July 25 is Dental Technician Day.
Photo: Shutterstock.
July 25 is the Day of the Dental Technician. The director of the Institute of Dentistry EV spoke about how the methods of prosthetics are changing, what will happen if teeth are not treated and why one can no longer be afraid of drills. Oleg Eremin from Borovsky Sechenov University and the deputy director for scientific works Leonid Borozdkin.
FELL ASLEEP, WOKE UP – THE TOOTH IS IN PLACE
When implantation was just beginning in the 1960s and 1970s, the implant was first implanted in the jaw and, when it took root, crowns were placed on it only after a few months. That is, the person was forced to walk with a pin and a hole in the jaw.
“Now we carry out implantation with a one-stage loading, that is, we install temporary crowns immediately,” says Oleg Eremin, director of the Institute of Dentistry named after E.V. Borovsky Sechenov University. – The patient is operated on and within about two hours the doctors remove, treat the teeth and place the implants. Moreover, the patient at this time is asleep and does not feel anything. Many clinics carry out implantation under local anesthesia. We operate under balanced general anesthesia (multicomponent). Considering that a person needs to keep his mouth open for so long and that a large number of people are afraid of dentists like fire, we consider this to be the most reasonable way. In many countries, teeth are treated under a gas mask or under intravenous sedation, and we also believe that the patient should not feel any discomfort.
While the patient rests after surgery, our dental technicians make the crowns. Thanks to 3D technologies, it takes about forty minutes to complete a crown and an hour and a half to complete the entire dentition of a jaw. It is no longer necessary to make a cast out of plaster, as before, then try it on and remake it. Now the technician scans the jaw, models the crown on a computer and prints it out.
After an hour and a half or two, the patient sits in the chair with the orthopedist, who places the crowns, which are temporary for now, made of plastic so as not to overload the implant, but are almost indistinguishable from the patient’s own teeth. The whole thing takes about five hours.
After this, the person continues to live a normal life. Of course, you should follow certain recommendations and take care of your oral cavity so as not to disrupt the integration process of the implants, but you do not have to worry about the crowns falling out.
The patient comes to the next appointment in three months. The doctor takes a photo of the implant, palpates it and determines whether permanent crowns can be installed or whether it is necessary to wait. Depending on the type of bone, this is done four to six months after surgery.
When the time comes, the surgeon takes the patient to the orthopedist. He scans the jaw and sends the images to the dental laboratory, where the permanent crowns are shaped and milled.
WHY IS IT IMPORTANT TO BE EXAMINED BEFORE SURGERY?
In some cases, it is necessary to treat some diseases before implantation.
“For example, if a person has an incorrect bite and this may be the initial cause of early tooth loss, he may first need to wear braces,” says Leonid Borozdkin, deputy director of research at the Institute of Dentistry at E.V. Borovsky Sechenov University. – And, of course, we perform the operation only after serious preparation. At the very least, perform oral hygiene and get tested. It happens that patients are surprised why they need this and reason: “It’s just dental treatment, what can happen.” And as a surgeon, I am surprised how it is possible not to do this. For example, if a doctor finds out that a person has persistently high blood pressure, he should first send him for a cardiac examination, rather than risk his health by starting surgery. It is necessary to exclude other risks – after all, a person may have a high risk of thromboembolism, etc. To avoid dangerous consequences, it may be enough to conduct a banal coagulogram and a blood test, but this is necessary. That is to say, carrying out the implantation without even knowing the state of the human body is simply dangerous.
In some cases, it is necessary to treat some diseases before implantation.
Photo: Mikhail FROLOV. Go to Photobank KP
WHAT ARE MODERN IMPLANTS?
Most often, modern implants are made of titanium. They differ in the quality of the titanium itself (it is important whether it contains impurities or not), the method of surface treatment, carving and shape. Pure titanium implants fail less often and last longer (up to 30 years).
– We are working with the innovative Russian implantation system “Iris”, in the development of which Sechenov University participated. This is a premium system, there are no analogues in our country, they are only available in Europe,” says Oleg Eremin.
