Dental implantation without bone grafting.

Is implantation possible without bone grafting?

Today, there are the latest foreign developments in this area - implantation according to the Frankfurt protocol in the complete absence of teeth, as well as special implants that can be used without first replenishing the volume of the jaw bone in 90% of cases. When a patient has narrow bone, a splitting technique can be used to allow the implant procedure to be performed without bone grafting. Thanks to this technique, the patient receives a finished prosthesis within 3-4 months. While with classical implantation technology with preliminary surgery to increase bone volume, tooth restoration is often delayed for 10–12 months. Thus, the splitting technique avoids invasive procedures such as transplantation of bone blocks taken from other parts of the jaw. In addition, there will be no need for subsequent correction of soft tissues, which is necessary after bone grafting, as a result of which the gum is greatly stretched, which often leads to exposure of the transplanted bone block or implant.

In what cases is bone augmentation necessary?

Refusal of bone grafting in some situations does not guarantee the success of implantation

Osteoplasty cannot be avoided if:

• extreme bone deficiency in height and/or width;
• advanced stages of periodontitis with loss of bone tissue.

Implantation in such cases can lead to serious complications:

• perforation of the maxillary sinus in the upper jaw with the development of an inflammatory process and odontogenic sinusitis
• damage to the jaw nerve of the lower jaw with numbness of the lip and lower face
• displacement and, as a result, rejection of the implant with inflammation of surrounding tissues

Installation of an implant using the splitting technique

Using a special instrument whose action is based on microvibration (somewhat reminiscent of the effect of ultrasound on tartar), the doctor carefully and non-traumatically makes a small incision in the bone. A special screw implant is installed in it, designed in such a way that it itself splits the bone ridge and increases the total volume of the bone. Unlike surgery using bone blocks, in this situation, specialists perform only one procedure. When plastic surgery with bone blocks is required, at least three operations are required: taking a bone block and transplanting it onto a narrow bone ridge, after 6-8 months - installation of implants, and also after another 3-4 months - gum plastic surgery, which, in turn, will continue to heal 2 months. Splitting the bone during implantation often makes it possible to avoid these lengthy procedures.

Price

Our Center operates a case payment system for treatment. This pricing policy eliminates unexpected costs for patients that they often encounter in other clinics. The turnkey price includes a set of procedures and materials for a specific service.

The implant installation case includes:

• anesthesia;
• implant Nobel Biocare (Switzerland), installation;
• consumables and superstructures;
• anesthesia;
• CT scan of the jaw before and after implantation.

Case on sinus lift and NBR:

• anesthesia;
• consumables (except bone);
• operation;
• applying and removing sutures;
• a set of medications to take home;
• examinations and control CT image.

You can view the prices for services in our Center here.

Features of implants

When implanting using the splitting method, screw implants of a special design are used. They have a cone-shaped body, thanks to which they easily enter the bone, pushing its edges apart, like a wedge. However, the wedge is easy to knock out, so the conical shape of the implant is combined with a cylindrical thread profile, which allows it to be firmly fixed in the bone tissue. This unique feature of such implants gives doctors the opportunity to install them in narrow bones without undergoing bone grafting. They smoothly screw into the gap between the bone walls through a hole measuring only 2 millimeters and do not damage them. In addition, the sharp thread of the screw implants and the wide spaces between the turns of the spiral, through which bone tissue quickly grows, contribute to faster stabilization. Thus, after three, maximum four months, permanent crowns can be installed.

Stages of implant installation for bone deficiency

Implantation in case of bone deficiency is necessarily preceded by bone grafting. It can be carried out as a separate stage or simultaneously with the installation of titanium roots. It is strictly forbidden to install a crown or prosthesis immediately after the procedure. It is important to ensure reliable fusion of the graft and artificial root with the jaw bone to avoid displacement. Implantation includes the following stages:

• Preparatory

  The most important stage to which we pay maximum attention. We examine the patient’s oral cavity, identify diseases of the teeth and gums, and prescribe treatment. We examine the maxillofacial apparatus, determine the size of the bone, on the basis of which a decision is made on the need for osteoplasty. Also at the preparation stage, a diagnosis of the patient’s health condition is carried out to identify possible contraindications. At the same time, surgery planning, computer modeling, selection of models and placement of implants in the jaw are carried out.

• Bone tissue augmentation

  If atrophy of the jaw bone is detected at the preparatory stage, osteoplasty is performed. Rehabilitation after the procedure takes 4-5 months. During this time, the transplant completely takes root. If the bone size allows, bone augmentation is carried out simultaneously with implantation, which significantly reduces treatment time.

