Prosthetics for malocclusion. Does malocclusion interfere with implantation?

Malocclusion is a problem that orthopedic doctors should not ignore when planning dental implants. It is important to find the source of the deformation (congenital adentia, childhood malocclusions, skeletal forms of malocclusion, etc.). This requires high-quality diagnostics and experienced orthodontists. Some malocclusions are treated orthodontically - by wearing braces or special equipment; in other cases, doctors may resort to the help of a surgeon (for skeletal malocclusion deformities). In any case, dental implantation in patients with malocclusion is not the first step in treatment.

If you place implants without correcting your bite

Unfortunately, many Moscow clinics still practice the work of an implantologist in isolation from the orthodontist and orthopedist. The patient comes, complains of missing teeth, and after some time an implant is installed and he is referred to an orthopedic doctor for prosthetics. This tactic is wrong.

Due to an incorrect bite, they may appear following problems: gum recession, increased abrasion teeth, selective tooth destruction due to uneven chewing load.
Reduced service life of a dental implant due to uneven load on it. Premature loosening of the implant and development of inflammation around the implant (peri-implantitis).
Incorrect bite negatively affects work digestive system and temporomandibular joints. The joints wear out prematurely, clicking, crunching, and pain in the TMJ appear.
The health of the neck muscles and posture depend on the correct bite. An incorrect bite can cause chronic headaches due to muscle spasms and nerve compression.
Saved psychological discomfort. Having installed a dental implant, the patient does not receive a beautiful smile; a partial solution to the problem leaves the patient with internal dissatisfaction.

Dental implantation at Dial-Dent

At Dial-Dent, any treatment is carried out comprehensively. If a patient has a malocclusion, it is first necessary to correct it, then undergo dental implantation, implant prosthetics and, if necessary, aesthetic prosthetics. Only this tactic guarantees correct load for a dental implant and long term services. All stages are discussed with the patient before the start of treatment.

In a situation where the doctor sees that without correcting the bite it is impossible to carry out dental implantation and prosthetics on implants, since the orthodontic situation may worsen and it is impossible to guarantee the service life of the crown on the implant, and the patient refuses orthodontic preparation, the patient may be denied implantation.

At regular intermedical discussions (round tables) that take place at Dial-Dent, doctors discuss complex cases, and the final decision is made taking into account the opinions of all necessary specialists. Below are photographs from the next round table of Dial-Dent specialists.

Malocclusion consists of improper closure of the teeth in the upper and lower jaws. As a result, deformations and displacements of the dentition occur. Prosthetics in conditions of malocclusion pose a significant problem.

Why is this dangerous and risky?

With an incorrect bite, the force during chewing changes, and the load on the teeth and jaws is unevenly distributed. Therefore, prosthetics in such conditions may not only not bring the desired effect, but even cause harm.

If the jaws are not closed correctly, the force of pressure on some teeth is greater, while others are less; accordingly, the load is distributed unevenly, which can cause the implant to be knocked down or broken. To prevent this from happening, the materials from which the artificial crown will be made must have sufficient strength. It is advisable not to perform implantation with ceramics, because... she is the most fragile.

In addition to uneven load, there is also the problem of teeth wearing out ahead of time; orthopedic structures, if the patient has them, also suffer. If you notice tooth wear, it is important to contact a specialist in time to cover your teeth with an artificial crown. Such a crown must have sufficient strength.

If there is a malocclusion, the teeth may tilt in different sides. Such a defect will complicate the prosthetic procedure, because It can be difficult to place an implant in a gap between teeth. Then applies special training surgical or orthodontic method, during which excess teeth will either be removed or the dentition will be straightened.

Prosthetic procedure for malocclusion

If the defect is not very pronounced, then the procedure is carried out as standard. A plaster cast of the jaw is taken for the patient, then an artificial prosthesis is modeled.

If there is significant curvature of the teeth, then the patient is advised to wear orthodontic structures for several years in order to straighten the dentition, and successful prosthetics become possible.

Where there is improper closure of the teeth, the future shape of the crown is carefully planned. The design should not cause difficulties when moving the jaws and should not have any impact adverse influence on adjacent teeth. The preparation method for each case is purely individual, depending on clinical picture every patient.

