The fear of having teeth extracted prevents many patients from scheduling their appointments. However, for a successfully functioning mouth, it is best to lose bad teeth. Dental implants can help patients who lose teeth for various reasons, such as accidents, tooth infection, and aging. The dental implant in Turkey procedure can manage the newly-formed gap in the patient’s teeth. It is a surgical fixture that attaches the jaw bone and jaw skull inside the bone. It is a healthy option to restore and enhance the patients’ smiles. Customers see their teeth look like natural teeth with dental implants. You also provide a great alternative for those who are unable or reluctant to wear a denture.
During a dental implant in Turkey appointment, the dentist may sedate the patient to make the process less difficult. The treatment stays behind the scenes with painless sedation. The period of surgery also relies on the number of dental implants placed. Dental implants often function well and for a very long time. Patients who have taken care of their teeth and gums will benefit the most. In general, dental implants can be very successful. The majority of people will use this method to improve success rates. It is not always possible to process individuals with weak bone. In addition, implants are not for everyone. If the patient has any of the following conditions, the implant surgery may not be a good fit for them.
Dental implants play an extremely important role in dental implant in Turkey treatment. Dental and dental diseases, especially the loss of teeth, lead to the development of new dental implant systems, which are progressing rapidly in the world health services and are also taking place in Turkey very fast. The dental implant differs according to the system, the difference in the alloy with the connection product, the connection to the bone, the platform features, and the surface processes. However, no matter what the features of the dental implant are and what the materials are, the basic structure and properties are the same. The dental implant in Turkey consists of screw, abutment, and super-structure parts.
Screw: It is the part of the implant that integrates with the bone and enters the bone. Biological interaction occurs between the implant screw surface and the implant bone tissue. The screw part is special for each implant system. Dental implants were first manufactured from titanium. It was understood that the rejection of the cells with bone tissue was very low and the success rate in the first years of the implant was satisfactory. It was observed by long-term studies that the success rate could not pass over the bar and that the incorporation in the bone was both slower in these implants and the average bone tissue did increase over the surface.
A widely applied dental implants procedure in oral and maxillofacial surgeons, have become more popular as an alternative solution rather than conventional bridges and dentures. They are applied for the integration of the implant into the bone with sufficient strength to be placed in bone-deficient edentulous areas. The endosteal implants, which are frequently used in daily practice, were first introduced in 1800.
The first person to hypothesize that osseointegration might be applied in implant dentistry was Pfaff, referred to as a “doctor in Brazil who used an osteointroduced blade to hold an artificial tooth for a patient who experienced local sequestration at the place of the implant.” Later on, Fernandez in 1937, inserted Vitallium and gold endosseous implants into canine bones and observed improved bone response around the Vitallium implants. In 1945, Baker reported that titanium could successfully be osseointegrated. Considering the developments at that time and the known dates, in 1952, Branemark prepared the first comprehensive scientific report. Having conducted numerous animal tests with his team, he concluded that the titanium implant allowed a successful osseointegration.
In the early years of the development of dental implants, endosseous implants were typically shaped like a screw, blades which is also known as top blade, vitallium, gold, and tantalum, becoming available in different forms and materials. A number of manufacturers started producing dental implants for commercial purposes and subsequently were made of titanium. More recently, zirconium oxide endosseous implants, with proof of osseointegration after, have been confirmed by clinical investigations.
Although the increasing number of dental implant availability is at consumers’ choosing in Turkey, data on annual dental implant types are limited, as dental implants are classified as medical equipment. In line with the swollen economy and burgeoning population, since 2002 Turkey annually produces endosseous dental implant types from other countries and performs the necessary legal inspections and produces a few brands of dental implant systems.
The next step after the diagnostic aids is to place the dental implant into the dental site. The dental implant in Turkey procedure actually consists of a few smaller steps:
The techniques of placing a dental implant in Turkey consist of two main methods. The surgical placement and the simplified or quick placement using the press fitting. If we are going to insert the dental implant with a surgical method, it should be an axed process like GBR or maxillary sinus augmentation prior to the dental implant in Turkey placement. The newly molecular biology and recent studies are both still not supporting the quick method of instantly placing the dental implant. And there are also few authors stating about the failure of the instantly dental implant placement technique which does not sound the same in the molecular and biological concept of the recent studies of bone tissue healing, osteology, and endocrinology. Bone healing is a bioprogressive pathway if we are in consideration of the molecular theory of life tissue healing, repairment, and regeneration.
