Implantation without sinus lift and bone grafting in the upper jaw

Is implantation possible without bone grafting?

Today, there are the latest foreign developments in this area - implantation according to the Frankfurt protocol in the complete absence of teeth, as well as special implants that can be used without first replenishing the volume of the jaw bone in 90% of cases. When a patient has narrow bone, a splitting technique can be used to allow the implant procedure to be performed without bone grafting. Thanks to this technique, the patient receives a finished prosthesis within 3-4 months. While with classical implantation technology with preliminary surgery to increase bone volume, tooth restoration is often delayed for 10–12 months. Thus, the splitting technique avoids invasive procedures such as transplantation of bone blocks taken from other parts of the jaw. In addition, there will be no need for subsequent correction of soft tissues, which is necessary after bone grafting, as a result of which the gum is greatly stretched, which often leads to exposure of the transplanted bone block or implant.

Warranty periods for implants with large threads

Each manufacturer sets its own deadlines for implants for implantation without bone grafting, since they do not have any defects or flaws. Therefore, when used carefully, the products do not crack, break or undergo deformation. There are no guarantees for the successful engraftment of implants in the bone mass, since the quality of the engraftment process is determined by the state of health of the person himself. Therefore, the patient must scrupulously follow all medical recommendations regarding oral hygiene after any type of implantation, as well as be as careful as possible about their health. Only in this case will the artificial root be permanently fixed in its place and not be rejected.

Installation of an implant using the splitting technique

Using a special instrument whose action is based on microvibration (somewhat reminiscent of the effect of ultrasound on tartar), the doctor carefully and non-traumatically makes a small incision in the bone. A special screw implant is installed in it, designed in such a way that it itself splits the bone ridge and increases the total volume of the bone. Unlike surgery using bone blocks, in this situation, specialists perform only one procedure. When plastic surgery with bone blocks is required, at least three operations are required: taking a bone block and transplanting it onto a narrow bone ridge, after 6-8 months - installation of implants, and also after another 3-4 months - gum plastic surgery, which, in turn, will continue to heal 2 months. Splitting the bone during implantation often makes it possible to avoid these lengthy procedures.

Features of implants

When implanting using the splitting method, screw implants of a special design are used. They have a cone-shaped body, thanks to which they easily enter the bone, pushing its edges apart, like a wedge. However, the wedge is easy to knock out, so the conical shape of the implant is combined with a cylindrical thread profile, which allows it to be firmly fixed in the bone tissue. This unique feature of such implants gives doctors the opportunity to install them in narrow bones without undergoing bone grafting. They smoothly screw into the gap between the bone walls through a hole measuring only 2 millimeters and do not damage them. In addition, the sharp thread of the screw implants and the wide spaces between the turns of the spiral, through which bone tissue quickly grows, contribute to faster stabilization. Thus, after three, maximum four months, permanent crowns can be installed.

Recommended cases of application of the method

To carry out a successful tooth implantation operation, it is necessary to have 3 mm of bone tissue: the crown must be surrounded on all sides. Therefore, the attending physician needs to carry out extensions using the classical method or the splitting method.

Splitting is recommended in the following cases:

• the patient's hard tissue is not enough;
• tissues dissolve;
• the gingival ridge is thin;
• tissues have atrophied.

There are cases in which the splitting method is not recommended. So, if the gingival ridge is less than 2.5 mm wide, then the remodeling process will not bring the expected result. If the structure of the bone tissue is loose, splitting is not desirable. Also, the absence of 4 teeth in a row is a contraindication to the use of this method.

If there is an infection or dental disease in the oral cavity, surgery is not performed. Allergies to drugs, low immunity and blood disorders should all be investigated before surgery to determine whether the method is suitable or not.

How many lost teeth can be restored this way?

The technique makes it possible to restore any number of lost teeth. Even when implanting one tooth, technology allows an incision to be made in such a way as to insert the implant into the bone without damaging the adjacent teeth. But most often, a narrow bone occurs in the absence of a large number of teeth, so specialists usually install two to four implants on each side.

