Types of implants and which implants are better to place

Snitkovsky Arkady Alexandrovich

Chief physician of the professorial dentistry “22 Century”, dentist, orthopedic dentist

Author of the article:

Scientific team of dentistry “22 Century”

Dentists, candidates and doctors of medical sciences, professors

Types of Dental Implants

Today, every modern dental clinic offers such a service as dental implantation. Let's look at the basic terms and concepts, as well as types of dental implants.

Basic terms

• A dental implant is a structure that is installed into the jaw bone during surgery and replaces the roots of the teeth, and also serves as a support for prosthetics;
• An abutment is a supragingival structure that imitates a tooth stump. It can be integral with the implant (non-separable design) or as a separate structure (demountable design);
• The healing abutment is a supragingival intermediate structure. Essential for creating a beautiful natural gum margin. (in the case where the abutment and implant are a single whole, not used);
• Osseointegration is a direct structural and functional connection between living bone tissue and the surface of the implant implanted into it.

Prosthetics prospects

Completion of osseointegration is not the end of the process. Now you need to put the prosthesis on the artificial root. It can be single (crown), bridge or full jaw. Comfort when chewing, diction, and aesthetics depend on the capabilities of prosthetics. The wider they are, the better for the patient, especially in complex clinical cases. Therefore, dentists say that when choosing an implant, you need to focus not only on the manufacturer, but also on the condition of the patient’s jaw. The question is not whether Korean or German, Swiss or Israeli implants are, but which of them are better suited for a particular case.

Implantation can be:

• Direct (performed immediately after tooth extraction);
• Delayed (3 months or more pass after tooth extraction).

Prosthetics can be performed simultaneously with the installation of an implant or also after a certain time (two-stage technique).

The choice of one or another implant or method of operation depends on the patient’s general condition , oral hygiene, the volume and quality of the jaw bone tissue, and the patient’s financial capabilities.

Price

The cost of compression dental implantation consists of the cost of diagnosis, the preliminary stage, including treatment of caries, removal of tartar, removal (if indicated), implantation technique, prosthetics and the selected type of implant and prosthesis.

The implantation procedure itself is expensive, but if you know that it is for life, while metabolic processes in the bone tissue continue, it does not atrophy, the correct chewing load is maintained, the face is transformed, and the quality of life is justified, then the price is justified.

And since compression implants are used for bridges, and not for single crowns, the price depends on the number of implanted roots. For example, for one jaw with complete edentia, one-stage implantation with a combination of 6 - 12 implants and an adaptive prosthesis on a metal frame, the cost at the RUTT clinic will be 265,000 rubles, for a titanium one - 295,000 rubles. If this is a segment of three teeth, then you need to calculate from 135,000 rubles, from 5 - from 200,000 rubles. on average for Moscow.

Dental implant materials

Dental implants
Depending on what material the implant is made of, there are:

Metal

Most dental implants are made of titanium and its alloys. The peculiarity of this material is such that the body does not recognize it as something foreign. In this regard, excellent biocompatibility is noted. It is also characterized by high strength and lack of toxic effects.

Ceramic

Ceramics occupies a special place in dentistry in terms of aesthetics. Its color and light transmission allow it to imitate natural teeth as closely as possible. But when it comes to implantation, aesthetics are not so important. Biocompatibility comes first. The interaction between ceramics and bone tissue has not been fully studied. Thus, we cannot say affirmatively and positively about osseointegration. Therefore, the choice of this type of material remains a big question .

What material are dental implants made of?

Today, from the existing variety of brands of implantation systems, patients have the opportunity to choose the most suitable treatment option for themselves, both with a small budget and choose dental products from the premium class category. But it is worth noting that all manufactured dental implants, expensive and budget, must have certain quality characteristics necessary to ensure the safety of the body’s health. First of all, these characteristics include the material from which modern dental implants are made.

Alloys

Almost all budget dental implant systems use a titanium alloy with the addition of aluminum and vanadium. This biomaterial has high strength characteristics, however, the content of the above-mentioned metals in it can have some negative impact on the implant healing process. Currently, medical titanium alloys have appeared, the chemical composition of which has better biological compatibility with living tissues of the body. These are alloys of the second and third generation: titanium alloy with niobium; an alloy of titanium with zirconium, molybdenum and tantalum.

Titanium implants

Pure titanium is considered the best material for dental implantation; it is bioinert to the tissues of a living organism and is not rejected by them, has high strength and hypoallergenic properties, and is very resistant to aggressive environmental influences.

Dental implants made of pure titanium integrate faster due to absolute biocompatibility and are not perceived by the body as a foreign body.

Titanium dental implants are non-toxic, have a low specific gravity, which eliminates the feeling of weight in the implantation area, and do not cause taste changes after installation.

They are more expensive, but have a wide range of advantages.

Titanium dental implants are the most favorable option for replacing teeth, especially in the chewing group, since it is the painters who take on the greater load when chewing food. Pure titanium, in terms of strength, meets these requirements to a greater extent.