• Implantation

  Performed using a patchwork method. The implantologist dissects and peels off the gum mucosa, uses special tools to form a hole into which he screws the implant and performs manipulations to increase the size of the bone (if one-step plastic surgery is indicated). Then he closes the rod with a plug screw and applies sutures. Osseointegration of the artificial root with the jaw tissue takes 4-5 months. During this time, a temporary removable denture is made to hide the aesthetic defect.

• Prosthetics

  After the structure has healed, the gum is dissected again, the plug is removed, and a gum former is placed to create a beautiful gum contour. After 2 weeks, the former is replaced by an abutment, and impressions are taken. The final stage is fixation of the crown or fixed prosthesis.

How many lost teeth can be restored this way?

The technique makes it possible to restore any number of lost teeth. Even when implanting one tooth, technology allows an incision to be made in such a way as to insert the implant into the bone without damaging the adjacent teeth. But most often, a narrow bone occurs in the absence of a large number of teeth, so specialists usually install two to four implants on each side.

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Snitkovsky Arkady Alexandrovich

Therapist, Orthopedist

Is implantation always possible without bone tissue augmentation?

Typically, the jawbone is oval in shape. Then, during the process of atrophy, only its upper part on the buccal (front) side loses volume, while its base remains wide and supports the rest of the bone. In this case, we can safely carry out “splitting” and not be afraid that the bone will break. However, if the ridge lacks thickness along its entire length, or is less than two millimeters, bone grafting is necessary. True, such situations are quite rare, and in these cases doctors are forced to follow the classic path - performing plastic surgery using bone blocks.

Do mini-implants and all-on-4 implants help avoid bone grafting?

Mini-implants can only be used as temporary structures or to fix a removable denture. If the prosthesis rests on such implants, they will be rejected. Therefore, when implanting all on four, standard size implants are used.

The All-on-4 or All-on-6 techniques allow you to place a permanent prosthesis on implants, most often with screw fixation. Only a very experienced doctor should install an orthopedic structure, since even a slight error in calculations can lead to improper distribution of the chewing load and cause implant rejection. With all-on-four implantation, implant placement can also be done using the splitting method. This is a simple and effective procedure that is absolutely safe for the patient and avoids bone tissue buildup.

Why you shouldn't be afraid of the procedure

Some patients refuse to have implants installed if, based on the results of a preliminary examination, they are told that they cannot do without bone augmentation. The main reasons are myths that are based on fears, lack of information, and studying incomprehensible publications on the Internet.

Myth 1. It's painful and scary

The anesthesia may not work, it will be painful, and there will be swelling after the operation.

• Causes of Pain during and after surgery are directly related to osteoplasty technologies. Traditional surgery using a hammer, chisel and other “punitive” instruments does require increased anesthesia during the operation and often causes pain and swelling afterward.
• Reality Our Center uses our own low-traumatic ultrasound protocol . Piezosurgery significantly reduces the trauma of the operation, the device delicately affects bone tissue, and turns off when approaching blood vessels, nerves, and the lining of the maxillary sinus. The operation in a state of medicated sleep using a combo protocol of sedatives and anesthetics eliminates pain and nervous tension. A rehabilitation complex, including microcurrent and PRP therapy, injections of lymphatic drainage drugs, completely relieves post-operative discomfort, including cosmetic discomfort.

Myth 2. It takes a long time

The implantation time will increase because you need to wait for the bone material to engraft.

• Causes Critical bone loss does require a two-step procedure. The operations are divided by time - first bone grafting and several months for the bone to mature enough to support the implant, only then implantation.
• Reality It is impossible to neglect this moment. But bone tissue augmentation and implantation can be carried out in one stage , if the volume of preserved bone allows it. New bone tissue will form simultaneously with the healing of the implant.

Myth 3. It's traumatic

It is necessary to take the bone for transplantation from another area of ​​the jaw in order to transplant it to the implantation site.

• Reasons Indeed, there is a protocol when one’s own bone tissue is used as a material for grafting. It is necessary to further traumatize the patient and perform another operation to remove material from the area behind the wisdom teeth or chin.
• Reality This method is not used in modern dentistry and in our Center. We use biocompatible bone grafts and growth stimulants , which trigger processes that cause bone cells to grow and thicken. The new volume fuses with its own bone, forming a single mass.

Myth 4. It's unethical

Bone tissue from other people is used for transplantation.

• Reasons Yes, previously materials of allogeneic origin were used, which were sterilized and processed many times during the production process.
• Reality We do not use bone materials from other people , since it is impossible to track the degree of purification, the absence of proteins or genes of another person that act as allergens.

What if not only the thickness, but also the height of the bone is not enough?

