Dental implants are the modern solution to the problem of lost teeth and an alternative to dentures. They are already a routine and are offered by majority of dentists worldwide. New implant systems are much easier to apply and their application is not accompanied by risks. The implantation is associated with certain requirements, the most important of which is a sufficient amount of bone.
Even for relatively small sized dental implants should have enough space in the bone to be placed so as to serve as carriers of bridges or crowns. The possible positions are limited by a number of factors and especially the availability of adequate bone that surrounds and supports the tooth implant itself and remoteness from situated adjacent structures such as the maxillary sinuses in the upper jaw and the lower jaw channel in which pass nerves and blood vessels.
Only after we have secured enough bone to place the implant can plan where and how many of them to be. So the first step in deciding whether a case can be treated with implants is precisely the available and sufficient bone.
Most importantly – is there enough bone?
Therefore, the first step towards implantation is to make sure that we have enough volume and bone quality. This requires imaging ( X-ray ) tests of the facial bones ( upper and lower jaw ) – orthopantomography ( OPG ) and computed tomography 3D ( CBCT – Cone Beam Computed Tomography ) which can clearly show the location of existing teeth, the shape and anatomy of the sinuses, the thickness and volume of the bone in different areas and computerized image can be examined from different angles, directions and cuts. This helps a lot in choosing the best place for not risky implants.
There are modern computer systems for planning the positions of implants that are positioned very accurately in three dimensions observing all risk areas, ensuring sufficient distance from neighboring natural teeth, sinuses into the nasal cavity and vascular nerve bundle running in the channel bottom jaw.
Unfortunately not every location in the mouth where there is missing a tooth that has been removed is a place to put the implant. Implants are not used as substitutes for teeth 1:1 and is looked for suitable locations for their placement. This allows a smaller number of implants to replace a large number of missing teeth.
For this purpose using high-tech 3D X-ray imaging which shows in real size all bony structures of the face and head and allows to determine the “right” best place to implantation. It is wrong to think that every place where there are removed ( missing ) tooth is suitable for implant placement. The implant must be placed at certain distances from the existing natural teeth but also far enough from the bottom of the sinus or the channel of the lower jaw, while there is sufficient bone which it surrounds and supports. Experience shows that such “ideal” cases are rare and the objective reality in most patients face dentist-implantologist with the need to seek solutions under adverse conditions.
Bone quality is also a key. The structure of the bone is porous, spongy bone made of rods surrounding bone cells. Too porous bone and low bone density and hardness are unfavorable for placement of dental implants and can not guarantee their stability for a long time. The quality of the bone is determined according to a scale for practical purposes be divided into four basic types.
With advances in dental implants are designed as additional procedures that provide the necessary space and specific systems implants – short dental implants and micro implants not need a lot of space and place even in a serious lack of bone. While the lack of bone can be provided by various additional grafts and techniques the bad and soft bone can not be “corrected” to serve as a good receiver implant. With the use of additional surgical techniques can be provided sufficient bone and subsequent implantation. Proximity to the sinus is adjusted with “sinus lift” procedure the lack of bone volume is obtained by “bone grafting” ( bone grafting ) or ridge split procedure. The follow-up to the implant placement will be described in the sequel of the material.