There are few main stages in the dental implant in Turkey placement: Management of the patient’s medical history, and in case taking other needed information. The dental radiographic examination and dental tomography. Sizing and measurement of the dental site and dental planning. The surgical placement of the dental implant. The post-operative dental implants procedure and medication to be given. The dental impressions and dental temporary restorations. Rotation-zygoma implants (anyangioplasty, zygomaticus) for immediate mouthpieces, nonrotations if possible. The tromboelastometry for easy coagulation is required in patients with heart blood diseases (Dental Implants Procedure for Dental Surgical Rotation).
Before the commencement of dental implant placement, presurgical evaluation and planning should be performed. First, the patient’s history and a physical examination should be conducted. As a result of tests that have been performed, patients who are candidates for surgical intervention do not display any evidence of any systemic disease at likelihood for impediment or delay in healing. In the planning of dental implants, several issues must be addressed, such as the patient’s requirements and objectives. The quantity and quality of the alveolar bone tissue must be assessed to ensure the dental implant’s long-term success. One of the diagnostic tests recommended for the treatment planning of dental implants is panoramic x-ray. The upgraded version of the panoramic x-ray machine is the cone beam system, which provides three-dimensional images and is utilized in the X-ray column.
Before surgery is scheduled, dentists typically use cone beam systems to create a three-dimensional image of the jaw and propose the treatment to the patient. The simulator can accurately plan the operation down to the smallest detail. The patient and dentist can be aware of the required surgical dental implants procedure, how many implants will be embedded, and where the implants will be positioned. Beyond planning dental implant in Turkey placement, cone beam simulation is utilized to evaluate several aspects of dental implant placement, such as the spatial relationship between the cortical bone and the inferior alveolar nerve, the maxillary sinus, the buccal bone width, and the lingual or palatal shape in the mandible. In the case of nonreplacement, the planned implant postoperative panoramic x-ray results in great concordance due to the less clear and important-related implant position.
The anatomic structures of the jaws with major nerve and blood supplies should be carefully noted before determining the implant position. Suitable anesthesia techniques required to keep the patient in the most comfortable position for surgery should be chosen. For contraceptive purposes, regional block and topical anesthesia alone may not be adequate for anxiety and gag reflex. Persons who develop anxiety or syncope during dental implant in Turkey treatment are often apprehensive. Sedatives, local anesthesia following inhalation analgesics, high concentration oxygen, short-term anesthesia, or a combination of these therapies can be applied. Nerve injuries due to local infections are the major issues with mandibular wisdom tooth extractions that can spread to the cheek and neck.
There is no evidence that flapless surgery is associated with increased success; however, soft tissue will often be inadequate for concealing implants. Maximizing spacing between the implant and adjacent future crowns, between adjacent implants, and establishing sufficient buccal and lingual/palatal tissue width results in the optimal emergence profile of the pontic and may prevent the soft tissue-related complications, especially recession. Incisions are used to expose the underlying bone and position implants in the optimal place to allow for proper alignment of the crowns. The primary objective of mucoperiosteal flap surgery is the initiation of marginal incision initiation needed for exposure of the bone. Mucoperiosteal shoulder technique has incisions made; mucoperiosteal full-thickness flaps may be required if extensive surgery is required. Mucoperiosteal flaps should have a tension-free adaptation to enable coverage of the planned implant. A mucosal shoulder anchored in the periosteum may be preferred to achieve greater width of tissue adaptation flap closure and lesser scar contraction. The periosteum vascular blood supply is not impaired until the surgery is less than 3 mm deep, periosteum-anchored mucoperiosteal surgery results in minimal cortical bone circulation injury and may result in higher bone levels than adjacent teeth.
In the marginal gaps identified with a periodontal probe before wound closure, bone debris irrigation is performed with a sterile saline solution. The cleanliness of the implant, which is a pure titanium device representing the surface in the oral environment, requires physical care measures to ensure safety and reliability in the surgical field. Healing abutments and cover screws provided by the manufacturers may be selected for the implant. Abutments, if unaffected by the inflamed tissue or contaminated by the contaminated area, can directly approach stainless steel healing cap or cover screws to support soft tissue surrounding ensure secondary healing. The mucoperiosteal epithelium should fit without tension over the implants. A continuous suture technique for mucosal closure is one most commonly preferred technique to surgically close deviations, avoid sutures opening and accumulation of bacteria. Potential adverse suture extraction mechanical trauma to the tissue described in detail is minimized by using a very lightweight suture to reduce the risk of breakage. Harmful pressure areas for sutures should be avoided, and sutures should remain 7-14 days. In the event of local infections, sutures may be removed in 5 days.
