Surgery

Dental surgery is a specialized field that involves the diagnosis, treatment, and management of common disorders and diseases of the mouth, teeth, and surrounding structures.

Dental Implantation:
What You Need to Know

Implantation is the installation of an artificial tooth to replace a lost one. If you have had a tooth extraction, we recommend getting an implant. This is the most modern and safest way to restore a tooth. The new artificial tooth will be both beautiful and strong. In this way, you can restore a single tooth, several teeth, or even an entire row. The artificial teeth will look and function just like natural teeth—both in function and aesthetics.

How does an artificial tooth work?

  1. An implant is an artificial root (usually made of titanium) that is placed by a dental surgeon into the bone tissue.

  2. The abutment (or post) is a “connector” between the implant and the crown.

  3. The crown is the visible part of the tooth, placed by a prosthodontist. Typically, the crown is made from ceramics or zirconia.

  4. Everything is ready! You now have a functional new tooth. Our primary task is to maintain the treatment result. This means you need to come for professional cleanings and examinations at least twice a year.

Today, there are several methods for implant placement, and all of them (according to indications) are used at Art Smile Clinic:

  • Classic Two-Stage Implantation
  • One-Stage Implantation – Using this technology, we place an implant and immediately apply a healing cap or temporary crown.
  • Immediate Implantation – An implant is placed immediately after tooth extraction (immediate implantation). For this to be performed, it is necessary that the gum tissue does not become infected or inflamed after the tooth extraction, and the bone tissue must be in the required quantity.
  • All-on-4 Implantation
  • All-on-6 Implantation
  • All-on-8 Implantation
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All on 4

All-on-4 means “all on four.” The doctor places only 4 implants in one jaw, and then a fixed denture is secured onto them. The teeth look, feel, and function like your natural teeth.

It consists of two phases:

  1. 4 dental implants are fixed into the upper or lower jaw. These are small titanium screws that replace the root parts of lost teeth.
  2. Immediately after the implantation of the jaw, a temporary prosthesis is placed onto the 4 implants. (In some cases, the temporary prosthesis is secured 3-7 days after implantation.) Once the implants have fused with the bone (3-6 months), a permanent fixed prosthesis is placed.

Disadvantages of the All-on-4 Method

After implantation and the placement of such prostheses, there may be a loss of bone volume. Therefore, we do not recommend the All-on-4 technique for younger patients. For this age group, classic implantation is recommended.
“All-on-4” is a suitable technique for patients over the age of 60-65.

All-on-6

All-on-6 is a safe technique where the surgeon places 6 implants instead of 4.

Six is the optimal number of implants to allow the proper placement of titanium implants.

What is the difference between the All-on-6 and All-on-4 techniques?

While these technologies are similar, there are some key differences:

  • All-on-6 is suitable for patients with severe bone atrophy: The 6 implants placed in areas with normal bone condition provide reliable support for the All-on-6 prosthesis. However, in some cases, bone volume might need to be increased, which will be clarified during an individual consultation with the implantologist.

  • All-on-6 prostheses are recommended for younger patients, whereas the All-on-4 technique is more suitable for older patients. It is well-known that bone tissue in the area of the lost tooth gradually shrinks, and this shrinkage can only be stopped by implant placement. This means that the more implants, the better the bone condition.

  • All-on-6 implantation creates a stronger base for the prosthesis and the prosthesis lasts longer because the load is distributed across six points instead of four.

Tooth Autotransplantation - What is it?

Autotransplantation is the transplantation of tissue from the same patient. Tooth autotransplantation is a procedure in which a tooth that is not essential for chewing (such as an “eight” or an extra tooth) is transplanted into the location of a lost tooth, where it is most needed.

Which tooth can be a candidate for transplantation?

Most commonly, the donor tooth is the “wisdom tooth” or third molar. Transplantation of the wisdom tooth is the most popular option. As known, the wisdom tooth hardly participates in the chewing process, is difficult to clean, and cavities easily develop on it. Even a retained tooth (i.e., one that has not erupted) can serve as a donor.

Are only wisdom teeth transplanted?

Supernumerary teeth are also suitable for autotransplantation, as long as they are healthy and appropriate in shape and size.

There are teeth that “stand out” from the dentition, cause inflammation, and do not enhance the smile. Sometimes the only way to deal with such a tooth is to extract it. Then, this tooth becomes a candidate for autotransplantation and can completely replace the missing adjacent tooth.

