Проблемы имплантации зубов

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Олимов, А., Мукимов, О., & Исанова, Д. (2020). Проблемы имплантации зубов. in Library, 20(2), 346–350. извлечено от https://inlibrary.uz/index.php/archive/article/view/14295
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Аннотация

Дентальная имплантация в настоящее время является одним из наиболее перспективных направлений в реабилитации стоматологических больных. Несмотря на достигнутые успехи, дентальная имплантация, как и другие хирургические методы лечения, сопровождается разного рода осложнениями. Наиболее частые осложнения носят воспалительный характер. Однако в дентальной имплантологии существует множество проблем. В данной статье представлен обзор научной литературы о факторах риска ранних и поздних осложнений дентальной имплантации. Считается, что хорошо прижившийся и интегрированный дентальный имплантат должен функционировать не менее 10 лет, удовлетворять пациента в эстетическом и функциональном отношении, иметь клиническую стабильность, быть биосовместимым по отношению к окружающим тканям.

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¡ÇÁÅÊ ÒÈÁÁÈ¨Ò ÆÓÐÍÀËÈ

ÓÇÁÅÊÑÊÈÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË

UZBEK MEDICAL JOURNAL

Olimov Azimjon

Muqimov Odiljon

Isanova Diyora.

Tashkent State Dental Institutå

ooazik@mail.ru

PROBLEMS OF DENTAL IMPLANTATION

http://dx.doi.org/10.26739/2181-0664-2020-2-3

ÀNNOTATION

Dental implantation is currently one of the most promising areas in the rehabilitation

of dental patients. Despite the success achieved, dental implantation, like other surgical
methods of treatment, is accompanied by various kinds of complications. The most
common complications are of an inflammatory nature.

However, there are many problems in dental implantology. This article presents a

review of the scientific literature on risk factors for early and late complications of
dental implantation.

It is considered that a well-established and integrated dental implant should function

for at least 10 years, satisfy the patient in aesthetic and functional terms, have clinical
stability, and be biocompatible with respect to the surrounding tissues.

Keywords: dental implant, mucositis, periimplantitis, risk factors for dental

implantation, autoimmune diseases.

Îëèìîâ Àçèìæîí

Ìóêèìîâ Îäèëæîí

Èñàíîâà Äè¸ðà

Òàøêåíòñêèé ãîñóäàðñòâåííûé ñòîìàòîëîãè÷åñêèé èíñòèòóò

ÏÐÎÁËÅÌÛ ÄÅÍÒÀËÜÍÎÉ ÈÌÏËÀÍÒÀÖÈÈ

ÀÍÍÎÒÀÖÈß

Äåíòàëüíàÿ èìïëàíòàöèÿ â íàñòîÿùåå âðåìÿ ÿâëÿåòñÿ îäíèì èç íàèáîëåå

ïåðñïåêòèâíûõ íàïðàâëåíèé â ðåàáèëèòàöèè ñòîìàòîëîãè÷åñêèõ áîëüíûõ. Íåñìîòðÿ
íà äîñòèãíóòûå óñïåõè, äåíòàëüíàÿ èìïëàíòàöèÿ, êàê è äðóãèå õèðóðãè÷åñêèå
ìåòîäû ëå÷åíèÿ, ñîïðîâîæäàåòñÿ ðàçëè÷íîãî ðîäà îñëîæíåíèÿìè.

Îäíàêî â äåíòàëüíîé èìïëàíòîëîãèè ñóùåñòâóåò ìíîãî ïðîáëåì. Â äàííîé


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ñòàòüå ïðåäñòàâëåí îáçîð íàó÷íîé ëèòåðàòóðû ïî ôàêòîðàì ðèñêà ðàííèõ è ïîçäíèõ
îñëîæíåíèé äåíòàëüíîé èìïëàíòàöèè.

Ñ÷èòàåòñÿ, ÷òî õîðîøî óñòàíîâëåííûé è èíòåãðèðîâàííûé çóáíîé èìïëàíòàò

äîëæåí ôóíêöèîíèðîâàòü íå ìåíåå 10 ëåò, óäîâëåòâîðÿòü ýñòåòè÷åñêèå è
ôóíêöèîíàëüíûå ïîòðåáíîñòè ïàöèåíòà, îáëàäàòü êëèíè÷åñêîé ñòàáèëüíîñòüþ è
áûòü áèîñîâìåñòèìûì ïî îòíîøåíèþ ê îêðóæàþùèì òêàíÿì.

Êëþ÷åâûå ñëîâà: çóáíîé èìïëàíòàò, ìóêîçèò, ïåðèèìïëàíòèò, ôàêòîðû ðèñêà

äåíòàëüíîé èìïëàíòàöèè, àóòîèììóííàÿ áîëåçíü.

