Implantation of upper teeth: features of the operation, technology

Chief physician

German Implantology Center - Magomed Dakhkilgov, maxillofacial surgeon, implantologist, orthopedist Please note that the German Implantology Center is an official and certified partner of all leading and world-recognized implant systems. We are one of the key partners in Russia precisely because of our enormous professionalism and accumulated practical experience of successful many years of work in installing implant systems of all configurations - from single implantations to total ones.

This will ensure you receive excellent service and reliability from your front dental implants in both the short and long term.

We were one of the first in Russia to begin installing zirconium dioxide implants, which have a number of advantages over classic titanium implants, primarily due to their aesthetics and strength. Especially when it is necessary to carry out implantation in the area of ​​the front missing or replaced teeth:

Remember one simple truth: an implant is installed once and for life

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Causes and consequences of tooth loss in the front

Most people at one stage or another in their lives have encountered the problem of tooth loss - adentia. The reasons for the occurrence of such a defect in the dentition can be very different:

• insufficient oral hygiene: leading to the destruction of dental crowns and/or severe gum disease,
• untimely treatment of caries: entails pulpitis, periodontitis, cyst formation, granulomas on the roots,
• jaw injuries: the smile area is most often injured,
• inflammatory diseases in the nasal sinuses: inflammation can be transmitted to the roots of the upper dentition (since the border of the sinuses is located very close to them),
• eating foods that destroy tooth enamel: for example, large amounts of sour fruits and juices,
• bad habits: for example, smoking (in general, it is harmful to all tissues of the jaw system),
• biting hard foods, and sometimes even inappropriate use of the front teeth - biting on any hard objects, toys (especially important for children).

If even one tooth is missing, a late visit to the dentist inevitably entails a number of problems. First of all, the bite is disrupted: neighboring teeth begin to shift towards the missing one, the dentition becomes curved, the tooth on the opposite jaw moves out of the bone socket, which can also lead to its loss over time. The more pronounced the adentia, the more the bite situation worsens.

The absence of one or more front teeth not only leads to disruption of chewing function and bite, but also affects a person’s psychological well-being. People who have problems with smiling become more withdrawn, smile less, communicate less, trying not to draw attention to their aesthetic defects. For people in public professions, the “loss” of attractive appearance is especially critical.

The best solution for losing front teeth is implantation. It involves restoring the tooth root, as well as installing a crown on top of the implant, resulting in a completely physiological replacement of natural with artificial. It is almost impossible to distinguish one from the other! And you can evaluate the quality of the implantation of the front teeth in the photo “before and after” treatment - the restorations look very natural, like your own.

Basic recommendations

To reduce the risk of complications after surgery, it is important to follow individual and general recommendations:

• Careful oral hygiene.
• Smokers should stop smoking.
• Do not eat too cold or hot foods.
• During the recovery period, avoid solid foods.
• Have it professionally cleaned every six months.
• Do not allow intense chewing load on the implants.
• Visit your doctor periodically to track progress statistics.

This dental operation is not only complex, but also has a wide range of contraindications. In such cases, a bridge is used to restore aesthetics.

Advantages of implantation over classical prosthetics

The main advantage of implanting the front upper or lower teeth is the ability to install single crowns on implants (rather than a bridge). By restoring the anatomical structure of a natural tooth root using an implant, you can achieve ideal results:

• reliability and durability: the natural and full functionality of the dentition is restored. Implants are made of biocompatible high-strength titanium, which allows them to last for decades, while the bone tissue around the implants does not atrophy, since the chewing load enters the bone through the implants, as through natural roots. As for crowns on implants, the patient can choose metal-ceramics - it lasts about 15 years, is quite durable and aesthetic, or zirconium and aluminum oxide - the most modern materials, the most durable, highly durable,
• comfort in use: dentures on implants not only look, but also feel natural, and caring for them is no more difficult than caring for natural teeth;

• natural spaces between the teeth are preserved: artificial crowns on implants are located at a short distance from each other, and are not combined with each other, as with bridge prosthetics, which also adds naturalness to the entire dentition,
• the natural contour of the gum around the crown is preserved: it is formed thanks to orthopedic components that are placed on the implant during its fusion with the bone (in the smile zone, the abutment performs the function of a gum former),
• the neighboring teeth are not injured: with the help of implants, only missing teeth can be restored, without injuring (without grinding down) the neighboring healthy ones.

