Cyryl Mickiewicz

DENTAL IMPLANTATION

Today, dental implantation is the most effective method of restoring dental defects worldwide. This is the most advanced technology with many advantages: a crown made on a dental implant is aesthetic and functional, it does not differ in appearance from a real tooth. For example, STRAUMANN dental implants come with a lifetime warranty (technical cost of implant and crown).

Benefits of Dental Implants

Natural-looking appearance of dental crowns on implants.

Alternative methods of replacing lost teeth involve the fabrication of bridge or removable dentures. Almost always, after wearing bridges or removable dentures, serious restoration of bone and gum tissue volume is required, which is comparable in cost or higher than simple implantation immediately after tooth extraction.

Bridge prostheses in most cases require grinding down of the supporting teeth (there are always at least two supporting teeth, as bridges with one support are prohibited) to a thickness of 1.5-2 mm around the entire perimeter of the crown part, which requires their preliminary pulp removal. Currently, there is no guarantee for quality pulp removal, it is a very complex and often unpredictable process that can lead to inflammatory processes after 5-6 years and, consequently, loss of the supporting tooth. As a result, the supporting tooth will have to be removed, planning a new bridge with an even larger number of "suspended" teeth and new "victim" supports. From a biomechanical perspective, it is desirable that each tooth is responsible only for itself. A tooth in the bone socket is fixed by special fiber-shock absorbers that distribute the load evenly. When the tooth is overloaded (in this case, adding suspended crowns), irreversible processes of soft tissue (gum) and bone loss around the supporting tooth can occur, leading to unaesthetic appearance and loosening, falling out of the supporting tooth, and inflammation development around it. Often, when prosthetics are needed in an area where a "suspended" crown was located, we face a lack of bone and gum tissue, just as when planning to replace a tooth where inflammation and gradual bone loss have developed for a long time.

Of all types of removable dentures that rely on natural teeth, we only make telescopic dentures. Only they can properly distribute the load on the supporting teeth for many years without destroying themselves and the surrounding bone and gum tissue. This type of prosthesis requires mandatory pulp removal of all supporting teeth. In our clinic, it is forbidden to manufacture bridges in combination with various supporting elements for removable dentures.

When a tooth is extracted, there is almost always irreversible loss of bone and gum tissue. Although it is possible to manage to place an implant even with minimal bone and gum volume, the long-term result of such intervention will be disappointing: lack of aesthetics, inflammation, peri-implantitis, implant loss, repeated implantation in more difficult conditions.

Tooth implantation involves screwing a titanium implant into a pre-prepared bed in sufficient bone volume, forming the gingival part, manufacturing and screwing a tooth crown to the implant.

Methods of Dental Implantation

When conditions allow, implantation can be performed immediately after tooth extraction (one-stage) or after healing of the extracted tooth socket (two-stage). The optimal time for implantation after tooth extraction is 8 weeks. Bone and gum augmentation can be performed with both methods.

Dental Implantation Process

Before dental implantation, it is recommended to make a surgical guide, through which the implant bed can be prepared with perfect accuracy exactly where needed, according to computed tomography data.

Planning and manufacturing of surgical guide.

Scheme of bone preparation with drills of different diameters.

Working with the guide

Implantation plan using guide

Implant Crowns - The Final Stage of Rehabilitation

Considering that patients come to the clinic not just to replace the root of a lost tooth (dental implantation), but to get a fully functional tooth, an important part of comprehensive rehabilitation is the fabrication of an implant crown.

For an implant crown to serve as long as possible, many factors need to be considered:

1. Sufficient bone tissue around the implant.
2. Correctly selected and properly placed implant.
3. Volume of soft tissues surrounding the implant and crown.
4. Material used for the gingival part (zirconium dioxide) and chewing surface ("soft" zirconium dioxide, lithium disilicate) of the implant crown.
5. Method of crown fixation on the implant (screw-retained or cement-retained).
6. Possibility of hygienic cleaning of the gum-crown complex, so-called "implant service".

Thus, it is obvious that the question of making an implant crown needs to be discussed BEFORE planning dental implantation.

What are Veneers?

Veneers are thin ceramic overlays that are placed on the front surface of teeth to correct their shape, color, and position.

I have accumulated unique experience in making all-ceramic veneers. Given that I started working with this method of correcting tooth shape and color back in 1999 in France, today I can provide you with 25 years of observation results. All clinical cases without exception are documented through photo registration. Today, for highly aesthetic all-ceramic veneers, we use feldspathic ceramics and lithium disilicate. The success and result of all-ceramic veneer prosthetics depend on preliminary digital planning. Working in a team with a master dental technician and extra-class assistants allows us to achieve the desired long-term result. We are deeply convinced that there are no simple clinical cases. Regardless of the restoration volume, each patient's wishes are unique and individual, which requires dedication from me and the dental technician at all stages of work.

In cases where minor correction of tooth shape and color is required, thin veneers can be made that do not require grinding down tooth tissue. Highly aesthetic Noritake feldspathic ceramics (Japan) and lithium disilicate (e.max, Ivoclar Vivadent, Liechtenstein) are used as materials for such ultra-thin veneers. Such veneers are also called Lumineers. A transparent adhesive bonding system is used to bond thin veneers. The lifespan of thin veneers is unlimited and depends on the condition of the dental system as a whole.