Îëèìîâ Àçèìæîí

Ìóêèìîâ Îäèëæîí

Èñàíîâà Äè¸ðà

Òîøêåíò äàâëàò ñòîìàòîëîãèÿ èíñòèòóòè

ÄÅÍÒÀË ÈÌÏËÀÍÒÀÖÈß ÌÓÀÌÌÎËÀÐÈ

ÀÍÍÎÒÀÖÈß

Òèø èìïëàíòàöèÿñè µîçèðãè êóíãà êåëèá ñòîìàòîëîãèê áåìîðëàð

ðåàáèëèòàöèÿñèäà ýíã èñòè³áîëëè ñîµàëàðäàí áèðè á´ëèá ³îëìî³äà. Ýðèøèëãàí
ìóâàôôà³èÿòëàðãà ³àðàìàé, áîø³à æàððîµëèê äàâîëàø óñóëëàðè êàáè òèø
èìïëàíòàöèÿñè òóðëè õèë àñîðàòëàð áèëàí áèðãà êåëàäè.

Áèðî³, òèø èìïëàíòîëîãèÿñèäà ê´ïëàá ìóàììîëàð ìàâæóä. Óøáó ìà³îëàäà

òèø èìïëàíòàöèÿñèíèíã ýðòà âà êå÷ àñîðàòëàðè ó÷óí õàâô îìèëëàðè á´éè÷à
èëìèé àäàáè¸òëàð êåëòèðèëãàí.

ßõøè òàøêèë ýòèëãàí âà èíòåãðàöèÿëàíãàí òèø èìïëàíòàòè êàìèäà 10 éèë

äàâîìèäà èøëàøè, áåìîðíè ýñòåòèê âà ôóíêöèîíàë æèµàòäàí ³îíäèðèøè,
êëèíèê áàð³àðîðëèêêà ýãà á´ëèøè âà àòðîôäàãè ò´³èìàëàðãà íèñáàòàí
áèîìóòàíîñèá á´ëèøè êåðàê.

Êàëèò ñ´çëàð: òèø èìïëàíòè, ìóêîçèò, ïåðèèìïëàíòèò, äåíòàë èìïëàíòàöèÿ

ó÷óí õàâô îìèëëàðè, àóòîèììóí êàñàëëèêëàð.

R

elevance. The success of dental implants depends on the General state of the
patient's div, as well as on the technique of implant placement, the skill and

experience of the implantologist and the management of the patient in the postoperative
period.

Indications for dental implantation are partial defects of the dentition or complete

absence of teeth, the inability for various reasons to use removable prostheses (deformities
of the jaws, pronounced gag reflex on the prostheses).

Objective : Experimentally and clinically justify the advantages and disadvantages of

dental implants. Find the optimal resolve to avoid dental implant problems.

Material and research methods:
Before the implantation operation, the patient must undergo a comprehensive

examination, which includes collecting complaints, anamnesis, examination of the oral
mucosa, while assessing the condition of the teeth, alveolar processes, the type of bite,
the level of oral hygiene, and, if necessary, consulting other specialists. In addition, x-
ray examination of the dental system is performed using computed tomography. This
method allows to visualize the state of the jaw bones in three dimensions, and to assess
bone density, the trabecular nature of the figure, the condition of the sinuses, the


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ÓÇÁÅÊ ÒÈÁÁÈ¨Ò ÆÓÐÍÀËÈ | ÓÇÁÅÊÑÊÈÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË | UZBEK MEDICAL JOURNAL

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volumetric parameters of the alveolar processes, the degree of atrophy of the jaw bone,
the distance between al-violarium ridge and maxillary sinus floor, the topography of the
mandibular canal. In addition, during the planning of the operation, an instrumental
examination is performed, which includes measuring the width of the alveolar processes
to select the location of the future implant.

All complications after dental implantation are usually divided into two groups: early

(manifested in the period from a few days to 2-3 weeks after surgery) and late (developed
after several years). Early complications are typical of the inflammatory process that
occurs as a result of mechanical trauma to the tissues of the maxillofacial region, namely:
postoperative edema, bleeding in the area of the installed implant, appearing after the
termination of the VASO-constrictor action of epinephrine, which is part of the solution
for anesthesia. In addition, pain may occur, as well as a rise in temperature to 38°C.
divergence of sutures, eruption of part of the implant through the mucous membrane
are also early complications, but unlike other complications, they are often not a sign
of failed implantation and are usually the result of non-compliance with the patient's
precautions during the postoperative period.

Late complications after dental implantation include the appearance of inflammation

in the periimplantation zone during the period of osteointegration or after the completion
of osteointegration.

