Artificial objects that are placed in the body and fulfill the function of a tissue or organ are referred to in medicine. implant ” is named. The word is derived from the word “implant”, the Latin “implantare”, the verb to plant. Artificial elements placed in the mouth to function as a tooth root are also called implants. Other synonymous names of artificial roots used in the mouth dental implant, dental implant, oral implant, intraosseous implantand this is a synonym for the last endosseous implant are words. We can summarize the general definition of dental implants as “elements that are applied to the jawbones instead of missing teeth and support the prosthesis”.
Looking at its history, it is supported by archaeological findings that even in the Egyptian and Maya civilizations, artificial materials such as jade, etc., were planted in the jawbone to replace the lost teeth. In 1908, Greenfield patented the first dental implant in the USA. Until the middle of the last century, many dentists made similar applications to the implants used today. However, all of these approaches and efforts remained empirical applications and studies that did not go beyond case reports. Branemark et al. and Schroeder et al. with pure titanium implants. Branemark investigated the subject in more detail in 1955, noticing the tight adaptation between bone and titanium during an experiment examining revascularization in rabbit tibias by vital microscopy. Branemark et al. described this phenomenon as ” osseointegration‘ and defined it as ‘direct contact between living bone tissue and titanium implant, observed with magnification at the light microscope level’. The same researchers later reinforced this phenomenon with the definition of ‘direct structural and functional connection between living bone tissue and the implant surface under load’. Swedish researchers have pioneered the scientific platform of the subject by bringing the results of the treatments applied for the rehabilitation of total edentulous cases with fixed prosthesis since 1965 to the dentistry literature with two publications in 1969 and 1977.
In this treatment concept, prostheses fixed with occlusal captive screws are made on four to six implants placed in the anterior regions of the lower and upper jaws. Osseointegrated dental implants, which initially emerged for the rehabilitation of cases of total edentulism, have expanded the field of indications in the light of the successful results found over time and have become to cover the treatment of all forms of tooth deficiency. Today, the use of osseointegrated implants in dentistry has become quite common. The main target of intraosseous oral implant applications is the rehabilitation of all kinds of edentulism with osseointegrated implants and implant-supported prostheses. The implantation procedure described by Adell (1) for root-shaped implants, following the removal of the mucoperiosteal flap under local anesthesia, was performed at a speed of 2000 revolutions per minute and under cooling with sterile saline solution, using the drills with increasing diameters, respectively, prescribed by the implant system, and the implant was lengthened in diameter and length. preparation of the equivalent bone cavity, cutting the implant threads in the bone at a speed of 20 revolutions per minute, placing the implant at the same speed, and finally suturing the flap. This method, which is specific to the Branemark implant system, is called the Branemark method ( my name mod Branemark) was named (44).
The surgical method of the Branemark system, the spread of cylindrical and screw-shaped implant systems, and some differences in terms of revolution per minute with other implant systems, the fact that the size of the bur used is unique in each system, the use of internal cooled burs by some systems, and the use of smooth cylinder implants with a hammer at the end of the surgical phase. Although there are differences such as placement, low cycle, sterile cooling and atraumatic surgery principles are accepted and applied (40). Instead of attributing the aforementioned implantation method to an implant system and investigator, many investigators prefer atraumatic precision surgical procedureThey prefer the term (atraumatic meticolous surgical procedure) (44).
The stages of the atraumatic precision surgical procedure used in root-shaped implants are as follows:
– Application of general anesthesia, sedation or local anesthesia according to the situation of the case;
– Crestal or vestibular incision;
– mucoperiosteal flap removal;
– Using the burs of the implant system used in growing diameters and in accordance with the length of the implant to be used;
– Preparation of the intraosseous implant socket with a certain number of revolutions per minute.
Studies have shown that exposing the living bone tissue to a temperature above 43°C for 1 minute is a critical point for the denaturing of bone cells (21,22,25). In the light of these studies, Albrektsson (2) reported that the maximum speed should be 2000 revolutions per minute while preparing the bone cavity. In contrast, Babbush et al. (10) reported that a maximum speed of 500 rpm in externally cooled bur systems, 1500-1600 rpm in internal cooling systems and 0-20 rpm in implant placement. Sandallı (38), on the other hand, stated that different bone quality was encountered according to the anatomical regions and therefore it was not sufficient to work at standard speeds while preparing the implant socket, and stated that it would be appropriate to work at the lowest speed that could cut the bone. During the placement of the implant, the surface of the implant should never be contaminated in order to avoid any infection or foreign body reaction. If the implant body has to be held with a hand tool for any reason, this tool must be titanium or titanium coated. It has been suggested that following implantation, the implant should be kept away from chewing forces and trauma under the oral mucosa to achieve osseointegration (1,3).
This period, which is called the recovery period, is accepted as 3 months for the lower jaw and 6 months for the upper jaw. According to the implants applied according to this technique, fully embedded (submerged) or surgical application. double surgical stage They are called (two-stage) implants. On the other hand, a group of researchers is open to the oral environment, transmucosal(non-submerged) and single surgical stage Proving that osseointegration will be achieved with (one-stage) implants, they argued that the relationship with the oral flora would be healthier by forming the peri-implantar connective tissue attachment from the initial period in this type of implant (17). Collaert et al. (19) could not find statistical significance between the groups in single-stage and double-stage applications with Branemark system implants. Sandallı (38) applied dual surgical stage Pitt-Easy Bio-Oss implants as a single stage and showed that they are osseointegrated in the same way. Blade implants, which are called semi-submergible or semi-open in the oral environment, have also been shown to be osseointegrated when placed with atraumatic surgery (30,37).
