Dr. Andrijevskis: “To smile again!”
Each person can experience a moment when smiling is uncomfortable because of a missing tooth. Dental implants are the best solution to replace missing teeth. Our leading expert of dental implantology, doctor Sergejs Andrijevskis, explains how to smile comfortably again.
Why it is important to replace a missing tooth with an artificial one even if the missing tooth is not visible and does not cause discomfort for a patient.
Of course, there are people who live their remaining life like that. But if the tooth is missing for a long period of time it causes the deformation of the jawbone, which leads to changes of the face shape and lip lining, leading to the wrinkles around the mouth. If the tooth right next to the missing one has no support, it can migrate to the gap. The bite can change and teeth become loose.
Where to start if patient considers placement of the implant?
First the patient has to have consultation to do the x-rays, CT if needed, because sometimes in the location of the missing tooth there can be reduced bone volume. In such cases, bone grafting must be performed before the implantation.
What causes changes in the bone
Bone atrophy in the place where the tooth is missing occurs because there is a decrease in the need for intense blood supply and nutrients. The longer the period after the extraction, the more plausible that grafting will be necessary. Bone volume tends to decrease also after use of removable dentures for long periods.
Do the bone changes occur in case of a devitalized tooth?
No, that’s why sometimes it is recommended to preserve even the devitalized tooth.
I have heard about both artificial and graft from patient’s own body to prepare jaw for implantation.
Mostly artificial bone is used. In cases when patient’s own bone is used it is a more complicated procedure (and costs for about 1000 euros more) because bone needs to be gathered from somewhere, mostly from chin or mandibular angle. Formerly bone graft was taken from the hip, but it was too soft.
What happens if organism rejects the artificial bone?
In those 2% of cases when non-union between the artificial bone and recipient’s bone occurs, procedure is performed repeatedly, and usually second attempt is successful, but if the union of bones fails again, the next step is bone graft from patient’s own body or another method to replace the missing tooth, for example a dental bridge. What is a dental bridge? It means that both teeth on either side of the gap are prepared by removing a portion of enamel, these teeth form part of the bridge which holds the artificial tooth. It is a great solution when implantation is not an option because of health problems, which interfere with the stability of an implant.
Which health conditions cause problems for implantation?
This group includes oncological patients and patients suffering from osteoporosis, which are treated using bisphosphonates, which are widely used in Great Britain during the chemotherapy and radiation therapy. Implants can be placed only five years after the last treatment session is completed. Also severe health conditions such as stroke, myocardial infarction, tuberculosis, and psychiatric diseases can cause problems for implantation. There are several relative risks such as smoking. Odds of non-union of implant to the patient’s bone for smokers is 10-15%. Smokers also have to be aware that smoking must be avoided for two weeks after implantation.
Is there age limitation for dental implants?
Dental implantation can be performed for patients who are at least 16 years old with no upper age limit.
Which implant materials are best to choose?
System of dental implants consists of several components – implant fixture which is placed in a jaw bone, abutment which functions as a connecting element and crown or artificial tooth, which is placed on the abutment. Most popular material for fixture is titanium, if it is made in a country with approved quality control, it would be a problem to make it incorrectly. Abutment and crown usually are made of the same material, which can be chosen – metal-ceramic or zirconium.
Advantage of metal-ceramic is lower price (for about 150 euros). It is suitable for patients with thick gums or if the implantation is in the back part of the mouth. While zirconium abutment and crown are more expensive, it is also more aesthetic if incisors are replaced, because zirconium abutment is invisible in case of thin gums (there can be a grey line between crown and gums if metal-ceramic is used).
What is the process of dental implant placement?
After the doctor’s consultation, the patient receives treatment plan which consists of several appointments. If bone grafting is necessary, then as I mentioned previously, initial stage is bone grafting, but in case of minimal decrease of bone volume grafting and fixture placement can be performed at the same appointment.
2-6 months after placement of fixture, it is stable and healing cap can be placed to help surrounding gum tissue to heal correctly.
After two weeks, the restoration is performed. The impression of patient’s teeth is performed, which is needed in technical laboratory to form permanent crown or artificial tooth. If one crown is necessary then artificial tooth is made right after impression, in more complicated cases with two, three or more missing teeth, also trying on for one or two times is necessary.
What happens while fixtures heal? What can be done with gaps of missing teeth?
In case of lateral teeth nothing is done. For front teeth, there are few options – temporary crown, which however can get loose after biting, for example apple and mal-union of fixture can occur. Another option is to leave implant underneath the gum and use removable partial denture, which is a better option from the healing point. Sometimes it can be combined with bridge.
Shape and colour of teeth also are important…
This part is performed in laboratory, as I usually say – teeth artists form the crown according to the adjacent teeth to adjust artificial tooth to others. Sometimes corrections and trying on are necessary to achieve the best result.
Front teeth might be the most complicated.
In the back of the mouth it is very important to form correct bite so the natural functions could be performed, but I agree that in the front it is more complicated. It is not unusual to form artificial tooth from temporary materials, so that the patient could evaluate the shape and colour.
Sometimes the patient uses this temporary artificial tooth for a month, to make sure they feel satisfied. It is particularly important when all the teeth are replaced.
As I have heard, many people don’t like the gap between front teeth which they have naturally. Is this a frequent problem and what can be done?
Of course, it can be corrected. But, for example, in London where I also have a practice, a patient who originated from Africa wanted to keep it, because it is a beauty element for them.
Do the crowns change colour in the course of time?
No! But beware that crowns cannot be whitened. If patient wants to whiten his teeth he has to do it before the colour of crown is adjusted. But it must be taken into account that natural teeth will get darker after a while, not the implants, that’s why whitening must be repeated each 6 month or year as necessary.
Does the whitening harm implants?
No, it does not. But surrounding tartar can become darker, so dental hygienist must take care for crowns.
If the implant is fixed is it for life?
If oral hygiene is performed adequately, there should be no problems. With advancing age parodontosis can occur, which is ruthless on both natural and artificial teeth. If oral cavity is healthy, implants holds for very long periods of time, at least 20 years.
Sergejs Andrijevskis, dentist, implantologist
Has practice both in Riga and London. Graduated from Riga Stradins University, MBA studies, Master’s degree in implantology and dental surgery in Germany, International Medical College (IMC). Now together with several engineers is working on own implants, which are planned to be offered not only in Latvia, but also abroad.
A motto he works by: “Stomatology is not only medicine, but also an art.”