If there is little or no enamel, a full crown is preferred.
Teeth gnashing, clenching (bruxism) or grinding. If patients have an underbite or straight alignment with para-functional disorders such as chewing pencils and eating ice. If there is excessive crookedness.
If there are class 3 disorders (closure disorder in which the lower jaw closes further).
1- If your teeth are noticeably crowded, protruding or recessed, if your upper and lower jaws are curved, or if there is a mismatch between your teeth and other facial features,
2- If there is an aspect of your smile that you find unappealing, such as excessive gum tissue showing while smiling,
3- If you experience difficulty with biting and chewing due to the relationship between your teeth and jaw,
4- If you have developed persistent habits such as mouth breathing, thumb-sucking, or nail-biting, or have had these habits in the past,
5- If you have trouble closing your mouth or cannot fully close your lips,
6- If you experience pain or hear noises from your jaw joint,
7- If you were born with a cleft lip or palate, or have a similar condition,
8- If a family member has received orthodontic treatment or has an orthodontic issue,
9- If you have a missing tooth and your remaining teeth are shifting out of place,
10- If you struggle to clean your teeth properly due to crowding, leading to gum problems,
11- If there are noticeable gaps between your teeth,
12- If you lost your baby teeth earlier than normal, you may require orthodontic treatment.
Orthodontic treatment is becoming increasingly prevalent in society, and the belief that it can only be undertaken at a young age has become widespread due to its long-term use in children and young adults. However, it is important to note that orthodontic treatment can be applied to patients of all ages.
Various companies in the market manufacture aesthetic brackets to fulfill aesthetic requirements. These brackets are designed in a way that their color resembles the color of tooth enamel and does not draw much attention. A large number of our adult patients opt for aesthetic brackets as they are not too conspicuous and fulfill their satisfaction.
The “lingual technique” is a popular orthodontic treatment option among adults as it offers the advantage of being less visible. With this method, wires are placed on the inside of the teeth, making them invisible from the outside and providing a significant aesthetic benefit.
Nowadays, individuals are becoming increasingly aware that orthodontic treatment is the most natural approach to achieving straight teeth and an attractive smile. By undergoing orthodontic treatment that lasts around 8 to 24 months, you can obtain a naturally beautiful smile that will last a lifetime. A natural and beautiful smile can boost your self-esteem and improve your quality of life.
During the initial appointment with an orthodontist, a thorough examination is conducted to assess whether orthodontic treatment is necessary. The orthodontist also provides information regarding the duration and cost of the treatment. Before beginning orthodontic treatment, it is important to address any dental issues such as decayed teeth or gum bleeding. Poor oral hygiene may prevent the insertion of wires, therefore, it is essential to complete any necessary treatments beforehand. Once the decision to undergo orthodontic treatment is made, the planning phase begins. This involves collecting various records and data, including intraoral and extraoral pictures, measurements of the teeth in the upper and lower jaws, and, if necessary, lateral cephalometric and hand and wrist x-rays. The treatment plan is then developed based on these findings.
An implant is an artificial tooth root that is made to replace missing teeth and placed in the jawbone. Implants made of titanium are biocompatible with human tissues and become a part of the body as a result of the biological bonding with the jawbone.
Implants are suitable for situations where a person is missing a single tooth, multiple teeth, or all their teeth. When there isn’t enough bone in the target area to place the implant, bone addition procedures can be utilized in many cases to successfully apply the implant.
Missing a single tooth: If you have a gap between your teeth due to a missing tooth, you can opt for implant treatment to fill the gap without affecting the teeth adjacent to it. This way, your healthy teeth won’t be damaged. However, there should be enough room in the gap for the implant to fit. The gap will gradually close up as your remaining teeth shift over time. Therefore, getting an implant before the gap closes completely is important.
