Dental implantation: contraindications and possible complications (reviews). Deciding on the possibility of implantation

Diseases or injuries sometimes lead to tooth loss. This affects not only the decrease in the functionality of the oral cavity, but also affects the aesthetic perception and self-esteem. The very quality of life can be determined by the quality of the teeth. And you can fill the gap with both bridges, crowns and pins, as well as implants. At the same time, the latter is visually indistinguishable from a real tooth, does not require grinding of neighboring teeth, does not force special structures to be fixed, for which it is valued. However, no matter how wonderful dental implantation, contraindications and possible complications are still present.

A small digression into history

People tried to make the first dental implants in ancient times. The finds of archaeologists testify that gold was in Ancient Egypt, Indian ones were made of semi-precious stones, ancient Chinese from ivory, ancient Roman from metal. But then it was extremely difficult to do, accompanied by high risks. Dangerous was the complications after implantation were even more deplorable.

The main problem was that the materials used simply could not get used to the human jaw, so problems arose sooner or later. But in the 60s of the 20th century, scientists revealed the amazing properties of titanium, which turned out to be biologically inert, and since the 80s they have already learned how to integrate this material into human bone, starting the era of implantation. It is titanium that can grow into the bone, therefore, screw cylindrical implants were created on its basis.

Not everything is so simple: contraindications and complications

On the one hand, an implant can be placed at any age in any vacant space in the jaw. Even if it has been damaged, its integrity is restored by modern medicine by building up bone tissue, into which a new tooth is then placed. But on the other hand, this procedure is not available to everyone. There are a number of contraindications that will not allow you to restore a beautiful smile with this method.

The level of medicine is now high, the technology is proven, the materials are reliable. It would seem that dentistry is not dangerous, even if it is dental implantation. Are there any complications? Some don't even think about it. In fact, this is still an operative intervention, which has a number of risks, so the issue must be taken seriously. It is not always possible to foresee absolutely everything, but doctors do everything possible so that complications do not arise.

General absolute contraindications

This service is not provided to people who have blood diseases, bone marrow cancer, tuberculosis, immune disorders and autoimmune diseases, as well as type I diabetics. They do not perform surgery on clients with certain congenital or acquired diseases of the central nervous system, including mental ones. These diseases are among the absolute contraindications. Even bruxism can become an obstacle, i.e. gnashing of teeth, and hypertonicity of the masticatory muscles, which will not allow the implant to fix normally and the wounds to heal. Intolerance to anesthesia also becomes an obstacle to the operation.

Among medical contraindications, there are also relative, which are temporary. So, if a person has a distress syndrome or is taking medications that will negatively affect healing, then intervention may be denied. Do not perform surgery on patients who have recently undergone radio or chemotherapy, but over time this procedure may become available to them.

Relative and temporary contraindications

According to the above indications, from the point of view of medicine, dental implantation is not performed. Contraindications and possible complications may also be associated not with diseases, but with the physical condition. A specialist may not allow persons who have nerve endings of the jaw or the bone tissue itself to be in poor condition. This question is individual and is revealed during a personal examination. Misdiagnosis can lead to complications. So, if a patient has osteoporosis, i.e. the bone tissue is sparse, then the implantation of the implant is difficult.

A relative contraindication is the presence of problems with other teeth. But it is enough to do so that there are no carious teeth and other diseases for the issue to be reconsidered. It is also necessary to cure periodontitis and gingivitis first. Arthrosis of the temporomandibular joint can become an obstacle. Implantation is not performed for pregnant women. Also on the list of adverse events are alcoholism, smoking and drug addiction.

Contraindications are not a reason for despair

But under certain conditions, dental implantation is still possible, to whom contraindications were not allowed at first. Many relative and temporary causes can be eliminated, cured, wait a certain time, etc. Sometimes it is possible to completely get rid of contraindications, and sometimes it is enough to minimize their possible influence to make successful implantation possible.

In some cases, treatment or special preliminary preparation can be carried out, which evens out the situation. For example, if the case is in insufficient volume of bone tissue in the right place, then it can be carried out which will then allow the implant to be placed. And there are a number of procedures that counteract osteoporosis, stimulate bone growth and help it recover over time.

