Implant Treatment and Maxillofacial Surgery

Implant Treatment
Before talking about implant treatment, we should mention to missing teeth and missing teeth treatment options.

 

What Is Missing Teeth and How It Occurs?

Missing teeth can occur as a result of decay, periodontal diseases and trauma. In some cases, some people can have a missing tooth or teeth congenitally.

The number of missing teeth is quite determinant in shaping the course of treatment. There can be a single tooth missing while also partial or total teeth missing can be seen on jaws. This situation is important in choosing a suitable method for treatment.

What Are Treatment Options for the Treatment of Missing Teeth?

There is not a single treatment option for all cases and for all patients in case of missing teeth. The first rule of success is to choose the right treatment method in accordance with the number and area of missing teeth.

In the treatment of missing teeth, implant-supported dental prosthesis and removable denture are densely used as conventional methods. In the application of implant-supported dental prosthesis, enamels of adjacent teeth are abraded and an implant-supported prosthesis is produced which covers adjacent and missing teeth. These prostheses are stabilized on adjacent teeth through cementing and cannot be removed by patient. Removable dentures are applied in cases of total missing teeth or multiple missing teeth when there are no adjacent teeth or when adjacent teeth are not resistant enough to carry prosthesis. As its name suggests, removable dentures can be applied and extracted by patient. Also, there are some cases in which implant-supported prostheses and removable dentures are used together.

Dental implants are developed in addition to conventional methods with the advancement of technology. Dental implants can eliminate the need for fixed and removable prostheses while they can also be used in combination with fixed and removable prostheses.

What Is Dental Implant?

The term implant originates from the Latin words “in” and “planto” which mean “in, within” and “to plant”, respectively. It is a name given to “an organic or an inorganic object which is planted on a suitable surface in order to obtain a function” and is transferred to other languages from French. In medicine, implantation means to place a material within body.

Implant prostheses used for supplying missing teeth or lost parts in oral area are prostheses which are applied within or on jawbones, which take support from a substructure called implant and which provide engagement.

Dental implants which are used today are screws made of titanium, placed within jawbones and function as tooth roots. These screws cling to jawbones and teeth are placed on them. In other words, implants cannot be seen in mouth since they are buried within bones. However, artificial teeth fastened on implants which function as tooth root can be seen.

What Is the First Stage of Dental Implant?

 

The first and the most important stage of implant is systemic and intraoral examination and examination of panoramic x-ray and, if needed, volumetric tomography. Thanks to this initial examination, doctors can observe whether patient has any systemic illness or whether he is allergic to something, and thanks to intraoral examination, the number and area of missing teeth and prosthesis options to be applied can be determined. In case treatment method contains dental implants, implant suitability of implant area is determined through various examinations on jaw x-rays since implants are to be placed within jawbones.

Can Implant Be Applied to Everybody?

 

Patients with nephropathy, uncontrollable diabetes, radiotherapy history, acute hormonal disorders, blood disorders, heart valve prosthesis, chronic alcoholism, drug dependency, cross reactions towards foreign bodies are under risk for dental implant. If a patient has a systemic illness, implant is applied after determining suitability through consultation with other doctors from relevant medical fields.

If there is no systemic case which may hinder implant application the width, height and quality of bone on implant area and gingival health are assessed. An implant has a particular caliber and size and this implant with particular caliber and size should be placed within bone and even the bone should have a certain thickness. In case the width, height and quality of bone in implant area are suitable, implant application can be proceeded.

How Long Should I Wait for Implant after Tooth Extraction?

 

In case the thickness and the quality of bone and gingival health are sufficient, implant can be applied in the same séance subsequent to tooth extraction. However, in other cases, it is appropriate to apply implant after waiting 4 months for bone recovery subsequent to tooth extraction.

How Many Implants Should I Have?

