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How May I Get Implants If I Lack Bones İn The Upper Molar Region?
MAKALE #14329 © Yazan Dt.Güzin KIRSAÇLIOĞLU | Yayın Mart 2015 | 2,255 Okuyucu
PROCEDURES TO HEIGHTEN THE SINUS BASE
It is certain that many patients now choose implants for their high rate of success and comfort. Although many patients wish to have implants, some do not have proper bon structures for such procedures. Early tooth loss promotes thinning of the jawbone. Therefore, for the bone losses that occur especially on the upper jaw teeth, the sinus base sagging down is effective. The sinus base has to be increased in order to apply an implant treatment.
Today, the advancements in dentistry make the implantation of patients with bone defects on the upper jaw posterior area possible for the dentists, through new methods of therapy.
THERE ARE TWO METHODS SUGGESTED FOR THIS:

A) HEIGHTENING THE UPPER SINUS BASE VIA THE TRANSCRESTAL METHOD: In the regions where the toothless space has adequate width and the height is minimum 5mms where the sinus base is straight, the base may be heightened with the transcrestal method. The main disadvantage of this technique: The sinus membrane might be ruptured. Though, when performed cautiously and by experienced hands, the risk is minimal.
B) HEIGHTENING THE UPPER JAW SINUS BASE VIA THE LATERAL WINDOW METHOD: In the regions where the toothless space is adequately wide, but its length is shorter than 4-5 mms, the sinus base may be heightened via the lateral window method. The lack of bone length and bone thinning occurs in a three-dimensional manner. Toothless posterior upper jaw is assessed not only via the initial bone height under the maxillary sinus, but also vertically and horizontally. If there is a serious issue with the vertical dimension, and if the vertical dimension is lacking, to create the required bone mass and provide the implantation as well as making preliminary prosthetics, adding bone mass is required, which could be done by heightening the sinus base adding bone graft, followed by the implantation in the same session. Alternatively, the sinus base could be raised first ant the implantation could be performed after the bone formation is complete.
IN THE LATERAL WINDOW METHOD;
Implant success: To assess the success with implants, the 85 studies regarding the one-year or longer follow-up data of patients with protheses (These studies cover 14,944 implants applied to the grafted sinuses of 4807 patients) show that after 12-107 months (average 31,2 months; median 29 months) that follow the prosthetic installation, there is a change between 61.2% and 100% regarding the rate of success (average 94,2%; median 95%).
BONE MATERIAL THAT IS USED IN THE LATERAL WINDOW METHOD
AUTOGENOUS GRAFT (AUTOGRAFT): The implantation of the material extracted from regions such as the mouth or the bottom, excluding the area to apply the procedure, on a person’s own body.
ALLOGENOUS GRAFT (ALLOGRAFT): The graft transfer between two different individuals of the same species, that is, the bone transfer between two humans.
XENOGRAFT (XENO GRAFT): The graft that is received from a donor of a different species. ALLOPLIST: The inorganic, artificial or inert material implanted into the tissue (gaining popularity nowadays).
PRETREATMENT ASSESSMENT AND PLANNING FOR PROCEDURES TO HEIGHTEN THE SINUS BASE RADIOLOGIC ASSESSMENT:
The choice of patients plays an important role regarding the success of the implantation in the procedures to raise the sinus base. The dentist has to assess both the anatomy of the sinus with the neighboring structures, and the changes of the jawbone after pulling out a tooth. This is why different radiologic analyses are required. In the radiologic assessment -> Sinus -> The toothless one is analyzed.
ASSESSING THE OVERALL HEALTH CONDITION
There should not be a local or a systemic health problems that affects bone healing in the patients who require sinus base elevation. These diseases are assessed according to the doctor’s decree:
-> For the uncontrolled diabetic patients,
-> For the patients that undergo radiotherapy that covers the head and the neck regions,
-> For transplantation patients who underwent a long-term, continuous immunosupression therapy
-> For the patients with osteoporosis.
The patients with naropsychiatric problems should be assessed as they cannot follow the rules that should be followed after the surgery.
MEDICATION USED:
An entire list of all the medications used a long time before the surgery. This way, the dentist will be able to decide whether a certain condition may compromise the surgical procedure and take measures accordingly. For the patients who are using xiphonates intravenously or receiving chemotherapy or a medication that could suppress bone healing and the immune fuel, surgical procedure must be avoided. Medication types such as antitrambatic medication require extra caution during surgery. The antitrombatics without a high risk of bleeding should not be cut during treatment.
ALLERGIES
The person should be analyzed for any allergy of antibiotics or medications, so that no issues will arise with the medications given after the therapy.
TOBACCO and ALCOHOL; Smoking is a risk factor for both the original bone, and the implants located on the grafted posterior upper jaw.
It is known that alcohol affects the bone graft. In addition, the main problem regarding alcoholism in the implant patients consists of subsidiary problems such as malnutrition, bad mouth hygiene or a problem of adaptation. For these reasons, people with alcoholism should work in coordination with their doctors on this aspect.
PEOPLE WITH ADAPTATION PROBLEMS;
For patients that have issues regarding adaptation, there may be problems with the procedure. These patients include, but are not limited to, patients who lack the habit of mouth maintenance.
Yazan
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