Possible Complications

Dental implantation has contraindications and possible complications. Some of them may occur even during the installation of a titanium rod and / or shaper with a crown, others appear in the postoperative period, and some may occur after a rather long time. The qualifications of a specialist and his experience are very important in order to correctly assess the condition of the client's tissues even before the operation, as well as professionally perform the procedure itself. According to some estimates, complications occur in 5% of operations.

It is worth noting that in some cases complications arise due to the fault of the patients themselves. Medical recommendations must be strictly followed: carefully monitor hygiene, give up certain bad habits and, importantly, observe the load regime that falls on the implant. You should not miss the scheduled periodic examinations in order to keep the process of osseointegration under control, and in case of complications, identify and eliminate them at the initial stage.

Complications during surgery

During the procedure itself, soft tissues, alveolar canals, or even the facial artery can be damaged. Sometimes there are reviews that there was a perforation of the maxillary sinus or nasal cavity. When working with the lower jaw, sometimes there is damage to the nerves, penetration of bone tissue into the mandibular canal. There are also dangerous bleedings, or the bone tissue overheats in the process of forming a bed for a future implant.

Sometimes in such cases, the procedure simply has to be interrupted, but there is a risk that this dental implantation will become unavailable at all. Contraindications and possible complications reviews here are characterized as the most unpleasant. So, overheating of the bone tissue will no longer allow the titanium rod to take root in this place in the future. Bone perforation and sinus penetration are even more dangerous. Fortunately, the risk is minimal, such cases are extremely rare.

Postoperative and long-term complications

Assume that you have already had dental implants. What complications can there be after it? Sometimes there is a divergence of the seams, the occurrence of pain and inflammation. The titanium rod may simply not take root, not fully fixed or loosened. Sometimes the bone tissue around it can collapse, which is called peri-implantitis. Sometimes, on the contrary, bone growths appear around the place of fixation. Rejection of the implant due to titanium allergy, osteoporosis, or bone burn is also possible, preventing further implantation.

The choice of a specialist

Haste and economy in this matter are unacceptable. This operation is not cheap, and it is also associated with the most expensive - health, and therefore requires the most serious approach. To find out for sure whether dental implantation is suitable, to clarify contraindications and possible complications, you should contact at least two specialists from good clinics. This advice is given by experienced people regarding all doctors, but here it is also very relevant. This approach will allow you to better understand the issue, listen to the opinions of different doctors, perhaps identify some contradictions and sort them out in a timely manner.

It is also worth learning more about the clinic and the doctor, both from official sources and from real patients who performed implantation here. Ideally, if these are familiar people, whose word can be completely trusted. But it will not be superfluous to study the reviews of others.

Most owners of new implants, indistinguishable from real teeth, are very satisfied with the purchase. But there are those who experience pain or discomfort when biting for a long time, and those who have gone through inflammation. By the way, you should immediately understand what dental implantation is, what complications there are and what should be done in these cases.

So, with the same inflammation, a “cleansing” is performed in a clinic, treatment is prescribed, after which it will be possible to forget about problems forever. Under no circumstances should the process be left to chance. If anti-inflammatory therapy fails, the implant may be removed.

The first time after the operation there is always numbness associated with anesthesia. But if the sensitivity is not restored after 4 or more hours, then this may indicate damage to the mandibular nerve. Also, in the first hours after the operation, bleeding from the wound may occur. If after a week it did not stop, we can say that a vessel was hit during the operation. These complications require the intervention of specialists.

Categorically, in the presence of which complications are possible or preliminary treatment is necessary, as well as local and temporary.

Absolute contraindications

There are diseases in which any surgical intervention is categorically not recommended, it is allowed only in case of a real threat to life. These are, for example, cardiovascular diseases, problems with blood clotting, diseases of the central nervous system, a vivid example of which is a mental disorder in which the patient may not adequately respond to the doctor's intentions. In addition, the presence of malignant tumors, diseases of the endocrine system, problems with connective tissue, liver and kidney failure is considered an absolute contraindication.

Pronounced allergic reactions to the drugs used by the doctor, as well as alcoholism and drug addiction, can be attributed to the same category.

Contraindications to dental implantation are diseases of the skeletal system, pathologically reduced immunity, as well as the age of the patient up to 22 years.

