Implants step by step
I Before surgery
1. INITIAL CONSULTATION
An important issue for the entire implant treatment process is the patient's expectations in terms of prosthetic and cosmetic results. Often, achieving optimal implant treatment results requires additional procedures, such as bone or soft tissue reconstruction, or even orthodontic treatment. The discussion will help to dispel any doubts and answer any questions you may have about the course of treatment. The duration of the treatment and the costs will also be discussed, as well as the risks, guarantees and responsibilities incumbent on both the doctor and the patient.
2. INTERVIEW
At the first consultation, it is important to exchange information on the Patient's general state of health. During the interview and examination, the implantologist obtains detailed information about the Patient's state of health and asks, among other things, whether he or she has been under specialist medical care in the last 10 years and whether he or she has undergone any operations, whether he or she is constantly taking any medication, including sleeping pills, sedatives or antidepressants, and whether he or she is being treated for osteoporosis (treatment of women for osteoporosis may prevent implantation).
Particular attention is additionally paid to heart disease, liver lung disease, kidney disease, possible diabetes, thyroid disease or coagulation disorders. In middle-aged people, mainly women, a history of osteoporosis is important.
Since regular smoking impairs the regenerative capacity of the soft tissues, a conversation about this topic with smokers is always an additional part of the interview. Smoking definitely worsens the effects of implant treatment.
Finally, the patient fills in a health questionnaire, in which he or she confirms the answers according to his or her state of knowledge with his or her signature.
3. CLINICAL TRIALS
The clinical examination, or so-called oral examination, is an indispensable supplement to the history. The doctor will always ask questions about hygiene habits, the presence of oral inflammations, bleeding gums or any observed increase in tooth mobility.
During the dental examination of patients qualified for implant treatment, we assess:
- soft tissues (mucosal mobility, colour and thickness, presence of scars, ulcers or other conditions),
- teeth (mobility, caries, plaque and tartar),
- Periodontium (bleeding, pathological pockets),
- tooth positions (inclination, crowding, displacement),
- edentulous areas (width and height of the alveolar process, undercuts, irregularities).
The doctor pays attention to any prosthetic restorations that may be used - their care and whether the patient maintains good oral hygiene.
The clinical examination of the site where the implant is planned to be inserted must be extremely thorough. It is important to determine the height of the appendage in the area of the implant and its width. Radiographs and 3D CT scans help with this.
COMPUTED TOMOGRAPHY
The starting point for planning implant work is an assessment of the quantity and quality of the bone tissue to support the implant.
This information is needed by the clinician to assess the bone before the dental implant is placed, but also to monitor changes in the bone after insertion.
On the basis of the pantomographic picture we can only evaluate the conditions provisionally.
A three-dimensional and extremely precise image that allows us to accurately plan and efficiently perform the implant procedure is provided by 3D COMPUTER TOMOGRAPHY.
AT UNIDENT UNION® As a standard, implantology patients are referred to the KODAK 9500 3D cone beam CT scanner, which is one of the most modern in Poland and available directly at the clinic.
Using the CT scanner, we assess:
- bone condition (density, presence of lesions, degree of bone atrophy),
- height of the alveolar process at the site of the planned implantation, in all dimensions - condition of the teeth,
- the condition of the teeth,
- thickness of the mucosa,
- position and size of the maxillary sinuses,
- course of the inferior alveolar nerve,
- location of ford openings,
- distance to the bottom of the nasal cavity.
Such a precise diagnostic examination allows us to plan the entire implantological process, including augmentation procedures. It also shortens the implantation process itself and reduces post-operative discomfort, as the implantologist has a fully visualised surgical field.
GENERAL MEDICAL EXAMINATIONS
It is not possible to determine the potential healing capacity of the bone tissue by means of modern diagnostic methods. This means that, prior to placing an implant, the doctor can only provide a general prognosis of the healing process. Among other things, the decision as to whether to proceed with implant treatment is facilitated by ordering blood tests.