Gum plastic surgery after implantation of the front teeth or the formation of a beautiful gum contour is carried out using an abutment (although usually, if the tooth is out of sight, a gum former is used). This orthopedic component has a rounded shape and a diameter close to the diameter of the future crown. The denture will be installed in such a way that its lower part will cover the aesthetic gingival margin.

How to walk with front tooth implantation?

If we talk about installing a crown on an implant in one visit, then it is possible, but not in all cases. If there are contraindications, so that the patient does not go without a tooth, we install an immediate prosthesis instead of a crown, which is fixed on the teeth adjacent to the “missing” and does not damage the soft tissues. Perhaps this type of prosthesis is not a masterpiece of aesthetics, but it does its job well - it replenishes the dentition, and it looks good. In addition, the patient will not have to wear it for a long time - a maximum of four months, after which the prosthesis will be replaced with a permanent crown.

How to place implants in the anterior region - methods and stages of installation

There are 3 main types of implantation of anterior teeth: classical implantation with delayed loading and express implantation with immediate loading; there is also implantation with early loading. Let us consider the features of these methods further.

Option 1: Classic two-stage implantation with delayed loading

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Classical implantation consists of two main stages:

1. the surgical stage is the installation of the implant itself: then you need to wait for the implant to engraft into the bone, which takes approximately three to six months. During this time, the patient can have a temporary removable crown installed to hide the defect in the dentition. A limited chewing load should be transferred to the implant that has not taken root, so the crown is slightly removed from the bite, relieving pressure on the intraosseous part,
2. prosthetics: after the implant has firmly taken root in the bone (after 3-6 months), you can proceed to the second stage - prosthetics. To do this, an abutment is installed on the implant - the top of the implantation system, which will first serve as a gum former (so that there is a beautiful and natural gingival contour around the future crown). Subsequently, the abutment will support the crown. The abutment can be either metal (gray or gold) or white zirconium dioxide for high aesthetic requirements. Next, impressions are taken, and after a few days the finished permanent crown is fixed to the implant.

Option 2: Express implantation with immediate loading

Implantation with immediate loading is also called one-stage, since all stages are carried out one after another without a long wait for the implant to engraft into the bone tissue. But this method is not suitable when restoring 1-2 teeth, because with immediate loading, the implants are splinted with an extended prosthesis, otherwise they will move. A single crown or bridge-like prosthesis in an aesthetically significant area is not capable of splinting implants. That is, one-stage protocols with immediate loading can only be used if a completely edentulous jaw or segment of the masticatory zone is being restored.

The immediate load implantation process is as follows:

1. installation of artificial roots: can be used as classic two-part structures (implant + abutment), as well as one-piece one-piece structures, when the tip of the implant remains above the gum during installation (as an abutment).
2. Next, the doctor immediately takes impressions to make the prosthesis: well-equipped clinics use an intraoral 3D scanner, digital software, and modeling of a new smile in accordance with the “golden ratio” to create prosthetics. The data is sent to special robotic high-precision equipment in the dental laboratory. As soon as the product is ready, the prosthetics stage begins,
3. installation of the denture a maximum of 72 hours after the surgical stage: and the patient can begin to chew with a full-fledged denture on the first day.

Thus, the total period of implantation with immediate loading is limited to only a few days, but do not forget that in the future it will be necessary to replace the adaptive prostheses with permanent ones.

Option 3: Early loading of implants in the smile area

Here, a permanent crown will not be placed immediately after implantation, but there is also no need to wait 3 or more months. On average, a permanent crown is placed 6-8 weeks after the surgical stage (and before that you need to wear a temporary plastic one). Early prosthetics are possible if a special progressive implant is installed - with an active surface or nanostructures that accelerate the growth of new bone on the surface of the implant and its secondary stabilization (osteofixation) by 2-3 times.

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Which clinic to choose

You can get dental implantation in Moscow at one of the ROOTT MCDI clinics. Installation of a two-stage ROOT implant (Switzerland) at the Moscow Center for Dental Implantology will cost 32,000 rubles. (excluding the cost of the crown), express implantation ROOTT – 44,000 rubles. (together with a temporary crown). You can learn more about the implantation technologies used in order to choose the most preferable option and have an idea of ​​what to be prepared for at a free consultation with an implantologist. Appointments can be made by phone or online.

Modern dentistry offers a number of methods that give patients a chance to regain their beautiful smile. Every year, implant treatment becomes more popular and accessible.