Relative contraindications

Relative contraindications include taking immunosuppressants, anticoagulants and cytostatics, which increase the risk of rejection of implanted teeth.

This also includes diseases such as diabetes, sexually transmitted diseases, HIV and many others.

It is dangerous to carry out this operation in the presence of other metal implants, exhaustion of the body, poor nutrition, severe stress, smoking, alcoholism. In this case, it is desirable to conduct a course of general healing of the body before the operation.

Local contraindications

These include various oral diseases that need to be treated before having a dental implant. This may be incorrect, inflammation of the gums, neoplasms in the oral cavity, diseased teeth with caries, and similar problems in which it may not be possible to implant a tooth well.

Temporary contraindications

There are cases when a patient cannot be placed only in a certain period, for example, during and chest, during the period of inflammation and viral infections.

The same type of contraindications includes chemotherapy and radiation therapy. In all these situations, it is necessary to wait until the end of this period, and then re-examine for general health and the presence of other contraindications.

Implantation is a surgical intervention in the human body, more precisely in the oral cavity, to restore a tooth or a number of teeth that have been lost due to many reasons. This can be hereditary, acquired dental diseases, injuries or improper hygiene. If you do not take action, then soon, due to the additional load, there will be serious problems with neighboring teeth.

How is an implant placed?

In order to avoid disastrous consequences, it is important to consider, before placing dental implants, contraindications and the presence of any diseases. An artificial tooth is based on a metal screw that is implanted into the bone tissue. Next, a prosthesis, or crown, is attached to it. The metal embedded in the bone is biologically inactive, therefore it does not harm the body and does not cause allergies.

At first, only a few large medical centers could afford to restore teeth. Now this operation is available to everyone.

Types of implants

Depending on where the implants will be installed, they are divided into several types that differ in shape.

• Root - the most common, have a cylindrical shape, similar to the root of a tooth;
• Subperiosteal - are installed on too thin bone tissue from the inside of the gums. Despite the simplicity of this procedure, such devices have their drawbacks. A metal structure is implanted under the periosteum and takes up a lot of space. Due to the lack of tissue, supports can protrude into the mouth and cause discomfort. This can be avoided by building up the bone, but not all patients agree to such an operation;
• When it comes to prosthetics of the anterior teeth, endosseous, or intraosseous, plate dental implants are installed.

Contraindications, if any, do not depend on the type of construction chosen. There is also a way to reinforce a loose tooth with endodonto-endosteal implants so as not to lose it completely.

Today, thanks to a large number of manufacturers, it is possible to individually select the type of system that fits perfectly to the anatomical structure of the patient's jaw.

Indications and benefits of implantation

As a rule, the use of artificial teeth is resorted to for medical reasons, although for aesthetic purposes, the procedure to correct defects is carried out quite often. The loss of front teeth is a serious problem that entails difficulty in chewing food. Therefore, the only way out is dental implants. Contraindications are an important point that requires special attention.

Even in cases where there are gaps in the inconspicuous parts of the jaw, it is highly recommended to implant implants in place of missing teeth (to preserve neighboring ones). This operation gives:

• minimal risk of injury to healthy teeth;
• strong and reliable strengthening of dentures in the oral cavity.

In addition, now there is no need to grind and thereby spoil the adjacent ones. Implantation is indicated when one or more teeth are missing in a row, end defects are observed, and all teeth are missing. In the latter case, a complete removable denture can be fixed.

When should dental implants not be placed? Contraindications, diseases

There are two types of contraindications for implantation - absolute and relative. The former include such severe chronic diseases as:

• tuberculosis;
• diabetes;
• oncology;
• disorders in the nervous system.

Relative contraindications:

• diseases of the oral cavity (malocclusion, periodontitis);
• pregnancy.

It is necessary to carefully study, before placing dental implants, contraindications. Pregnancy itself is not a ban, but stress in this position is very dangerous for the mother and unborn child, so no doctor will agree to perform an operation. In any case, before the procedure, it is necessary to consult a doctor and examine for the identification or exclusion of the above facts prohibiting implantation. Further, at an appointment with an orthopedist, options and methods of implantation, cost, timing and methods of treatment after surgery will be considered.

Many are concerned about the question of whether there are contraindications for dental implants for the elderly. Age doesn't seem to matter. The problem lies in the general state of human health, its attitude to medicines and anesthesia. Older people have more diseases that can become an obstacle to the procedure.