At a workshop of the European Federation of periodontists in 2008, an agreed

opinion was developed on infectious and inflammatory lesions in the area of dental
implants, based on modern scientific evidence, which was proposed to include
perimplantation mucositis and perimplantitis.

Mucositis is an inflammation of the soft tissues adjacent to the structure, which is not

accompanied by a violation of osteointegration.

Peri-implantitis is an inflammation of the tissues surrounding the implant, accompanied

by horizontal or vertical resorption of the supporting bone. According to current data,
mucositis develops in 80% of individuals, while peri-implantitis was detected and
described in 28-56% of the examined patients.

Let's take a closer look at some of the causes of peri-implantitis. Smoking is a significant

risk factor for peri-implantitis. According to S. I. Zhadko and F. I. Gerasimenko, tissue
healing after implantation in Smoking patients is significantly worse than in non-
smokers [14, 15].

This is due to the fact that people who are addicted to Smoking have an increased

formation of plaque, and, consequently, an increased risk of gingivitis and periodontitis,
as well as the occurrence of severe bone resorption. Smoking reduces blood supply to
tissues due to the vasoconstrictor effect of nicotine on arterioles. Smoking releases toxic
by-products, such as nicotine, carbon monoxide, and hydrogen cyanide, which inhibit
the reparative function of div tissues. Treatment of dental patients with nicotine
dependence using dental implantation, if the patient refuses to smoke, reduces the
likelihood of developing complications to the level of non-smokers [16].

Iatrogenic causes that may be risk factors for peri-implantitis include non-compliance

with the rules of asepsis and antiseptics; insufficient awareness of the doctor about the
patient's health, undiagnosed foci of chronic infection in the maxillofacial region,
leading to an unsuccessful result; discrepancy in the size of the implant to the size of the
implant bed; formation of a subgingival hematoma at the time of surgery with its subsequent
suppuration; destruction of bone tissue caused by excessive force of screwing the implant
(more than 45 N / m); overheating and, as a consequence, bone necrosis when dissecting


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ÓÇÁÅÊ ÒÈÁÁÈ¨Ò ÆÓÐÍÀËÈ | ÓÇÁÅÊÑÊÈÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË | UZBEK MEDICAL JOURNAL

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at high speeds; excessive dissection of bone tissues; errors at the stages of prosthetics,
namely: chronic trauma and periodontal overload, incongruence of the orthopedic
structure; the presence of micro-gaps between the implant and the abutment [17,18].

Systemic violation of bone remodeling is a contraindication to the restoration of

chewing efficiency using dental implants [19].

The absence of a keratinized gum may also be the cause of peri-implantitis, since the

long-term service of the dental implant, its aesthetic and functional role requires a good
condition and structure of the supporting tissues.

The function of protecting the implant and the surrounding bone tissue from the

penetration of microorganisms and the traumatic impact of a food lump is performed by
an attached gum covered with a multi-layer flat keratinized epithelium, which normally
surrounds a healthy tooth or implant. The width of the keratinized gum varies from 4 to
9 mm. Due to the removal or loss of teeth, the attached gum is reduced and rarely
exceeds 2 mm or even completely disappears. At the same time, the risk of developing
inflammatory phenomena around the implant increases.

Already in 1996, T. Berglundh, T. and Lindhe et al. we performed experiments on

dogs and found that when the thickness of the keratinized gum is less than 2 mm, bone
resorption occurs around the implant and reaches the visible size within 6 months [29-
32].

According to T. Linkevicius et al. during the first 2 months after the dental implant is

installed, the biological width around the implant is formed, similar to the biological
width around the natural tooth. This phenomenon provokes a loss of bone tissue in the
case of initial insufficiency of the soft tissue thickness in the implantation zone to form
a minimum volume of biological width (on average 3 mm). A narrow keratinized gum
does not provide a tight fit of the soft tissues surrounding the implant, which in turn
creates favorable conditions for plaque accumulation and increases the risk of developing
mucositis and perimplantitis. This is due to the fact that the tissues around the implant
(periimplant tissues) and periodontal tissues differ in structure and resistance to bacterial
infection. The gum surrounding the implant consists of a large amount of collagen and
contains half as many fibroblasts as the gum around the tooth. In this case, the collagen
fibers are not attached to the surface of the implant, but are located parallel to its
surface, which leads to the formation of a space in which plaque accumulates, causing
inflammation. The pronounced mobility of soft tissues around the neck of the implant or
abutment contributes to this. A sufficient width of the keratinized gum forms a dense
fibrous cuff around the neck of the implant, thus preventing the penetration of
microorganisms and food residues [33-35].