In some cases, when it is necessary to remove a patient's own tooth, most often in the case of front teeth, dentists have the option of inserting an implant into the socket immediately after extraction. Then a “temporary” crown can be installed, thanks to which the patient maintains dental aesthetics, speech and chewing function. After about three months, the temporary crown is replaced with a permanent one, made by a technician in a laboratory. Single-stage implants themselves are slightly different in price from those that are loaded with delayed loading.

You can get advice from experienced specialists about dental implantation in the smile zone in the capital’s dental clinics:

Dental implants are the latest technologies that provide exceptional comfort of use. Patients who have lost their front teeth due to an accident, tooth decay, or other diseases can enjoy the ability to function normally and smile without fear, without discomfort, thanks to dental implants. The most modern method of replacing missing teeth is implantation.

Dental implants are placed when we lose our natural teeth. Most often, the decision to replace missing front teeth is made for aesthetic reasons. It's no secret that missing teeth can lead to changes in our appearance, or rather, facial features. You can see the appearance of your cheeks, mouth and nose change. Wrinkles appear faster in the middle part of the face, which makes us feel unattractive.

However, it is worth remembering that from a medical point of view, the replacement of missing teeth, both front and back, is very important. The absence of teeth disrupts the functioning of the chewing system, which over time affects both aesthetics and our health. The absence of molars causes improper grinding of food, which leads to the development of diseases of the digestive system, such as peptic ulcers or increased stomach acidity.

What kind of implants are placed in the smile zone?

Which implants are best? When implanting anterior teeth, the features of the anatomical structure of the patient’s bones, the location of the nasal sinuses (above the upper jaw), and nerves must be taken into account. Implants must have a root-like shape, not provoke allergies, withstand the stress of jaw compression, and also fuse firmly with the bone. And the bone should not sag much over time. Therefore, it is better to give preference to the most reliable and clinically proven brands - Nobel Biocare, Astra Tech, Straumann. The narrowness of the orthopedic space does not allow the placement of wide implants, so preference is given to products with a narrow diameter of 3 mm.

Laser Application

Modern Elite-Dent implantology uses a laser for dental implantation; dissection of the gums and mucous membranes is performed not with a scalpel, but with a light beam. This allows you to get the best cosmetic and functional result, as well as eliminate the pain of the procedure and discomfort in the postoperative period. The advantages of a laser incision are bloodlessness, quick access to the working area, sterility, the bactericidal effect of the beam significantly accelerates healing, and the time of surgical intervention is halved. This is a gentle and effective method with a short recovery period. Implantation of the upper anterior incisor using a laser is somewhat more expensive, but allows you to avoid pain, risks of complications and achieve ideal aesthetics.

How to choose crown material – and is it worth making them very white?

Highly aesthetic translucent pressed ceramic E.max is recommended as crown materials for prosthetics of upper anterior teeth on implants. But only if an extended prosthesis is made, because ceramics on single crowns will simply crack when rubbing against a metal abutment. Or single ceramic crowns or bridges can be used on individual zirconia abutments. In general, dentists recommend using zirconium dioxide and aluminum oxide on the upper and lower teeth as a solid base, and then veneering the crowns with aesthetic ceramics. These materials provide sufficient strength and excellent aesthetics, which is important for the smile area.

Metal-ceramics for the smile area is not recommended, because... may give the gums a “bluish” or gray tint. The only option is if the metal base is made of an aesthetic metal - gold, for example, or titanium coated with a golden color.

If you plan to whiten adjacent teeth in the future, then you need to choose the color of the crown, taking into account the new color of your smile. But this is often difficult to do, because... enamel can lighten by 3-4 or 8-15 tones. In the first case, you should not make the permanent crown very white, because... it can remain much lighter after whitening the rest of the teeth. In the second case, it will have to be changed after whitening, because the crown on the implant will look darker than the rest of the area. Therefore, it is better to do whitening first, and then select the shade of the permanent crown.

Possible side effects

Among the possible complications after the implantation procedure, the main one is rejection of the product. In this case, the latter is removed, and then the specialist must make a decision regarding the rationality of a repeat procedure. In addition, certain adverse reactions may occur:

• Pain that does not stop for several days after the procedure. To get rid of it, painkillers are used. If they do not help, you should seek advice from a specialist.
• Minor bleeding. It should be noted that aspirin should not be used as a pain reliever. This is due to its ability to reduce blood clotting rates. If such situations repeat for more than 10 days, you need to visit an orthopedist.
• Numbness in the area where the product is located. If this feeling does not go away 4-6 hours after the manipulation, this may indicate damage to the nerve endings.
• An inexperienced specialist can harm neighboring teeth or tissues.
• Swelling of the facial area may appear some time after surgery. This is a normal reaction of the body to surgery. As a rule, after 5-7 days the swelling goes away. If this does not happen, the symptoms indicate the beginning of the inflammatory process.
• A slight increase in temperature is caused by the implantation of a foreign body. Optimal values ​​are 37.2−37.5 degrees. Higher values ​​indicate the presence of infection in the body.

