Difficult cases during dental implantation

For example, for some, the same sinus lift (building up bone tissue in the upper jaw) or tooth replantation (transplanting a wisdom tooth to the place of a removed molar) are too complicated operations to undertake, but not for the Sirius Dent Medical Center dental implant dent medical center. Over 20 years of experience, we have learned to successfully perform dental implantation for all categories of patients and not give up, even if the implant disintegrated on the first attempt (this happens rarely – less than 1% of patients).

What can complicate the process of dental implantation

It is easiest to install a dental implant in clean bone, when the hole after tooth extraction has completely healed, there are no inflammatory processes in the oral cavity, and the bone tissue is more than 8 mm. But this does not always happen. If we are talking about the upper jaw, and the tooth extraction was traumatic (for example, it was removed together with an apical cyst or there was inflammation), it happens that there is not enough bone tissue, and the person needs bone grafting. On the lower jaw, the problem is more often that the bone is too narrow or it is necessary to take care of the repositioning of the neurovascular bundle so as not to touch it during implantation. Of course, for the Sirius Dent Medical Center, this is not a reason to refuse the patient treatment, but it is worth understanding that this is additional time and money.

If a person has been living without a tooth for a long time, their bite changes, and the teeth shift to a different position. Therefore, to make prosthetics possible, additional orthodontic treatment is necessary.

And these are just common problems in the oral cavity, but there are also concomitant diseases: diabetes mellitus, hypertension and other pathologies of the cardiovascular system, autoimmune diseases. All this must be taken into account by the dentist-surgeon when developing a treatment plan.

How to prepare for implantation in the presence of complications

At the Sirius Dent Medical Center, each patient is offered to fill out a special questionnaire containing a number of questions about his general condition. If in this way the dentist-surgeon detects a disease that worries him, he passes the letter to the anesthesiologist, who requests medical documentation. After the patient has provided the conclusions of the relevant specialists, the anesthesiologist and surgeon consult the patient again and decide which tactics are best to choose. Whenever possible, a week or two before the operation, specific treatment is carried out for this patient: for example, if a person has a cardiovascular disorder, the family doctor or cardiologist prescribes drug therapy, which will improve the necessary indicators before the surgical stage of implantation. This way, complications during dental implantation surgery can be avoided.

Implant prosthetics in the complete absence of teeth and insufficient volume of jaw bone

Implant prosthetics in the case of adentia (absence of teeth), especially when it comes to elderly patients with a number of concomitant diseases, is not an easy task. But fixed prosthesis on implants not only restore aesthetics, but also return a person the ability to enjoy their favorite food.

Restoring a smile includes the surgical and orthodontic stages of tooth implantation. Moreover, often each stage is carried out by a separate doctor: a dental surgeon installs an implant in the jaw bone and, if necessary, performs bone grafting, and an orthopedist manufactures and puts on crowns. But often the first to get down to business is a dental technician who conducts a preliminary virtual modeling of future teeth. Thus, planning dental implantation includes the following steps:

• the laboratory creates a model based on the patient’s impressions;
• the orthopedist plans how many supports he needs to install all the crowns;
• the surgeon thinks about how exactly these supports — implants — will be installed and whether bone grafting is required.

The implantation itself in the complete absence of teeth is carried out in the reverse order. If we are talking about «all 4» implantation, then the implants are installed in the front part of the jaw, where bone tissue is usually sufficient.

We were dealing with this situation when an elderly man with removable dentures on both jaws came to the Sirius Dent Medical Center. He got used to wearing dentures and even learned to chew on them, but when small food particles (for example, fig or raspberry seeds) got under the denture, they injured the mucous membrane and caused pain. So we installed a removable denture with support on implants in such a way that nothing could get under it.

In the case when it is necessary to restore the full dentition (this requires at least eight implants on the upper jaw and six on the lower) and the implantation is also performed in the projection of the chewing teeth, where the bone tissue is resorbed, the operation is combined with bone grafting.