Some medical examinations have, if there are large fragments, staples, clips on blood vessels and dental implants, contraindications. MRI is one of those because of the presence of a metal foreign body in the oral cavity.

Stages of the operation

1. Examination of the patient by a specialist.
2. The gum is incised under local anesthesia.
3. A hole is drilled in the bone.
4. A metal pin is inserted.
5. The wound is sutured.

The procedure takes 30-50 minutes, the implants will take root no earlier than in two months.

The oral cavity after implantation will have to be looked after a little differently than the way we used to do it from childhood. The dentist will advise special hygiene products that must be used. In addition, after the operation, during the time that the doctor prescribes, you should not eat too hot or cold foods, as well as solid foods.

oral care

Implants are foreign bodies that need at least two months to take root. Following the recommendations will allow you to consolidate the result and enjoy new teeth for many years.

The patient may feel pain after the operation. In this case, the doctor prescribes general and local treatment. Local treatment includes rinsing the mouth and lubricating the inflamed gum area. General treatment is carried out with antihistamines and painkillers, as well as antibiotics. They have contraindications for dental implants (reviews about them overwhelm the Internet). However, they are not always objective, so it is not worth making final conclusions without a doctor.

As a rule, patients who have undergone such an operation have positive feedback. After all, the functionality of the teeth is not disturbed, and they feel just like their own. It is hardly worth talking about aesthetic effects: a perfect smile is the dream of every person who does not have it from birth. And yet, before deciding on harm, contraindications - everything must be taken into account in order to get the desired result.

Service life of false teeth

How much the patient carries is influenced, first of all, by the individual characteristics of the patient. For starters, these are biological compatibility with the implanted material, bone volume and gum structure.

On average, if you properly care for your teeth and follow the doctor's recommendations, you can wear the system for 20-25 years. However, an important role is played by the skill of the doctor and the quality of work.

4D implantation

A new method of implantation - 4D-implantation. It is practiced in Europe quite successfully. Its peculiarity is that it became possible to insert a titanium pin even into a small amount of bone tissue. Patients not only can, but should load such dental implants already two weeks after the operation (if there are no visible complications). Contraindications have not been canceled with this method, and therefore examinations and preliminary consultation with a doctor are required.

Such implantation costs less than usual, because it does not require a large number of surgical interventions. Due to the fact that the implants are integrated into the bone, there is no specific innervation in this connection. Therefore, pain with strong pressure on the artificial tooth will not be felt.

Dental implants are a modern method of solving many dental problems. True, he has many contraindications, so not in every situation it is permissible to carry out surgical intervention.

In addition, many people still hesitate to take this step due to the risk of complications.

Contraindications and possible limitations

Dental implantation is a serious step that you need to prepare for. This is because there are many restrictions. And if they are not taken into account, then serious harm can be done to the body.

Dentists, having vast experience behind them, are able to give practical advice and plan optimal treatment even in the presence of some undesirable circumstances. The main thing is patience and readiness to strictly follow the recommendations of the doctor.

Can't and period

There are absolute contraindications, in which implantation will have to be abandoned completely:

Restrictions with the possibility of a solution

Along with absolute restrictions, relative contraindications are distinguished. Treatment with implants is allowed after the elimination of the following factors:

There is another classification of contraindications associated with the sources of restrictions, according to which they may be of a general or local nature.

Local contraindications: lack of bone tissue or its unfavorable structure, insufficient distance to the nasal, maxillary sinuses and alveolar nerve, lack of habit of regular oral hygiene.

General contraindications include:

Despite a huge list of limitations, dentists find options for implantation with a positive course of surgical intervention and rapid engraftment dynamics. This is largely facilitated by modern methods and high-tech equipment.

Possible complications immediately after implantation

After surgery, the body often reacts to the appearance of a foreign body inside the jaw. There are various side effects, which, depending on the individual characteristics, may not appear at all or occur in a complex.

Most often it is:

The process of installing dental implants:

Complications at the implant healing stage

After a successful operation, it is too early to relax, as serious complications may appear at the engraftment stage. Among them are:

One step ahead of the decision

Before choosing a clinic and a treating implantologist, you need to read the reviews of patients and weigh the pros and cons. The success of the operation and the speed of implant implantation depend on the experience of the dentist.