Patients often turn to an orthopedic dentist with problems not only of an aesthetic nature, but also with the absence of some teeth. These can be molars on the upper and lower jaw, which are often removed early therapeutic indications. Such patients do not always immediately seek orthopedic help; many postpone implantation and prosthetics for various reasons.

Later, patients come to the orthopedist, but there is room for prosthetics in the area extracted tooth is no longer enough. There can be many reasons: neighboring teeth could move towards the defect or tilt, which is even worse. There are also situations when antagonist teeth move towards the defect. Usually this is clearly shown by an x-ray, when the crown parts of the teeth on both sides of the defect are practically in contact with the contact surfaces, and there is a large distance between the roots. This position of the teeth subsequently causes problems with periodontium, with exposure of the roots of the teeth and patient complaints about food getting stuck, that is, noticeable discomfort. For such patients, the orthopedist recommends preliminary orthodontic treatment, without which prosthetics will be impossible. The orthodontist, in turn, carries out preparations with the movement of teeth into correct position, and then, when the conditions for prosthetics are created, transfers the patient to an orthopedist to continue treatment.

Why is it important not to delay starting treatment?

If the patient has no tooth upper jaw, then the lower antagonist teeth may begin to move upward. If there is no tooth in the lower jaw, then upper teeth, which are located above this defect, can also move down. And jaw blocking can occur when a displaced tooth prevents chewing correctly, which sometimes causes dysfunction of the temporomandibular joint. It happens that after the removal of the sixth and seventh teeth, the eighth teeth, wisdom teeth, erupt, then the orthodontist will have to make a decision about their removal or preservation.

Decreased bite depth

Another typical situation is the loss of lateral teeth and increased wear of the front teeth. The consequence of this situation is a decrease in the height of the bite. Before prosthetics, orthopedists refer such patients, especially those with an incorrect, deep bite, to an orthodontist to “raise” the height of the bite.

Correction of the smile zone and missing anterior incisors

Occurs aesthetic problem in the smile zone, associated with the absence of front teeth, for example, second incisors. Nowadays, it is not uncommon that even their rudiments are missing. It does not cause complaints as long as there are baby teeth in this place, but after their removal the question arises about restoring the defect. In such situations, the orthodontist, orthopedist and implantologist choose a comprehensive treatment strategy. Options are being considered with implantation and prosthetics in this area or orthodontic movement of adjacent teeth with their further restoration with veneers to create a harmonious smile.

A less common situation is the absence of one of the front incisors. If the defect has existed for quite a long time, then problems may arise with implantation in this area due to a lack of bone tissue. Then the orthodontist proposes a treatment plan with moving the lateral incisor to the place of the missing central one, and prosthetics on the implant is carried out in the freed area where there is enough bone tissue.

Partial or complete orthodontic treatment?

We offer different options. Sometimes full orthodontic treatment is necessary for an aesthetic and functional result. If we're talking about For patients who already have quite a lot of orthopedic structures on the upper jaw, there are no lateral teeth, there is crowding, a close position of the front incisors on the lower jaw, then it will be sufficient to align the lower incisors and, as far as possible, raise the bite. In this case, we are talking about partial orthodontic treatment, lasting not 1.5-2 years, but much faster.

Local problems, such as tilted eighth teeth in the absence of seventh or sixth teeth, are solved by the support of two miniscrews without the use of a brace system or by using small systems for the lateral group of teeth. This will also be partial orthodontic treatment.

Team approach

In solving such clinical situations a team approach is required, in which general concept An orthopedist is in charge of treatment. He discusses the desired result with the orthodontist, and the orthodontist analyzes the possibility of its implementation. In such a situation, the orthopedist plans the movement of the teeth with an accuracy of millimeters and gives specific instructions to the orthodontist.

Sequence of treatment

Prosthetics are performed after orthodontic treatment. When there are already some orthopedic structures in the oral cavity (crowns, veneers), it is permissible to position braces on them. However, after the end of orthodontic treatment, the structure will most likely have to be replaced, because the shape of the dentition and bite will be different.