If there are doubts about the patient's general health, the dentist will order laboratory tests:
- blood count with smear,
- OB,
- bleeding and clotting time,
- sugar,
- HbS,
- HIV,
- TSH, T3, T4 hormones,
- vitamin D3 levels
- serum calcium, sodium, potassium.
and contacts the patient's general practitioner and together they give their approval for the planned treatment.
Menopausal patients should be screened for osteoporosis risk, although in many implant centres this condition is not considered an absolute contraindication to implantation. Patients actively treated for osteoporosis cannot implant.
4. TREATMENT PLANNING
After collecting and analysing the data from the analysis of radiographs, the tomographic examination and the medical history, the doctor presents the patient with all the available information about the implantological methods that can be used in his or her case, determines the optimal place for the insertion of the implants and the required number and size of implants.
Two or three alternative ways of replacing missing teeth with implants are often prepared. They differ in the number of implants, prosthetic solutions and costs.
A preliminary cost estimate for implant treatment is also created at this stage.
NOTE! For implant-supported restorations the cost of the laboratory procedure can only be approximatedas it depends on the positioning of the implants during surgery and the use of individually selected abutments. However, these differences do not exceed 10% of the planned amount. It is not possible to foresee unexpected additional costs that may arise if the patient's health condition changes during treatment and this would affect the change in procedures. However, these accidents are very occasional and we are practically always able to determine the expenses that the Patient will have to incur with different treatment options.
5. CONSENT TO TREATMENT
Prior to the procedure, the Patient is given a "Consent for Surgery" to sign. This is a kind of agreement between the doctor and the patient which not only enables the performance of the procedure, but also proves that the patient is fully aware of the whole procedure and the obligations taken on by the doctor.
II Implantation procedure
Prior to the procedure, the Patient is given a "Consent for Surgery" to sign. This is a kind of agreement between the doctor and the patient which not only enables the performance of the procedure, but also proves that the patient is fully aware of the whole procedure and the obligations taken on by the doctor.
1. ANAESTHESIA
The insertion of one or more implants into well-formed bone is such a minimally invasive procedure that standard local or regional anaesthesia is sufficient and does not require a break from daily activities.
2. THE TREATMENT
Implantation is a surgical procedure, performed under fully aseptic and sterile conditions.
Implant placement involves preparing the site for the implant and then inserting the implant into the site.
The implant site is made with the calibrated drills with which every implantology system is equipped. Its dimensions correspond exactly to the diameter and length of the implant we intend to place in it.
Once the osteotomy, or hole for the implant, has been made, it is screwed into the implant with sufficient force to ensure stabilisation while not overheating and damaging the bone.
The implant procedure takes approximately 20 minutes. The patient does not experience any unpleasant sensations either during or after the operation.
Due to the number of surgical procedures involved in implant treatment at UNIDENT UNION®, we use 2 methods:
- one-stage
After insertion into the bone, the implant is supplied with a so-called healing screw, which protrudes from the gum after the procedure. The gum is brought closer together with sutures, which are removed after 7-10 days. This method eliminates the need for a second procedure - exposing the implant, which occurs after a period of osteointegration. This is, of course, the primary advantage of the one-stage procedure. It does, however, impose a high degree of hygienic rigour on the patient regarding the operated site and the entire oral cavity. It also slightly increases the risk of inflammation of the gingiva and bone around the implant, which can cause disturbances in the process of fusion of the implant with the bone.
- two-stage
- first stage - insertion of the implant. After insertion, the implant is closed with a so-called locking screw. The soft tissues are deposited and sutured over the implant. The implant is completely invisible, completely covered by the gum. After 7-10 days, the sutures are removed and the surgical site completely heals. The process of osteointegration, i.e. fusion of the implant surface with the bone, takes place. Its duration varies and depends on the implanted area and the quality of the bone tissue. It is significantly prolonged in the case of simultaneous bone reconstruction with the implantation.
- second phase - uncovering the implant. Once the implant is healed, a second surgical stage takes place to expose it and replace the locking screw, with a healing screw. Sutures are again placed for 7-10 days. Once the healing screw has shaped the gum around it (this takes about 2-3 weeks), we can proceed with the prosthetic restoration of the teeth on the implants.