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Snitkovsky Arkady Alexandrovich

Therapist, Orthopedist

Is implantation always possible without bone tissue augmentation?

Typically, the jawbone is oval in shape. Then, during the process of atrophy, only its upper part on the buccal (front) side loses volume, while its base remains wide and supports the rest of the bone. In this case, we can safely carry out “splitting” and not be afraid that the bone will break. However, if the ridge lacks thickness along its entire length, or is less than two millimeters, bone grafting is necessary. True, such situations are quite rare, and in these cases doctors are forced to follow the classic path - performing plastic surgery using bone blocks.

Do mini-implants and all-on-4 implants help avoid bone grafting?

Mini-implants can only be used as temporary structures or to fix a removable denture. If the prosthesis rests on such implants, they will be rejected. Therefore, when implanting all on four, standard size implants are used.

The All-on-4 or All-on-6 techniques allow you to place a permanent prosthesis on implants, most often with screw fixation. Only a very experienced doctor should install an orthopedic structure, since even a slight error in calculations can lead to improper distribution of the chewing load and cause implant rejection. With all-on-four implantation, implant placement can also be done using the splitting method. This is a simple and effective procedure that is absolutely safe for the patient and avoids bone tissue buildup.

What are the consequences of bone tissue atrophy for the patient?

• psychological discomfort: 98% of patients2 are brought to the clinic precisely because, due to lack of teeth, they cannot lead a full life - communicate with people, smile, take photographs,
• changes in the shape of the face, early aging: wrinkles appear near the mouth, the position of the chin changes, the skin on the cheeks becomes more flabby, and the lips sink inward,
• problems with nutrition: due to the absence of teeth, the patient has to significantly adjust the diet - solid fruits, vegetables and meat are excluded from it. As a result, the body weakens due to a lack of vitamins, disturbances in the functioning of the digestive system occur,
• problems with dentures: due to the unevenness of the alveolar ridge, removable dentures have to be constantly repositioned, since they sag along with the bone, become uncomfortable and are poorly fixed.

Olga Alexandrovna, 51 years old

“I wore removable dentures for a long time because they refused to implant me - they said that I needed bone augmentation and the treatment period would be about 2 years. And only here they solved my problem - in just 4 days I was given back a full life and confidence. And most importantly, I was given back the ability to smile, which I had long forgotten about!”

• refuse complex bone augmentation surgery
• go all the way from installing implants to fixing dentures in just a few days
• forget about uncomfortable removable dentures
• start LIVING for real

watch a video with the patient

Features of prosthetics for atrophy

• For implantation, bone tissue augmentation or sinus lifting is required when installing classic implants. In this case, the patient will have to be content with only removable prosthetics for several months (while the implanted bone takes root, and then the installed implants),
• in some situations, it is possible to install implants and grow bone in one step, but for this there must be favorable conditions,
• when implanting a complete or almost complete dentition, it is possible to use deeper parts of the bone that do not undergo atrophy - this way it is possible to avoid bone grafting (read about the use of similar treatment protocols below),
• removable prosthetics leads to the continuation of atrophic processes, while the prosthesis sags3, as a result, it is poorly fixed and requires frequent relining,
• under a dental bridge, which is attached to living teeth, atrophic processes also develop (since the load falls only on the supports).

According to research, today only about 40% of respondents know that bone loss occurs after tooth loss. Moreover, 70% of them would agree to undergo dental implantation if they knew that removable or bridge dentures do not stimulate the functioning of the jaw bone, but lead to its further resorption4.

What if not only the thickness, but also the height of the bone is not enough?

In this case there are also several options. If the bone height is not enough in the lateral parts of the upper jaw, a sinus lift should be performed. If the bone height is at least 4 millimeters, we can increase the volume of bone tissue while simultaneously installing a high-quality implant. If it is less than 4 millimeters, then after sinus lift you will have to wait 5–7 months before implantation. But if the bone is wide and its height is 5-6 millimeters, then you can do without a sinus lift - here they use short implants with strongly protruding threads. Due to their large surface area, these short but wide implants can withstand the same load as conventional ones.

