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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 5

Open sinus lift, cystectomy, implantation.

1. In the photo a site of opacity is visible in the projection of the right maxillary sinus, which probably indicates the presence of a rhinogenous cyst in the sinus.

2. Planned amount of manipulation is shown in this picture. Removal of the mucocele (top right), and installation of 8 implants with simultaneous sinus lift. At the bottom in the area of 36th, 37th, 47th and 46th teeth installation of four implants with simultaneous splitting of the alveolar ridge.

3. When working in lateral departments it is very convenient to use an interdental wedge. The wedge is individual, and it is made of conventional silicone impression material before the operation.

4. Occasionally during sedation patients become uncontrollable, and this wedge is more convenient than the conventional "frog" wedge that can for example be swallowed.

5. A cut is made on the top of the alveolar ridge in the first quadrant.

6. The muco-periosteal flap is elevated. It is of a trapezoid form, and its basis is turned to the transitory fold.

7. A processing window is formed with the help of a convex bur with diamond chips. Diamond chips on the bur do not injure Schneider membrane.

8. Schneider membrane is gently elevated from the bone.

9. Beds for the implants are created with the help of a chisel.

10. Osteotomy is performed on top of the ridge with the help of a separating disk.

11. The cyst cover is visible through the membrane at careful examination.

12. The cyst is removed through a single puncture with tweezers.

13. Mucocele is a peculiar retension saccular cyst formed in the result of blockage of small ducts.

14. Perforation of the membrane through which the cyst is removed.

15. A resorbable membrane folded in the form of tubes is installed under the Schneider's membrane and thus closes the perforation. It acts as a dome formed in the created space.

16. Sinus grafting is made with synthetic bone material with addition of allobone and autobone taken from the alveolar ridge.

17. Bone is mixed with blood plasma (after centrifugation).

18. The processing window is closed with a titanium membrane that is attached to the bone with pins.

19. The membrane will be removed at the stage of healing caps installation.

20. Installation of implants.

21. The wound is sutured with Prolene 5.0.

22. At the end of the operation according to the protocol we must make a control x-ray shot. As you can see, all the planned manipulations were carried out in a single operation.

23. Splitting of the ridge is planned and carried out in the fourth quadrant. By consecutive use of tools (expanders) we are able to split the ridge and install implants.

24. Bone scraper appeared to be an excellent tool for autobone extraction.

25. We mix the extracted autobone with alloplant and put it into the opening in the ridge.

26. Going into the second quadrant, we make a longitudinal insection along the top of the alveolar ridge bordering the 27th tooth.

27. The tooth is extracted.

28. We elevate a muco-periosteal flap and form a lateral window in the maxillary sinus.

29. A set of curettes made by DASK is used. An OSTEON II graft is prepared.

30. Thanks to parallel pins all subsequent implants can be installed as parallel to the selected plane as possible.

31. Closed sinus lift is carried out through the socket of the extracted tooth. The plunger of the syringe with the graft (OSTEON II) is initially pulled back in order to saturate the material with the serum obtained by centrifugation of blood.

32. The ridge in the area of extraction is powdered with graft. Then the socket and the window are covered with a Collagen (Dentium) resorbable membrane.

33. The wound is sutured with Prolene 5.0.

34. Moving to the third quadrant we split the ridge with the help of special tools (spreaders and expanders) according to the protocol of the operation.

35. That’s how expanders looks. Skills of the surgeon allow to split the ridge and install the required number of implants simultaneously.

36. As we see the implants are surrounded by at least 1 mm of bone tissue.

37. In four months we perform soft tissue grafting (to get a zone of keratinized attached gingiva) and install implants at the same time.

38. We see a donor area in the first quadrant. Please note that the donor site is located closer to the palate relative to the top of the ridge.

39. The mucous transplant is in the blood plasma which we received as the result of the patient's blood centrifugation.

40. A cut of 2-3mm is made closer to the palate relative to the top of the alveolar ridge. We split the flap vestibularly. We see cover screws of the implants through the remaining periosteum.

41. Healing abutments are installed.

42. The wound is sutured with Prolene 5.0.

43. In the forth quadrant we make a cut on the top of the alveolar bridge. It should be on the fixed mucosa. We split the flap vestibularly and move it apically to the transitory fold.

44. Healing abutments are installed.

45. The resulting flap (in the first quadrant) is sutured to the uncovered periosteum (of the fourth quadrant). Prolene 6,0.

46. The donor site in the second quadrant. It is located closer to the palate relative to the top of the ridge.

47. A cut is made 2-3 mm higher of the top of the alveolar ridge. We split the flap vestibularly, elevate together with the periosteum and see cover screws of the implants.

48. Healing abutments are installed. The wound is sutured with Prolene 5.0.

49. The resulting flap (in the second quadrant) is sutured to the uncovered periosteum (of the third quadrant). Prolene 6,0., pressing and fixing seams are used.

50. Pressing seams are to be removed on the third or fourth day.

51. Medical examination in a week after the gingival plasty and removal of the remaining stitches.

52. The third quadrant.

53. Medical examination in a week, the forth quadrant.

54. Removal of the stitches.

55. View of the donor zones in the first and second quadrants.

56. Holes for the transfer screws are drilled in the areas of implants in custom trays made of light-cured plastic.

57. View of metal-ceramic crowns on plaster models of the upper and lower jaws. In the area of 36th, 37th, 47th teeth crowns are made with transocclusal attachment directly to the implant.

58. Complete work

59. Control orthopantomogram after treatment.