Dental implants essentially substitute the missing tooth roots, are placed by a minor surgery in the jawbone and are used as supports for the prosthetic restorations that will be constructed. Their construction material is titanium with a properly treated surface, so that they are integrated in the jawbone. They are fully biocompatible materials and have been used for decades both in dentistry, and in many other fields of medicine. Their resistance and their light weight are two more principal advantages of them.
The shape of dental implants is usually cylindrical or conical (root-form) and their dimensions (diameter and length) vary, so that we can choose the appropriate implant for each patient depending on their requirements and anatomy.
Advantages of implants compared to the classical prosthetic restorations.
-The natural teeth on the two sides of the missing tooth are not drilled
-There is no sensitivity to various stimuli (cold, hot, sweet)
-They prevent the absorption of the bone with age
-They contribute to the preservation of the morphological characteristics and the improvement of the aesthetics of the face
-They look more like natural teeth
-They contribute to the increase and preservation of the chewing ability
-The contribute to the improvement of speech and ingestion
-They offer self-confidence to the patient as fixed restorations
-There is the possibility of easy, painless and low cost correction of their prosthetic restorations whenever it is required
-They facilitate a better oral hygiene
Procedure Before the surgical insertion of the implants, a detailed medical and dental history is taken, and the radiographic examination takes place with the use of a panoramic and intraoral dental X-ray, while in the last years the CBCT-Cone Beam Computed Tomography of the jawbones is also used, and is now required. Furthermore, the original dental impressions of the patient are taken and dental plaster casts are constructed for the study of the mouth, on which, with the aid of special programs and software, we study, plan and construct digitally and in 3D mode the implants and their prosthetic restorations. In this way we can design digitally, with a very high precision and safety, the place of the implants and the prosthetic restoration that will be constructed and will be supported by them. The entire restoration can be presented to the patient in 3D and digital mode before the surgical insertion of the implants, so that the patient can also have a full picture of the procedure and be adequately informed about the future picture of his/her mouth. A prerequisite for placing an implant is a very good oral hygiene by the patient, the regular re-examination as it is scheduled by the dentist, while smoking is a relative contraindication.
Preoperative Planning Preoperative planning is the most important stage of the restoration with dental implants. Obtaining a detailed medical history, the thorough study of the anatomical and functional conditions in the stomatognathic system and the detailed updating of the patient are the necessary steps before proceeding to the implantation process. The patient must have an excellent level of oral hygiene and must have fully understood the increased hygiene requirements that the restoration with dental implants entails.
Implantation Procedure After the full updating of the patient and if he/she agrees with the prepared treatment plan, the surgical insertion of the implants is programmed to be performed at our properly equipped dental surgery with local anaesthesia, taking all the necessary safety measures for the painless and safe procedure. The postoperative course usually includes a small oedema (swelling) of the area and a slight pain for 1-2 days, which is treated with common painkillers, while after 10-12 days the sutures are removed.
Period of integration of the implants in the bone (osseointegration) After their implantation, around the implants begins a process of reformation of the bone and of its adhesion to the specially treated titanium surface, for a time period of 2-4 months depending on the case. By this process, the implants are essentially integrated in the jawbone and are immobilized, so that they can receive the prosthetic restoration and function as natural teeth.
Prosthetic restoration After this period and since their immobilization has been checked with the special apparatus our dental surgery is equipped with, we proceed to the taking of dental impressions, so that the prosthetic restoration is constructed by the dental technology laboratory. In a period of 1-2 weeks the final prosthetic restoration is ready to be placed in the mouth and function. In some cases and particularly for aesthetic reasons, there is the possibility of immediate construction of a temporary prosthetic restoration even on the same day of insertion of the implants. The re-examination of the patient, as it is scheduled by the attending dentist, guarantees the preservation and maintenance of the functionality of the implants in the mouth.
One of the most common intraoral surgical procedures is the extraction of impacted third molars (wisdom teeth). The wisdom teeth or third molars are the last teeth in the back part of each jaw and very often do not erupt in the mouth, remaining impacted even during the entire life of the patient. They usually cause discomfort during their eruption in the mouth and there is often no sufficient space in the jaw for their full eruption. Furthermore, the cases where wisdom teeth cause the generation of cysts around their roots are not that rare, which affects the density of the jawbones or leads to the formation of an oedema or abscess. Finally, when the impacted wisdom teeth have an inclination angle compared to the other teeth of the jaw, they are implicated that they contribute to their movement or distortion. For all the above reasons, their surgical extraction is often, and depending in each individual case, recommended.