Dental implantation is currently one of the most promising areas in the rehabilitation

of dental patients. Despite the success achieved, dental implantation, like other surgical
methods of treatment, is accompanied by various kinds of complications. The most
common complications are of an inflammatory nature.

Results and discussions:
However, there are many problems in dental implantology. This article presents a

review of the scientific literature on risk factors for early and late complications of
dental implantation.

It is considered that a well-established and integrated dental implant should function

for at least 10 years, satisfy the patient in aesthetic and functional terms, have clinical
stability, and be biocompatible with respect to the surrounding tissues.

The success of dental implants depends on the General state of the patient's div, as


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21

ÓÇÁÅÊ ÒÈÁÁÈ¨Ò ÆÓÐÍÀËÈ | ÓÇÁÅÊÑÊÈÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË | UZBEK MEDICAL JOURNAL

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2 | 2020

well as on the technique of implant placement, the skill and experience of the
implantologist and the management of the patient in the postoperative period.

Indications for dental implantation are partial defects of the dentition or complete

absence of teeth, the inability for various reasons to use removable prostheses (deformities
of the jaws, pronounced gag reflex on the prostheses).

Before the implantation operation, the patient must undergo a comprehensive

examination, which includes collecting complaints, anamnesis, examination of the oral
mucosa, while assessing the condition of the teeth, alveolar processes, the type of bite,
the level of oral hygiene, and, if necessary, consulting other specialists. In addition, x-
ray examination of the dental system is performed using computed tomography. This
method allows to visualize the state of the jaw bones in three dimensions, and to assess
bone density, the trabecular nature of the figure, the condition of the sinuses, the
volumetric parameters of the alveolar processes, the degree of atrophy of the jaw bone,
the distance between al-violarium ridge and maxillary sinus floor, the topography of the
mandibular canal. In addition, during the planning of the operation, an instrumental
examination is performed, which includes measuring the width of the alveolar processes
to select the location of the future implant.

All complications after dental implantation are usually divided into two groups: early

(manifested in the period from a few days to 2-3 weeks after surgery) and late (developed
after several years). Early complications are typical of the inflammatory process that
occurs as a result of mechanical trauma to the tissues of the maxillofacial region, namely:
postoperative edema, bleeding in the area of the installed implant, appearing after the
termination of the VASO-constrictor action of epinephrine, which is part of the solution
for anesthesia. In addition, pain may occur, as well as a rise in temperature to 38°C.
divergence of sutures, eruption of part of the implant through the mucous membrane
are also early complications, but unlike other complications, they are often not a sign
of failed implantation and are usually the result of non-compliance with the patient's
precautions during the postoperative period.

Late complications after dental implantation include the appearance of inflammation

in the periimplantation zone during the period of osteointegration or after the completion
of osteointegration.

At a workshop of the European Federation of periodontists in 2008, an agreed

opinion was developed on infectious and inflammatory lesions in the area of dental
implants, based on modern scientific evidence, which was proposed to include
perimplantation mucositis and perimplantitis.

Mucositis is an inflammation of the soft tissues adjacent to the structure, which is not

accompanied by a violation of osteointegration.

Peri-implantitis is an inflammation of the tissues surrounding the implant, accompanied

by horizontal or vertical resorption of the supporting bone. According to current data,
mucositis develops in 80% of individuals, while peri-implantitis was detected and
described in 28-56% of the examined patients.

Let's take a closer look at some of the causes of peri-implantitis. Smoking is a significant

risk factor for peri-implantitis. According to S. I. Zhadko and F. I. Gerasimenko, tissue
healing after implantation in Smoking patients is significantly worse than in non-
smokers [14, 15].

This is due to the fact that people who are addicted to Smoking have an increased

formation of plaque, and, consequently, an increased risk of gingivitis and periodontitis,
as well as the occurrence of severe bone resorption. Smoking reduces blood supply to


background image

22

ÓÇÁÅÊ ÒÈÁÁÈ¨Ò ÆÓÐÍÀËÈ | ÓÇÁÅÊÑÊÈÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË | UZBEK MEDICAL JOURNAL

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2 | 2020

tissues due to the vasoconstrictor effect of nicotine on arterioles. Smoking releases toxic
by-products, such as nicotine, carbon monoxide, and hydrogen cyanide, which inhibit
the reparative function of div tissues. Treatment of dental patients with nicotine
dependence using dental implantation, if the patient refuses to smoke, reduces the
likelihood of developing complications to the level of non-smokers [16].

