Malocclusion consists of improper closure of the teeth on the upper and lower jaws. As a result, deformations and displacements of the dentition occur. Prosthetics in conditions of malocclusion pose a significant problem.
Why is this dangerous and risky?
With an incorrect bite, the force during chewing changes, and the load on the teeth and jaws is unevenly distributed. Therefore, prosthetics in such conditions may not only not bring the desired effect, but even cause harm.
If the jaws are not closed correctly, the force of pressure on some teeth is greater, while others are less; accordingly, the load is distributed unevenly, which can cause the implant to be knocked down or broken. To prevent this from happening, the materials from which the artificial crown will be made must have sufficient strength. It is advisable not to perform implantation with ceramics, because... she is the most fragile.
In addition to the uneven load, there is also the problem of teeth wearing out ahead of time; orthopedic structures, if the patient has them, also suffer. If you notice tooth wear, it is important to contact a specialist in time to cover your teeth with an artificial crown. Such a crown must have sufficient strength.
If there is a malocclusion, the teeth may tilt in different directions. Such a defect will complicate the prosthetic procedure, because It can be difficult to place an implant in a gap between teeth. Then special preparation is applied using a surgical or orthodontic method, during which excess teeth will either be removed or the dentition will be straightened.
Prosthetic procedure for malocclusion
If the defect is not very pronounced, then the procedure is carried out as standard. A plaster cast of the jaw is taken for the patient, then an artificial prosthesis is modeled.
If there is significant curvature of the teeth, then the patient is advised to wear orthodontic structures for several years in order to straighten the dentition, and successful prosthetics become possible.
Where there is improper closure of the teeth, the future shape of the crown is carefully planned. The design should not cause difficulties when moving the jaws and should not have any impact on adverse influence on adjacent teeth. The preparation method for each case is purely individual, depending on clinical picture every patient.
Hello! I have been scheduled for removal of the last two upper molars on the left, because... they have rotten roots. I plan to get implants because there will simply be nothing to chew on this side. Do I need to contact an implantologist only after 3 months after removal or is it possible to place implants immediately? I would also like to clarify, I have a completely wrong bite, will this interfere with implantation? In addition, there are bridges on the front 4 upper teeth (for two teeth each), they have already fallen off, then the teeth were built up with pins and the crowns were put on again. In general, they have been keeping their word of honor for 7 years now. And I am afraid that when they make an impression for the crowns for the implants, they will completely fall off. Is it possible to make a cast of not the entire jaw, but only the left side, without touching the 4 front incisors?
Ruslan, hello! In addition to the classical dental implantation, there is also a so-called express method. Its peculiarity is that the implant is installed immediately after tooth extraction, or even immediately covered with a crown. But this technique is not suitable for everyone. Therefore, consult with a specialist who knows your clinical case. Bite defects are sometimes indeed a problem during implantation. In some cases, treatment with braces or removal of some teeth may be necessary before installing an implant. And yet, malocclusion does not always affect the implantation process. It all depends individual characteristics patient's dental apparatus. As for prostheses that “keep on their word of honor,” they need to be replaced with reliable orthopedic structures.
Experts distinguish two degrees of occlusion:
- Jaw displacement. With a slight displacement, implantation is possible. Sometimes in similar situation the problem can be corrected through the use of dentures. When severe jaw misalignment is observed, implantation will most likely be denied.
- Not correct position teeth. When the roots of adjacent units do not interfere with the installation of the implant, attention is paid to aesthetics. If you cannot achieve the ideal look right away, alignment is required using a braces system. Another option is to remove interfering units.
To more accurately determine the clinical situation, a preliminary x-ray examination oral cavity and take impressions of the jaws.
Minor deformations include:
- lack of space in the dentition to install a full crown on an implant;
- tilting or incorrect rotation of some teeth;
- large gaps between teeth.
In case of minor violations, implantation can be performed. However, the patient is informed of possible risks. If he is ready to put up with it, the procedure is carried out.
If there is severe malocclusion, titanium roots cannot be installed until the dentition is straightened. For this purpose, preliminary orthodontic treatment is carried out. Otherwise, there is a risk of strengthening and strengthening the deformity, which may even harm the patient. Therefore, an implant surgeon may refuse to perform implantation.
What is the dental system and why do deviations occur?
The dentofacial system refers to the upper and lower jaws, as well as all their constituent elements:
- temporomandibular joints;
- gums;
- chewing muscles;
- teeth;
- bone tissue;
When all the teeth are in place, the occlusion is correct, and there are no inflammatory processes in the oral cavity, then the dental system is normal and functioning well. At the same time, the teeth are able to withstand maximum chewing loads and are not injured. In the presence of defects, chewing dysfunction occurs, which creates obstacles for the installation of implants. Most common abnormal changes V dental system are considered:
- bite deformation - displacement of the jaws relative to each other;
- incorrect arrangement of teeth, presence of gaps between them;
- anomalies in the structure of the bone tissue of the jaw;
- loose bone structure or atrophy.