Procedure of surgical extraction of third molars (wisdom teeth) After taking a detailed medical and dental history of the patient, we proceed to the radiographic examination by taking a panoramic X-ray or a cone beam computing tomography scan (CBCT) of the jaws, when this is deemed necessary (being close to sensitive organs – anatomical structures, such as nerves, arteries or sinuses). Subsequently the patient is fully informed about the possible postoperative complications, such as a mild oedema (swelling) and localized pain for 2-3 days, which, however, are covered by the administered medication. After all the necessary measures for the surgical procedure have been taken, with local anaesthesia and with the appropriate instruments, the impacted teeth are removed, the wound is sutured and the necessary postoperative instructions are given. After 8-10 days the sutures are removed and usually after 20 days the patient can normally chew on the side of the extraction. The duration of the surgery is usually 30-40 minutes, while the simultaneous extraction of the upper and lower wisdom teeth on the same side is often recommended, in order to achieve the less possible discomfort for the patient.
In the cases where one or more teeth are missing and if there exist teeth on both sides of the gap, one of the options of treatment is the classical fixed prosthetics with the construction of a bridge. In this case the existing teeth before and after the gap are drilled, impressions are taken and the bridge is constructed at the dental technology laboratory, which, after its intraoral tests and the selection of the appropriate color, is permanently adhered on the supporting teeth. The construction materials of a fixed prosthetic restoration vary depending on the requirements and the particularities of each case.
Construction materials of fixed prosthetic restorations
1. The most common construction material of crowns or bridges is porcelain-fused-to-metal, which includes an interior frame of an alloy of biocompatible metals and is externally covered by porcelain in the color of the adjacent teeth. Porcelain is a fully biocompatible material with excellent breaking strength, abrasion resistance, while its color remains unchanged over time.
2. Another construction material of the frame is zirconium (zirconia acid), which is also covered with porcelain, and which is recommended mainly in the restorations of the front teeth. Zirconium is a material of whitish color, of an excellent resistance, equal to the metal, which due to its whitish color satisfies perfectly the aesthetic requirements and has more advantages compared to the metal, which sometimes leads to a grayish zone on the gums over the neck of the tooth.
3. A third construction material of the fixed prosthetic restorations is the all-ceramic porcelain, which depicts perfectly the aesthetics of a natural tooth thanks to its refractivity to light.
In case that a tooth has sustained a fracture (crack) or discoloration after an endodontic (root canal) treatment, the construction of a crown is recommended, which practically covers and protects the entire tooth. For the construction of a crown the same procedure that is described in the case of a bridge is followed and the construction materials are similar. The crown is permanently adhered to the prepared teeth and acts like a natural tooth, protecting it against possible cracks and improving its aesthetics.
Removable prosthetic restorations
In the cases where some or all of the teeth of the patient are missing, one treatment option is the construction of a removable prosthetic restoration. The partial dentures (“partial set of artificial teeth”) and the complete dentures (“false teeth”) belong to this category of restorations. In both the above cases the patient must remove his/her restorations before sleep and clean them.
Partial dentures are removable prosthetic devices that restore the lack of some teeth in the dentition and which rest on the other teeth, as well as on the gums of the patient. These restorations can be easily removed, cleaned and put back in their place by the patient at any time. Their advantage is their easy, fast and low cost construction. At the same time, they can be cleaned by the patient himself/herself and they can be readjusted-corrected by the dentist at any time in the future when a change in the mouth of the patient (e.g. loss of teeth) occurs. Their disadvantages are their reduced aesthetics and retaining compared to a fixed restoration and the problems they often cause to chewing and to the speech of the patient, which will eventually have adverse effects to the self-confidence and the psychology of the patient.