Osseointegration is the integration of an intra-bone implant, free from fibrous tissue, and strongly joined with adjacent living tissue. In 1986, Adell first used this term. A true initial approximation can be simplified to fibrous encapsulation confined but cannot occur after. The biological aspect of osseointegration cannot be discussed without mentioning the significance of host bone density to the successful outcome and how firmly the implant achieves maximum development of microscopic and submicroscopic osseointegration. The initial stability of an osseointegrated prosthesis is provided only by friction from the implant to bone, and friction can be provided. This provides long-term stability to withstand the biting and chewing forces. Furthermore, any pathogen’s invasion chances are considerably reduced.
Dr. Per-Ingvar Branemark, a Swedish orthopaedic surgeon who discovered this phenomenon, first used the term “osseointegration”. By direct structural, functional, and esthetic bone growth, osseointegrated implants rigidly fix and bound in the supporting jawbone are accepted and anchored. Osseointegration is increasingly becoming a common and mainstream thing. This method provides both biological and neural skeletal structures with a high degree of biocompatibility. Around 1978, Lee and Branemark prepared the first scientific information about the comprehensive mechanism for the selection, panel, and use of osseointegration installations. Bone growth of coarse rough surfaces of micro and macro is the key to effective osseointegration of mechanosensitive due to differences in potential electrical charge of varying intensity. Rough surfaces enhance biological osseointegration activity, resulting in strong and long-lasting connections between the implant and bone over time. Dynamic osseointegration tests focus in vitro on enzyme-mediated events and are essential for specific excavation and adhesion. Skin that was created away from the dental implant in Turkey can be attached to the skeletal matrix. Dental implants located in the bone do not have a normal periodontal ligament, nerves, or blood vessels.
Osseointegration
Osseointegration was first defined by Albrektsson in 1981 as the direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant. The state of osseointegration is defined as an interface where no detectable movement between the implant and the bone can be observed under physical loaded situation. Some authors have distinguished between osseointegration and the biologic component of osseointegration. Whereas osseointegration involves the direct anchorage of bone to the implant’s surface, the biologic component of osseointegration involves the formation of connective tissue between the bone and the implant.
Osseointegration Process
Osseointegration is a complex and sophisticated intra or intercellular process, rather than as separate single biological events. The physicochemical nature of the implant’s surface is also recognized as an important component in these healing events. At the moment of implant placement, the bone does not touch the active implant surface. After implantation, the repair processes start around the implant, which continues with remodeling and the formation of primary spongiosa in the peri-implant hard tissue. This process leads to osseointegration, which means a direct structural, functional, and long-lasting connection between ordered, living bone and the surface of a load-carrying implant.
After primary stability is achieved, functional loading of the implant may accelerate peri-implant calcified tissue regeneration around the implant. The molecular neuromodulation and signaling pathways responsible for osseointegration are a complex phenomenon in molecular biology. Secretion of the pro-inflammatory cytokines such as tumor necrosis factor (TNF), interleukin-1, and the transforming growth factor (TGF) are the pro-inflammatory factors necessary to initially trigger and assist the co-location within the peri-implant bone. In implant placement, most of orthopedic and dental implant in Turkey surgeons scrape up the bone on the implant bed. The scraping produces bone particles which are a primary function to trigger osteoconduction and bone repair. The osteoconduction promotes new bone formation through the differentiation of the pluripotent mesenchymal cells into osteogenic cells attached to an osteoconductive surface. The peri-implant bone transforms into lamellar bone with the final appearance identical to the adjacent bone. Once achieved, the lamellar bone healing, the remodeling phase continues over time to obtain the secondary osteons. For osseointegration to occur, the presence of viable and healthy bone is essential. The osteoporotic bone would not be adequately re-mineralized and restored by the time needed to obtain the new bone deposition and primary bone repair onset. Rapidly growing or multifocally growing bone tumors can also be managed with radical jaw resections without representations of these initial apoptotic cells. If not dead, in the presence of live cells such tumors require histological experiments to understand if the nano-hydroxyapatite functions as a benign reparative tissue, contributing to triggering bone-forming mechanisms. The apoptosis of cells from 3 to 9% in relation to the viability of pre-implantation bone cell viability is additional and relevant information to evaluate the ability to heal and osseointegrate the nano-hydroxyapatite texture-coated implants.