Due to the length of time since tooth loss, we perform in our clinic:
immediate implantation n- The implant is inserted immediately after tooth extraction. Such procedures are possible, but we carry them out rarely, mainly due to the risk of lack of proper osteointegration and the high unpredictability of the aesthetic results.
- A prerequisite for immediate implantation is the absence of inflammation of the extracted tooth and its alveolar area.
- Ideally, the diameter of the tooth to be extracted should be smaller than the diameter of the anticipated implant, which allows the bed to be carefully prepared to guarantee maximum contact between the active implant surface and the bone.
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Often with such procedures, it is necessary to use special biomaterials with which to fill the free spaces between the implant and the bone, and membranes that protect and facilitate bone reconstruction and regeneration.
Early implantation - The implant is inserted 8-12 weeks after tooth extraction. - This is a very favourable time to replace a lost tooth with a dental implant, as there has not yet been much bone loss and the space left by the extracted tooth has been completely covered by a mucous membrane.
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After 2-3 months, new, young bone is formed in its place. Any inflammatory changes that previously developed in the bone have also healed.
Late implantation - the implant is carried out more than 3 months after tooth extraction. - More than 3 months after tooth extraction, the bone conditions for implantation can deteriorate significantly due to the progression of vertical and horizontal atrophy of the edentulous process.
- The longer the time since the tooth was extracted, the greater the atrophy. Obviously, the amount of atrophy is not the same in every patient, which can be determined by, genetic factors, age and general health conditions.
- Statistically, approximately 30% patients will require additional procedures, which may be bone grafts, regeneration to rebuild lost bone.
- Bone reconstruction procedures are carried out as separate procedures to prepare the patient for implant treatment or at the same time as placing the implants.
After the implantation procedure
In order for the implants to take up residence in the bone (and augmentation procedures performed) - what we call osteointegration - we usually cannot load the implant immediately after the procedure.
The healing period usually lasts between 3 and 6 months, depending, for example, on whether the jaw has undergone surgery. In the mandible, the osteointegration process is faster, between 3 and 4 months, while in the maxilla it takes 5-6 months.
Very important for this process are the first days and weeks after the procedure, when the mechanical connection to the bone created by its screwing is converted into biological osteointegration. This occurs approximately two to four weeks after surgery. It is important that there is no inflammation of the soft tissues and bone during this time, which could ruin this process.
In order to avoid such a situation, the Patient must comply with the following recommendations:
- Immediately after the treatment, make a cold ice pack on the face for 3-4 hours.
- If pain occurs, the dentist will prescribe appropriate pain medication.
- You can only eat or drink once you have regained full sensation in the anaesthetised area.
- Avoid hot foods and liquids in the first few days after the procedure.
- Talk as little as possible for the first 2 days after surgery.
- Do not smoke or drink alcohol for the first two days after the procedure.
- All exertion should be avoided, no bending, no lifting, no sports.
- Do not use the sauna or solarium.
- Rinse the mouth with lukewarm, boiled water after each meal.
- Use rinses such as: Eludril
- Clean the remaining teeth regularly, but spare the implant area.
- During the first few weeks when brushing your teeth, avoid the treatment area. We recommend using antibacterial mouthwash. After this period, toothbrushes with special soft bristles can be used to clean the area around the healing wound.
- Do not manipulate the tongue around the implant.
- Before two weeks, we do not train intensively and we also give up going to the pool.
The healing period lasts from 2 to 6 months. During this time, a temporary crown is placed over the implant.
Seven to 10 days after implantation, the sutures securing the wound are removed.
After removal of the stitches for the next 6 weeks, the patient should:
- Clean the implant area with a toothbrush and massage the gingiva.
- Do not touch the implant or the insertion site with your fingers.
- Do not touch the implant site with your tongue.
- Avoid major efforts if possible.
- Follow-up appointments should be observed even when healing is going smoothly.
After 6 weeks, there should be no trace of surgical interference. The implant, covered by the gum, increasingly fuses with the bone. After radiological confirmation of its osteointegration, we proceed with prosthetic reconstruction.