In the case where all the teeth are missing, one treatment option is the construction of a complete denture (false teeth). It is a removable restoration which rests exclusively on the gums of the patient and is based in the function of a suction cup (the generation of a vacuum between the gums and the denture by the presence of saliva). Its advantage is its easy, fast and low cost construction. At the same time, it can be cleaned by the patient himself/herself and it can be readjusted-corrected by the dentist at any time in the future when a change in the mouth of the patient occurs. Its disadvantages are its reduced aesthetics and retaining compared to a fixed restoration and the problems it often causes to chewing and to the speech of the patient, which will eventually have adverse effects to the self-confidence and the psychology of the patient. In order to relieve the patient from the problems that complete dentures cause it is possible to place 2 implants in the lower jaw or 3-4 in the upper jaw, so that the denture can rest on them and be adequately retained by them, while the patient still has the possibility to remove and clean it.
Endodontic (root canal) treatment
In case of inflammation or necrosis of a tooth with or without accompanying pain due to various causes (dental caries, wound) and in order to maintain the tooth functional and symptomatic in the dentition, the endodontic (root canal) treatment is recommended. During the procedure of endodontic treatment and after adequate local anaesthesia has been administered, the tooth is drilled so that there can be an access to its nerve, which is removed. Subsequently, the root canal of the tooth is cleaned and disinfected chemico-mechanically and the appropriate antiseptic medicines are placed. At the end of the treatment the root canal of the tooth is filled with the appropriate biocompatible materials and the tooth is restored with a filling or a crown (cap) and is maintained symptomatic and functional in the mouth after the treatment.
Periodontal diseases are essentially diseases of the periodontal tissues (gingiva (gums) and alveolar bone). The most common of them are gingivitis and periodontitis.
Gingivitis Gingivitis is essentially the inflammation of the gums and its causes are principally the bacterial plaque which concentrates at the edges of the gums around the teeth. It occurs more often at young ages and up to the age of 30-35 years. Its causes are principally poor oral hygiene and secondarily the intake of some medicines, pregnancy, or even structural abnormalities of the teeth. The gums appear inflated, intensely red, oedematous and bleeding during their brushing or without any cause. Furthermore, the presence of calculus (tartar) can be often observed, in the form of hard yellow or brown deposits on the teeth. The treatment of gingivitis requires the removal of calculus by the dentist and systematic brushing and use of dental floss by the patient. An antiseptic mouthwash can be additionally used. After 1-2 weeks the gums return to their normal state.
Periodontitis Periodontitis is a disease of the gums, but also of the alveolar bone that supports and surrounds the teeth. In periodontitis the bacteria have penetrated deeper in the gingival sulcus and have affected the bone, which leads to its gradual loss and, possibly in the future, to the mobility and maybe the loss of the teeth that have been affected. Periodontitis is distinguished in various forms and degrees of gravity, occurs more often at older ages (35+ years) compared to gingivitis and is usually the result of a chronic uncured gingivitis. Typical symptoms of periodontitis are the inflation, redness and bleeding of the gums, as well as the mobility of the teeth. Furthermore, in advanced forms, the recession of gums and the exposure of the roots of the teeth can be observed, while its progression leads to the loss of teeth. The treatment of periodontitis includes an essentially deeper cleaning of the roots of the teeth with special instruments and usually with the use of local anaesthesia, as well as the systematic oral hygiene by the patient with the use of a toothbrush, dental floss and interdental brush. Additionally, it is possible to use an antiseptic mouthwash, while the regular re-examination by the dentist is necessary, in order to control and stabilize the disease. Periodontitis is often related with more general diseases, such as diabetes mellitus, heart problems and some autoimmune diseases.
Tooth whitening is a painless and, in general, safe method of change of the color of teeth chemically. The procedure, according also to the Ministry of Health, is clearly a dental practice and must be performed only under the supervision of a dentist, with the use of approved and certified preparations and a certified protocol. Tooth whitening aims at changing the color only of the natural teeth and is performed with various methods. The most popular, safe, predictable and effective method is the so-called combined method, according to which the principal procedure is performed at the dental surgery with the use of a special plasma light transmitter (whitening lamp), which activates a gel that is placed on the teeth and which, in turn, by penetrating to their internal structure, breaks down their chromogenic substances. The session at the dental surgery lasts approximately 45 minutes. Personalized splints - with the proper gel - are additionally provided to the patient, which must be used during the night, for approximately a week. The result is a whiter appearance of the teeth and a more beautiful smile. The fillings and the crowns (caps) consist restrictions of the whitening, since their color cannot change with the method of tooth whitening. During the treatment it is recommended to avoid foods and habits that contain colorants, such as smoking, coffee, tea and red whine.