Experts distinguish five types of deformation:
- deep- when the bottom row is almost completely covered by the top;
- distal- the upper jaw protrudes significantly forward compared to the lower jaw;
- mesial- sagittal anomaly of occlusion, when the chin (lower jaw) protrudes forward;
- open— partial or complete non-occlusion of teeth;
- cross- transversal anomaly, in which one of the jaws is only partially formed or is displaced to the side from the other.
Due to malocclusion, the load on the jaw is distributed unevenly, which leads to premature destruction of units located in the area maximum pressure. If an implant ends up there, peri-implantitis may develop, which provokes rejection. Therefore, before implanting titanium roots, all problematic issues must be eliminated.
What could be the consequences if implants are installed and the anomaly is not corrected?
Before implantation, it is important to consult with an orthodontist in order to pre-select methods for correcting existing defects and plan the stages of treatment. Otherwise, the following complications may occur:
- violation of the integrity of the temporomandibular joints (clicking, crunching, pain appear);
- destruction of certain teeth exposed to the greatest chewing load;
- increased abrasion tooth enamel;
- premature loosening of the artificial root and development inflammatory process(peri-implantitis);
- psychological discomfort and internal discontent;
- reduction in the service life of the implant due to uneven load on it;
- chronic headaches resulting from pressure nerve endings and muscle spasms;
- worsening deformity.
Is it possible to correct a bite if an implant is already installed?
Correction of occlusion disorders after implantation is not carried out. The fact is that after osseointegration the artificial tooth root becomes absolutely motionless in the jaw bone. This is its main difference from natural material, which is slightly springy or “cushioned” and amenable to artificial movement.
The implant after engraftment is immobile and cannot be moved
The titanium rod is implanted at a certain angle and repeats the position/inclination natural teeth. When living units begin to shift, the implant moves along with them, which can provoke rejection. Therefore, bite correction is always carried out before implantation.
If the patient has implants in the mouth and occlusion correction is required, they are removed. This is followed by orthodontic treatment and re-implantation of titanium roots, taking into account the formed occlusion. There may be isolated exceptions - when the implant is installed before the defects in jaw closure are corrected, and then the natural teeth are displaced, attracting or pushing them away from the fixed metal root.
Price
| Service name | Cost, rub. |
| Bite correction | |
| Consultation with an orthodontist | For free |
| Tying the arch to one bracket | 400 |
| Fitting and applying the arc | 500 |
| Observation during the treatment phase | 1000 |
| Alginate impression | 1000 |
| Placing one bracket on the NO MIX material | 1800 |
| Making a diagnostic model (2 pcs.) | 2500 |
| Diagnostic model calculation | 2500 |
| Treatment of anomalies (bite correction) | 70000 |
| Implantation | |
| Operation | |
Malocclusion is a problem that orthopedic doctors should not ignore when planning dental implants. It is important to find the source of the deformation (congenital adentia, childhood malocclusion, skeletal forms of malocclusion, etc.). This requires high-quality diagnostics and experienced orthodontists. Some malocclusions are treated orthodontically - by wearing braces or special equipment; in other cases, doctors may resort to the help of a surgeon (for skeletal malocclusion deformities). In any case, dental implantation in patients with malocclusion is not the first step in treatment.
If you place implants without correcting your bite
Unfortunately, many Moscow clinics still practice the work of an implantologist in isolation from the orthodontist and orthopedist. The patient comes, complains of missing teeth, and after some time an implant is installed and he is referred to an orthopedic doctor for prosthetics. This tactic is wrong.
- Due to an incorrect bite, they may appear following problems: gum recession, increased tooth wear, selective tooth destruction due to uneven chewing load.
- Reduced service life of a dental implant due to uneven load on it. Premature loosening of the implant and development of inflammation around the implant (peri-implantitis).
- Incorrect bite negatively affects work digestive system and temporomandibular joints. The joints wear out prematurely, clicking, crunching, and pain in the TMJ appear.
- The health of the neck muscles and posture depend on the correct bite. An incorrect bite can cause chronic headaches due to muscle spasms and nerve compression.
- Psychological discomfort persists. Having installed a dental implant, the patient does not receive beautiful smile, a partial solution to the problem leaves the patient with internal dissatisfaction.
Dental implantation at Dial-Dent
At Dial-Dent, any treatment is carried out comprehensively. If a patient has a malocclusion, it is first necessary to correct it, then undergo dental implantation, implant prosthetics and, if necessary, aesthetic prosthetics. Only such tactics guarantee correct load for a dental implant and long term services. All stages are discussed with the patient before the start of treatment.
In a situation where the doctor sees that without correcting the bite it is impossible to carry out dental implantation and prosthetics on implants, since the orthodontic situation may worsen and it is impossible to guarantee the service life of the crown on the implant, and the patient refuses orthodontic preparation, the patient may be denied implantation.