Memo to the patient after implantation

When is bone grafting needed?

Lack of bone leads to gum loss, and this negatively affects the aesthetics of the smile area and the osseo-fixation of the implant. Therefore, before installation, the dentist may even recommend undergoing multislice tomography (rather than standard cone-beam) in order to accurately assess the volume and condition of the bone. Further treatment can go in the following directions:

• bone augmentation before implant installation: used in a classic two-stage treatment protocol. First, the bone is surgically replanted, then they wait for it to heal (about 6 months), and only then the implant is installed,
• bone grafting during implant installation: a faster way, and also a reliable one - there is no risk that by the time the “roots” are implanted, the bone will again lose volume (as could be the case in the previous case). Used for protocols with early loading.

Stages of the procedure

• Diagnostic

Assessment of the volume and general condition of the maxillary bone structures using x-ray diagnostics - orthopantomography and CT with 3D modeling.

• Preparatory

Hygienic cleaning is carried out - all dental deposits are removed, caries and other dental diseases are treated.

• Surgical

The operation is performed under local anesthesia. The operation lasts on average 30-50 minutes; the use of laser equipment significantly reduces the intervention time.

• Orthopedic

After implantation of the implant, an abutment is installed, onto which the adaptive prosthesis is fixed. Permanent dentures are carried out after complete engraftment of the artificial root.

Service life of implants in the smile area

Modern implants have a very high survival rate - at the level of 98-99% in the long term. This, and high-quality materials, guarantees them an almost eternal service life. But such indicators apply to a greater extent to brands in the premium segment and those close to them from the middle price category. If we consider the reviews of patients who have undergone implantation of upper or lower front teeth using the Straumann or Nobel brands, we can see that their level of satisfaction with the comfort of life after 10 years of wearing these implant systems exceeds 90%. While satisfaction with economy class products is less than 80% for the same period.

This is explained by the fact that the survival rate of implants here is also lower - 93-95% after 5 years of wear (and not after 10 years). Therefore, you need to pay special attention to choosing a brand so that your new smile lasts as long as possible. And another factor in the durability of the restoration is the right choice of doctor. The specialist must have continuous experience in implantology and do his work to a high standard - as evidenced by his portfolio and patient reviews.

Conditions necessary for high-quality implantation

• Careful selection of crown material that does not differ from neighboring teeth;
• Providing a natural-looking gum contour;
• Carrying out the operation in a short time after tooth extraction, so that the problems of atrophy do not have to be solved;
• Optimal choice of implantation system
• Carrying out bone augmentation, if necessary;
• To reduce the likelihood of complications, it is recommended to choose a protocol with delayed or immediate loading.

Choosing an implant

This process requires an individual approach, because each person has his own characteristics and needs. To make the right choice, the doctor analyzes the situation, having complete information:

• Regarding the anatomical features of the skull - the location of the sinuses, the exit points of the nerves;
• About protocols and methods used in maxillofacial surgery.

Experienced doctor

• Positions the implant at the optimal angle, ensuring its stability and safety;
• Eliminates the possibility of damage to the facial nerve;
• Minimizes the likelihood of artificial root rejection.

How is implant care related to their service life?

Implantation is one of the few solutions that allows you to make your smile flawless and attractive. In addition, implants ensure the preservation of bone and gum tissue. The bone receives a certain chewing load and does not atrophy, and the gums fit very tightly to the dental crown, which allows you to care for the oral cavity in all the usual ways - regularly use a suitable toothbrush and toothpaste, massage the gums, use an irrigator to clean hard-to-reach interdental spaces. In general, the rules of care are similar to regular oral care. However, it is not recommended to overuse dental floss around implants (only those labeled “super-floss” are allowed); it is better to use an irrigator for this. Proper care is one of the main conditions for a long service life of restorations.