Partial tooth loss: It’s not necessary to have an implant for every missing tooth. The placement and number of implants needed are determined based on the condition of your teeth and bone structure. An x-ray and examination are required to determine the number of implants and their locations. Dental bridges can be created between natural teeth and implants, allowing fewer implants to fill the gaps.
Complete tooth loss: If there are no teeth in the upper or lower jaw and the jawbone is suitable, 6 to 8 implants can be placed in each jaw for a total of 12 to 16 implants. With these implants, a fixed prosthesis can be created. If the jawbone is unsuitable for implant placement, a removable prosthesis can be made with fewer implants.
The suitability of the patient’s jawbone structure is crucial for the successful placement of dental implants, as the implants have specific width and height requirements. The patient’s bone structure must be wide and tall enough to support the implant. Bone grafting and soft tissue techniques can address insufficient bone structure to prepare the area for implantation. Patients with well-controlled health conditions who are not undergoing chemotherapy or radiotherapy can receive implants regardless of age, although very young patients must have completed adolescence.
When administered correctly, anesthesia ensures you will not experience pain during the procedure. Local anesthesia is typically used during implant surgery, but sedation or general anesthesia can also be utilized at the patient’s request. Implant surgery is generally simpler than tooth extraction and can cause minor discomfort that may be felt in the evening following the procedure. However, this pain is typically milder than the pain felt after tooth extraction and can be alleviated with mild painkillers, although it may not even be necessary to take painkillers in many cases.
No, although there is discussion in dentistry, it is not yet a common practice. The healing process, during which the implants fuse with the bone, takes 1.5-2 months in the lower jaw and 3 months in the upper jaw. If bone formation procedures are necessary, this period may extend to 6-9 months, depending on the extent of bone loss. It is crucial to minimize the load on the implant during this period. The dentist will provide information about the timeline for placing the prosthesis based on measurements taken after placing the implant. If tooth loss is not an issue, a temporary prosthesis may be created during this waiting period.
Before undergoing implant treatment, it is essential to consider several important factors. The patient’s overall health condition is one of the critical factors that significantly influence the success of the implant. If the patient suffers from a severe health issue that can hamper healing, implant treatment may not succeed. Patients with uncontrolled diabetes, for instance, have a higher risk of implant failure. However, patients who manage their diabetes and maintain their blood sugar levels can safely receive implant treatment. Patients undergoing chemotherapy or radiotherapy have lower resistance, making implant healing problematic. Therefore, it is not recommended to undergo implant treatment during this period. However, with the doctor’s approval, implant treatment can be carried out after 6-9 months of treatment completion. People with cardiovascular disease and high blood pressure can also receive implant treatment with their doctor’s consent.
Heavy consumption of alcohol and cigarettes can have a negative impact on the success of dental implants. Thus, extra care should be taken, particularly during the healing phase. Dental implants are not recommended for those who smoke excessively (2-3 packs per day).
Apart from these, patient care is one of the most crucial factors in implant success. Adhering to the post-implant treatment guidelines and not missing follow-up appointments can enhance the implant’s success rate.
The success of the implant is affected by two crucial factors: the conditions under which the implant is placed, which should be suitable and conducted by a specialized doctor, and the quality of the implant itself.
When implanted by a skilled specialist in suitable conditions, implants have a long lifespan. It’s important to remember that our natural teeth are meant to last a lifetime but without good care and regular check-ups, they can also be lost. With proper care and regular dental check-ups, implants can last a lifetime.
Preparing the patient: Pre-medication may be required before operation. The nurse will decide whether this is necessary depending on the patient’s health status.
The patient is dressed in a suitable gown before they enter the operation room prior their operation (head bonnet, cloth patient gown). The mouth area is wiped with antiseptic solution. The patient’s forehead area is covered with a sterilized cover.
Surgical protocol: Implant surgery is usually performed with local anesthesia. Can be performed under general anesthesia or under sedation if necessary or if the patient requests so.
