Implant surgery

A number of dental surgery procedures are designed to prepare the oral environment for safe implant placement.

Sinus lift procedure (sinus lift)

A relatively common obstacle to implant placement is too little bone separating the oral cavity from the air space that is the maxillary sinus. Recent advances in dental surgery make it possible to solve this problem by increasing the amount of bone needed to stabilize the implant through a procedure to raise the floor of the maxillary sinus (sinus lift).

If there is insufficient bone height into which the implantologist plans to place the implant, the sinus lift procedure should be performed by one of the two available methods. The primary goal of this procedure is to raise the bone wall forming the sinus floor in such a controlled manner that it will allow new bone to be created in the resulting space through the insertion of bone substitute material.

1. “Closed” (osteotome) method - involves the insertion of bone substitute biomaterial through a hole made for implant placement. It is a solution that allows to increase the size of the bone to a small extent, but has the unquestionable advantage of using the same hole that is needed to insert the implant, thus making the procedure less invasive. What's more, the implant is inserted at the same visit. Due to the lack of full visual control over the operation being carried out, the sinus lumen is sometimes accidentally opened. In this case, the doctor is forced to carry out the procedure with the second method described.
2. Metoda „otwarta” - polega na wprowadzeniu materiału kościozastępczego przez specjalnie do tego przygotowany otwór boczny. W przeciwieństwie do metody „zamkniętej” zabieg ten wiąże się z wykonaniem dodatkowego nacięcia i otworu dostępowego do zatoki, co stanowi pewną niedogodność, jednak zapewnia doskonały wgląd i pozwala na zwiększenie wysokości kości w znacznie większym zakresie. Decyzja dotycząca jednoczesnego wszczepienia implantów podejmowana jest indywidualnie – w przypadkach, w których przed zabiegiem istniała dostateczna ilość kości, a dno zatoki zostało podniesione nieznacznie, implantolog może wprowadzić implanty na tej samej wizycie, tak jak ma to miejsce w przypadku metody „zamkniętej”. W sytuacji większej interwencji, wszczepienie implantów musi zostać odroczone na okres do kilku miesięcy.

1. Augmentation - guided bone regeneration

Another surgical procedure often performed prior to implantation is guided bone regeneration. Under this name is a procedure whose purpose is to surgically create or restore bone tissue in the area where dental implants are planned to be placed. This procedure is used wherever the doctor, on the basis of radiological examinations, finds insufficient conditions for placing an implant in the place indicated for it.

Bone atrophy is a natural process that progresses with age, but under special circumstances it accelerates, resulting in pathological conditions. When a natural tooth is lost, there is a collapse of the alveolar process toward the alveolus, which is where the tooth used to be. In addition, when the bone fragment in question is not stressed by masticatory forces, further bone atrophy and thinning of the structure occurs. When the process is not very advanced, tooth reconstruction with implants is possible by using shorter and thinner screws. After a certain limit, even the smallest implants do not guarantee the success of the treatment, and then the implantologist must rebuild the missing bone before placing the implants. The solution is to perform a guided bone regeneration procedure, which aims to increase the dimensions of the alveolar process. This is done by creating full-grown bone tissue so that the placement of implants is completely safe.

The augmentation procedure involves inserting biological bone material or bone substitute material of synthetic origin into the desired area, and then covering it with a membrane, the parameters of which allow selective permeability with simultaneous demarcation of the material. Under such conditions, after several months, the embedded material is transformed into natural bone tissue, which can form the base for the future implant.

Based on a thorough radiological evaluation, the implantologist assesses whether an augmentation procedure is necessary as a treatment prior to the implant procedure, or whether it can be performed concurrently, during the implantation. In the latter case, we are usually dealing with minor atrophy, and augmentation is intended to improve the existing bone conditions and stabilize the inserted implant. However, when the bone atrophy is so severe that there is no possibility of implant insertion, then it is necessary to wait several months for the bone to form, which will be the site of the implant. Regardless of the technique used, the augmentation procedure itself is painless and is performed under conventional local anesthesia. The implant doctor gives detailed recommendations to the patient after such a procedure. Radiological analysis, especially CBCT examination (link), which allows a very accurate assessment of the amount of bone in three dimensions, is crucial in the preoperative evaluation. With this approach, augmentation procedures are predictable and safe.

Bone substitute materials used in bone reconstruction procedures can come from the patient's own tissues (autogenous materials), from animals (xenogeneic) or from another human being (allogeneic).