeth! Canine and first premolar (4ka). The patient brought the picture. It is quite ancient. Filmy and not the clearest, but what is. (Photo taken with phone)
Someone will think, what's wrong with that? Well, an implant, well, a tooth. Bridge and bridge. And the fact that the teeth have a ligamentous apparatus, one of the functions of which is cushioning. That is, when chewing, the teeth “spring” a little, when, as an implant, it is rigidly fixed in the bone and is deprived of this function. Something like a lever comes out. There is an overload of the transition area of the "pin" into the body of the implant, as a result of its fracture.
Well, let's summarize!
Dear friends, you must understand that neither a large amount of work, nor the removal of all teeth, nor bone grafting, nor the number of implants is terrible. The only scary thing is that one small “I will tolerate” can result in a big “I should have had it yesterday”. The more and longer you endure, the more voluminous and longer your treatment will be. By brushing your teeth on time, you can prevent caries. Having healed caries in the initial stages, you will save yourself from its complications in the form of, for example, pulpitis or periodontitis. Having cured pulpitis or periodontitis in time, tooth extraction will bypass you. Timely restoration of a lost tooth will save you from bone grafting, etc. After all this, I think it makes no sense to say that a timely visit to the dentist, and indeed to any other doctor, will protect you from unnecessary nerves and expenses. Here and so everything is clear without words. So brush your teeth, pull yourself up and let's meet more often for preventive checkups than for dental problems.
Stay tuned!
Sincerely, Andrey Dashkov
What else to read about dental implants?
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Source: habr.com