In this case there are also several options. If the bone height is not enough in the lateral parts of the upper jaw, a sinus lift should be performed. If the bone height is at least 4 millimeters, we can increase the volume of bone tissue while simultaneously installing a high-quality implant. If it is less than 4 millimeters, then after sinus lift you will have to wait 5–7 months before implantation. But if the bone is wide and its height is 5-6 millimeters, then you can do without a sinus lift - here they use short implants with strongly protruding threads. Due to their large surface area, these short but wide implants can withstand the same load as conventional ones.

How to determine the possibility of implantation without osteoplasty

The decision is made exclusively by the dental surgeon after computer diagnostics

In our Center, it is carried out on a detailed 3D tomograph SIEMENS SIRONA GALILEOS of high accuracy with a minimum level of radiation . Allows you to obtain ideal and reliable diagnostic results with a minimum of x-ray load. When making a decision, the following are taken into account:

• dimensions of your own bone in height and width;
• bone density and structure;
• location of the maxillary sinuses and mandibular nerve.

If the parameters allow us to use one of the possible methods without bone augmentation, we will be happy to take this chance.

A lifetime guarantee is provided for dental implantation in our Center.

This means that we do not have the right to risk your health and must perform the operation in such a way that you will forever forget about the problem with which you came to us.

Levin Dmitry Valerievich Chief physician and founder of the Doctor Levin center

We will never prescribe additional surgery for you if it is not necessary, but if implantation is dangerous and involves risks, let us make a decision based on your individual parameters.

What determines the healing time of implants?

It is known that classic root-shaped implants take root on the lower jaw within 3 months, and on the upper jaw within 5-6 months. The timing depends on the primary stabilization, that is, on how tightly the implant was fixed in the bone during its installation, and on the density of the bone. In hard bone, the implant receives good initial stabilization and can be loaded with a temporary crown after only 3 months. If the bone is soft, it is necessary to postpone prosthetics for a longer period, otherwise the implant may be rejected.

With the advent of an implant system with large threads, it became possible to speed up the healing time in soft bone, since it increases the area of ​​contact between the implant surface and bone tissue, and therefore contributes to more durable stabilization. In both soft and hard bone, the healing time of such an implant is about 3 months.

Cost of the procedure

The price of the procedure consists of the cost of the implant, the doctor’s work, as well as the cost of temporary and permanent prosthetics. Due to the fact that specialists do not perform bone grafting, the price of implantation, of course, decreases, but not much. This technique was created not to save on implant installation, but to avoid additional surgery in cases where this is possible.

For example, if the bone volume is sufficient and its condition is ideal, you can install any modern implant - it will take root and function for a long time. But if it is necessary to carry out a sinus lift simultaneously with implantation, it will be necessary to use implants that are fixed even in 1-2 millimeters of bone. But if the bone is narrow, the best option would be to use the splitting technique followed by installation of an implant with a wide thread. Everything is fair here - the doctor does not focus on your wallet, but advises and selects the most optimal treatment plan in accordance with the specific clinical situation.

Publisher: Expert magazine about dentistry Startsmile.ru

Clinical cases when osteoplasty is indispensable:

1. There are 2 or more units of teeth missing nearby and very severe atrophy of bone tissue is observed in height or width, or in two dimensions at the same time.
2. Severely aggravated periodontitis.
3. If there is a deficiency of bone tissue in the area of ​​the maxillary sinuses, preference should be given to sinus lifting.
4. If a tooth is damaged as a result of trauma, without restoring bone tissue it is impossible to obtain high-quality aesthetics of the gingival contour.

All cases must be carefully analyzed by specialists in order to eliminate all risks as much as possible.

Despite the seemingly obvious advantages of implantation without bone augmentation, in each individual case a preliminary thorough diagnosis, 3D planning and modeling of the future result of prosthetics with a load on the implanted implants are carried out.

In clinics with high quality treatment, the primary task of doctors is to carry out treatment in such a way that the patient does not return to “rework”, but fully enjoys full teeth for as long as possible. When you have decided on the choice of clinic and specialists for implantation and prosthetics, the only option for successful treatment will be complete trust in the specialists.

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In our center, with a thorough assessment of physiological capabilities, more than one treatment plan will be proposed. Depending on your preferences and capabilities, you almost always have a choice. The specialists of the Es-Dent dental center daily perform operations to install implants and perform bone grafting in different volumes and levels of complexity.

Taking into account the clinical picture of each patient, focusing on high-quality long-term results, we always offer the optimal treatment option. If bone grafting can be avoided before installing implants, then all factors will be taken into account and the implantation will be guaranteed to be successful.