Pure titanium, unlike other dental materials, is very plastic and resistant to rough mechanical influences.

The titanium surface of a dental implant is subjected to special treatment to obtain a complex porous relief similar to the bone structure using various methods of chemical and physical modifications, as well as various methods of deposition of nanoparticles.

But how to take care of the aesthetics of the front teeth if a titanium dental implant is installed?

In case of subsequent installation of a factory or custom titanium abutment, the patient receives a strong hygienic connection, but there will be no aesthetics, because the metal is slightly translucent and gives a visible gray stripe at the gum level.

Some systems in their line have standard white zirconium abutments; you can also make an individual zirconium abutment using CAD/CAM technology or a combined zirconium abutment on a titanium platform, which are perfect for the smile area.

By choosing titanium dental implants, you significantly reduce possible risks; they will last for decades; our prices for titanium dental implants are reasonable in Moscow and meet the capabilities of most patients.

Zirconium and ceramic implants

Dental implants made of zirconium and ceramics are safe for the body, they are highly biocompatible and do not cause allergic reactions, they take root well, but dental implants made of metal-free ceramics are less durable. Due to the fragility of the material, ceramic implants are not recommended for installation in the chewing teeth area. Zirconium dioxide metal has sufficient strength and many natural light shades, which is effectively used to maintain a highly aesthetic appearance in the frontal area of ​​the dentition. Compared to titanium dental implants, the price of zirconium implants is much higher and is used extremely rarely.

According to the form they are distinguished:

Cylindrical

Thanks to the porous structure, a strong connection with the surrounding bone tissue is ensured. Currently, cylindrical implants are produced dismountable, designed for a two-stage application method.

Screw

In order to have an idea about these implants, let's look at the structure of the jaw bone.

The cortical plate is a kind of shell, the strongest, consisting of 95% mineral salts.

Spongy bone is the main layer of bone tissue, represented by crossbars and septa with many small vessels (capillaries). It is in this section that the roots of the teeth are located.

The basal layer is a continuation of the spongy layer, but the septa are located closer with a small number of vessels. Maximum strength and thickness .

Screw implants have a number of advantages:

• Cone shape;
• They are installed in place of the roots of natural teeth, that is, in the spongy layer. When chewing, they also transfer the load to the surrounding bone tissue, thereby maintaining metabolic processes in it at the proper level. It turns out that this type of implant is the most physiological;
• The presence of threads, which increases the area of ​​contact with bone tissue, and, consequently, faster osseointegration is noted;
• They can be collapsible or non-removable, one- and two-stage, have a smooth, rough surface or a coating of bioactive materials;
• They come in different diameters and lengths, which expands the indications for their use.

One of the main conditions for the use of screw implants is the presence of a sufficient volume of high-quality bone. But even if there is a lack of it, it is possible to establish them with the help of additional operations (sinus lifting, bone grafting, etc.). Only the duration of treatment and recovery will change.

In today's market you can see many implant manufacturers. Let's take a look at the leading representatives.

General and specific contraindications

Who is contraindicated for dental implants? Implantation is a surgical operation and, like any other operation, it has contraindications. They are divided into two types: general for any type of implantation and specific dental ones.

The following concomitant diseases are common to all types of implantation (and to surgical interventions in general):

• violation of coagulation (blood clotting), diabetes mellitus, tuberculosis, chronic rheumatism - these diseases complicate wound healing and implant placement;
• pregnancy and lactation;
• childhood and adolescence – children and adolescents continue to grow, and this is fraught with displacement of implants or their rejection, or slowdown in the growth of individual organs as a result of the installation of dental implants in them;
• diseases of bone tissue that reduce its regenerative abilities;
• diseases of the nervous system;
• cancer during exacerbation, HIV and AIDS, specific diseases of the immune system that weaken the body as a whole and do not allow it to recover after operations.

The following can be considered specific contraindications to dental implantation:

• when installing implants in the upper jaw, it is necessary to take into account such factors as the proximity of the sinuses (aka the maxillary sinuses), as well as the width and density of the bone at the point of contact of the jaw with the sinuses; in some cases, the implantation procedure may be preceded by a sinus lift;
• chronic, including inflammatory diseases of the oral mucosa;
• patient's failure to comply with oral hygiene;
• insufficient height and density of bone tissue at the site of proposed implantation (this applies to both the upper and lower jaws) - in such a case, bone grafting can correct the situation.

It is worth noting that diabetes and advanced age are not currently included in the list of contraindications for dental implantation.

Dental implants in the upper jaw

Advantages and features:

• Each implant is covered with a unique TiUnit material, thanks to which the process of osseointegration occurs much faster (in its structure and composition it is very close to bone tissue);
• 3D planning of the operation, which is the key to the accuracy and high aesthetics of the finished structure;
• Due to the design features of the thread and the body of the implants themselves, tissue trauma is minimal;
• A wide range of implants in diameter and length makes it possible to install them even in the most seemingly difficult clinical situations;
• Simplicity, logic and accuracy in the surgical protocol (operation);
• All Nobel implants have identification numbers. Fake is impossible.