Iatrogenic causes that may be risk factors for peri-implantitis include non-compliance

with the rules of asepsis and antiseptics; insufficient awareness of the doctor about the
patient's health, undiagnosed foci of chronic infection in the maxillofacial region,
leading to an unsuccessful result; discrepancy in the size of the implant to the size of the
implant bed; formation of a subgingival hematoma at the time of surgery with its subsequent
suppuration; destruction of bone tissue caused by excessive force of screwing the implant
(more than 45 N / m); overheating and, as a consequence, bone necrosis when dissecting
at high speeds; excessive dissection of bone tissues; errors at the stages of prosthetics,
namely: chronic trauma and periodontal overload, incongruence of the orthopedic
structure; the presence of micro-gaps between the implant and the abutment [17,18].

Systemic violation of bone remodeling is a contraindication to the restoration of

chewing efficiency using dental implants [19].

The absence of a keratinized gum may also be the cause of peri-implantitis, since the

long-term service of the dental implant, its aesthetic and functional role requires a good
condition and structure of the supporting tissues.

The function of protecting the implant and the surrounding bone tissue from the

penetration of microorganisms and the traumatic impact of a food lump is performed by
an attached gum covered with a multi-layer flat keratinized epithelium, which normally
surrounds a healthy tooth or implant. The width of the keratinized gum varies from 4 to
9 mm. Due to the removal or loss of teeth, the attached gum is reduced and rarely
exceeds 2 mm or even completely disappears. At the same time, the risk of developing
inflammatory phenomena around the implant increases.

Already in 1996, T. Berglundh, T. and Lindhe et al. we performed experiments on

dogs and found that when the thickness of the keratinized gum is less than 2 mm, bone
resorption occurs around the implant and reaches the visible size within 6 months [29-
32].

According to T. Linkevicius et al. during the first 2 months after the dental implant is

installed, the biological width around the implant is formed, similar to the biological
width around the natural tooth. This phenomenon provokes a loss of bone tissue in the
case of initial insufficiency of the soft tissue thickness in the implantation zone to form
a minimum volume of biological width (on average 3 mm). A narrow keratinized gum
does not provide a tight fit of the soft tissues surrounding the implant, which in turn
creates favorable conditions for plaque accumulation and increases the risk of developing
mucositis and perimplantitis. This is due to the fact that the tissues around the implant
(periimplant tissues) and periodontal tissues differ in structure and resistance to bacterial
infection. The gum surrounding the implant consists of a large amount of collagen and
contains half as many fibroblasts as the gum around the tooth. In this case, the collagen
fibers are not attached to the surface of the implant, but are located parallel to its
surface, which leads to the formation of a space in which plaque accumulates, causing
inflammation. The pronounced mobility of soft tissues around the neck of the implant or
abutment contributes to this. A sufficient width of the keratinized gum forms a dense
fibrous cuff around the neck of the implant, thus preventing the penetration of
microorganisms and food residues [33-35].


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ÓÇÁÅÊ ÒÈÁÁÈ¨Ò ÆÓÐÍÀËÈ | ÓÇÁÅÊÑÊÈÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË | UZBEK MEDICAL JOURNAL

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It should be noted that the absence of a dense keratinized cuff around the implant

makes daily hygiene procedures less comfortable due to the high trauma of the mobile
mucosa.Increasing the thickness of the soft tissues covering the coronal part is achieved
by transplanting a free connective tissue graft, which helps to increase the volume of the
gums.

One risk factor for peri-implantitis is the presence of implant rejections in the

patient's history. Twenty years ago, many dentists had great doubts about dental implants
and considered them unreliable and unpromising, since the treatment was accompanied
by quite frequent complications that led to the rejection of implants. Currently, due to
the use of new technologies, the number of rejections has significantly decreased and,
according to statistical analysis of modern dental practice, is 2-5 % of implant rejections
in the first 5 years of their operation.

According to M. D. Perov and V. A. Kozlov, the destruction of bone tissue that occurs

after the rejection of implants has a negative effect on the overall health of the patient.
In the patient's oral cavity, the consequences of implant rejection are manifested in the
form of loss of bone volume in the dentoalveolar region, and in some cases, the
impossibility of repeated dental implantation [36, 37]. Therefore, the rejection of implants
in the history must be taken into account when selecting patients, determining the
indications for surgery and predicting the results of dental implantation.

Speaking of systemic pathologies, when planning implantation, it is necessary to pay

attention to the presence of diabetes in the patient first of all. This disease is at the
forefront of risk factors and relative contraindications to surgical interventions, including
dental implantation.High blood glucose levels negatively affect the ability of tissues to
repair. Accordingly, the process of osteointegration is significantly slowed down.

