Dental implant

• implant - part of the structure directly implanted into the bone
• temporary implant - usually serves as a support for a temporary prosthetic structure and must be removed at the time of permanent prosthetics
• gingival former (also: gingival cuff former - FDM ; healing - jargon , from the English healing abutment , literally "support for healing", "healing support")
• abutment (from the English abutment , literally "support") - the part of the structure attached to the implant serves as a support for the future crown or prosthesis
• suprastructure - a superstructure for an implant, the collective name for all types of abutments and formers

• Intraosseous (endoossal)
• Subperiosteal (submucosal)
• Basal
• Endodonto-endossal

By type of construction, collapsible and non-collapsible (single-component) implants are distinguished.

Collapsible Implant

A collapsible implant consists of the implant itself and a superstructure (suprastructure) called an abutment. Such an implant can be installed according to a one- and two-stage protocol. The two-stage protocol involves the complete immersion of the implant and covering it with the mucous membrane, as a result of which any contact of the implant with the oral cavity is excluded - this procedure is called the first stage of dental implantation . The second stage is to install some kind of superstructure (suprastructure) - it can be either a gingiva former or an abutment with a temporary crown or other type of prosthetic structure. After what period of time will the second stage be performed, the implantologist usually decides, relying on data on bone quality, age and general condition of the patient, as well as his clinical experience. Classic terms are 4-6 months, but recently there has been a tendency to reduce waiting times to 2.5-3 months. This is due to a better understanding of the process of osseointegration , as well as optimization of macrodesign and microcharacteristics of the implant surface.

Fixed Implant

In a non-separable implant (the terms are also used: one-stage implant, monoimplant), the intraosseous part of the implant and the abutment are usually made of a single piece of material. After installation, the implant with its supragingival part immediately comes into contact with the oral cavity. At the discretion of the doctor, a gum shaper or a temporary crown is installed. In the case of installing a temporary prosthetic structure (crown, bridge or complete prosthesis) on the implant no later than three days after implantation, an immediate load is indicated.

Intraosseous implants are divided into root-shaped, plate-shaped and combined implants. The most common are root-shaped implants, which can be cylindrical or conical in shape.

Root implants can differ significantly in the macro design of the thread: non-aggressive, aggressive with deep runners, mixed.

In dentistry, titanium alloy implants are used with great success. Typically, the intraosseous part of the implant is made of commercially pure titanium VT1-0 (class 4), due to the best mechanical properties, VT6 Ti-6Al-4V (titanium-aluminum-vanadium alloy, class 5) is also widely used.

Dental implants are also made from zirconium dioxide . Such implants have a cosmetic advantage, since there is no dark transmission through the mucous membrane, sometimes manifested when using implants made of titanium and alloys. However, zirconia is osseointegrated to a lesser extent than titanium, and is also difficult to finish in the oral cavity. In view of this, zirconia implants are not widely used in the world.

Research is ongoing to find new biocompatible materials. In particular, clinical trials are underway of a titanium-zirconium alloy (commercial name "Roxolid"), designed specifically for dental implantation.

Nanostructured titanium is considered as a promising material for dental implants ^[1] . Due to a significant decrease in the average size of crystalline grains, its strength becomes comparable with the strength of the VT6 alloy, which allows the manufacture of smaller implants. It was found that nanotitanium provides better osseointegration compared to coarse-grained titanium.

It should be understood that the desired result in dentistry is the restoration of the function and aesthetics of the dento-maxillary system as a whole. A dental implant in this context can only be a stage in the overall process, being a support for the final restoration. The implant must be both functional for the patient, and convenient for the dentist at the installation stage. This is facilitated by: a well-thought-out surgical set of cutters and screwdrivers; logical sequential protocol for the preparation of osteotomy (bone bed). The presence of different forms of the implant enables the implantologist to choose the optimal design depending on the bone conditions. For example, in a porous, cancellous bone, a cone-shaped implant with an “aggressive” self-tapping thread is more suitable, and achieving adequate stabilization with a cylindrical implant with a fine thread pitch will be a difficult task. If the requirements are not satisfied, then the implant system is somehow rejected.

The implant should:

• Be convenient at the installation stage.
• successfully integrate, not cause oppression of osseointegration, and possibly potentiate it. This is facilitated by a high degree of purification from mechanical particles and the level of sterilization.
• give great opportunities in prosthetics
• provide long-term preservation of consumer properties / do not break

However, it should be borne in mind that the success of the procedure depends not only on the materials, but also on the experience of the doctor who installs the implants, since 80% of failures occur due to the low qualification of the specialist ^[2] .

Indication for implantation is the absence of a tooth (adentia) for any reason. ^{[3] [4]}

With the loss of one or several teeth, the bone tissue in this place becomes thinner over time due to the absence of a chewing load, which leads to deformation of the maxillofacial system. The presence of the implant provides an adequate load on the jaw bone, similar to the natural root of the tooth, therefore, thinning of bone tissue does not occur. Every person who has lost one or more teeth as a result of various injuries, illnesses, or tooth decay have indications for dental implants. Elderly people can also undergo the implantation procedure, since the determining factor in its implementation is more likely a state of health than age. The question of whether dental implantation is possible is decided by a dentist after a thorough medical examination of a particular patient and a detailed examination of the condition of his teeth.