The only downside worth noting is the high cost.

ASTRA TECH implants

ASTRA TECH implants
The system was developed by Swedish scientists and is popular in many countries.

Advantages and features:

• Made of the highest class titanium, which has excellent biochemical qualities;
• Modified OsseoSpeed ​​surface, which accelerates the process of osseointegration;
• The connection of the implant to the Conical Seal Design abutment is located below the gum level, which allows for a more even distribution of the chewing load;
• Patented microthread in the upper part of the implant (in the neck area), which also improves the distribution of chewing pressure;
• The company provides a lifetime guarantee.

Among the disadvantages, high cost can be noted.

Hi-Tec implants

Hi Tec Implants is one of the leading Israeli companies that has been producing a wide range of implants for over 20 years. During this period, the company has established itself as a representative of quality materials at an affordable price .

Advantages and features:

• A wide selection of types of structures, which allows you to choose the optimal one for each specific clinical situation;
• The implants are made of the highest quality titanium;
• Simple surgical protocol (operation progress);
• Having our own full-cycle production allows us to ensure a high level of quality control of dental implants (implants) and a reasonable cost.

Thus, this implantation system combines high quality and reasonable cost. Among mid-level implants, Hi-Tec takes first place.

Implant survival rate

Today, the high quality of implants (subject to cooperation with quality manufacturing companies) means the highest survival rate than ever - 98.5%!

But even if the implant does not take root, you have a guarantee, and they will simply install it again. Therefore, you should not read horror stories about bad cases on the Internet - they happen extremely rarely, and there may be several reasons:

1. Poor quality of the implant used
2. Individual factors
3. Poor implant care
4. Systemic diseases of the patient (HIV infection, AIDS, hypertension, uncontrolled diabetes mellitus)

Lamellar

Plate implants
The intraosseous part is a wide thin plate with a textured surface (macrorelief in the form of a snake or corrugated structure) and holes. Such implants are practically not used, as they have more disadvantages than advantages.

Firstly, they differ in shape from the roots of natural teeth, thus they are not able to withstand and distribute the chewing load in the proper volume. Therefore, the service life is not long.

The only positive thing that can be noted is the low cost.

Combined

The shape and size of such implants are determined strictly individually, depending on the number of lost teeth, the thickness of the jaw bone and other factors.

Highlight:

• Lamellar-root-shaped;
• Disc: for weak, atrophied bone in cases where bone grafting is impossible;
• Transosseous: used for severe atrophy of the jaw bone, installed through an incision in the chin area;
• Ramus-frame dental implants: a fairly extensive design that covers almost the entire jaw. It is used for severe bone atrophy and serves as a support for both removable and fixed prostheses.

Such implants are used only in cases where screw installation is not possible. The operation requires more time, the process is complex and traumatic . The recovery period is much longer, and the service life is short.

Basal

Such implants are installed in the basal layer of the jaw bone tissue. It is denser than the spongy layer. This ensures good primary stabilization. Prosthetics can be performed 3-5 days after the operation.

The intraosseous part and the abutment are a single unit. Therefore, it is impossible to correct the supragingival part after installing the implant. There are many cases of loss of aesthetics - dentures look unnatural and do not adhere well to the periodontal tissues.

The process of installing basal implants is not very complicated and traumatic, but basal implants have more “cons” than advantages.

Firstly, this is not titanium (after installing this type of implant, the orthopedic doctor simply bends them with forceps, creating parallelism), but it is titanium that has the property of “fusing” with the bone.

Secondly, with Basal implantation, osseointegration does not occur and it is rather the denture that holds the implants in the bone, and not vice versa.

Thus, at first glance, there are more advantages of basal implants, but the disadvantages are so significant that their use is questionable.

Lifespan of dental implants

Although implantation is significantly more expensive than traditional prosthetics, with a long-term calculation the costs are equalized. This is due to the fact that traditional bridges, crowns, clasp or nylon dentures need to be replaced on average every 5 to 7 years, and the supporting teeth will have to be ground down again each time. How long does a dental implant last? The minimum service life of a dental implant is about 30 years, and if all the doctor’s instructions are followed, the implant will last you a lifetime. Most manufacturing companies, including world industry leaders, who invest considerable funds in the latest developments, provide a multi-year or even lifetime warranty on their products. This applies to the part of the structure that is located inside - that is, the root (base plate, etc.) and the abutment. A crown installed on an abutment has a more limited service life, but it is also significantly longer than that of a traditional prosthesis installed on ground natural teeth. This is on average 10 – 15, sometimes 20 years. If we are talking about implantation for a young person, then, of course, he will be interested in what happens to implants in old age. With proper care and preventive examinations, nothing should happen to the artificial root.