It is important to note another group of diseases that affect the development of

mucositis and perimplantitis-thyroid disease. These diseases are characterized by an
increase or decrease in the production of thyroid hormones. At the same time, both
hyperfunctions and hypofunctions of the thyroid gland have a negative impact on the
osteointegration of the implant. According To M. V. Shcherbakov, the risk group includes
women with a tendency to hypothyroid States. If both bone resorption and bone formation
are slowed down when thyroid hormones are deficient, then hyperthyroidism results in
increased bone rearrangement, but its structure is disrupted, in particular, the level of
mineralization decreases and bone resorption increases [38].

Autoimmune diseases (exacerbation of collagenoses, autoimmune thyroiditis, etc.)

can be attributed to the risk of developing postoperative complications after implant
placement. Diseases of this category, as a rule, are a direct contraindication for reconstructive
operations and dental implantation, since they prevent the successful course of reparative
processes and sharply reduce the likelihood of postoperative recovery of functions [39].

It is known that immunodeficiency conditions of the oral mucosa contribute to the

development of violations of microbial biocenosis. At the same time, in gingival tissues,
especially in periodontal tissues, there is a tendency to excessive bacterial growth and
the formation of an unhygienic state in the oral cavity. In this case, surgical interventions
on the alveolar process (reconstructive operations, tooth extraction, immobilization of
facial bone fragments, dental implantation, etc.) are performed in conditions of increased
risk of inflammation [40].

One of the key factors in the development of perimplantitis is infection of perimplant

tissues by oral microorganisms, which occurs due to poor oral hygiene and the formation
of dental plaque on the surface of the implant suprastructure, as well as specific and


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non-specific reactions that occur under the influence of anti-gene substances of microbial
associations of dental plaque. The effect of dental plaque implies microbial contamination
of peri-implant tissues [41].

According to N. Wenz et al., for the formation of dental plaque in the area of the

prosthesis on the implant, the nature of the surface of the prosthesis is of great importance.
N. Wenz et al. in the experiment, it was noted that twice as much plaque containing
numerous bacterial colonies is formed on the rough surface of the suprastructure as on
the smooth surface [42].

Of great importance for the development of the inflammatory process in the area of

the integrated implant is the adhesion of bacteria and the formation of dental plaque on
its protruding part, and the higher their concentration, the lower the degree of
colonization of bacteria.

Many studies have shown that orthopedic elements that rely on implants last much

longer if the patient takes care of them properly.

However, the patient's inability to properly care for the prostheses leads to a decrease

in the service life and premature loss of the implant. All this determines the need to
develop and implement additional means of individual oral hygiene, which allow for
high-quality and effective care of prostheses on implants [43].

After prosthetics on implants, daily thorough individual oral hygiene is required

throughout the entire period of operation of the prostheses. With poor hygiene in the area
periimplantitis zone is formed dental plaque, which can lead to the development of
mucositis and peri-implantitis in the future. Preventive examinations at least twice a year
and professional hygiene procedures allow you to identify the initial manifestations of
inflammation and eliminate them. Otherwise, the service life of implants is significantly
reduced [44].

It should be noted that an important risk factor for dental implants is the presence of

a patient's history of periodontitis. The literature describes a lot of evidence about the
relationshi p of this disease with a predisposition to perimplantitis. Thus, in patients with
chronic periodontitis, complications of dental implantation are more common. The
development of peri-implantitis in individuals with inflammatory periodontal diseases
in anamnesis is confirmed by the results of many scientific studies devoted to this
problem.

The results of clinical studies have shown that the risk of developing periimplantitis

in patients with periodontitis, both in active form and in remission, is five times higher
than in patients with healthy periodontitis. There is reason to believe that the
microorganisms that cause periodontitis and peri-implantitis are identical. Similar
pathogenic microorganisms are found in the periodontal pockets of the teeth and the
area around the implants, but a number of authors deny the possibility of infection of the
periimplant zone from pathological foci of infection in the periodontal tissues [45].

In addition, crowns and prostheses on implants differ in shape and structure from

natural teeth in that they have undercuts that make it difficult to perform hygienic
procedures. According to some authors, the microflora of the oral cavity after prosthetics
on implants changes and the patient has a tendency to develop inflammatory processes,
which negatively affects the functioning of prostheses and implants [46].

Conclusions:
Thus, there are a large number of problems in dental implantology, the leading place

among which is occupied by the causes of mucositis and perimplantitis. Risk factors for
the development of peri-implantitis are non-Smoking patient; iatrogenic causes;


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osteoporosis; availability of microscale between the dental implant and the overdenture;
non-compliance with hygiene of the oral cavity; a history of periodontitis; no keratinization
gums, providing stabilization of the gingival margin; systemic diseases (diabetes, thyroid
disease, systemic lupus erythematosus, vasculitis, etc.); a history of rejection of one or
more implants; immunodeficiency; infection of periimplant tissues with oral
microorganisms. With a good objective analysis of the preimplantation situation and
assessment of risk factors, good results can be achieved when placing a dental implant
that ensures clinical stability and functioning of the implant for at least 10 years,
without damaging the tissues attached to it, without developing negative symptoms and
sensations that satisfy the patient both in functional and aesthetic aspects.

