Implantation and gum augmentation

Dental implantation is gaining popularity among different groups of the population every day. This is explained by the fact that this method of tooth replacement is quite reliable, since it was invented several decades ago. During all this time, scientists have conducted thousands of scientific studies, invented many implant systems, examined a large number of patients many years after the treatment. This made it possible to fully analyze the capabilities of this area of dentistry, combine all the information with each other and create a single set of specific data. Thanks to this data, it became known that implants take root in more than 90% of cases. Also, numerous studies helped to determine the most durable types of implants, which turned out to be intraosseous. Moreover, today many surgical and orthopedic treatment protocols have been invented that allow you to perform surgery with maximum preservation of soft tissues and bone, and prosthetics - with the achievement of ideal aesthetics and function. Thus, we can conclude that implantation is not a "know-how", but a proven method of dental rehabilitation.

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Indications for the procedure

Indications for implantation are any defects of the dental arches up to complete adentia. That is, no matter how many and what teeth are missing, they can always be replaced with implants. The issue of indications and contraindications for implantation has always remained controversial and ambiguous. This problem is explained by the individuality of each case. For example, a 75-year-old woman with hypertension of the second degree and many other somatic pathologies wants to undergo a course of total implantation.

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Technique gingival augmentation

The implantation technique is determined at the treatment planning stage. This is due to the fact that the type of implantation is selected strictly individually. The patient's age, health, occupation and psychological state are taken into account. For example, if a young, relatively healthy person wants to immediately restore a lost tooth and perform express implantation, then such a plan can be implemented. However, if a person is of mature age, has chronic periodontal disease, suffers from somatic pathologies, then he needs to undergo special preparation: eliminate all pathological processes, achieve a state of remission and perform a two-stage implantation. This classic method is more reliable and consistent, which allows you to first control the engraftment of the implant, and then the formation of the mucous membrane.

Traditional two-stage implantation involves dividing the treatment course into separate stages. The first stage is osseointegration. During this period, the mucous membrane is dissected, a bed for the implant is drilled in the bone and it is inserted. After this, the implant is covered with a flap of the mucous membrane and tightly sutured. The next 3-4 months are the osseointegration period. During this time, the bone tissue in the implant area undergoes structural changes. In the first weeks after the implant is inserted, the bone tissue undergoes minor destructive processes. This is due to the fact that when drilling the bone, the cutter destroys the layer of osteocytes (bone cells) with which it was in contact. Consequently, the marginal ball of the bone begins to necrotize. However, as paradoxical as it may sound, in this case necrosis is a normal process that disappears after a short period of time. It is replaced by active osseointegration. During this phase, several control X-rays are taken to ensure that the healing is proceeding without any deviations. After 3-5 months, the mucosa above the implant is cut, the plug is unscrewed from the implant and a gum former is installed.

It is very interesting that most people know what an implant looks like, but have no idea what a gingiva former is and what role it plays in implantation. In fact, its task is no less important than any other element of the structure. A gingiva former is a part that is attached to the implant after its osseointegration. This element looks like a screw with a metal cylinder or cone of a certain diameter and height (depending on the tooth being replaced). With its help, the mucous membrane acquires the necessary volume and structure by “overgrowing” the structure. The gingiva former heals for 2-3 weeks after implantation. Considering the good ability of the mucous membrane to grow and recover, installing this element for such a period is considered quite sufficient. After removing the former, an abutment is installed in the implant. From this moment, the orthopedic stage of treatment begins. That is, the task of the implantologist is to screw in the implant, control its integration and build up the gum. And the task of the orthopedist (prosthetist) is to give the gum a natural appearance and aesthetic contours. As mentioned earlier, the orthopedic stage begins with the installation of the abutment. This part acts as a tooth stump. That is, it is a metal copy of a tooth ground down for a crown. A temporary plastic crown is installed on the abutment, after which the mucous membrane begins to acquire a more physiological appearance. The stage of temporary restorations is very important for the overall result of treatment. It allows the mucous membrane to adapt to new conditions and create such an adhesion of the gum to the crown that will not differ from the contour of the gum of "real" teeth. In addition, temporary crowns allow a person to get used to a new appearance, smile parameters, diction and chewing features in new conditions. The opinion of loved ones (parents, spouses, friends) also plays an important role; they can express their criticism only if the permanent crowns have not yet been made and any changes can be easily made. The patient uses temporary crowns for several months and only after the gums have fully adapted are permanent structures made. Thus, the gums are formed during implantation only at the stage of temporary restorations. Permanent dentures are fixed provided that the mucous membrane has fully adapted. Ceramic crowns are copies of temporary ones in shape, but they have better physical characteristics. Permanent dentures do not wear out, are more durable, and reproduce the micro and macro relief of teeth. They also have optimal optical characteristics (color, brightness, contrast, transparency, etc.), which significantly improves the aesthetics of teeth.