Since no significant immunovascular reaction to particulate nano-hydroxyapatite coating occurs, the apoptotic rate can be considered really non-consequential. This appears to be clear evidence of the great biocompatibility of the ceramic coating of these implants. In 7 days, although the inflammation tissue is not completely regressed, the proliferation and differentiation phase in peri-implant bone tissue has already started. The first relatively thin apposition of newly formed bone around the implant is visible. Inflammation signs subside to a very mild and non-harmful picture.
Placing the abutment is the next step. The abutment’s job is to help support the artificial tooth or restoration, which is usually placed a few weeks after the abutment installation. That’s because after the implant surgery, your gum will need some time to heal and your jawbone will need time to integrate with the implant. This attachment is crucial when it comes to giving your new teeth the stability and strength to last.
The abutment is different from an implant in that it is a functional component rather than an integrated piece that fills in where the tooth is missing. The abutment actually allows the implant to become usable and ready to support the teeth or other restoration. That’s because it protrudes just beyond the gumline and acts as the foundation onto which the crown or restoration will be placed. To do that, the abutment installation will require a re-opening of your gum to have access to the implant. After connecting the abutment to the implant, your dentist will close and reopen the gum around the installed abutment a couple of times. These exposures will give your dentist the chance to make sure the gum around the abutment is healing correctly and reshaping the gum if necessary using a temporary abutment. A final, permanent abutment will be placed before the artificial tooth is.
The abutment is used to connect the implant, which has been fitted under the gingiva and emerged from the toothless jaw’s mucous membrane, to the prosthetic tooth or other restoration. It gives a broader range of prosthetic options to the dentist by taking force that comes over it and the remaining parts of the implant during function.
The abutment forms a material that is suitable in terms of biocompatibility, to the surroundings of the area that it is used in, so it can support the aesthetic aspects. It is the part of the dental implant in Turkey system that can provide the force transition between the implant fixture and prosthetic component.
A proper abutment contributes to the connection between the implant-post and the remaining part of the implant system and provides it to be easily disassembled. It provides impermeability against bacterial and moisture between the remaining abutment and the fixture abutment. Also, it makes the correct distribution of the masticatory forces on the implant fixture, and it can dissipate the masticatory forces from the implant body to the alveolar bone physiologically because of its flexibility feature.
The abutment partly provides the fit of the tissues around the implant because it is in touch with implant-neighboring surfaces, based on its size and geometry, and its material composition. Moreover, it cannot have a direct effect on the primary stability of the implant because it is applied secondary to the implant fixture. Abutments are manufactured as one-piece and two-piece.
The next subcomponent until now is also going to be mentioned, prior to the abutments, which are one of the integrated parts of the dental implant prosthesis.
Each of the techniques employed for crown abutment placement has advantages and limitations, depending on both the implant and abutment designs and operator preferences. The clinician must adhere to specific protocols to ensure that implant movement is limited and that traumatic occlusal relationships are avoided during the dental implants procedure to ensure the restoration’s proper occlusion. The increase in abutment circumference generally allows a safer and easier impression, enhancing the method when implant angulation has been precisely established.
The choice of which final abutment to use will depend on the final prosthodontic restoration to be employed. If screw-retained reconstructions are planned, a screw-retained abutment or the use of a copy of the temporary structure is indicated; if a cemented restoration will be supplied, a straight, concave angle-type abutment is selected. The main objective of an abutment is to correctly position a single crown or bridges onto an endosseous osseointegrated dental implant in Turkey. The smallest standard the clinician uses, the closest the prosthetic abutment at the abutment-implant interface junction, and the best the polishing of the abutment, the minimal resultant abutment-implant complex.
The dentists can place abutments at different stages. Impression taking should be performed according to the manufacturer’s instructions. An open coping and pick-up type transfer abutments can be indicated. When dealing with screw-retained reconstructions, the location and trajectory of implants are transferred to the stone cast with laboratory analogs. On the other hand, if the fixed prosthesis is intended to be cement-retained, the transfer posts are cemented inside the impression copings on the stone model. When a temporary restoration is planned, there is no need to place the abutment.