At regular intermedical discussions (round tables) that take place at Dial-Dent, doctors examine complex cases, and the final decision is made taking into account the opinions of all necessary specialists. Below are photographs from the next round table of Dial-Dent specialists.
Patients often turn to an orthopedic dentist with problems not only of an aesthetic nature, but also with the absence of some teeth. These may be molars on the upper and lower jaw, which are often removed early by therapeutic indications. Such patients do not always immediately seek orthopedic help; many postpone implantation and prosthetics for various reasons.
Later, patients come to the orthopedist, but there is room for prosthetics in the area extracted tooth is no longer enough. There can be many reasons: neighboring teeth could move towards the defect or tilt, which is even worse. There are also situations when antagonist teeth move towards the defect. This usually shows clearly x-ray, when the crown parts of the teeth on both sides of the defect are practically in contact with the contact surfaces, and there is a large distance between the roots. This position of the teeth subsequently causes problems with periodontium, with exposure of the roots of the teeth and patient complaints about food getting stuck, that is, noticeable discomfort. For such patients, the orthopedist recommends preliminary orthodontic treatment, without which prosthetics will be impossible. The orthodontist, in turn, carries out preparations by moving the teeth into the correct position, and then, when the conditions for prosthetics are created, he transfers the patient to the orthopedist to continue treatment.
Why is it important not to delay starting treatment?
If the patient has no tooth upper jaw, then the lower antagonist teeth may begin to move upward. If there is no tooth in the lower jaw, then upper teeth, which are located above this defect, can also move down. And jaw blocking can occur when a displaced tooth prevents chewing correctly, which sometimes causes dysfunction of the temporomandibular joint. It happens that after the removal of the sixth and seventh teeth, the eighth teeth, wisdom teeth, erupt, then the orthodontist will have to make a decision about their removal or preservation.
Decreased bite depth
Another typical situation is the loss of lateral teeth and increased wear of the front teeth. The consequence of this situation is a decrease in the height of the bite. Such patients, especially those with incorrect deep bite Before prosthetics, orthopedists refer to an orthodontist to “raise” the height of the bite.
Correction of the smile zone and missing anterior incisors
There is an aesthetic problem in the smile area associated with the absence of front teeth, for example, second incisors. Nowadays, it is not uncommon that even their rudiments are missing. It does not cause complaints as long as there are baby teeth in this place, but after their removal the question arises about restoring the defect. In such situations, the orthodontist, orthopedist and implantologist choose a comprehensive treatment strategy. Options are being considered with implantation and prosthetics in this area or orthodontic movement of adjacent teeth with their further restoration with veneers to create a harmonious smile.
A less common situation is the absence of one of the front incisors. If the defect has existed for quite a long time, then problems may arise with implantation in this area due to a deficiency bone tissue. Then the orthodontist proposes a treatment plan with movement lateral incisor in place of the missing central one, and implant prosthetics are performed in the freed area where there is enough bone tissue.
Partial or complete orthodontic treatment?
We offer different options. Sometimes full orthodontic treatment is necessary for an aesthetic and functional result. If we are talking about patients who already have quite a lot of orthopedic structures on the upper jaw, there are no lateral teeth, there is crowding, a close position of the front incisors on the lower jaw, then it will be sufficient to align the lower incisors and, as far as possible, raise the bite. In this case, we are talking about partial orthodontic treatment, lasting not 1.5-2 years, but much faster.
Local problems, such as tilted eighth teeth in the absence of seventh or sixth teeth, are solved by the support of two miniscrews without the use of a brace system or by using small systems for the lateral group of teeth. This will also be partial orthodontic treatment.
Team approach
In solving such clinical situations, a team approach is required, in which general concept An orthopedist is in charge of treatment. He discusses the desired result with the orthodontist, and the orthodontist analyzes the possibility of its implementation. In such a situation, the orthopedist plans the movement of teeth with an accuracy of millimeters and gives specific instructions to the orthodontist.
Sequence of treatment
Prosthetics are performed after orthodontic treatment. When there are already some orthopedic structures in the oral cavity (crowns, veneers), it is permissible to position braces on them. However, after the end of orthodontic treatment, the structure will most likely have to be replaced, because the shape of the dentition and bite will be different.
Orthodontic treatment in the presence of restorations
If dental prosthetics is necessary, before starting orthodontic treatment, the orthopedist plans to install special, milled plastic crowns for the period of wearing the braces system. Such structures withstand the fixation of locks and the movement of teeth well; after completion of the orthodontist’s work, it will be necessary to replace them. temporary crowns to permanent ones, taking into account the corrected bite.
The retainer does not stick to orthopedic structures, with the exception of veneers - in this case it is not affected inner surface the tooth and retainer will be securely fixed. On ceramic crowns It is almost impossible to glue a retainer, so a retention mouthguard is provided for patients with such designs. The first year after completion of treatment, it will relieve the load on the front teeth and will be a retaining factor, guaranteeing the stability of the result.