As a result, two-stage implantation can last about a year. A person gradually approaches the desired result. Naturally, this type of treatment is more reliable and easier for the doctor, since during the year the implantologist and orthopedist have the opportunity to understand the peculiarities of the patient's body and conduct treatment more thoroughly.

Express implantation is becoming more and more popular every day. This is primarily due to the marketing work of private dental clinics. They attract people by guaranteeing that they will restore a lost tooth in just a few days. Having looked at the superficial information about two-stage implantation, one can imagine what a colossal amount of work the implantologist and orthodontist perform during express implantation in a short period of time. During the first visit, diagnostics and treatment planning are performed. During the second visit, the patient is screwed with an implant together with an abutment (for express implantation, they are made as a single structure). After that, an impression is taken or the oral cavity is scanned, and temporary structures are fixed the next day. At this stage, each doctor, depending on his work protocol, chooses the period of use of temporary restorations. It is desirable that the patient has the opportunity to get used to them and evaluate their shape. But often specialists fix permanent crowns as early as possible in order to justify the temporary advantages of express implantation to the patient. This can only be done if the doctor is confident in his abilities. This factor is very important, because during the treatment process, there is a simultaneous load on the implant, osseointegration and partial bone resorption (due to the load). Along with partial bone resorption, there is also a certain loss of soft tissue. If all these processes are not taken into account, then there will be a violation of the gum adhesion and the absence of the gingival papilla around the crown. In this case, the restoration will look very unattractive and so-called "black triangles" will be determined between the teeth.

What does the gum look like after implantation?

The appearance of the gum after implantation does not depend on the method of the operation. First of all, the aesthetics of the gum is associated with the quality of the implantation. If the course of treatment is carried out at the highest level, the gum will have a pale pink hue. Its contour will be located symmetrically with the contour of the gum on the opposite side. The gingival papilla will fill the entire space between the crown and the adjacent tooth. If the color of the artificial crown, its shape and size correspond to the rest of the teeth, then after the treatment no one will be able to distinguish a “live” tooth from an implant. Moreover, this applies not only to people not associated with dentistry. High-quality work can be so accurately matched to the shape of the face, muscle tone, skin color that even a specialist will not always determine the presence of an artificial crown on the implant. Moreover, an implant and restoration performed at the highest level will ensure the aesthetics and function of the structure not only for the first two or three years, but also for the next ten years with appropriate care of the oral cavity and the body as a whole.

Contraindications to the procedure

It should be noted that at this age, surgery is extremely undesirable. Moreover, the body of an elderly person no longer has such an active detoxification and regenerative function as at a young age. Therefore, taking antibiotics, analgesics, anti-inflammatory drugs, injections of anesthetic solutions - all this will negatively affect the health of an elderly person.

It is also worth noting that implantation is unacceptable in childhood. Constant restructuring of the jaw bone tissue and teething characterize the children's dental and jaw system as a dynamic structure. Therefore, an implant, being a stationary element, can delay the growth of the jaws, leading to incorrect and incomplete teething.

For people with decompensated forms of diabetes mellitus, various types of immunodeficiencies, and mental disorders, implantation is performed only in exceptional cases. Moreover, such treatment is performed after a thorough and comprehensive examination by other specialists.