The clinician should assess the occlusal multiplanar relationship with the patient in an adjusted vertical dimension of occlusion before the abutment is placed. Measurements should include the mid-abutment flat marginal edge and facial height, as well as the patient’s cant in relation to the inter-commissure and interpupillary axis. When abutments are placed, the absence of unilateral and mutually protected occlusal contacts in a 3 to 4 degree envelope of function, with a minimal occlusal contact of 80 microns, is to be tested.
Placing artificial teeth is a process that follows the treatment applied to the mouth prior to implant application and in conjunction with implants. It is a significant process for a comfortable, healthy, and aesthetic implant restoration. There are numerous types and materials involved in artificial teeth. Each type of artificial teeth has different characteristics, indications, and details that should be noted in the pre-preparatory examinations of the cases. Although the displacement of natural teeth in the mouth is their roots and natural tooth tissues, dental implants are artificial teeth that are placed on the jawbone to function as roots.
Artificial teeth can be made from many different materials. However, even the most durable materials will eventually develop some signs of wear and tear. The choices for both crowns and bridges are porcelain, porcelain fused to metal (PFM), full gold crown/bridge (FGC), or polycarbonate. The material that is chosen is determined based on the location of the implant and whether it is a straight or angled implant. Patients may also be informed that the implant teeth will cover more or less space to help maintain bone structure in a more cosmetic way, but the majority of patients typically prefer metal structures that emphasize strength. The custom crown is made. The crown is shaped to match the patient’s natural teeth and is inserted onto the implant. In a subsequent consultation, further treatment of the crown and implant are reviewed and, if necessary, adjustments are made.
In the dental implant in Turkey procedure, an artificial tooth is created to replace the lost tooth. These are also called prosthetic teeth. There are three types of prosthetic teeth, as listed below:
For dental implant restorations, two kinds of artificial teeth are available in Turkey, and they are classified into two based on whether they are fixed or removable. What distinguishes these two types? First, artificial teeth supported by dental implants and removed to be cleaned are referred to as removable. Second, fixed artificial teeth on dental implants are those that are firmly linked to the implants and can only be removed from the mouth by a dentist. Which choice is best for me? Fixed or removable teeth for dental implants can provide numerous advantages. The decision between these two options largely depends on the patient’s preferences and requirements.
How to take care of fixed teeth? The maintenance of fixed teeth on dental implants is most similar to that of natural teeth. It is necessary to floss and brush your teeth twice a day. Is there anything I need to know about removable artificial teeth after my dental implant in Turkey treatment? Removable teeth should be cleaned every day. Removable artificial teeth should be cleaned twice a day using denture cleaners and toothbrushes. A sanitizing solution for dentures can be used to clean them. Place the removable artificial tooth in a cup or bath, submerged in water, and add denture sanitizer for at least 15 minutes. It is still necessary to brush it. The hole was cleaned as well as the tip-shaped should be unemotionally in the cabin. To do so, use a soft-bristled toothbrush. The underparts of the artificial teeth as well as the implants should be made easier to access by removing the artificial tooth during the cleaning process.
In the determination of type and number of implants to be used, patients’ financial situation, treatment time, and patients’ personal convenience and the habit of regular maintenance of artificial teeth should be taken into consideration. Patients who are not convenient for regular maintenance and those who are not economically convenient should be informed about the use of a removable option. However, removable and fixed superstructure prostheses can be produced according to the planned implant diameters. The analysis will provide significant contributions to the selection of the most advantageous method.
The fixed artificial teeth are an option that requires less additional care by the patient, though they cannot be easily removed, since they are fixed on the implant or natural teeth. There is no special discomfort in the use of the fixed bridge, which looks and feels like natural teeth, yet it is less stable compared to fixed bridge used in multiple-tooth deficiencies because it is fixed by implant. On the other hand, the removable type can be easily taken out of the mouth and placed back by the patient. However, special care is required in the maintenance of these elements. In addition, the implant system ensures the use of the prosthesis more conveniently and healthily than other alternatives, especially for the treatment with a bridge of more than one unit of teeth. It is more appropriate due to its encountered positive effects on the bone structure (stimulating the bone) on the inside of the jaw bone and it is long lasting. Finally, the use of implants in bridge-making treatments dental implant price less than compensating by using only implants for equal missing tooth.