Orthodontic treatment in the presence of restorations

If it is necessary to replace teeth, before starting orthodontic treatment, the orthopedist plans to install special, milled plastic crowns for the period of wearing the braces system. Such structures withstand the fixation of locks and the movement of teeth well; after the orthodontist completes the work, it will be necessary to replace the temporary crowns with permanent ones, taking into account the corrected bite.

The retainer is not glued to orthopedic structures, with the exception of veneers - in this case it is not affected inner surface the tooth and retainer will be securely fixed. On ceramic crowns It is almost impossible to glue a retainer, so a retention mouthguard is provided for patients with such designs. The first year after completion of treatment, it will relieve the load on the front teeth and will be a retaining factor, guaranteeing the stability of the result.

Commentary by the chief physician of Dial-Dent S.V. Zukora: “Patients who seek dental implants are often unaware of other problems present in their dental system other than missing teeth. Sometimes the patient knows that he has periodontitis and an alarming question arises about how securely the implants will stand if his own teeth are lost due to periodontitis... At the same time, the condition of the bite remains unattended. Few people know that malocclusion can cause pain in the temporal joints, headaches, neck pain and many other problems. Implantation in a malocclusion aggravates all existing problems, so it is necessary to correct the bite before dental implantation. For patients who do not agree to follow the doctor’s plan, we can refuse implantation, and this is done solely for the benefit and preservation of the patient’s health! The connection between malocclusion and planning for dental implantation will be discussed below in this article.”

Incorrect or uneven bite standing teeth- this is serious and global problem, affecting all levels of the patient’s dental system, as well as the aesthetics of a smile, posture, muscle tone, sleep quality, hormonal system etc. When planning dental implantation, situations sometimes arise when it is necessary to correct the bite before implantation. For example, neighboring teeth have moved to the place of a lost or ungrown tooth, and now there is not enough space for an implant.

Planning for dental implantation should begin with a visit to an orthopedic dentist, who assesses the condition of the gums, bone tissue, bite, develops the design of dental crowns and plans the depth and angle of installation of the dental implant for comfortable and reliable dental prosthetics on implants.

Commentary by implant surgeon V.P. Alaverdova: “The prosthetist (orthopedic dentist) prepares a task for the surgeon, developing a surgical template for installing a dental implant. The surgeon will install the tooth implant at the same depth and angle as developed by the orthopedic dentist. This is the only way to achieve excellent aesthetic and functional results when using implant prosthetics. During my consultation, I evaluate the patient’s bone and gums - volumes, bone quality, etc. Dial-Dent is very the right approach. There's a team here and we have everything you need diagnostic equipment and specialists who can competently draw up and implement a comprehensive treatment plan. Many times I had to remove implants installed in other clinics, since installing normal dental crown It was impossible."

Degree of bite deformation and dental implantation

During the consultation, the orthopedic dentist assesses the condition of the bite, and, in the presence of bite disorders (improper closure of teeth, unevenly growing teeth, crowded teeth, etc.), the degree of the disorder and the impact on the structures of the oral cavity and other organs and systems. The degree of malocclusion can be assessed only after calculations x-rays, casts of jaws, studying photographs, etc. In some situations, the participation of an orthodontist is necessary.

Minor bite deformation

If there is a slight deformation of the bite (improper rotation or tilt of some teeth, gaps between the teeth, a slight lack of space for a crown on the implant), you can proceed with dental implantation in conditions of deformation. Of course, in this case it is necessary to discuss the consequences with the patient - in some cases it will not be possible to achieve an ideal aesthetic and functional result. If the patient and the doctor are ready to ignore minor nuances, then implantation can be done.

Significant malocclusion

If the bite deformation is significant, then dental implants cannot be installed! At serious violations bite, the patient is advised by an orthodontist who can offer various options correction of bite before dental implantation.

If the bite deformity is significant and cannot be ignored, then we, the Dial-Dent doctors, do not have the right to install dental implants without prior orthodontic treatment, as this will lead to fixation, and in some cases, worsening of the deformity, and will ultimately harm the patient ! Therefore, we either motivate the patient to correct the bite, or, if this fails, we simply refuse dental implantation. Refusal in this case is good for the patient!

