> IMPLANTS – DENTAL SURGERY
The dental implant is a root made of titanium which is bolted to the jaw bone during surgery. It is used to replace the natural root of a tooth.
Nowadays dental implants are made of titanium, as it offers a 98% possibility of osseointegration and is highly functional due to its strength and biocompatibility.
The diameter of an implant varies between 3 to 5 mm, and its height ranges from 10 to 15 mm.
Reasons for dental implants:
- Absence of a root after a extraction
- Broken or fractured root
- Complete rehabilitations of the mouth for medical or aesthetic reasons
- Replacement of removable dental prostheses for fixed prostheses
Procedure for dental implants:
- The conventional method for dental implant
The classic method of placing dental implants involves the surgeon submerging the implant for a period of 2-3 months in order that it becomes integrated into the bone.
- Immediate loading of dental implants
In this case, the surgeon screws the prosthetic pillar (a necessary piece used to fix a crown, a bridge or prosthesis) into the implant on the same day that it is posicioned. The provisional resin prosthesis is made and placed during this appointment.
This method allows the patient to chew again immediately, guarantees the patient more comfort and also achieves a more immediate aesthetic result.
The type of technique used depends on the quality and height of the bone of the patient.
Type of surgery and anesthesia:
Dental surgery is ambulatory and is done under local anaesthesia. In some cases it can be done with sedation for greater patient comfort.
Postoperative follow-up for dental implants:
It is recommended that a follow-up visit with panoramic X-ray is performed 2-3 months after the intervention to check that the implant is integrated into the bone and that the treatment can be continued.
Once the treatment is over, we recommend an annual check-up.
Sinus Lift and bone grafts
This is a common and straight forward procedure used in dental implantology. It is particularly used for complete rehabilitations of the mouth in patients with a significant reduction of the bone.
The sinuses are like “empty chambers” above the jaw bone.
The sinus lift or sinus lift procedure with bone graft increases the amount of bone in the jaw thus improved the results of osseointegration of the implant.
Indicators for the sinus lift:
- Resorption of the bone for various reasons (removal, hereditary, diseases)
- Insufficient space to place the implant.
Sinus lift procedure:
Consist of detaching the membrane that covers the sinus cavity and lifting it to allow the bottom of the cavity to be filled with bone grafted bone.
In most cases synthetic bone is used.
Other types of bone grafts include:
- The autogenous bone graft: using the patient’ s own bone
- The allograft: human graft taken from another person
- The xenograft animal: graft, also called “biooss”
Type of surgery and anesthesia:
Sinus lift surgery is ambulatory and is done under a local anaesthesia. In some cases it can be done with sedation for greater patient comfort.
Postoperative follow-up of the sinus lift:
A follow-up is recommended with a panoramic X-ray of the mouth three months after the intervention to check if the amount of bone grafted is sufficient in order that the treatment can be continued.
> COSMETIC DENTISTRY AND DENTAL PROSTHESIS
Crowns and dental bridges (fixed dental prosthesis)
The fixed dental prosthesis is as the name suggest, a non-removable prosthesis. It is attached to the jaw by natural teeth or implants.
In a natural tooth, the part that comes out of the gum is called a crown. It is the section covered by enamel. Therefore, the prosthetic dental coverage is a crown that covers the damaged part of the tooth and protects it from external aggressions or replaces the absence of a natural crown.
Reasons for a crown or dental bridge:
- Following an endodontic treatment
- To repair a damaged tooth
- After the placement of an implant
- For aesthetic reasons
Type of dental crowns
- Porcelain fused to metal crown:
This is a crown made by a metal coping covered by aesthetic ceramics
Nowadays, porcelain is fused to metal crowns thus giving good aesthetic results.
- Porcelain crown (full porcelain crown):
This is a crown made entirely of ceramic. There are two different types of ceramics used: a high-strength ceramic for the coping, and an aesthetic ceramic to cover it.
- Zirconium crown:
This is a crown consisting of a zirconium oxide coping covered with an aesthetic ceramics.
The zirconium is characterized by its high resistance, its biocompatibility and its aesthetic qualities. Today is the case that more resembles a natural tooth.
- All Resin crown:
This is a crown composed of a polymer resin.
It is typically used as a provisional crown whilst the final crown is being made.
It is resistant and aesthetic results are not those of a crown covered by aesthetic ceramics.
- Dental bridge:
A dental bridge consists of a set of crowns sealed to each other and fixed in adjacent teeth. Usually replace the absence of several teeth. Sometimes, the dental bridge is an alternative to the placement of dental implants.
Regardless of the indication to fit a dental crown (implant, endodontics, etc.), the professional shall take the measurements of the prepared tooth. This is usually done with a silicone compound.
The precision of the measurement is important so that the dental technician can manufacture a crown that perfectly fits the tooth.
The crown if fixed to the tooth and sealed with a final aesthetic cement.
Dental veneers are small and thin custom made shells that cover the front face of the tooth.
There are 3 types of veneers (composite veneers and porcelain veneers):
- Veneers in direct composite:
The dentist places them with a paste manually attached to the tooth, like an aesthetic filling. Molds are not needed.
- The “Componeer” veneers preformed of composite:
These are prefabricated veneers made of aesthetic composite material (resin). They give good results but its long-term durability is not as tough as ceramic facets. Molds are not needed.
- Porcelain veneers of dental lab:
They are made of a shell of ceramic aesthetics that offers an especially good light diffusion
Normally, these veneers require 5-7 days to be manufactured. Provisional veneers are place made of composite shutter material while the final one are ready.
Indications for dental veneers:
- Discoloured teeth
- Chipped, cracked, with irregular surface teeth
- Correction of the interdental space
- Aesthetic reasons
Dental Veneers procedure:
The placement of porcelain veneers is done in two visits to the dental clinic:
- First visit: preparation of the teeth and taking measurement.
The enamel of the tooth is slightly reduced on its inferior part. The veneers are very thin so that virtually no action is required on the tooth that it covers. The tooth is just slightly reduced and usually no endodontics is needed.
Measurements will be taken of the prepared teeth with a silicone compound to manufacture the veneers.
- Second visit: fitting of the dental veneers
The veneers are glued with definitive aesthetic cement using a technique that allows the veneer to be completely sealed to the tooth.
The fitting of prefabricated veneers “Componeer” is made in a single visit. The same thing occurs with direct composite, where the material is applied directly by the dentist on the tooth after a very superficial polish.
Fixed hybrid prosthesis
The fixed hybrid prosthesis is a dental prosthesis of full resin bolted on implants.
It is usually fixed with microscrews in 4 -6-8 implants. The prosthesis is usually made up of a bridge of 12 teeth.
Also, it could be made of in ceramics depending on the type of bite of the patient and the antagonist teeth, as well as the needs of resistance or elasticity.
There are advanced techniques to fix this type of prosthesis in patients with little bone, in which we are experts:
- Zygomatic and Pterygoid Implants:
This is an implant of specific size, diameter and angle that is fixed in the zygomatic bone, the cheekbone bone. Is only used for rehabilitation of the upper jaw.
Allows avoiding a bone graft from another part of the body.
- Technique “all on four” / “all on 4 “:
This technique consists of placing 4 implants with specific angulation in patients with little bone to be able to fix the prosthesis. It allows the immediate loading of the prosthesis: the patient will leave with a provisional prosthesis on the same day that the implants are placed while the final prosthesis is made.