The donor tooth must be healthy, intact, and its root system should align with the root system of the extracted tooth: it is impossible to transplant a tooth with four roots to replace a tooth with two roots.

When is transplanting necessary?

The first permanent molars (chewing teeth) in children and adolescents are especially prone to rapid decay, which quickly progresses and destroys the teeth. If such a tooth is extracted without being replaced, it can lead to malocclusion. Artificial implants should not be placed in adolescents because their jaws are still growing, and teeth shift their positions.

In this case, autologous tooth transplantation is an ideal solution. Furthermore, in adolescent teeth, the pulp (neurovascular bundle) is still larger, and during transplantation, it can survive with new vessels, allowing the transplanted tooth to stay alive.

Tooth transplantation is also suitable for adult patients: the procedure will cost less than installing premium implants, and such a tooth will take root more quickly and easily than an artificial one.

Autotransplantation is used in cases of congenital absence of teeth or when a tooth is lost due to trauma.

Are there contraindications for surgery?

Autotransplantation is not possible if the donor tooth is not suitable in size, or if the root has an unusual shape. In such cases, extraction may be difficult and traumatic, potentially damaging the donor tooth during the process.

The younger the patient, the higher the chances of successful transplantation without complications. Therefore, autotransplantation is not performed on elderly patients.

Which doctors perform autotransplantation?

Tooth transplantation is a complex treatment that involves a whole team of dental specialists:

  • The surgeon performs the surgery, removes the damaged tooth, and transplants the donor tooth in its place.
  • The endodontist treats the canals in the replacement tooth.
  • The prosthodontist strengthens the tooth with a crown.

Do I need any examination before the surgery?

First of all, it is essential to ensure that the replacement tooth and the base of the extracted tooth align properly according to the 3D scan images, which allows for a preliminary assessment of the tooth parameters.

Absolute accuracy is needed here, so we create a 3D digital model of the donor tooth and print it using a 3D printer.

How does autotransplantation work?

The surgeon carefully (minimizing damage to surrounding tissues) removes the damaged tooth and performs a complete 3D fit.

Next, the replacement tooth is extracted with great care and relocated as quickly as possible to the site of the extracted tooth. The quicker the transplant is done, the more living cells will remain in the replacement tooth, improving its attachment. If the tooth has been missing for a long time, a new socket is surgically formed.

The final step is to stabilize and strengthen the transplanted tooth using a splint (a wire that connects to adjacent teeth with a light-curing composite material to hold the tooth in place). And that’s it, the procedure is complete!

And what happens after the operation?

During the healing period, the transplanted tooth is temporarily isolated from the bite—so it does not come into contact with other teeth or participate in the chewing process.

In adult patients, root canal treatment should be performed about two weeks after the surgery. Unlike adolescents, in adults, the neurovascular bundle does not regenerate. To avoid complications, it is removed.

Once the canals are treated and sutures are removed, the final phase is orthodontics. A depulped tooth (meaning the nerve is removed) becomes brittle, so it is reinforced with a beautiful and durable ceramic crown. Now, you can be assured that your new tooth will last for many years.

How long does the operation take?

Depending on the complexity of the case, the surgery can last anywhere from 45 minutes to 2.5 hours.

How does the transplanted tooth take root and what are the possible complications?

Donor teeth in autotransplantation successfully take root in about 90% of cases, similar to artificial implants. However, there are potential complications:

  • Rejection of the transplanted tooth
  • Destruction of the transplanted replacement
  • Hypermobility (excessive movement) of the tooth
  • Obliteration of the pulp (loss of vitality)
  • Pulp necrosis
  • Root resorption

In adult patients, teeth usually have fully formed roots, so they must be depulped to protect the transplanted tooth from complications. If everything is done according to the procedure, and the depulped tooth is reinforced with a crown, it will take root with a success rate of 80-95%.

How is a classic two-phase dental implant procedure performed?

1. First Phase:

- Examination and thorough diagnosis (including X-rays, 3D scans, etc., based on indications).
- During the procedure, the implant is placed into a socket that has been previously prepared for implantation.
- The implant is closed with gingival sutures, and it typically takes around 3 months for the implant to integrate into the lower jaw and 4-6 months for the upper jaw.

2. Second Phase:

- Initially, a healing abutment and, if necessary, a temporary crown are placed.
- After 10-14 days, measurements are taken, and a permanent crown is made and placed.

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