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Consequences after the procedure

Implantation is a rather serious intervention, so there is always a risk of complications and negative consequences. If we talk about implantation itself, then complications may arise during it, which are typical for many unsuccessful surgeries. Some complications arise because the patient did not report any systemic pathologies. Other troubles may arise due to incomplete diagnostics of the patient and treatment planning. If we talk about complications common to the surgical field, then these include an allergic reaction to anesthetics, bleeding, fainting, collapse, hypertensive crisis, attacks of bronchial asthma, epilepsy, angina. Looking at the list of listed conditions, it is easy to understand that most of them can be avoided by informing the doctor about the existing disease. For example, hypertension, bronchial asthma, epilepsy and angina are the pathologies in the presence of which a person must consult a doctor and receive a medical opinion. The patient may not know about allergic reactions to anesthetics and antibiotics, so allergy tests are mandatory before the operation. Bleeding can occur due to blood diseases, blood vessels, and other reasons. For example, individual human anatomy may suggest a location of blood vessels that is not typical for most people. Because of this, the surgeon may accidentally damage an artery or vein. The same situation can happen if the anatomy of the human body is not known. Complex tooth extractions before implantation increase the likelihood of uncontrolled bleeding. Fainting, collapse, and increased blood pressure can suddenly occur with a person of any age and gender. This may be due to fear of surgical interventions, pain syndrome due to poor anesthesia, or weak vascular tone. In any case, these situations occur during surgical interventions. The occurrence of these complications does not cause confusion in an experienced surgeon. This is due to the fact that such conditions occur regularly, there is a clear protocol of actions for their relief, and these conditions do not entail any physical consequences for patients.

Mucositis and peri-implantitis

These complications should be highlighted in a special section, as they are considered specific to implantation. If a person has their own teeth, as a rule, there are three most common problems: caries, periodontitis and periodontitis. After implantation, the probability of losing an artificial tooth still remains. The cause of these consequences is periimplantitis - inflammation of the bone tissue around the integrated implant.

The prevalence of peri-implantitis ranges from 2% to 43% of cases. It is very interesting that the implant takes root in 95-99% of cases, and the surrounding bone tissue becomes inflamed with a probability of up to 43%. This is explained by the fact that the period of osseointegration is controlled by a doctor, who regularly performs professional oral hygiene. During the course of treatment, the patient understands all the responsibility that lies with him. Also, a person's motivation to quickly get an aesthetic and functional result plays an important role. When more than six months have passed since the installation of permanent restorations, people begin to treat implants with less care. Gradually, the volume of hygiene products begins to be limited to toothpaste and a brush, and the cleaning time is reduced to a minimum. As a result, the infection gradually penetrates the area between the abutment and the gum, which causes mucositis - superficial inflammation of the gum around the implant. Mucositis is somewhat similar to gingivitis: inflammation of the gum occurs in the crown area, which is accompanied by pain, swelling, itching and bleeding. Purulent contents may be released from the pockets. Although this situation is clinically quite vivid, the inflammatory process can be completely eliminated if you consult a doctor in a timely manner.

If the patient does not seek specialized help with mucositis, this disease can develop into peri-implantitis. In this case, the inflammation spreads to the bone tissue around the implant. At first, the lesion may be local, and over time it affects the entire bone tissue around the implant. Without qualified intervention, this condition leads to implant mobility and loss. If this happens, then all treatment will have to start over. First of all, it is necessary to eliminate the inflammatory process in the bone. Then it is necessary to perform bone plastic surgery to obtain the required volume. And only after this can the first stage of the implantation itself begin. It is worth noting right away that old crowns and implants cannot be reused. Despite their very high cost, after extraction from the bone, they can be left only as a souvenir and motivation for oral hygiene. Even careful processing of the implant will not allow it to be reused. This is due to its unique surface, which is treated with various acids and sandblasting machines to obtain a rough surface. If even a minimal amount of pathogenic microorganisms remains in the implant recesses, peri-implantitis is likely to recur. Therefore, it is rational to use a new, completely sterile design and not repeat previous mistakes.

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Gum recession after implantation

This complication is quite common, especially when performing express implantation immediately after tooth extraction. However, this does not mean that this method of installing an implant has a negative effect on the gum condition. Rather, this effect is explained by the natural loss of soft tissue after tooth extraction. Incidentally, the same processes occur with bone tissue. These are completely physiological processes that should be amenable to surgical correction. Most often, the volume of recession fluctuates within 1-2 mm, but in some cases these indicators can be more significant, which looks like gum splitting. To restore the aesthetic and barrier properties of the gum, its plastic surgery is performed. The operation is performed under local anesthesia. Depending on the area and location of the defect, a method of its replacement is selected. The specialist determines the most suitable donor site in the oral cavity and takes a graft from it. This tissue is moved to the defect area and sutures are applied.

