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What problems can tooth implantation solve?

• Single tooth missing. In this case there is no need to remove the neighbor teeth nerves and turn-process these neighbor teeth for tooth crown attachment
• A few teeth missing in a row. Tooth implantation provides a possibility to place a stationary dental prosthesis instead of a removable dental prosthesis.
• All teeth missing

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Tooth Implantation History

In 1965 professor Ingvar Branemark was a head of research group at the University of Goteborg (Sweden) and his studies finally resulted in osteo-integration discovery (titanium prosthesis integration into tissue). Branemark’s researches were aimed at jaw bone healing and regeneration after injury. The most remarkable thing about this is that osteo-integration phenomenon was discovered accidentally.

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Clinical Case 3

Rehabilitation of teeth #15, #16, #23, #27, #28

1. The patient complained of partial absence of teeth on the lower jaw and frequent loosing of structures based on the 15th and 16th teeth, and 26th, 27th and 28th teeth on the left.

2. The patient consulted another clinic and was told that in her case it was impossible to install implants due to the lack of bone. Crowns and bridges were installed about 10 years ago.

3. Control OPG x-ray after the first operation. Implants were installed instead of teeth № 24 and 26 with simultaneous open sinus lifting, the 28th tooth was removed, and simultaneous splitting of the ridge was carried out in the places of teeth № 45 and 46.

4. Presence of fragments of endodontic instruments in the distal buccal canal did not scare our endodontist.

5. The fragment was removed, and root canals were refilled.

6. After 4 months it was time to install healing caps in the implants in the places of teeth № 24 and 26. At the same time cast metal cores were fixed in the places of 23rd and 27th teeth, on which it was planned to fix a temporary wire-reinforced plastic prosthesis.

7. Installation of cast healing caps in the places of 24th and 26th teeth was carried out simultaneously with soft tissue grafting. We got a zone of keratinized attached gingiva right away. Cutting line was in the palate 8-10 mm top of the ridge so that we could split the muco-periosteal flap and pick only the mucosa, leaving the periosteum, which would heal by secondary intention. The resulting site of the mucosa was transferred to the mucosal surface of the vestibular and locked with pressing seams of Prolene 6,0 which were to be removed in three days.

8. The temporary plastic bridge reinforced with wire and based on 23rd and 27th teeth was returned to its place and fixed with temporary cement. It was important that the prosthesis did not put pressure on the transplanted area of the mucosa. The ends of the suture material were cauterized not to hurt the patient.

9. OPG x-ray 3 months after the implant placement.

10. As we can see, 3 months after the surgery mucosa is pale pink. No mucous strands are detected (there is a movable mucosa, which starts near the top of the alveolar ridge). A postoperative scar is slightly visible. In the place of augmentation there is a decrease in the depth of the vestibule because of increasing of the bone in the lower jaw.

11. In order to deepen the vestibule in the implants zone, it was decided to use a free epithelial graft from the palate corresponding to the expected deepening in size and shape. Guidelines were applied to the donor area with the help of a stencil.

12. Taking the transplant

13. Free autograft in the physical solution.

14. The donor site, the bottom of which is the subepithelial layer.

15. The haemostatic sponge is laid, the wound is left to heal by secondary intension.

16. The free graft laid on the periosteum is fixed by U- shaped and pressing stitches. Healing caps are installed to fix the graft. As we can see in the photo, the depth threshold increased by an average of 0,5 - 1 cm.

17. An incision is made medial to the crest of the alveolar ridge of the maxilla.

18. Only the mucosal flap without the periosteum is elevated.

19. By means of a probe, localization of implants was defined.

20. Through individual osteoperiosteal punctures cover screws were removed and healing abutments were installed.

21. We do not recommend not re-cut the periosteum with elevating the muco-periosteal flap in areas of bone augmentation.