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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 8

Extraction of teeth # 11,12,13,25,27,38, implantation # 21,11,12,15,16,23,25,26,36., splitting # 21-23 + block, # 13- block.

1. The patient who came to the clinic was diagnosed with partial edentulism of both jaws. There were complaints about loosing of structures in the upper jaw and partial absence of teeth in the lower jaw on the left. It was proposed to remove the remnants of the teeth in the upper jaw together with bone grafting, installation of implants and extraction of teeth # of 34, 35 and 38. Implants were planned to be installed in the area of teeth # 34 and 36.

2. Clinical picture in the oral cavity.

3. Third quadrant. The cut is made along the top of the crest, a little lingually. The cutting line has to be on the fixed mucosa. We see the apical exposure of the 35th tooth. The vestibular plate has been lysed.

4. Subsequently we remove the teeth that were planned to be extracted. It is important that after the removal walls of teeth sockets remain undamaged (no breaking or cracking). For these purposes we would recommend using support tools and equipment (periotomes, pyezo surgical tools).

5. While forming the bed for the implant in the area of tooth # 36 we apply the osteotome technique. In the photo we can see how the osteotome pushes the vestibular plate of the vestibular ridge as it plunges into the depth of the bone. Also convex osteotomes seal the walls of the formed bed for the implants.

6. We know that in most cases it is possible to collect autobone from the patient’s donor area (retromolar space of both jaws, chin). In our clinic we try to use a mix of bone, i.e. mix of autobone, xenobone and synthetic material (OSTEON II). We also widely use alloplant made of tibia (it depends on the application). The resulting mixture is put into the blood plasma obtained by centrifuging the patient's blood or we soak it with physical solution.

7. The use of parallel pins helps the surgeon to work in parallel and aligned with the neighboring teeth and implants. A pin is set in the implant in the area of tooth # 34. The socket of tooth # 35 is filled with a mix of bone materials. In the area of tooth # 36 there is a cover screw fixed on the implant.

8. Then we proceed to the upper jaw. We extract teeth # 11, 12, 13 and 26., or rather their remnants.

9. We make a longitudinal section on the top of the alveolar ridge. As expected, the width of the ridge in the anterior area is very small for the classical implantation. In the mirror we can see that in the lateral departments the cut is closer to the palate relative to the top of the ridge, i.e. on the fixed mucosa.

10. The implant is installed in the area of the 24th tooth. We split the ridge in the anterior area and see how the vestibular plate is separated from the total amount of bone…

11. But… the vestibular wall breaks off (despite the fact that we wanted to separate the vestibular wall by the principle of green branches). What should we do then? – The broken-off section can not be left mobile as it will get lysed, so we fix it to the alveolar ridge with titanium screws. Thus we change the protocol from splitting to bone grafting with a block. In this area we install implants in the area of teeth # 22 and 21.

12. In the area of tooth # 22 there is a hollow in the ridge. In order not to create deficit of bone and seal the walls of the receiving bed (we remove part of the tissues of the emerging bed when the drill passes through the bone), we use the osteotome technique of forming beds for implants. We use convex osteotomes. We see the bed after using the tool.

13. Taking into account that adjacent implants and more precisely parallel pins are installed in parallel, we install an implant in the formed bed in the area of tooth # 23. After obtaining the desired torque and depth relative to the palatal wall, we see that on the vestibular surface a portion of the implant remains outside. We have a certain amount of autobone obtained earlier, so we move it to the bare surface of the implant and condense it with the concave osteotome (concave osteotomes do not slide off the bone).

14. All implants are plugged with cover screws. Cover screws in these implant systems have both a hexagon box and a slotted cut. The whole area of our intervention is covered with a mixture of autobone, alloplant and synthetic bone. We see that a resorbable membrane (Collagen (Dentium)) is fixed in advance from the vestibular surface and is ready to overlap the ridge.

15. Before we close the ridge with a resorbable membrane we put membranes made of fibrin clots on the surface of the bone. The clots are made by the method of compression between two sterile gauzes.

16. We "shroud" the alveolar ridge in the second quadrant with a resorbable membrane Collagen (Dentium), which as we know consists of up of 7 layers.

17. Through the shaped bed some part of mixed bone material is introduced under Schneider membrane with the help of special tools or osteotomes. Bed for implants in the areas of 16 and 17th of teeth are formed.

18. Let’s procede to the first quadrant. The cut is made on the top of the alveolar ridge, 0.5-1 mm palatal (at fixed mucosa). In the area of the 16th we form a bed for the implant which will be installed simultaneously with carrying out a closed sinus lift. The bed is formed with a convex osteotome, the floor of the maxillary sinus is broken with a concave osteotome.

19. Parallel pins and then cover screws are installed in implants in the areas of 16th and 17th teeth.

20. We chose the maxillary tuberosity in the first quadrant to collect autobone. We need bone for the block in the area of the 13th tooth. Bone is extracted with a trephine.

21. In the photos we see a piece of autobone on a sterile drape and the donor area after the procedure.

22. We try to install an implant in the area of the 13th tooth. During the formation of the implant bed with an osteotome we see that the vestibular plate is cracked. Implant with a parallel pin is installed in the formed bed. A third of the implant surface remains outside the bone and this is not right ...

23. Therefore we decided to remove the installed implant. In the area of the 12th tooth we form a bed for the implant using an osteotome and install an implant.

24. After the implant is extracted in the area of the 13th tooth a piece of autobone is transferred in its place (from the mound of the 18th tooth) and fixed with titanium screws.

25. The area of intervention (13th tooth) and cracks which were formed by splitting are covered with a bone mix (autobone, alloplant and synthetic bone), and then with fibrin clots and a resorbable membrane (Collagen (Dentium)).

26. These are fibrin clots pressed and laid on the alveolar ridge.

27. In the picture we see the wound sutured with Prolene 4.0. Of course, after this amount of intervention the patient is bound to soft tissue grafting prior to the stage of prosthetics. In our clinic this manipulation is often performed simultaneously with installation of healing abutments.

28. Final orthopantomogram.