 

After implant is determined to be a suitable treatment option for patient, the next subject is the determination of how many implants should be applied. The number of implants is determined according to the number of missing teeth and missing teeth area. In edentulous cases, the need for the implants is determined considering the prosthesis to be applied on implants. This number can change from 2 to 14-16.

The next subject after the determination whether patient is suitable for implant is to determine how many implants should be applied.

What are Implant Options?

 

The size, caliber and surface features of implant are important in implant choice. However, this choice is made by doctor, not by patient. Apart from these, there are so many brands among which choices can be made. The significant point is to trust doctor and to make a choice from appropriate brands which are suggested by doctor and are in accordance with World Health Organization standards.

How Implant Operation Is Conducted?

 

Firstly, a sterile environment is provided for the operation. Doctor, nurses and patient get prepared in accordance with operational conditions and then the operation commences. Implant operation is generally conducted under local anesthesia, that is to say, through anaesthetizing only the application area while patient is conscious. A small cut is opened in gingiva on implant area and thus gingiva is raised. Implant alveolus is opened within bone and implant is placed in this alveolar area. After the placement, gingiva is sutured. Operation time changes between 10-30 minutes and patient does not feel any pain.

What Procedures to Follow after Operation?

 

Gingiva over implant is removed with laser or with a small cut after 2-6 months approximately according to applied surgery method, implant area and bone characteristics; the piece to remain in mouth and prostheses are applied. Prosthesis production stage takes 5-15 days. The purpose of waiting phase is to ensure implant’s bonding with jawbone, that is to say, to provide a recovery process. In some cases, especially in missing incisor teeth cases, prosthesis can be applied without any bonding phase subsequent to implant application if bone characteristics and compatibility of teeth are as required.

Will I Be Toothless until Prosthesis?

 

Until prosthesis application, temporary prostheses are applied after operation in order that patients can fulfil both aesthetical and functional needs.

What Are Prostheses Options to Be Applied on Implant?

 

In case of single missing tooth, only one implant is applied and a crown (artificial porcelain tooth) prosthesis is mounted on this implant. In cases of more than one missing tooth, bridge prostheses are applied on implants. In edentulous cases, either 2-4 implants are applied on both jaws and removable prostheses are placed on these implants, or 6-8 implants are applied on both jaws and fixed prostheses are placed on them.

What Should Be Done If Bone Width and Height Are Not Sufficient?

 

Bone width starts to diminish after tooth extraction and the recovery of bone in the extraction area. For this reason, implant should not be applied too late after extraction. In case bone width is not sufficient on implant area, there are some methods to be able to apply implant on this area:

  1. Fine implants can be used. (May not be appropriate for all cases.)
  2. Bone graft and membrane application: this process is applied in case bone width is on the limit, bone thickness which surrounds implant is not sufficient, there are openings on bones after implant placement.
  3. Implant can be applied through expanding bone with expanders.
  4. Split osteotomy can be applied. Bone is cut vertically and implant is placed in this cut area through expanding bone gradually.

Insufficiency of bone height is generally seen in maxilla. Air holes which take place on molar teeth areas both in the right and the left sides of head and which have functions such as decreasing the weight of head are maxillary sinuses. When teeth below sinuses are extracted, the sinus base moves toward the extracted area in time and decrease the bone volume in this area. This low volume becomes insufficient for implants to be entirely impacted within bone and treatment results unsuccessfully. Treatment options for this case are:

  1. Short implants.
  2. Sinus Lifting: A new hole is opened on bone, slouched sinus membrane is lifted and bone graft is placed between. Implant can be applied after this process.
  3. Internal Sinus Lifting: In cases when the amount of slouched sinus is not much, no new opening on bone is required. Implant alveolus is opened, sinus membrane is lifted through this hole and implant is applied.

These processes are advanced surgical operations. However, they can be applied with local anesthesia without causing pain. Implant operation take 10-20 minutes approximately.

What to Be Careful about after Implant Application?

