Implants in dentistry

The problem of prosthetics and remains valid today. Many types of dental prostheses, particularly removable not meet patients, as cause great inconvenience to wear. Significantly expand the capabilities of orthopedic treatment helps dental implants, which are widespread in the last 20-30 years.
Implantology is a science that studies the possibilities of prosthetics on implants.
Implantation (from lat. in - in, plantare - plant) is defined as a method to restore chewing function and beauty species by the introduction into the jaw bone, metal, ceramic, plastic implants, followed by a rational prosthesis. The specified method each year finds more and more supporters.
With the obvious achievements in this field of dentistry researchers are faced with certain difficulties. The most important problem is the biocompatibility of the material of the implant and a living organism. Used today in the clinic implants only partly meet the necessary requirements. The problem of creation of functional systems, adequate dental authority, also remains open. Despite this, existing at the present stage the types of implants used strictly on the grounds can successfully solve most of the problems, the resolution of which only recently seemed doubtful.
Historical roots of implantation go far into the past. Already the inhabitants of ancient civilizations, along with the ability to treat a number of diseases tried to restore and lost teeth. The most ancient copies of dentures found on the territory of Egypt. Their dates back to the III Millennium BC By this time, and include the first examples of implantation. In 1893 in the area of Honduras was discovered the skull of a man who lived in the period of ancient Maya civilization with implanted tooth carved out of black stone and placed on the second place the lower left hand tools. Studies have shown that the implant is served in a long time.
In search of a suitable material in different time attempts implantation of various metals, gutta-percha, polymers, ceramics. So, Maggiolo in 1809 used as a support under pinned gold teeth roots. The interest to this problem appeared again only eight decades. Harris in 1887 implanted lead tooth, fused cast in a porcelain crown and extended platinum needle. Edwards (1889), was helping platinum teeth with ceramic crowns. A. Znamenski (1891) before the introduction of ceramic, rubber, gutta-percha implants inflicted on them cross risks for better fixation in the bone. At the turn of the century C. Payne (1900) proposed to use as a support for individual artificial teeth and full dentures gold and iridium pins.
A qualitatively new stage of evolution of the method was the use Greenfild (1913) intrabone, consisting of a hollow perforated cylinder. Under the implant hollow cylindrical mill (exact copy of the implant) formed a bed. Received bone core was introduced into the implant and then together with him were placed back into the bone. Here's own bone was used as podmazochnye material. Such implants to six years.
The father of modern dental implantology is considered Formiggini. He successfully applied tantalum implant, twisted wire in a cone (1947). Thirteen years later Chorchev modified and standardized the concept Formiggini, adding splinting technique. With a few changes this method exists today. In 1949, Goldberg and Gershkoff presented the first subperiostalr the implant. Within two years they have perfected and developed their technique In the next 20 years, she has changed somewhat, but is still considered one of the most successful.
1949-th was a year of unprecedented upsurge of interest in this issue. One by one the authors claimed the luck to work with different versions of the implants. But the conclusions of the majority of them were hasty. The exception was Lee, published in 1966, the results of long-term observations over intraosseous implants of cobalt-chromium alloy, which had a Central basis with multiple branches that are placed into wells recently extracted teeth. One of implants of this design functioned 13 years.
In 1959 Hodosh first used polymer (polymethylmethacrylate) as biomaterial. The implants were made by the prints with holes distant teeth, which then was placed. This success was confirmed by x-ray pictures, which clearly traced bone, sprouted in the substance of the implant.
Among adherents seriavina form implant the most successful results were obtained in A Scialom, connecting single pins in triplets. The created technique occupies a prominent place in modern clinical practice.
Thus, currently, there are six main types endoclinic implants available's the use:
1. Double helical screw;
2. Polymer tooth;
3. Triplet implant;
4. Frame-implant-supported in the field of branches of the lower jaw;
5. Laminar implant;
6. "Anchor" the implant.
In our country the first operation carried out by a doctor Sukhumi Republican stomatologic polyclinic A. B. Gorodetsky in 1959 He implanted tantalum pins on the lower jaw. Since 1981 doctors Kaunas made more than a thousand such operations. O. I. Stern organized the experimental laboratory of dental implants and prosthetics at the Kaunas medical Institute, which is the leading database of training of dentists in our country. Since 1981, they have developed and mastered almost all kinds of implantation.
Let us turn to the question about the material of the implant. Criteria of an ideal material include biocompatibility, biofunctionality, sterilizability, accessibility and ease of manufacturing, aesthetic factor.
Biocompatibility. The material must be inert to surrounding tissues, that is chemically stable, not causing allergic, non-toxic, carcinogenic.
Biofunctionality. The material of the implant must perform the mechanical function, be of sufficient strength and plasticity.
Sterilizability. The material of the implant must have the ability to be sterilized in order to eliminate the possibility of introduction of infection. Equipment sterilization, chemical, or thermal, should not be harmful to the implant.
The availability and ease of manufacturing. Selected material should be cheap, and getting to the configuration you need not be accompanied by excessive technical difficulties.
Aesthetic factor. The vast majority of plastic surgery today, including the implantationis performed to restore the aesthetic appearance. Therefore, the material of the implant with their presence should not disfigure the patient, but, on the contrary, create all conditions for cosmetic prosthetics.