Features of the upper jaw and difficulties when installing implants

Difficulties in implantation in the upper jaw are associated with the loose porous structure of the bone due to lower chewing load. Features of implant installation:

• To restore a full dentition, you will need more implants than in the lower jaw;
• artificial roots take 1-2 months longer to take root;
• high probability of bone grafting due to small jaw height, rapid bone atrophy after tooth loss;
• if during the operation the maxillary sinuses are damaged, inflammation, sinusitis, and runny nose occur;
• risk of damage to the nerve and infraorbital foramen if the protocol is not followed;
• aesthetic requirements for upper anterior crowns as they shape the smile.

Complications and risk of rejection

If the implantation of the front teeth (direct installation) or the production of prostheses was carried out with technological violations, if the patient himself is careless about the recommendations of the implantologist for rehabilitation, then complications may well begin - for example, peri-implantitis and rejection. The most common causes of violations on the part of the patient are poor oral care, eating hard food before the implant is completely implanted. Therefore, you should scrupulously follow all the doctor’s recommendations.

Why do you need a sinus lift?

Implantation is possible with the required amount of bone, installation of short or thin implants. But in the latter case, the risk of complications during engraftment or root rejection in the future increases. Thin structures do not protect against subsequent tissue atrophy.

Therefore, a sinus lift is used to build up bone tissue in the area of ​​the upper molars. The lack of bone tissue is compensated by using part of the maxillary sinus without damaging its mucous membrane. Through a puncture in the gum, the bottom of the sinus is carefully lifted, and the resulting space is filled with bone material.

Often surgery is needed even without bone atrophy - the bone next to the maxillary sinus is thin and does not have sufficient volume.

In the area of ​​the front teeth, a method of directed bone regeneration is used - the gum is exfoliated, material is added, a membrane is installed, the gum flap is returned to its place and sutured.

Alternative Recovery Options

The main alternative to implantation is bridge prosthetics. To do this, it is necessary to depulpize the incisors/fangs that remain at the edges of the defect and grind them for installation of a bridge. In addition, after installing the bridge, an increased load will be placed on the supports, which will accelerate the process of their destruction, and in places where there are no roots, the bone tissue[1] will sag, eventually forming a gap between the gum and the prosthesis. Therefore, in the absence of contraindications, installation of implants is still preferable.

Another option for prosthetics is the installation of a removable denture, clasp or partial plate. The simplest and most economical type of prosthetics, however, in terms of service life, functionality, aesthetics and comfort, it is significantly inferior to fixed bridges and crowns on implants. Therefore, a removable denture is considered only as a temporary option.

When installing a dental bridge, the cost of the bridge itself will be less, but prior to the day of its installation, preliminary preparation of the oral cavity and supporting units will also be required, which in the end may turn out to be even more expensive than a crown on an implant.

What does the cost depend on?

How much does a front tooth implant cost? In general, the cost depends on many factors: the type of implants (different brands of implants belong to different price categories), the need for preliminary preparation of the oral cavity, especially if bone grafting is required, as well as the selected material for the crowns. When visiting a free consultation with a dentist, you will be able to select the best options for each individual patient and draw up different treatment plans, indicating the cost and stages. Implantation is an expensive prosthetic option, but the cost of such treatment is justified by its long service life and functionality.

How much does it cost to place an implant in Moscow and the regions? The price of front tooth implantation is “turnkey” – i.e. with examination, installation of an implant and a permanent crown, it can cost 40 thousand rubles, or 100 thousand - depending on which implant and which crown the patient chose.

[1] Matveeva A.I., Frolov V.A., Gvetadze R.Sh., Borisov A.G., Kushkhabiev 3.3. The influence of implant parameters on the stress-strain state of bone tissue in the implantation zone // Dentistry. - 2010. - No. 1. - P. 54-55.

Author: Bespalov R. D. (Thank you for your help in writing the article and the information provided)

Contraindications:

• psychoneurological diseases;
• diabetes mellitus of any stage;
• hypertonic disease;
• malignant tumors;
• problems with blood clotting;
• any form of tuberculosis;
• diseases of the cardiac and vascular systems;
• hypertonicity of the masticatory muscles;
• AIDS and HIV;
• reduction of gum tissue (atrophic gingivitis).

Also, implantation of the front incisor is not carried out in the presence of inflammatory processes in the gum tissue, caries lesions, lack of bone mass, if nearby units are damaged. In such cases, measures are initially taken to eliminate the identified problems. When bone tissue atrophies, a procedure is performed to build it up. As practice shows, sinus lifting of the upper jaw is necessary in 85% of cases. Only after this is carried out is the implantation of the upper front teeth prescribed.