In addition to natural gum recession, it can be caused by aggressive brushing of teeth with a hard brush, drinking hot drinks, smoking and other bad habits. After gum plastic surgery, the patient is given all the recommendations again, information about the need for rational oral hygiene and possible consequences.

Care after the procedure

Post-implant care is no less important than the quality of the operation itself. Expensive implantation is like buying a car, it requires regular professional maintenance and self-care. Only if these conditions are met can we talk about the durability of the restoration.

The basic rules of care are to brush your teeth twice a day with a medium-hard brush. The paste should be used as recommended by your dentist. If you are prone to inflammatory periodontal diseases, it is recommended to use a paste with medicinal herbs (for example, Parodontax, Blend-a-med "Herbal Collection", Colgate "Medicinal Herbs"). If there are a lot of fillings on your teeth, then you are prone to carious lesions. For prevention, you should use pastes with microelements (Blend-a-med "Anti-caries", Lacalut "Flour", Sensodyne "Repair&Protect"). If you have no predisposition to such pathologies, it is advisable to combine the types of pastes. Regarding whitening paste, it should be said that it can be used no more than once a week. With frequent use, its abrasive particles can adversely affect the hard tissues of the teeth and the soft tissues of the gums.

It is difficult to overestimate the benefits of dental floss and interdental brushes. They do a great job of cleaning plaque from between teeth. Before purchasing these hygiene products, it is recommended to consult a dental hygienist. This will allow you to individually select the size of interdental brushes, which will further increase the effectiveness of the procedures.

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Reviews

Reviews of implantation and gum augmentation are mostly positive, because people most often get a satisfactory result from implantation. However, it should be understood that each person has a different opinion about successful treatment. Much depends on the psychotype of the personality and expectations of the patient. Some people believe that after restoring the aesthetics of the smile, people will immediately start to like them, problems will disappear and “everything will be different”. In fact, after implantation, a person will really have more self-confidence, self-esteem will increase. But you cannot perceive implantation as a new stage in the development of personality and expect radical changes in life. You should be more rational about such things. After all, loved ones will definitely be happy for a person who has restored their teeth. And ill-wishers will most likely feel envy that someone has the financial opportunity to undergo an expensive course of treatment to restore the aesthetics of teeth.

Also, many patients are promised by consultants to "look like a star", "become like a queen", "get a Hollywood smile". With these phrases, marketers guarantee an obviously impossible result. To fulfill their promises, the patient would have to be treated not only by a dentist, but also by other specialists. For example, many patients need to undergo a course of cosmetic procedures with an individual selection of skin hygiene products. People with posture problems should contact a posturologist for appropriate examinations. This will help to identify problem areas in the musculoskeletal system and correct posture and gait during therapy. If the patient is depressed, is an introvert and a sociopath, then he needs to visit a psychotherapist. By changing his attitude to his problems, a person will begin to be less emotional about minor troubles. Thus, after a comprehensive interdisciplinary approach, a person can really appear before society in a completely new image. He will easily communicate in a group, confidently meet new people, leave a pleasant impression, smile and enjoy life.

It is also worth noting the group of people who experienced implant rejection. Very often, such patients tend to talk about the unprofessionalism of doctors, low quality of medicine and expensive treatment. If you listen to such people, you can really believe that the person was cruelly deceived. But if you ask him a few questions, for example: "What is dental floss?", "What kind of interdental brushes did you use?", "How often do you smoke?", "How many times did you go to the dentist after implantation?", then it will become clear who is to blame for the complications after treatment.

In addition to negative reviews, you can also encounter the opposite situation. For example, a person did not receive the best quality treatment that could have been done. But having teeth and being able to chew food well became such a pleasant event for the patient that he wants to tell everyone around him his impressions. In this case, patients who turn to the same clinic for an aesthetic result may be disappointed. After all, their requirements are higher than in the previous case.

As a result, a person's reviews are not always a clear reflection of the quality of implantation. In such situations, it is worth trusting your loved ones and competent doctors who you consult.