Tactics of Dial-Dent specialists when a patient applies for dental implantation:

Commentary by orthodontist M.P. Sleptsova: “Many times I have seen patients with malocclusion have dental implants installed (not in our clinic) and crowns made on them. Implantation was performed without correcting the bite. The result in many cases is disastrous: the promised aesthetics are not there, the function is not adequate. The patient realizes too late what the catch is. But nothing can be fixed. Or you can by removing previously installed implants and losing the crowns. And this is expensive, requires surgical intervention and does not bring joy to either doctors or patients! Therefore, we must do everything correctly. Don't forget to go qualitative analysis bite situations before dental implantation, even if you do not feel any problems.”

Where to perform implantation?

Dental implantation should be carried out only after a comprehensive diagnosis and a complete treatment plan, which, if necessary, includes bite correction. The clinic where you plan to perform dental implantation should have a well-coordinated team of doctors who can perform complex dental treatment and possessing great experience. These are the kind of specialists we have at the Dial-Dent Family Dental Center, which is confirmed by the successful treatment of many patients.

Here are some examples of the work of Dial-Dent specialists:

Complex restoration of anterior teeth with bite correction
Correction of deep bite and elimination of TMJ dysfunction

Is it possible to correct a bite if an implant is already installed?

When a dental implant is installed, it is impossible or difficult to correct the bite. The dental implant is absolutely motionless in the bone! This distinguishes it from own teeth patients who are slightly mobile. You can move your teeth into your jaw, but a dental implant cannot! The angle of the implant and its position among the patient's teeth is dictated by the shape and position of other teeth (adjacent teeth, teeth on the opposite side of the jaw, and even teeth on the opposite jaw). It is clear that when correcting the bite, the patient’s own teeth will change their position, the angle of inclination in the jaw and the relationship between the teeth of the jaws. And the implant still stands. And it no longer fits into the changed conditions, either aesthetically or functionally! Therefore, if the bite is corrected after the implants have been installed (if this was not the treatment plan in advance), then problems arise. They are solved this way: either by removing the implant and reinstalling it in a corrected bite, or by ignoring the aesthetic and functional problems that have arisen. There is an exception here: sometimes implants are placed before the bite is corrected, and when the bite is corrected, the teeth are moved, attracting (or pushing) them away from absolutely motionless implants. But this is planned in advance and is united and inextricable healing process, in contrast to the situation when they do one stage and then think about another.

To plan dental implantation and calculate the cost, you must consult a dentist. Neither the experience of friends, nor stories from the Internet, nor calling clinics will provide comprehensive information!

Dentists joke that God gives teeth to a person for free twice, but you have to pay for the third. Teeth are not capable of self-healing. Losing even one is not as harmless as it may seem. In addition to aesthetic discomfort, facial features change, chewing function and digestion are disrupted. Dental implantation comes to the rescue - return beautiful smile quickly and forever. An implant surgeon and orthopedist at Vimontale Dentistry in Moscow talks about all the nuances of dental restoration with implants.

How did dental implants come about?

Actors who win an Oscar usually thank God and their parents. People who, with the help of implantation, regain their teeth and a comfortable lifestyle, kind words We must remember the Swedish professor Per-Ingvar Brånemark. Quite by accident, he revolutionized dentistry.

In 1965, Brånemark conducted research with a group of scientists. The professor implanted a titanium capsule into the rabbit and was very surprised when he could not remove it. So a happy accident helped to establish that titanium fuses with bone. Brånemark decided to use the discovery in dental prosthetics.

The first lucky one with titanium implants- Gust Larsson. A simple carpenter, like Professor Branemark, went down in the history of implantology. Larsson, 34, had a completely toothless mouth. Not life, but torment: eating, talking, smiling - everything is difficult. The man himself found Branemark, having accidentally learned about his experiments. There was nothing left to risk, and Larsson became the first person in the world to receive implants. The patient lived with them for more than 40 years, until his death, proving the effectiveness and reliability of the new method.

The first experiment was successful, but the patient Brånemark was in no hurry to declare a revolution in dentistry. The scientist spoke publicly about his discovery 20 years later. The message caused a sensation! An accidental discovery turned the world of prosthetics upside down and returned a comfortable lifestyle to toothless patients.