References:

1. Femandez-Estevan L., Selva-Otaolaurrachi E.J., Montero J., Sola-Ruiz F. Oral

health-related quality of life of implant-supported overdentures versus conventional
complete prostheses: retrospective study of a cohort of edentulous patients. Med. Oral
Patol. Oral Cir. Bucal. 2015; 20 (4): 450-458.

2. Jang H.W., Kang J.K., Lee K., et al. A retrospective study on related factors aff

ecting the survival rate of dental implants. J. Adv. Prosthodont. 2011; 3 (4): 204-215.

3. Moraschini V., Poubel L.A., Ferreira V.F., Barboza E.S. Evaluation of survival and

success rates of dental implants reported in longitudinal studies with a follow-up period
of at least 10 years: a systematic review. Int. J. OralMaxillofac. Surg. 2015; 44 (3): 377-388.

4. Rodrigo D., Martin C., Sanz M. Biological complications and periimplant clinical

and radiographic changes at immediately placed dental implants. A prospective 5-year
cohort study. Clin Oral Implants Res. 2012; 23 (10): 1224-31.

5. [Gudar'yan A.A. Immunological and microbiological features of postoperative

inflammatory complications of the maxillofacial region. Vestnik stomatologii. 2014; 3
(88): 59-63.

6. Vervaeke S., Collaert B., Cosyn J., Deschepper E., De Bruyn H. A multifactorial

analysis to identify predictors of implant failure and peri-implant bone loss. Clin Implant
DentRelatRes. 2015; 17(1): 298-307.

7. Êàçàíöåâà È.À., Ëóêüÿíåíêî À.À., Ñåäîâà Í.Í. Èííîâàöèè â ñòîìàòîëîãèè:

êëèíè÷åñêèå ïåðñïåêòèâû è ñîöèàëüíûå ïðîáëåìû. Âîëãîãðàä: Èçä-âî
Âîëãîãðàäñêîãî ÃÌÓ, 2017. 208 ñ. [Kazantseva I.A., Luk'yanenko A.A., Sedova N.N.
Innovatsii v stomatologii: klinicheskie perspektivy i sotsial'nye problemy. Volgograd:
Izd-vo Volgogradskogo GMU; 2017. 208 p.

8. Zhad'ko S.I., Gerasimenko F.I., Kolbasin P.N. Clinical indicators of the Schiller-

Pisarev test after implant placement in orthopedic patients with chronic nicotine
intoxication. Krymskii terapevticheskii zhurnal. 2011; 2: 94-96.

9. Renvert S., Aghazadeh A., Hallstrom H., Persson G.R. Factors related to peri-

implantitis - a retrospective study. Clin Oral Implants Res. 2014; 25: 522-529.

10. Ñìåòíèê Â.Ï., Áóðäóëè À.Ã. Àíäðîãåíû è êîñòíàÿ òêàíü // Ïðîáëåìû

ðåïðîäóêöèè. 2011; 5: 110-115. [Smetnik VP., Burduli A.G. Androgens and bone tissue.
Problemy reproduktsii. 2011; 5: 110-115. (In Russ.)]

11. Ðóäåíêî Ý.Â., Áóãëîâà À.Å., Ðóäåíêî Å.Â., Ñàìîõîâåö Î.Þ. Ìåäèêàìåíòîçíîå

ëå÷åíèå îñòåîïîðîçà ó âçðîñëûõ: ó÷.-ìåòîä. ïîñîáèå. Ìèíñê: ÁåëÌÀïÎ; 2011. 36
p. [Rudenko E.V., Buglova A.E., Rudenko E.V., Samokhovets O.Yu. Medikamentoznoe
lechenie osteoporoza u vzroslykh: the textbook. Minsk: BelMAPO, 2011. 36 p. (In


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Russ.)]

12. Furst U. Treating early periimplantitis with antimicrobial photodynamic therapy

(aPDT). European Journal for Dental Implantologist. 2008; 1: 335-43

13. Ìàéêë Ñ. Áëîê Äåíòàëüíàÿ èìïëàíòîëîãèÿ: õèðóðãè÷åñêèå àñïåêòû. Ïåðåâîä

ñ àíãëèéñêîãî, ïîä îáùåé ðåäàêöèåé Ì.Â. Ëîìàêèíà. Ìîñêâà: ÌÅÄ ïðåññ-èíôîðì,
2015. [Maikl S. Blok Dental'naya implantologiya: khirurgicheskie aspekty. English transl.,
Lomakin M.V., editor. Moscow: MED press-inform; 2015. (In Russ.)]