1-Insition and flap removal: To remove the flap, there have been several types of incisions suggested. Brenemark et al. proposed an arc-shaped incision in 1985 for edentulous mouths, located between the foramen mentale in the lower jaw and in front of the first molars in the upper jaw. Nonetheless, the recovery phase of this incision method is typically challenging due to edema and pain.
The current recommendation is to initiate the primary incision at the crest of the ridge or towards the keratinized tissue and continue with a secondary releasing incision in a buccal and/or lingual direction without harming the marginal gingiva of the neighboring teeth. The mucoperiosteal flap is then elevated using an elevator until the bone is exposed. At this point, the lingual or palatal flap is raised and secured with a suture passing through the opposing teeth’s roots. The granulation tissues that are attached to the bone are removed using bone forceps, and the bone surface is smoothed out as much as possible before preparing the implant socket. Adhering to these guidelines is crucial to prevent postoperative complications.
2-Preparation of the implant socket: The implant socket preparation involves several steps. First, the bone should be thoroughly washed with physiological saline to prevent overheating. Before drilling the socket, the surgeon should ensure that all necessary equipment is available. Then, the implant’s special set and physiodispenser are used to initiate the socket opening process. A starting bur with a diameter of 2mm is used to reach a predetermined depth. The direction of the socket is monitored in three dimensions using surgical templates and direction guides to ensure proper positioning of the missing tooth. A guide pin with millimetric markings is used to control the depth of the cavity, and the bur is moved up and down to allow continuous water flow to the working end. The implant socket’s axis is checked during placement, and the slot size is determined using the first guide bur and then expanded with burs of different diameters according to the missing tooth’s width. The socket is expanded as much as the bone allows, and the nesting process is completed by ensuring that no residue is left inside the nest.
3-Placing the implant: To place the implant, it should be inserted into its socket in the direction it was prepared for. The implant’s rotation speed should not exceed 20-40 rpm. Once the first thread enters the socket, the rest of the implant can be threaded into place without applying any additional force. The implant should be fully embedded into the bone up to its coronal margin. Once the implant is placed, the carrier piece is removed, and the implant’s healing cap is attached.
4-Flap closure and suturing: Following the completion of the implant placement procedure, the next step is to close the incision and suture the tissue. Before closing and suturing the gingiva, the area is washed with saline and all debris is removed. Then, the appropriate technique is used to start the suturing process. Once the sutures are in place, the patient is instructed to bite down on sterile gauze pads to apply pressure to the area.
The second stage of the implant process involves the exposure of the implants, preparing them for surgery or functional use. Prior to beginning this stage, it is important to take an x-ray to identify any radiolucent areas or bone defects that may be present around the implants.
In the procedure, the gingiva around the implant cover is raised, and any excess bone growth on the implant is removed using a drill. The closure screw is then fully exposed and opened with a suitable key. After removing the closure screw, a gingivaform is placed, selected according to the thickness of the gingiva. The screw should be positioned roughly 2mm above the gingiva.
If there is any slight movement of the implant, it suggests that osseointegration has not occurred. Even with local anesthesia, any pain around the implant should also be a cause for concern, as it may indicate the formation of soft tissue around the implant. To confirm the compatibility of the healing screw with the implant and to identify any radiolucent areas around the implant, periapical radiography should be performed.
The goal of the second surgical procedure is to attach a healing screw or abutment to the implant. Advancements in surgical and prosthetic techniques have led to improved functional and aesthetic outcomes. Current treatment methods allow for a more natural emergence profile to be achieved, with the aim of increasing the thickness and quality of the mucosa around the implant by adjusting the peri-implant soft tissue. Various mucogingival operations can be performed to modify the peri-implant soft tissue.
In natural teeth, the crown’s marginal edge is typically situated 0.5-1 mm below the gingiva. However, for aesthetic reasons, implant-supported crowns are usually positioned 2-4 mm below the gingiva. Therefore, the presence of keratinized tissue is crucial for both aesthetics and function.