What is dental implantation?

Dental implantation is the implantation of an artificial root into the upper or lower jaw. The implant is titanium, therefore it is completely biocompatible. This reliable crown support consists of:

titanium screw (implanted into the jaw during surgery);
abutment (attaches to the implant, resembles a ground tooth).

The answer to the question of whether to undergo dental implantation is clear: of course, yes. Today this is the most advanced method of prosthetics.

Photos before and after dental implantation

Lateral surgery chewing teeth.

Installation of an implant in the area of the front teeth.

The photo of dental implantation shows clinical case, when the patient has complete edentia in the upper jaw and several teeth are missing in the lower jaw.

Leading implant manufacturers

Dental implantation methods

A variety of dental implantation methods allow you to choose ideal option for every patient.

One-stage

For those who do not want to wait a long time and who have no contraindications, dentists offer one-stage implantation with immediate loading. The peculiarity of the method is that the temporary prosthesis and the implant are fixed in one step. Only a small incision is made in the gum. The temporary crown is replaced with a permanent one after 3 to 5 months. During this time, the dental implant finally takes root.

Two-stage

Two-stage implantation is time-tested. The operation takes longer, but the risk of complications is minimal - the doctor clearly sees what he is operating on by making an incision in the gum and folding back the flap. The abutment is installed six months after the implant has been implanted, the crown – a week after the abutment. This is a classic dental implantation, proposed by Professor Branemark.

One-step

Single-stage - implantation takes place simultaneously with tooth extraction. This is an ideal option for front teeth, when the aesthetic result comes to the fore. For chewing teeth this technique rarely used.

Stages of dental implantation

Before implantation. Dental implantation, like any other operation, requires careful preparation. The result depends on this. The doctor must plan the implantation procedure as accurately as possible and identify all possible contraindications. At the first appointment, the implantologist asks general questions due to health reasons. Referrals for tests and consultations with other specialists are provided if necessary. The oral cavity must be healthy - without caries and inflammation of soft tissues. A few days before surgery, you need to make an appointment for a cleaning.

Anesthesia. As a rule, local anesthesia is used for implantation. Modern drugs completely relieve the patient from pain and discomfort. If necessary, sedation or anesthesia is used.

Implant installation. If the dental implantation process proceeds without surprises, according to a pre-drawn plan, the operation will take 20 – 40 minutes. First, the doctor will install the implant, then check the degree of primary stabilization, and then decide whether to load it with a crown or not.

Fixation of the crown. A temporary crown is fixed if the dental implant is firmly anchored in the bone. In case of problems with the primary stabilization of the implant, only a gum former will be installed. A permanent crown can be placed after the artificial root has completely engrafted, after 3 to 5 months. An abutment will be fixed to the implant, and a permanent crown will be placed on it.

How long does the implantation procedure take?

Installation of one implant takes no more than 20 minutes. The artificial root takes from 3 to 5 months to take root. The entire period of treatment and recovery may take a year. The time frame is different for everyone, depending on the number of implants - some need to have 6 or more teeth implanted, others only need one. The duration of the process is affected by the volume and quality of bone tissue. The jaws also have peculiarities. On the bottom, the dental implant fuses with the bone faster, in 3–4 months, because the bone is denser. In the upper jaw, its volume is smaller, because of this the period of osseointegration is longer, 5 – 6 months. The end of implantation is fixation permanent crowns. Occurs after the implant has completely healed.

Types of implant-supported prostheses

Implant-supported dentures are securely attached to the jaw. There are several types orthopedic design. Your doctor will help you choose the right one.

Not removable dentures. Crowns are installed on the implants; in appearance, such teeth are no different from real ones. The method is suitable for the loss of one tooth or several in a row.

Bridge-like fixed prostheses. A bridge instead of single crowns is an economical option for the patient. Used for an area with several missing teeth in a row. Minimum – 2 implants.

Removable dentures. As a rule, they are used for complete edentia. Installation on an implant ensures that the prosthesis will not fall out of the mouth due to reliable fixation. At the same time, it is easy to remove it by unfastening the clasps. The patient chews easily, diction does not change, and there is no gag reflex.