Sinus lift with one-step dental implantation

Sinus lift with one-step implantation is not considered a difficult case at Sirius Dent Medical Center. This operation is performed regularly and with good results, using all available types of implants. But when we talk about one-step dental implantation, it is important to note that this term is used in three different cases:

• sinus lift with one-step dental implantation involves the surgeon lifting the floor of the maxillary sinus, installing the implant and filling this «pocket» with bone substitute material. Then new bone tissue grows around the implant, and the patient comes for prosthetics in nine months. This is how we usually work. If you separate the sinus lift and implantation, you will have to wait half a year for the implant to be installed and about another year for the crown prosthesis;
• tooth extraction with one-step implantation – in one operation, the implant is installed immediately in the socket of the extracted tooth, without waiting for the bone tissue to heal;
• one-step implantation of an implant with an abutment and a temporary crown.

Only in one of these cases does the patient return home with a new, albeit temporary, tooth. However, sometimes two-step implantation is possible: for example, if the extracted tooth was located on the lower jaw, where there is enough bone tissue, and had a thin root, an implant can be immediately installed, the diameter of which exceeds the diameter of the root, by drilling the hole. Then this is actually a one-step implantation into clean bone and a one-step implantation with temporary prosthetics. After all, the fewer surgical interventions, the more comfortable the patient.

Implantation in the case of congenital absence of lateral incisors and minimal distance between the roots of adjacent teeth

Implantation in the case of congenital absence of lateral incisors and minimal distance between the roots of adjacent teeth is a complex task for several doctors. Often, such patients have a fragile physique, small teeth and thin gums. First, the orthopedist aligns the patient’s bite with the help of aligners, braces or an orthodontic appliance and sets the teeth in the correct position. Sometimes surgical intervention is also necessary to expand the upper jaw to create space for the missing teeth. After that, implants are installed with subsequent prosthetics.

Not always the patient goes through all these stages in one institution. Once, a person after orthodontic treatment turned to our dental implantation medica center, who wanted to install implants in place of the lateral incisors on the upper jaw. With the help of the bracket system, he managed to expand the space between the roots of the teeth from 2 to 4 mm, so installing an implant with a minimum diameter of 3.5 mm without damaging the roots of the neighboring teeth was in principle possible, although not easy. This patient even had a surgical template – an individually designed mouthpiece-stencil for the implantation. However, we did not need it. We performed the implantation without touching any roots of the neighboring teeth (as we confirmed on the X-ray) and were even able to immediately install temporary crowns. So the patient went home with new teeth.

Tooth extraction with an odontogenic cyst at the root apex and subsequent one-stage dental implantation in one visit

The possibility of one-stage implantation after tooth extraction with an apical (odontogenic) cyst on the root depends on the size and localization of the cyst. Thus, in 60-70% of cases, such an operation is usually successful, but when the cyst is so large that after its removal there is almost no bone tissue left, the procedure is divided into two stages: first, the socket of the removed tooth is filled with bone substitute material and heals, and after three to four months the person returns for dental implantation of the tooth. Crown prosthetics are performed in half a year, if it is an upper jaw, or in three months on the lower jaw.

Let us share an example of a successful one-stage implantation. Once a patient came to us with acute pain in the lower jaw, and a CT scan revealed a cyst on the root of the tooth. The tooth was no longer treatable — it had to be removed along with the cyst. Moreover, two surgical approaches had to be used at once: through a small hole in the jaw bone on the side and through the socket itself.

After removal, the socket was filled with bone substitute material and an implant was immediately installed, since there was enough bone tissue. At the end, a gum former was fixed on the implant, and a few months later the patient came for prosthetics with a crown. Thus, this case is an example of another double-stage implantation.

So, as you can see, we at the Sirius Dent Medical Center are able to succeed in solving almost all problems. Even if the patient himself believes that implantation is not for him due to anatomical reasons, it is worth making an appointment with our specialists — we will find the optimal solution.