In implant applications, besides materials such as monocrystalline sapphire, aluminum oxide, titanium-aluminum-vanadium alloy, pure titanium has been the most used. When considered according to the surface properties, we come across polished pure titanium, titanium plasma spray or hydroxyl apatite coated implants(5). It has been reported that there are over 600 implant systems available today (26-47). In any intraosseous implantation procedure, osseointegration between bone and implant and its preservation can be achieved when a delicate surgical procedure and appropriate loading are provided according to the characteristics of living bone tissue. Studies show that most of the implant losses occur in the first year following the operation. The early occurrence of losses suggests that failure may be due to surgical errors or inappropriate prosthetic conditions. However, what is certain is that the surgical application technique directly affects the success or failure, which reveals the importance of the surgical stage in implant applications. After implantation, the desired bone response in the host region is remodeling. The first stage in the bone response is the compensation of non-viable tissues that initially surround the implant. Bone repair of the necrotic implant cortex depends on the presence of a sufficient number of cells, adequate nutrition of these cells, and sufficient stimulus for bone repair.
The heat released during the surgical phase is the first cause of failure. As a result of the research, it has been revealed that an atraumatic and controlled surgical method should be followed when an integration in the bone-implant relationship is desired. In implant applications, besides materials such as monocrystalline sapphire, aluminum oxide, titanium-aluminum-vanadium alloy, pure titanium has been the most used. When considered according to the surface properties, we come across polished pure titanium, titanium plasma spray or hydroxyl apatite coated implants. The implants used today are mainly produced from pure titanium and there are more than 600 implant systems in the world markets. Having as much contact area with the bone as possible in an implant that will be exposed to prosthetic loads is a factor that increases success in the long term. One of the ways to increase the contact area is to choose the longest and widest diameter implant, as anatomical conditions allow. One of the basic conditions of implant applications is that the implant placed in the bone is surrounded by bone from all sides. Therefore, making use of the anatomical conditions of the jaw bones as much as possible is an element that increases the resistance against occlusal forces both in terms of primary stability and during function. .
In order to understand who will be implanted or not, it is necessary to take the general anamnesis of the case first. The candidate for implant treatment should not have general medical contraindications. Blood diseases, HIV, hepatitis viruses are the factors to be considered in the evaluation. Systemic and local contraindications that should be considered especially in terms of implantology: diseases related to bone metabolism (eg, fibrous dysplasia, Paget’s disease), diabetes mellitus, alcoholism, smoking habit, bruxism, psychic disorders, bad habits, chewing habits. It should be remembered that implants can be applied under certain conditions in patients receiving radiotherapy. There is no maximum limit for implant applications in terms of age, but there is a minimum limit. In other words, there are some rules restricting the application for young individuals. In young individuals, implantation should be preferred after skeletal development is completed. For this purpose, the skeletal age of the individual is determined by evaluating the osseofication of the hand-wrist bones on the hand-wrist radiography. Cases of congenital tooth germ deficiency, ie agenesis, are successfully rehabilitated with dental implants. The most important problem that we encounter in this type of applications is what kind of bone tissue reactions the metallic implants will create in the growing young individual.
There are three main indication groups in the treatment of tooth deficiencies with implants: total, partial and single tooth deficiencies. Each group has its own treatment formats.
Total edentulism Rehabilitation with implants is found to be more successful than classical prosthetic treatment in patients with Three types of prosthetic solutions are applied in the treatment of total edentulous jaws: 2 implant supported removable dentures, 4 implant supported removable dentures, and fixed prosthesis on 5 or more implants. In such cases, 4 implants should be preferred instead of 2 in terms of prosthetics and increasing the chance of long-term use.
partial edentulism Since the cases of total edentulism differ from the cases of total edentulism in terms of aesthetics, biomechanics and microbiology, there are specific rules to be considered during the treatment planning stage. Points to be considered in such cases: number of implants, implant diameter and length, implant localization, intermaxillary space, periodontal health of existing teeth, implant-tooth connection (attachment types). In cases of partial edentulism, implant-tooth connection can be made, and only implant-supported prostheses can be applied.
Single tooth deficiencies This indication has taken its place among the routine implant treatments, with the successful results of studies on compensation with implants being detected in various studies. This indication differs from other applications due to the high aesthetic expectations of the patients. The most important factor that ensures success in the treatment is to perform the implant localization correctly in the planning phase and in the surgical phase. Another equally important factor is the provision of a “red aesthetic”, which describes the soft tissue contours, as well as the “white aesthetics”. In order to achieve red aesthetics, it has been determined that the bone-supported mucosal thickness, the level of the papillary and crown margins should be compatible with the adjacent teeth, especially in the anterior regions. One of the most important factors affecting soft tissue contours is flap design. By estimating the flap tension to be obtained after the implant application, taking into account the membrane and/or biomaterial applications; Considering the nutrition of the flap and the hard tissues underneath, the decision for vertical incisions should be made and the flap design appropriate for the case should be selected. In routine cases, the “aesthetic window” flap type, which includes the papilla protective flap and the incision technique to determine the bucco-palatal localization of the implant, has been found to be useful. The use of porcelain posts and palatal screws for white aesthetics provides additional aesthetic contributions. Parallelization of implant posts with each other and with other teeth in the mouth is one of the main problems encountered in implant applications, especially in the upper jaw. Another problem we encounter is that the implant post and the prosthetic structure it carries on the implants placed to eliminate single tooth deficiencies loosen and rotate over time under the influence of chewing forces. In cases where such prosthetic problems are encountered, straight or angled screw posts of the implant system with an interlock system that prevents rotation are used. As a result, “success” in implant applications in single tooth deficiencies can be achieved by meticulous treatment planning and prosthesis construction.
In summary, dental implants, which have specific examination, planning and application rules, have become one of the routine dentistry treatments in the light of more than 40 years of modern-scientific implantology data, and today they heal many patients.
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