As a rule, primary complications cannot be avoided, but these are temporary inconveniences and the main thing is that the implant takes root in the bone tissue and serves for a long time.

“It took me a long time to decide on dental implantation, as I heard a lot of conflicting reviews. For a long time I studied information on all dental clinics, and, finally, I can boast of a new tooth, which can not be distinguished from my relatives at all. The operation went well, but after it I had to endure slight difficulties. For two days the temperature was at 37.7, terrible weakness. They inserted a six from above, the right cheek swelled a little, but after a couple of days the swelling began to subside. In general, the recovery process went smoothly, implantation was easy. Thank you doctor!

Marina, Moscow

“The implantation of two teeth went relatively smoothly for me. I had to take into account a lot of nuances in the course of preparation for the operation, I took a course of vitamin therapy, since I have a tendency to frequent colds. Additional support of immunity with vitamins accompanied the entire course of treatment until the teeth were completely healed. In general, there is little that can be said about the operation, since anesthesia worked, but after the pain was palpable. Pleasant little, but the result deserves it. Before full implantation, he often visited the dentist, but there were no complications.”

Stepan, Sochi

“If I knew that such a long process of inserting implants, I would hardly have agreed to them. At first everything was fine, no contraindications were found. The operation went well, but after anesthesia, severe pain was felt, bleeding of the gums was observed, and there was a high temperature. Over time, everything seemed to go well, but for some reason the tooth did not take root, it began to stagger a little. The dentist prescribed a course of treatment, installed the implant back. So far everything is functioning normally, but for now I visit the doctor regularly. ”

Oksana, Penza

33.2. INDICATIONS AND CONTRAINDICATIONS FOR DENTAL IMPLANTATION. CHOICE OF IMPLANT DESIGN

Testimony to dental implantation are:

Partial defects in the dentition in the frontal or end sections;

Complete absence of teeth in patients without atrophy and with atrophy of the alveolar processes of the jaws;

Persons who cannot use removable dentures (increased gag reflex, allergic reactions to plastics, congenital and acquired jaw deformities).

Dental implantation is performed in young and middle-aged people. However, in elderly patients, with good general condition and the absence of contraindications, it is also possible to perform it.

Contraindications for dental implantation can be absolute And relative, general And local.

Absolute contraindications are:

Chronic somatic diseases of the body (tuberculosis, collagen autoimmune diseases - rheumatoid arthritis or Sjögren's syndrome, etc.);

Severe diseases of the cardiovascular system;

Endocrine diseases (diabetes mellitus, toxic goiter, dysfunction of the pituitary or adrenal glands, etc.);

Diseases of the skeletal system (dysplasia, osteodystrophy, osteoporosis);

Systemic connective tissue diseases (lupus erythematosus, scleroderma, etc.);

Diseases of the blood and hematopoietic organs (leukemia, agranulocytosis, coagulopathy, anemia, etc.);

Mental illness (psychosis, neurosis, etc.);

Radiation sickness;

chronic alcoholism;

Addiction;

The presence of malignant tumors (inoperable tumors, chemotherapy treatment, high doses of radiation therapy).

Relative general contraindications :

Diseases associated with a lack of intake of vitamins in the body (avitaminosis);

respiratory diseases;

Specific diseases (syphilis, actinomycosis);

Preoperative radiation therapy of malignant tumors at their early stages of development in organs and tissues located far from the maxillofacial region;

Dysproteinemia due to inadequate protein nutrition;

Dysmenorrhea;

Pregnancy;

Infectious diseases;

During the period of deterioration of the general condition of the body, due to various reasons (increased blood pressure, etc.);

Exacerbations of the chronic course of inflammatory diseases in various organs and tissues;

Absolute local contraindications for dental implantation can serve:

Malignant tumors of soft tissues and bones of the facial skeleton;

Benign tumors and tumor-like formations (dysplasia) of the jaws;

Radiation necrosis of the jaws (osteoradionecrosis);

The presence of precancerous diseases of the red border of the lips or the mucous membrane of the oral cavity;

The presence of clinical symptoms of metal intolerance (applies to metal structures of implants);

Severe form of generalized periodontitis and periodontal disease;

Idiopathic diseases with progressive damage (lysis) of periodontal tissues (Papillon-Lefevre syndrome, etc.);

Systemic connective tissue diseases with their manifestation in the maxillofacial region;

Low hygienic culture of the patient or his unwillingness to maintain high oral hygiene.

