What happens if a tooth is not restored?
The jaw bone exists for the sake of the teeth and lives according to the load rule: while the root transmits chewing pressure, the bone tissue is renewed and maintains its volume. As soon as the tooth is removed, the ridge area stops receiving load, and its restructuring begins - the wall of the socket becomes thinner, the ridge becomes lower and narrower. This happens most noticeably in the first months and during the first year; then the process slows down, but does not stop.
At the same time, the entire structure of the dentition changes. Neighboring teeth lose support on one side and slowly lean into the gap, cracks open between them where food gets stuck. The antagonist tooth on the opposite jaw, having lost its pair, begins to move out of its socket along with the gum and bone. After a few years, the gap ceases to be just a gap: in order to place an implant and crown, you first have to return the tilted teeth to their place orthodontically or shorten the protruding antagonist. That is why the phrase “I look like this for now” is more expensive than it seems, and we are not talking about money, but about the volume of future treatment.
- Bone loss in the area of the extracted tooth, most pronounced in the first year
- The tilting of adjacent teeth into the space and the appearance of food pockets
- Protrusion of the antagonist tooth and disruption of closure
- Overload of remaining teeth and accelerated wear
- Shift of chewing to one side and associated muscle and joint tension
- In the absence of front teeth - changes in speech and retraction of the soft tissues of the lip
Why is it not as painful as people think?
Fear of implantation is largely based on the word “surgery” itself and the idea that a screw is being screwed into living, sensitive bone. The bone inside has almost no pain receptors, and local anesthesia completely turns off the sensitivity of the gums and periosteum. Installation of one implant under favorable conditions takes from twenty to forty minutes, of which the actual work with the bone takes several minutes. Most patients who have already had tooth extraction experience later say that the removal was more difficult to bear.
- During surgery, pressure and vibration are felt, but no pain.
- Swelling after installation of one implant is usually small and lasts two to three days
- Painkillers are usually needed in the first day or two
- In cases of severe fear, sedation is used, in which the intervention is tolerated as a short nap
- Multiple implantations and bone grafting are more difficult to tolerate than a single implant - this should be taken into account when planning
- Stitches are usually removed after 7–10 days, and this is a painless procedure
The second misconception is about timing. There really is an expectation, but a person does not walk around with a hole in his teeth all this time. In most cases, a temporary structure is placed during the healing period: a removable denture of one or two teeth, an adhesive bridge, or, if the situation allows, a temporary crown directly on the implant. Therefore, it is more correct to say not “two years without a tooth”, but “several months with a temporary crown while healing takes place.”
Time frame: from removal to permanent crown
The main thing that is expected during implantation is osseointegration, that is, the fusion of the titanium surface with the bone at the microscopic level. This process cannot be accelerated by desire: it is subject to the biology of bone healing. The timing depends primarily on the jaw, because the lower bone is denser and healing in it proceeds faster than in the looser upper one.
- Немедленная имплантация — имплант ставят прямо в лунку сразу после удаления зуба. Возможна не всегда: нужны целые стенки лунки и отсутствие острого гнойного воспаления. Экономит время и лучше сохраняет контур десны.
- Ранняя имплантация — через 6–8 недель после удаления, когда десна зажила, а кость ещё не успела значительно перестроиться. Частый компромиссный вариант.
- Отсроченная имплантация — через несколько месяцев после удаления, на полностью зажившем гребне. Самый предсказуемый путь при воспалении или разрушенных стенках лунки.
- Приживление на нижней челюсти занимает в среднем 2–4 месяца, на верхней — 4–6 месяцев, после костной пластики срок увеличивается.
- Установка формирователя десны и формирование её контура — обычно 2–3 недели.
- Снятие слепка или цифровое сканирование, изготовление и фиксация постоянной коронки.
When is bone grafting and sinus lift needed?
The implant must be surrounded on all sides by bone - only then is it stable and the gums around it look natural. If the ridge has become narrow or low, the bones are built up. This is not a complication or a sign that the “case has been neglected”: this is a planned stage, which is planned according to a three-dimensional image in advance.
- Guided bone regeneration - bone replacement material is placed on the defect and covered with a membrane; often performed simultaneously with implant placement
- Split ridge - the narrow ridge is spread apart and an implant is placed in the resulting space
- Bone block transplantation - in case of a significant defect, requires a separate stage and time for engraftment
- Closed sinus lift - raising the bottom of the maxillary sinus through the implant bed, when the height of the bone is slightly lacking
- Open sinus lift - access from the side, with a significant lack of height; the implant is placed at the same time or in the second stage
- Alternatives to extensions: short implants, inclined installation, use of other parts of the jaw
The upper chewing teeth are the most common place where a sinus lift is required. The reason is anatomy: above the roots of these teeth there is a maxillary sinus, and after a tooth is removed, its bottom often drops, leaving only a few millimeters of bone. After an open sinus lift, you should not blow your nose forcefully for a week or two, you should sneeze with your mouth open, do not fly on an airplane or dive - sudden changes in pressure can disrupt healing. These restrictions seem trivial, but it is their failure to comply that most often spoils the result of a well-done operation.
Who should not and what should be done before surgery
There are few absolute contraindications; much more often we are talking about conditions that need to be put in order before intervention. Implantation in an oral cavity with active periodontitis and untreated caries means placing pure titanium in an environment full of pathogenic biofilm, and such an implant is highly likely to encounter inflammation in the first years.
- First, caries is treated, dental plaque is removed and gum inflammation is brought under control - this is not a formality, but a condition for the long service life of the implant
- Uncompensated diabetes mellitus dramatically impairs healing; with good glucose control, implantation is possible
- Smoking is the most significant controllable risk factor: it impairs blood supply to the gums and increases the likelihood of inflammation around the implant
- Taking medications for osteoporosis from the group of bisphosphonates and the like requires mandatory discussion with a doctor before surgery.
- Previous radiation therapy in the head and neck area, severe coagulation disorders, acute conditions - the issue is resolved together with specialized specialists
- Incomplete jaw growth in adolescents - implantation is postponed until growth is complete
- Grinding of teeth and the habit of clenching the jaw require a protective mouth guard, otherwise overload will destroy the structure
How long does an implant last and what does it depend on?
The titanium root is not destroyed by caries and does not hurt, and this is the main trap: people think that the implant does not require attention. In fact, it is not the metal that fails, but the bone and gums around it. The most common cause of long-term implant loss is peri-implantitis, inflammation of surrounding tissues with gradual bone loss, which occurs without pain for a long time. Therefore, durability is determined not so much by the brand of the implant, but by daily hygiene and regular inspections.
- Гигиена дважды в день, обязательно с очисткой промежутков: ёршики подобранного врачом размера, суперфлосс, ирригатор.
- Профессиональная гигиена и осмотр не реже одного-двух раз в год, а при перенесённом пародонтите — чаще.
- Контрольный снимок области импланта через год после установки и далее по назначению врача: он сравнивается с исходным и показывает малейшую убыль кости раньше любых жалоб.
- Отказ от курения — самый недооценённый вклад в срок службы конструкции.
- Защитная капа при скрежете зубами и своевременная коррекция смыкания.
- Контроль общего здоровья, в первую очередь уровня глюкозы крови.
The choice of implant system should be discussed separately, without discussing cost. What matters is not so much the origin of the propeller, but three practical circumstances: whether this system has been studied in long-term observations, whether it has a full line of components and whether it will be available in ten years. The implant lives for a long time, and sooner or later it may be necessary to replace the abutment or crown - if the manufacturer leaves the market, replacement becomes a problem. Therefore, the question “which system are you using and why exactly” is appropriate at the first consultation.