The most widely used for manufacturing dental implants metals and alloys. Technically pure titanium is flexible and very durable material, easily machinable, has good surface quality.
An alloy of titanium, aluminium, vanadium distinguished primarily high strength, good surface quality and somewhat lower plasticity.
Tantalum is considered the most inert metal. It is very similar to titanium almost every way, but used much less frequently (less accessible and more costly to produce).
Surgical stainless steel - an alloy of iron, chromium, Nickel, carbon.
Cobalt-chromium-molybdenum alloy (or Vitallium) - the main material used to manufacture many types of dental and other implants.

Polymers. The most acceptable are polymethylmethacrylate (PMMA), polytetrafluoroethylene (PTFE) and carbon fiber (or proplast). However, as the base material of the implant polymers not withstand chewing loads, so they are most frequently used as constituent elements of the design of the implant.
Ceramics. Based ceramic material used in implantology, is an alumina (Al2O3). This biomaterial occurs more often called "citodent", or corundum ceramics (in accordance with the name of the natural mineral corundum, representing net aluminum oxide).
As artificially manufactured corundum ceramics contains not only Al2O3, but in some cases some additives and admixtures, conditionally called corundum ceramics such, containing 95% or more of corundum.
Carbon. More often applied glassy carbon material. The success of carbon material determined its chemical inertness. Glassiness achieved controlled decomposition of carbon-containing components, such as phenolformaldehyde and some others at a temperature of 1000-3000°N
Testimony to the use of implants are: 1) defects of one tooth in mortalium Department, when the adjacent teeth are intact; 2) limited defects four or more teeth; 3) end-bilateral and unilateral dental arch defects in the absence of three or more teeth; 4) toothless jaw atrophied alveolar ridges; 5) in cases when there is intolerance dentures or increased sensitivity to plastics.
Surgery is recommended for patients under the age of 55 years, but implantation possible and at an older age with good health.
Contraindications are: poor hygiene of the oral cavity, alcoholism, diabetes, Wegener, collagenoses, organic lesions of the Central nervous system, blood diseases, corticotherapy, heart disease in the stage of decompensation, allergies.
The main objective of the implants to restore chewing function, create a support case for fixed or to improve the conditions fixing dentures; also important and cosmetic side.
Implantation significantly expands the choice of the treatment plan. Usually it is done in one visit under local anesthesia, depending on the design, immediately after tooth extraction or after 6-9 months.
The right shape and the number of implants provide distribution and dispersal of stress on the bone, not exceeding the physiological limit. Physiological limit this function load, feel the implant, which does not cause pathological changes in bone tissue.
In implantology is very important to understand the concept of "volume present bones". This is the amount of bone in which or around which can be placed implant. Total and partial volume present bones is the key to differential diagnosis and treatment plan. In line with this, select the type of implant, and the design of the prosthesis.
A few words about the peculiarities of prosthetics on implants.
Type of implant and the design of the prosthesis are closely related and form a single functional complex. Tech prosthesis has its own characteristics.
Maximum manipulations should be carried out prior to implantation: postimplantation period features high sensitivity of the mucous membranes of the oral cavity, so the excessive irritation may cause inflammation. Polished available abutment teeth, removed casts alginate elastic mass, cast plaster models and sent to the laboratory. Spend implantation. After 7-10 days after epithelium mucosa, pripadajuca crowns and standard caps on the heads of the implants is determined bite. At all stages are proposed Kaunas implantologists cofferdam (rubber tape with a hole), put on the head of the implant to prevent penetration in the cervical region impression mass, metal sawdust etc. Removed the second casts crowns.
In the manufacture of prostheses seek to use uniform metals or at least the materials with close electrode potentials to minimize galvanic effects in the mouth.
The quality of work at all stages must be great: small errors may cause the failure of the whole complex process of implantation.
usually, all the crowns are combined. They have good cosmetic qualities. The prosthesis is fixed with screws on the heads of the implants. This allows for any changes in areas quickly to remove and carry out the necessary interventions (Fig. 3).
full subperiostalr the implant can be manufactured as fixed and removable structures (Fig. 4 and 5).
Dentures on implants adequately restore chewing function, create a good cosmetics. 95% of patients with pathology of the gastrointestinal tract after implantation occurs stable remission, and 42% disappear neurotic phenomenon. After 6-7 years (average) implants become worthless: bone surrounding them, eventually atrophies, implants laid bare. In such cases, they should be removed and selected new design.
Contraindication number one for implantation - bad hygiene. So brushing mandatory 2 times a day, morning and evening. During the day the mouth rinsing after eating running water. From the use of toothpastes containing ions of chlorine and fluorine, to refrain: they attack the surface of the implant, causing corrosion processes. In addition, after implantation often not recommended to drink coffee and sugar.
The order of Ministry of health USSR №310 from March 4, 1986 "on measures to implement in practice the method of orthopedic treatment with the use of implants" obliges our dentistry wider application of this treatment, to further explore the possibilities of prosthetics on implants.
Further research will help to considerably expand the indications to application of implants, will make the implantation more noninvasive and less time-consuming.
The first steps in this direction have already been made.