Relative local contraindications :

Exacerbation of chronic (periodontitis, periostitis, etc.) and the presence of acute (abscess, phlegmon, etc.) inflammatory processes in soft tissues and jaws;

Destructive processes in the jaws of non-tumor origin (osteomyelitis, cysts), provided that filling of postoperative bone defects with osteoplastic materials (bioinert or bioactive ceramics, etc.) is included in the complex of their treatment;

Gingivitis, stomatitis, tonsillitis, sinusitis;

When treating diseases of the peripheral nervous system (neuralgia, neuritis, etc.);

Diseases of the temporomandibular joint (arthritis, arthrosis, dysfunction);

Pathological bite;

Poor oral hygiene.

Of course, this short list cannot take into account all possible diseases and conditions that can cause complications during dental implantation. Therefore, the doctor needs to be especially careful and thoughtful when preoperatively examining the patient and choosing him for dental implant surgery.

After making a positive decision on dental implantation, the doctor needs to justify the choice of material and design of the implant. The design of the implant is selected based on the topographic and anatomical features of the patient's dentition and jaws. In frontal section cylindrical implants are used, and in distal- plate and cylindrical implants.

According to G.M. Weiss (1992) the choice of implant design also depends on type of alveolar process of the jaw. At wide alveolar process both cylindrical and plate implant designs can be used. If alveolar process of medium width, This is the advantage of plate implants over cylindrical ones. At narrow alveolar process not endosseous, but subperiosteal implantation is shown.

According to K.P. Konstantin (1997) when implanting, it is necessary to take into account thickness of the mucoperiosteal flap, located along the crest of the alveolar process of the jaw, the width of its bone And the size of the loops-lacunae of the cancellous bone at the intended injection sites. The author noted that in patients with a thickness of the mucoperiosteal flap located along the crest of the alveolar process of the jaw of 1-5 mm and a width of its bone part of 3.5-5.5 mm, X-ray revealed medium looped(1-2 mm) spongy bone. With a thick (5 mm or more) mucoperiosteal flap along the crest of the alveolar process and narrow (up to 3.5 mm) of its bone part - small-looped(up to 1 mm), and with a thin (up to 1 mm) mucoperiosteal flap of the alveolar ridge and a wide (more than 5.5 mm) of its bone part - large-looped(more than 2 mm) spongy bone structure (Fig. 33.2.1).

Rice. 33.2.1. Large - (a), medium - (b) and small-loop (c) structure of the bone tissue of the jaw at the site of the planned implant insertion (according to K.P. Konstantin).

1 - almost the entire thickness of the jaw consists of a homogeneous compact bone;

2 - a thick layer of compact bone, placed around a dense trabecular bone;

3 - a thin layer of compact bone covers a dense trabecular bone;

4 - a thin layer of compact bone surrounds loose trabecular bone.

V.P. Protasevich (1998) believes that three main types should be distinguished architectonics jaw bones:

Type I - bone of increased density. The spongy layer is thin and is represented by powerful trabeculae. The ratio of compact and spongy layers can be expressed as 2:1;

Type II - bone of medium density. The spongy layer is represented by a well-developed network of strong trabeculae and is surrounded by a compact layer of bone 2–3 mm thick. The ratio of compact and spongy layers is 1:1;

Type III - the spongy layer is represented by a few thin trabeculae and is surrounded by a compact layer, the thickness of which does not exceed 1 mm. The ratio of compact and spongy layers is less than 0.5: 1. This type of architectonics corresponds to the state of regional osteoporosis.

With the structure of the jaw bone tissue, which corresponds to types I and II, the author prefers screw and cylindrical implants, because. with these types of architectonics, there are conditions for achieving osseointegration.

According to R.A. Levandovsky (1996), the implant should be of such thickness that after it is inserted into the alveolar process of the jaw, the thickness of the bone walls should not be less than the thickness of the implant itself. That is, the thickness of the implant should be no more than 1/3 of the width of the alveolar process of the jaw.