 

Subsequent to implant application, a patient can have artificial teeth within mouth and titanium screws within bones. These artificial teeth and implants should also be kept clean as healthy teeth. In this respect, oral hygiene is significant. Implants do not get damaged easily since they are made of titanium; however, the durability of implant actually depends on the health of surrounding gingiva and bone. In return, the level and health of gingiva and bone are directly proportionate to oral hygiene. As long as routine doctor controls are followed regularly, implants and prostheses can be used for long years without any problem.

Is It Possible for Body to Reject Implant?

 

The rejection of implant by the body is out of the question in case there are no systemic obstacles or any problems for gingiva and bones in the implant area. Otherwise, doctors should suggest other treatment options instead of implant.

Can Implant Be Applied to All Age Categories?

 

Implant is not suggested for children patients. Implants can be applied only after growth developmental period is completed. In case there is no systemic obstacle and if suitable bone is available, implants can be applied to geriatric patients.

Is Implant Harmful? Does Implant Cause Cancer?

 

Implants are made of a material which are studied for long years and which has the best tissue compatibility. Also, implants were tested many times before they were used. For this reason, their application is completely safe and there are no records in medical literature concerning their possible harms or cause to cancer.

Do Implants Have Guarantee?

 

It is not possible to promise a guarantee for something that is applied to mouth and which is under your control. Implant has the same guarantee with your health condition after a transplantation or a cardiac surgery. However, doctors try their best to apply implants. You will be informed about implant care and will be examined, if needed. In short, doctors will work hard to render your implant a successful one, but you should also make the same effort. You should take care of your dental hygiene and come to controls following the rules. Besides, many brands guarantee implant replacement free of charge in case you lose your implant for any reason.

Is Implant An Expensive Application?

 

Unfortunately, it is a bit more expensive compared to conventional methods. It is because the price of implants are high. Regardless of the reason, implants which are not compliant with World Health Organization standards and which are not produced by a reliable brand should not be preferred. The important thing is to have treatment from a reliable and specialized doctor and to prefer implant brands suggested by the doctor.

Maxillofacial Surgery

Tooth Extraction

 

Our purpose in dentistry is to help a patient to keep his or her natural teeth in mouth. However, teeth are extracted in case they decay to such a degree that cannot be saved through filling or root canal treatment, in case they have advanced lesion and inflammation on root apexes or have advanced gingival problems. Tooth extraction is generally extraction of relevant teeth from jawbone through locally anesthetizing the tooth and its environment. In case of lesion or inflammation on root apexes, extracted area is cleaned through scraping.

Complicated Tooth Extraction

 

Complicated extraction is generally the result of an extensively damaged teeth crown or the case when only tooth root is left. Except for these, an operation which seem like a normal extraction may turn into complicated extraction as a result of twisted tooth root or fracture of crown. As a consequence of this process, gingiva is generally sutured in order to enhance recovery of wound.

Impacted Tooth Extraction

 

Impactedness, in other words, the case when dentition cannot proceed due to lack of sufficient place, is generally seen in wisdom teeth or cusped teeth. However, any tooth can be impacted in any person and extraction can be unavoidable. Impacted tooth operation shows changes according to impaction type which can result either due to gingiva or both gingiva and bone. As it can be guessed easily, impacted teeth due to bone are more difficult to extract. In both cases, suturing is required for gingiva. The difficulty and duration of operation changes according to root structure, position and volume of a tooth.

Apicoectomy

 

Lesions can take place on root apexes within bone as a result of propagation of microorganisms as far as root apexes due to advanced decay. Generally, these lesions can be treated with root canal treatment. However, in cases which cannot be cured with root canal treatment, in addition to root treatment; bone on lesion should be lifted, lesion should be taken surgically with part of root apex and root apex should be filled.

Cystectomy

 

Cysts can occur due to various reasons dependently or independently from teeth. As for treatment, bone on cysts are lifted and cyst is extracted surgically. Biopsy should be carried out on the extracted piece and additional treatments should be applied, if needed.