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Dental implants
The material and the loading of the implants
The material of the implants is biocompatible, titanium or zirconium dioxide.
The implants replace the role of the roots of the teeth and are firmly fixed in the jaw or other bones of the face.
The osteointegration of the implants (fixation of bone on the implant surface) secures perfect stability against chewing pressure. It takes 6 months.
The restoration of the teeth and sometimes the gum, as well as supported by implants need to be connected to the implant or implants.
The retention of crowns can be managed either by a screw or by glue material.
There are 3 types of loading /by chewing forces/ of the implants: immediate, early and late.
Immediate loading is prefered if possible.
The abutment connects the dental implant to the dental prosthetic.
The multi-unit abutments with 4 different angulations/0, 17, 30, 45/ allow connecting 4-5-6 implants in one jaw to a full arch non-removable immediate restoration.
Classification of the implants
Classification based on their material
- titanium
- titanium alloys
- ceramic
Classification based on their shape
- blade
- cylinder
- screw
Classification based on their construction
- one-piece
- two-piece
Implant surgery /the course of implant insertion/
The tooth replacement procedure is recommended, as soon as possible. If we wait after the extraction, bone loss is inevitable and delay of the implant placement will result in loss of the bone mass. The root of the extracted tooth can be replaced in the same session (immediate dental implant, straight after extraction) or 6 weeks after the extraction (immediate-delayed) or 4 months after the extraction of the tooth (delayed). The surface of the implants contains specially designed microscopical pores that will be occupied by the growing bone cells. The direct structural connection between the living bone and the implant surface is called osseointegration. This firm bone-implant connection is responsible for the load-carrying ability of the implants.
One-stage procedure
One stage dental implant procedure is convenient for patients having enough gingival thickness. With this procedure, the dental implant is set into the jawbone and a healing abutment closes the implant. The gum flap does not cover the implant. The foreign body is exposed to the oral cavity. No need for the liberalization of the dental implant.
Two-stage procedure
A two-stage procedure is used for replacing teeth when there is no need for an immediate cosmetic solution. With this approach, the implant is placed into the jawbone and covered with a cover screw and with the gum flap. The foreign body is not exposed to the mouth.
Immediate Dental implantation
The implant is set into a fresh extraction socket. The immediate tooth implant can be a one-stage or a two-stage procedure similar to the implant set to the mature intact bone. If after a trauma the tooth needs to be extracted, usually the one-stage implant can be made. After a minimally invasive surgical extraction of the tooth and in case of high primary stability a one-piece dental implant or a temporary abutment can be used with a temporary acrylic crown. This is an immediate aesthetic restoration.
Loading of implants
Implant-supported restorations (crowns, bridges, removable restorations) can be fitted on the implants, which load the implants passing the chewing forces on the implants. The fixation of non-removable implant-prosthetic restoration can be carried out by screws (screw-retained crown), or with an adhesive material (cement-retained crown). Even the removable prosthesis is more stable if it is supported by the implants (implant-retained dentures). The retainer can be for example a locator. The case of edentulism implant-prosthetic rehabilitation provides an aesthetically pleasing and functionally efficient rehabilitation of the mouth. Transformation of the patient’s smile and appearance improves the quality of life.
If a crown after implant or a removable denture is set on the implants immediately after the implantation it causes the loading of the implant with the chewing forces. The hardness and the shape of the crown influence the transfer of loading forces. This treatment is called the immediate loading of implants. Acrylic crowns and acrylic dentures are most commonly used.
In an ideal case, just after the tooth extraction, an implant is inserted into the socket /immediate dental implant/, and a crown or removable restoration is fitted, resulting in immediate loading of implants (the patient will not even have one minute without teeth). However, this procedure requires a non-inflamed (sound) surrounding with sufficient bone quality. If the crown is not in contact with the opposing tooth in centric occlusion, the implant will be loaded only during chewing.
3D navigated implantation
The demand for more accurate implantation has driven the development of a 3D navigation implantation system. 3D planning software is suitable for viewing soft tissues in different colours in real sizes. The planning program allows the virtual positioning of the implants in 3D. Based on the planning a surgical template is made, which is fixed at the beginning of the operation. At the planned sites, a bore is made through the gum and the implant is screwed in. This method avoids making a flap. Dental implantation with the navigation system is the most advanced and accurate implantation procedure. This will allow optimal prosthetic restoration.
The advantages of navigated implantation for the patients:
- precise setting of the dental implant
- the implantation is made according to a pre-planned way, based on the prosthetic restoration
- we can support the patient in decision-making by showing the end
- shorter surgical time
- the operation is simple and safe and also minimal invasive enhancing a fast healing
- it enables the precise planning of the implant placement prior to the operation
- In some cases, this method can avoid bone grafting
All-on-X
In some cases with substantial bone loss, it is possible to make a 12-unit bridge on four implants without bone augmentation. The two lateral implants are placed not perpendicularly to the ridge, but at an oblique angle. The two mesial implants will be implanted in the vertical direction as usual. After surgery, without a healing period or delay, temporary bridges can be made. After the bone integration, the permanent bridge will be fitted. All-on-X dental implants in Hungary are very popular.
The most important criteria for this surgical intervention are as follows:
- The bone of the upper jaw needs to be of sufficient quality and quantity to drill the four holes for the implants without damaging the sinus and the base of the nose. The primary stability of all of the 4 implants has to be a minimum of 35Ncm so that the implants can be loaded immediately.
- In the lower jaw, the location of the nerve canal and the quantity and quality of the bone also determine whether the 4 implants can be loaded immediately. However, the quality of the bone of the lower jaw is rarely a problem and provides the primary stability needed for the implants.
- In both jaws, the minimum diameter of the implants must be 4mm and the minimum length of the implants must be of 13 cm in order for them to be immediately loaded and stable enough for a bridge to be attached.
