Dear friends, in previous articles, we discussed with you - ΠΈ . Today I would like to digress a bit and talk about implantation, and in particular simultaneous implantation, when the implant is installed directly into the socket of the extracted tooth and about sinus lifting, increasing the volume of bone tissue in height. This is required when installing implants in the area of ββ6, 7, less often 5 teeth in the upper jaw. Bone augmentation is required because there is a cavity in the upper jaw - the maxillary sinus. Most often, it occupies most of the upper jaw, and the distance from the edge of the bone to the bottom of this sinus is not enough to install an implant of the desired length.
The computed tomography clearly shows that there is a gap in the area of ββthe missing tooth.
I often hear doctors say, βNo, no, no, you canβt put an implant right away! First, we will remove the tooth, and as soon as everything heals, then we will install it! Reasonable question - why? Yes, who knows. Most interesting. Either because of the uncertainty in the prognosis, or because of the fear of complications, which, in fact, are no more than with a classical operation. Of course, with the condition that everything is done correctly. In my practice, the percentage of simultaneous implantation relative to the classical approach is about 85% to 15%. Agree, not a lot. Where almost every operation in which tooth extraction is indicated ends with implantation. An exception can only be acute inflammation in the area of ββββthe causative tooth, when pus flows mixed with snot. Or, when the implant is not at all stable and hangs in the hole like a pencil in a glass. Financial opportunities also play an important role. Anyone will spend money more willingly on anything but teeth. You can't argue with that. But there is one "But"! You must understand that the more time passes from the moment the tooth is removed to the start of prosthetics, the worse the conditions for placing this very implant. As the saying goes: "A holy place is never empty." Over time, a number of wildest problems appear, which also have to be solved. And this is always additional, and often considerable, costs. Do you need it?
Well! Let's move on to examples.
The simplest case of simultaneous implantation is a single-rooted tooth. Whether it's the upper or lower jaw.
This CT scan was taken before the tooth completely fell apart.
What do we see?
The upper left 5 is not subject to either therapeutic or orthopedic treatment. What are we doing? That's right - remove the tooth and screw the bolt.
I performed the most gentle, atraumatic tooth extraction and placed an implant with a gum former.
A gum shaper is something like a low (average 3 mm high), metal stump that sticks out a little above the level of the gum, thereby forming its contour before installing the crown. It looks something like this:
This is what the implant looks like:
The gray part is the implant itself. The blue part is the so-called temporary abutment, on which a temporary crown can be attached if implantation is accompanied by immediate loading. Basically, this abutment acts as an implant holder. After the implant is installed, the abutment is unscrewed, like a designer - with a special screwdriver, and a plug is screwed in its place. It is installed in the event that it is impossible to immediately install the gingiva former. Then the implant and all its constituent parts are completely under the gum, which means that we will not see anything in the oral cavity after the operation. Well, except for the stitches and... the rest of the teeth, if there were any left. In this scenario, the shaper is installed after the implant has taken root.
Next, we select the next level of complexity, when we have to remove the 6th tooth in the lower jaw. This tooth is two-rooted. Of course, we will not place an implant in the area of ββeach root, as someone might think. Although I have seen similar cases. The doctor apparently had a mortgage loan.
So, we need to install one implant, but clearly in the center. We will aim at the bone septum between the two roots.
We install the implant. To the left and right of it in the picture, the holes from the newly extracted tooth are clearly visible, which, as they heal, will be tightened.
Well, it's time to consider the case when you need to remove a tooth, install an implant and build up bone tissue in the upper jaw - a sinus lift. And the level of difficulty, meanwhile, increases. Not a mission with helicopters from Vice City, of course, but you have to be a little more careful than in the previous case.
Remember when I said the implant should be centered? So the 3-root tooth is no exception. The implant is installed, as in the previous case, in the septum, but already a three-rooted tooth. As we can see, the height of the bone in this area is about 3mm. This volume is not enough to place an implant of optimal length, therefore, the volume must be increased. Manipulation is carried out using a special "bone material". Someone calls it "bone powder", not to be confused with "white powder", although it is white, it is still presented in the form of granules. Produced as simply in glass containers,
and in a more convenient form - special syringes, with the help of which it is more convenient to work and bring the material into the surgical field.
It is a mistake to believe that a sinus lift is an operation "B" of the maxillary (maxillary) sinus. In fact, the manipulation is carried out "UNDER" it. As we have already found out, the sinus is a cavity in the upper jaw, a void, if you like, which is lined from the inside with a thin mucous membrane with ciliated epithelium. So, in order for the operation to be successful, the mucous membrane is locally exfoliated from the bone tissue and βbone materialβ is placed in the formed space between the bottom of the sinus and the mucous membrane, like in an envelope. In this case, with a parallel installation of the implant.
And now an example of a sinus lift and implantation, but 2 months after the 6th tooth in the upper jaw was removed. This patient had her 6 removed about a week ago at another clinic. The assistant did a CT scan.
Due to the fact that only a week has passed since the removal, we also see a βdark holeβ in the picture, like the one that the former left in your heart. Where the tooth used to be. That is, there is no bone tissue in this area. I started the operation 2 months later. They didnβt do a second CT scan after the hole healed, but believe me, everything healed enough so that the operation could be performed. During the operation, it was not possible to achieve a rigid stabilization of the implant, so I decided to install a plug rather than a gingiva former. Why? And because if the patient starts to gnaw crackers, then strong pressure can be applied to the implant, in particular the shaper, and therefore the implant can become loose or βfly awayβ into the sinus. At the same time, 8 went to the scrap.
Well, the last example for today is the removal of 2 teeth, the installation of 2 implants and a sinus lift.
As we can see, the conditions in this case are somewhat worse, about 2 mm. But this did not prevent us from carrying out the operation in full.
You may ask: - βWhy are there 2 implants, and not 3?β βWhat, will there be a bridge?β βBut what about load distributionβ, etc.?
In fact, the problem of overloads associated with bridges concerns only their own teeth. Since the teeth have a ligamentous apparatus. That is, the tooth is not tightly fused with the bone, but, as it were, springs in it. Here is the diagram:
In the presence of a bridge, the supporting teeth take on both their own load and the load of the tooth that is missing. Thus, an overload of teeth develops, and then they end up with the tooth fairy. The implant does not have such a ligament. It tightly fuses with the surrounding tissues, so there are no such problems as in the case of your own teeth. But this does not mean that a huge bridge for the entire jaw can be installed on two implants. The only thing that suffers in the presence of bridges is hygiene, which will need to be monitored especially carefully. Because it is much easier to care for free-standing teeth than for similar prostheses.
That, in fact, is all for today. I will be glad to answer your questions!
Stay tuned!
Sincerely, Andrey Dashkov.
Source: habr.com