Replacement of a single tooth with an implant. Questions of aesthetics
One of the biggest challenges today is considered to be the replacement with an implant of one tooth in an esthetically significant zone (anterior upper jaw, which can be seen while talking, chewing and smiling.) If 20 years ago, the main purpose of the implants was osseointegration (engraftment of the implant), then now the ability to perform this task is not questioned, and the expected life of the implant is calculated in decades.
Patients expect not only long-term functioning of the prosthetic implant, but their natural appearance, especially in the aesthetically important area in implant replacement of a single tooth. Implantation in the anterior maxilla is a problem of medium or high complexity.
The International Team for Implantology, ITI, has given a clear definition of the aesthetic standards of attached structures on implants: “an implant-supported aesthetic prosthesis is one that is in harmony with the structures of the mouth and face of the patient. Implants should be surrounded by healthy gum which thickness, color and contour is not diverse from the gum in the adjacent teeth. Prosthetic design should mimic natural teeth in color, shape, nature of surface, size and optical properties.”
This is the perfect description of the work done correctly.
So, in the aesthetic zone when replacing a single tooth with an implant I begin with assessing of aesthetic risk. The factors that allow us to estimate the aesthetic potential of the proposed design of implant are:
1. Patient’s expectations (as far as your expectations are reasonable).
2. Smoking (patients smoking more than 10 cigarettes a day are at risk. I motivate decreasing of number of cigarettes smoked prior to treatment.)
3. Smile line height (number of teeth and gums that are visible when chewing, speaking and smiling.)
The higher you smile line, the more aesthetic risk is.
4. Width and height of bone and soft tissues (the larger the defect, the more difficult it is to create an aesthetic work).
5. Somatic disorder.
6. Presence of periodontitis.
7. Level of self-care and willingness to cooperate.
8. Bruxism.
Having identified the overall aesthetic risk, together with you we define the likelihood of adverse outcome. Then we proceed to planning of replacing of a single tooth with an implant.
If there are defects in the bones and / or soft tissue, they must be removed prior to implantation or simultaneously with it. During the passage of a radiological study a surgical template is made basing on a wax model that will help us during the operation to properly install the implant.
Making of a temporary structure is planned afterwards, which I will suggest you for a period of several weeks to several months. Here are the options of ideal temporary structures during the replacement of a single tooth with an implant:
1.Dental bridge.
In case when the adjacent teeth are planned to be covered with crowns, the temporary bridge will provide excellent aesthetics and function.
2.Attached prosthesis of fiber reinforced plastic.
If the occlusion allows, I shall set you a crown with wings that stick to the palatine (interior) surfaces of adjacent teeth.
3.Orthodontic fixation.
If at the same time you are receiving the orthodontic treatment (braces), a crown can be fixed to a straight arc.
4.Retainer.
The crown is fixed in a kappa made in thermo-vacuum apparatus.
5.Removable partial denture.
The removable design that relies on the palate and the adjacent teeth
Then we proceed to installation of the implant.
Replacement of a single tooth with an implant can be performed simultaneously with the removal of a tooth - direct implantation, after 5-6 weeks after tooth extraction - initially delayed, after 4-6 months - secondary delayed, as well as with immediate loading (when with the implant a crown is being fixed during the same visit) and a two-step - the crown is fixed to the implant 3 months after its installation.
The choice of method is decided by the physician.
In case of bone defects, implanting may be held together or after the reconstruction of the bone (see section "Recovery of lost bone").
Classical surgery for the implant is as follows: under local anesthesia an incision of soft tissues is made, which are relegated to expose the bone. In the jaw bone, having bed pre-prepared, the implant is installed, then closed with soft tissue and stitched up.
Within 3 months the implant is osseointegrated (fused with the bone) and all the while you are using a type of temporary prosthesis. In 12 weeks after surgery, a second surgical stage is conducted - forming the gum for 14 days.
Two weeks later we get a reprint for making temporary crowns.
Next we fix a provisional (temporary) crown and using it in a couple of visits we form the gingival contour. With the provisional crown you have to stay for about 3 months and only after that I will fix you a permanent restoration (crown) made by a dental technician.
Here is the current protocol for replacing a single tooth with an implant.
The crown on the implant may be temporary on a cement or screw fixation and, later, on a final all-ceramic or ceramic-metal screw or cement fixation. (See section "prosthesis on implants").The kind of orthopedic construction is selected by a physician, focusing on the depth of the implant platform and the axis of slope.
Recommendations.
Only the doctor who will conduct the implantation should remove the front teeth of upper jaw which are to be removed, as he will make it less traumatic assuming future implantation, and coronal part of the removed tooth can be used as a temporary crown.
You must first make a CT scan and produce a surgical template, it will guarantee that you'll be ready for possible additional surgery and the doctor will be able to conduct a geometrically correct installing of the implant.
Find out whether the implantologist knows the bone reconstruction techniques or works in tandem with such specialist, because during surgery a necessity in this may occur. Do not persuade the doctor to quickly put on a crown - an early load may lead to disintegration (loss of fixation) of the implant or an unsatisfying aesthetic result.