Conditionally removable dentures. They are very similar to removable dentures, but they cannot be removed without the help of a doctor. The prosthesis is secured not with locks, but with screws. The most common installation methods differ in the number of implants on which the structure is attached. There can be a minimum of three, four and six titanium roots.

Implantation of 1 tooth usually does not affect the patient’s lifestyle. Installation of several implants, and even with bone grafting, may cause slight swelling. The problem disappears 2 to 4 days after surgery. In order for the process of implant engraftment and restoration to be successful, you should listen to the doctor’s recommendations:

At first, avoid too hot/cold food;
chew on the side where there was no surgery;
brush your teeth carefully;
bathhouse, sauna – postpone;
don't get too cold.

After bone tissue augmentation – sinus lift – there are more restrictions:

do not fly on an airplane;
don't dive;
don't blow your nose;
sneeze and cough with open mouth;
do not drink through a straw;

After 3–4 weeks, restrictions are lifted. Aftercare after dental implants is no different from oral hygiene with your own teeth. It is also necessary to brush your teeth thoroughly, rinse your mouth after eating, and have a hygienic cleaning. Experts recommend adding an irrigator to a regular brush and paste. The device is especially useful after complex implantation with restoration large quantity teeth.

Indications and contraindications

Dental implantation can be used in cases where one, several or all teeth are missing. Many are afraid of this technique, considering it risky. The list of contraindications is not as long as it might seem.

Absolute contraindications:

age ( jawbone fully formed only by 17–22 years);
blood clotting problems;
oncological diseases;
osteoporosis;
recovery after myocardial infarction;
cardiovascular diseases in the acute stage;
diabetes mellitus in the stage of decompensation;
illnesses connective tissue;
alcoholism;
diseases skeletal system;
malfunctions nervous system;
chronic failure liver, kidneys;

Relative contraindications:

bearing and feeding a child;
active smoking;
abnormal bite (requires adjustment);
acute periodontitis (requires treatment);
tartar (requires removal);
diabetes mellitus in the compensation stage;
bruxism.

Pregnancy and breastfeeding are relative contraindications to dental implantation for women. But doctors still recommend postponing the procedure. Women who are expecting a child are not recommended at all surgical interventions without special indications, especially in the first trimester, when vital formation occurs important organs child. Implantation is performed using local anesthesia; after the operation, painkillers and anti-inflammatory drugs are prescribed; before implantation, x-rays. All this is extremely undesirable for pregnant women. During pregnancy, immunity is reduced, and recovery after implantation may be delayed. Breast-feeding– another reason to postpone implantation: medications are prohibited, and stress may cause milk to disappear.

Feelings during surgery

Installing 1 implant feels like removing one tooth. Doctors make this comparison when patients ask them what to expect from dental implant surgery. In most cases, artificial roots are implanted under local anesthesia. But patients who begin to worry even before the operation begin are sedated with local anesthesia. It is not a painkiller, but a sedative, relieves stress, anxiety, increases pain threshold. The patient remains conscious, but in a state close to deep sleep. Painful impulses are blocked, fear and anxiety go away, while the contact between the patient and the doctor is maintained. After sedation, there are no memories of the operation, neither good nor bad.

Strong fear, especially complex treatment, complex dental implantation - in these cases the patient can be put to sleep using anesthesia. He falls asleep with a toothless mouth and wakes up with teeth.

Risks of implantation

The survival rate of implants today is a record 99%. But no one will ever give 100%; it is impossible to eliminate all risks. Someone will definitely fall into this 1%. Complications during implantation are very rare, but they do occur. During implantation of an artificial root, the following may happen:

Inflammation of the tissue around the implant (peri-implantitis). The doctor will rule out the cause of the inflammation and treat the root with special solutions. In case of relapse, the implant will have to be removed and the bone tissue will have to be restored.

Implant rejection. It happens extremely rarely. The artificial root is removed.

The implant is unscrewed together with the plug. This may occur during abutment placement. In the absence of inflammation, the titanium root is put in place.

The implant is pushed into the maxillary sinus. In such cases, only removal of the titanium root will help.

Exposing the upper part of the implant. Enough common complication, which has a greater impact on aesthetics than health.

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