“We are constantly working with the manufacturer to improve the implants,” adds Leonid Borozdkin. – And this year we started a new study. We decided to try to treat the surface of the implant with a laser. Today, a certain structure of the implant with all the dimples and inclusions, into which the patient’s bone tissue cells then grow, is formed in two ways. The surface is bombarded with an ion beam or with a sandblast. But this is not a precise and controlled method. And with the help of a laser we can achieve optimal depth and make indentations in strictly defined places. Another advantage of this type of processing is that the laser leaves no traces or particles of unnecessary materials.
Sechenov University already has test samples of laser-treated implants. And studies have been conducted on animals. We are now recruiting a group of people who will agree to install new systems themselves. “In fact, they are as safe as the previous generation of implants, but this is an innovative development, so testing is necessary. We hope to complete the study by the end of the year and start using new implants in daily practice,” says Leonid Borozdkin.
WHAT ARE CROWNS?
The main materials used are metal ceramics, zirconium and pressed ceramics. Cermets are considered a thing of the past. “They were used at a time when implants were not even heard of, but bridges were made,” explains Oleg Eremin.
Pressed ceramics are more expensive than metal ceramics, but they look better. Usually, these crowns are placed in the smile area, and a simpler material is used in the chewing area – zirconium. They can also be combined. But in each case, everything is selected individually, the doctor each time looks for a middle ground, of course, discussing everything with the patient, who has the final say.
WHY IS “MAINTENANCE” IMPORTANT AFTER IMPLANTATION?
Unfortunately, many people believe that after implantation, there is nothing to worry about: you have teeth and you are fine. Unfortunately, crowns may look new, but this does not mean that everything is normal underneath them and that there is no inflammation.
“Both implants and crowns are foreign bodies in the body,” Leonid Borozdkin reminds us. – Therefore, a lot depends on the general condition of the body and on the care. It is necessary to brush your teeth correctly: use not only a brush, but also dental floss, toothpicks and irrigators with certain products. At least once every six months, go to a professional hygiene clinic so that the doctor can clean the cavity under the crown, remove plaque and tartar from healthy teeth and prevent infections from spreading throughout the oral cavity.
And of course, the worst habit for teeth is smoking. It kills both teeth and the periodontium (the tissues around the tooth that hold it in place) and the mucous membrane of the oral cavity. And all this affects the lifespan of the implant.
In addition, there are diseases, for example, endocrine and digestive tract diseases, which affect the condition of teeth and their supporting apparatus. If a person has a stomach ulcer, the neutral environment of the oral cavity becomes acidic, periodontitis occurs, and this is a threat to both teeth and implants.
But this does not mean that these patients cannot be fitted with dentures. You just need to consult with specialist doctors and follow precautions.
WHAT DISEASES CAN BE CAUSED BY UNTREATED TEETH?
“Against the background of poor oral hygiene and improper dental treatment, problems can arise throughout the gastrointestinal tract – often there is pathology of the temporomandibular joint, followed by neuropathies of the trigeminal nerve,” says Oleg Eremin. But there is also a less obvious connection, which has been the subject of many interesting studies. They prove that dental diseases lead to chronic and sometimes acute cardiovascular pathologies. After all, what is caries? This is a microbial process in the crown of the tooth. And if it is not treated, pulpitis begins – microbes enter the pulp of the tooth (the area where the nerve is located). As a result, microbes enter the bloodstream, which carries them to all organs, including the heart. We warn our patients about this, especially those who, out of fear of treatment, bring themselves to a state of complete horror in the oral cavity.
The worst thing is that affected teeth do not always hurt, so internal processes can imperceptibly lead to chronic inflammation inside the jaw, which, with a decrease in immunity or provocation, threatens to lead to purulent inflammation. In this case, the patient has to undergo a serious operation in a maxillofacial surgery hospital. Simply because he did not treat the tooth in time.