• good cosmetic effect;
• restoration of important physiological functions;
• prevention of the negative effects of missing teeth.

Installation of the implant allows you to:

• restore a lost tooth without damaging healthy adjacent teeth;
• create additional support and install a fixed prosthesis;
• create a support to improve the fixation of the removable denture.

• blood diseases
• coronary heart disease ;
• hypertension
• diseases of the central nervous system ;
• diabetes mellitus ;
• oncological diseases ;
• severe forms of periodontal disease ;
• congenital or acquired malocclusion ;
• patient age up to 16 years;
• immunopathological conditions ;
• systemic diseases of the connective tissue (rheumatic, rheumatoid processes, scleroderma , etc.);
• tuberculosis .

Similar contraindications occur in approximately 10% of the population ^[2] . These contraindications are only relative and are determined primarily by the severity of the disease. It is not recommended to install implants for very young or, on the contrary, too elderly patients, as well as those who smoke or drink too much alcohol.

Of particular importance is the level of oral hygiene. Implantation cannot be performed without sanitation of the oral cavity (all teeth must be cured), since any focus of infection in the body can nullify the work of the implantologist because of the high probability of subsequent rejection of the implanted implant.

The installation of dental implants can lead to peri- implantitis, which occurs due to the bacterial flora that enters the external surface of the implants through plaque. The treatment of this disease was carried out by Korean researchers using a titanium brush.

Antidepressants

Taking antidepressants during implantation four times worsens its results, according to a study ^{[ what? ]} University of Buffalo. Although a larger sample of patients is required for more accurate conclusions, the researchers recommend that attending physicians should not use antidepressants when implanting teeth. ^[five]

Beta blockers

Beta-blockers promote the integration of dental implants into bone tissue and reduce their rejection. The findings are based on a Canadian study of 1499 dental implants in 728 patients, in which the implant rejection rate in people who took beta-blockers for other indications was 0.6%, and in those who did not - 4.1%.

Heartburn Remedies

Drugs for treating heartburn can worsen the survival of dental implants. The data are based on a Canadian study of 1773 dental implants in 799 patients, in which the implant rejection rate in people who took drugs for treating heartburn was 6.8%, and in those who did not - 3.2%. Researchers attribute this phenomenon to the fact that drugs for treating heartburn reduce intestinal absorption of calcium.

The service life of implants in different patients varies and varies from several years to ten to twenty-five, depending on the state of human health, primarily on the presence of dental or systemic pathologies. You should visit a doctor in a timely manner, observing his recommendations and not neglecting preventive measures ^[2] .

It is very important for each person who has decided to undergo the implantation procedure to know that after the operation, mandatory scheduled examinations by the dentist are necessary - after 1, 3 and 7 months. The doctor will be able to check the functionality of the implanted implant, the state of oral hygiene, signs of inflammation or rejection of the implant.

In the future, an annual inspection by a specialist is required, during which:

• using radiography , the quality and density of bone tissue are studied;
• occlusion and articulation are checked;
• if necessary, the patient receives advice on hygiene ;
• wear and tear of crowns and fillings covering the holes of the fixing screws is recorded;
• the condition of the teeth is examined.

The term "dental implantation" in dentistry is understood only as implantation of a dental implant. Subsequently, a crown is attached to the implanted implant with cement, which can be temporary - plastic, cermet, ceramic, gold, etc. With respect to the bone, it should be at the same level as the crown of the tooth replaced by the implant. In practice, two types of fixation of crowns on implants are most often used: cement or screw.

The choice of crown type depends on the specific situation and the financial capabilities of the patient.

• Implants
• Dental prosthetics

• Gurfinkel L.N., Gizatullin R.M. Testing of dental implants // Dental South. - 2007. - No. 7 . - S. 50-52 . (inaccessible link)
• Ibragimov T.I. , Bychkov A.I., Aleshin N.A., Tibilov V.F. Use of a new type of suprastructure with a micro shock absorber on dental implants for prosthetics of patients with complete absence of teeth // Clinical Dentistry. - 2010. - No. 1 . - S. 58-60 .
• Matveeva A.I., Frolov V.A., Gvetadze R. Sh., Borisov A.G., Kushhabiev 3.3. The effect of implant parameters on the stress-strain state of the bone tissue of the implantation zone // Dentistry. - 2010. - No. 1 . - S. 54–55 .
• Robustova T.G. Dental implantation: surgical aspects. - M .: Medicine, 2003 .-- 557 p.
• Robustova T.G., Path S.A. Application of temporary intraosseous dental implants // Russian Dental Journal. - 2005. - No. 1 . - S. 46-48 .