Types of implantation without osteoplasty

The first and most optimal option for implanting an artificial tooth root without plastic surgery is if the patient’s bone tissue is in ideal condition. In this case (depending on the indications and wishes), classical two-stage technology or one-stage technology can be used. With a two-stage method, at the first stage the implant is integrated and 3–6 months are waited for the completion of the osseointegration process; at the second stage, the gum is formed and a permanent prosthesis is installed. When implementing a one-stage option, all manipulations are performed in one surgical intervention. You can read more about this in another article on our website.

Insufficient volume and size of bone tissue is an indication for osteoplasty. But in some cases it can be avoided. Let's consider the options:

• if the alveolar ridge is narrow and of sufficient height, install implants with a smaller diameter than the standard size;
• if the height of the ridge is insufficient (less than 5 mm) and its normal width, fixation of an implant shortened in height with protruding threads;
• in case of atrophy of the alveolar ridge tissue - the use of the basal technique with the introduction of a titanium root into the deep basal layers;
• with simultaneous tooth extraction and implant installation. With this option, the tissue has not yet undergone loss, so there are no restrictions on the operation;
• when completely edentulous prosthetics are performed using the “All on 4” or “All on 6” method (the jaw prosthesis is installed on four or six implanted implants). The technology involves selecting optimal fixation points for titanium roots in areas that are most suitable for their installation and inclined positioning of integrated titanium rods;
• with a narrow ridge, use the splitting method (intercortical osteotomy). Its essence is that a specially shaped implant, when screwed in, splits the ridge without damaging it, but is securely strengthened there.

Important: implantologists of the “Smile” clinic network have the technology to install implants of any size and with any features. At the same time, doctors use implantation systems only from reliable and proven brands.

What determines the healing time of implants?

It is known that classic root-shaped implants take root on the lower jaw within 3 months, and on the upper jaw within 5-6 months. The timing depends on the primary stabilization, that is, on how tightly the implant was fixed in the bone during its installation, and on the density of the bone. In hard bone, the implant receives good initial stabilization and can be loaded with a temporary crown after only 3 months. If the bone is soft, it is necessary to postpone prosthetics for a longer period, otherwise the implant may be rejected.

With the advent of an implant system with large threads, it became possible to speed up the healing time in soft bone, since it increases the area of ​​contact between the implant surface and bone tissue, and therefore contributes to more durable stabilization. In both soft and hard bone, the healing time of such an implant is about 3 months.

Cost of the procedure

The price of the procedure consists of the cost of the implant, the doctor’s work, as well as the cost of temporary and permanent prosthetics. Due to the fact that specialists do not perform bone grafting, the price of implantation, of course, decreases, but not much. This technique was created not to save on implant installation, but to avoid additional surgery in cases where this is possible.

For example, if the bone volume is sufficient and its condition is ideal, you can install any modern implant - it will take root and function for a long time. But if it is necessary to carry out a sinus lift simultaneously with implantation, it will be necessary to use implants that are fixed even in 1-2 millimeters of bone. But if the bone is narrow, the best option would be to use the splitting technique followed by installation of an implant with a wide thread. Everything is fair here - the doctor does not focus on your wallet, but advises and selects the most optimal treatment plan in accordance with the specific clinical situation.

Publisher: Expert magazine about dentistry Startsmile.ru

What's included in the price

Our Center operates a case payment system for treatment. This pricing policy eliminates unexpected costs for patients. The turnkey price includes a set of procedures and materials for a specific service.

The implant installation case includes:

• local anesthesia
• implant Nobel Biocare (USA)
• installation operation
• consumables and superstructures
• basic bone tissue augmentation at the neck of the implant
• examinations, control CT scan of the jaw after implantation

Case on sinus lift and bone grafting:

• local anesthesia
• bone augmentation surgery
• consumables (except bone)
• routine examinations and control CT image of the jaw

In our Center, after surgical operations, a set of medications is given to take home free of charge. In this way, we prevented the purchase of counterfeit products and saved our postoperative patients from searching for the necessary medications in pharmacies.