14. Zigdon-Giladi H., Machtei E.E. Jurnal of Clinical Periodontolog. 2015; 42 (1):

89-95.

15. Vered Y., Zini A., Mann J. Teeth and implant surroundings: Clinical health in-

dices and microbiologic parameters. J. Quintessence International. 2011; 42: 339-344.

16. Wenz H. J., Bartsch J., Wolfart S. & Kern M. Osseointegration and clinical success

of zirconia dental implants: a systematic review. International Journal of Prosthodontics.
2008; 21: 27-30.

17. Ìèõàëü÷åíêî Ä.Â., ßêîâëåâ À.Ò., Áàäðàê Å.Þ., Ìèõàëü÷åíêî À.Â. Ïðîáëåìà

âîñïàëåíèÿ â ïåðèèìïëàíòèòíûõ òêàíÿõ è ôàêòîðû, âëèÿþùèå íà åãî òå÷åíèå /
/ Âîëãîãðàäñêèé íàó÷íî-ìåäèöèíñêèé æóðíàë. 2015. ¹ 4(48). Ñ. 15-17. [Mikhal'chenko
D.V., Yakovlev A.T., Badrak E.Yu., Mikhal'chenko A.V. The problem of inflammation
in periimplantitnyh tissues and factors affecting its course. Volgogradskii nauchno-
meditsinskii zhurnal. 2015; 4 (48): 15-17. (In Russ.)]

18. Êàëàìêàðîâ À.Ý., Ñàââèäè Ê.Ã., Êîñòèí È.Î. Îñíîâíûå çàêîíîìåðíîñòè

âîçíèêíîâåíèÿ ïàòîëîãè÷åñêèõ èçìåíåíèé â êîñòíîé òêàíè ïðè îðòîïåäè÷åñêîì
ëå÷åíèè ïàöèåíòîâ ñ èñïîëüçîâàíèåì äåíòàëüíûõ âíóòðèêîñòíûõ èìïëàíòàòîâ /
/ Èíñòèòóò Ñòîìàòîëîãèè. 2014. ¹ 2(63). Ñ. 45-47. [Kalamkarov A.E., Savvidi K.G.,
Kostin I.O. The main patterns of the occurrence of pathological changes in bone tissue
in orthopedic treatment of patients using dental intraosseous implants. Èíñòèòóò
Ñòîìàòîëîãèè. 2014; 2 (63): 45-47. (In Russ.)].

Библиографические ссылки

Fernandez-Estevan L., Selva-Otaolaurrachi E.J., Montero J., Sola-Ruiz F. Oral health-related quality of life of implant-supported overdentures versus conventional complete prostheses: retrospective study of a cohort of edentulous patients. Med. Oral Patol. Oral Cir. Bucal. 2015; 20 (4): 450-458.

Jang H.W., Kang J.K., Lee K., et al. A retrospective study on related factors aff ecting the survival rate of dental implants. J. Adv. Prosthodont. 2011; 3 (4): 204-215.

Moraschini V., Poubcl L.A., Ferreira V.F., Barboza E.S. Evaluation ofsurvival and success rates of dental implants reported in longitudinal studies with a follow-up period of at least 10 years: a systematic review. Int. J. OralMaxillofac. Surg. 2015; 44 (3): 377-388.

Rodrigo D., Martin C., Sanz M. Biological complications and pcriimplant clinical and radiographic changes at immediately placed dental implants. A prospective 5-year cohort study. Clin Oral Implants Res. 2012; 23 (10): 1224-31.

[Gudar'yan A.A. Immunological and microbiological features of postoperative inflammatory complications of the maxillofacial region. Vestnik stomatologii. 2014; 3 (88): 59-63.

Vervaeke S., Collaert B., Cosyn J., Deschepper E., De Bruyn H. A multifactorial analysis to identify predictors of implant failure and peri-implant bone loss. Clin Implant DentRelatRes. 2015; 17(1): 298-307.

Казанцева И.А., Лукьяненко А.А., Седова Н.Н. Инновации в стоматологии: клинические перспективы и социальные проблемы. Волгоград: Изд-во Волгоградского ГМУ, 2017. 208 с. |Kazantseva 1.А., Luk'yanenko А.А., Sedova N.N. Innovatsii v stomatologii: klinicheskie perspektivy i sotsial'nye problemy. Volgograd: Izd-vo Volgogradskogo GMU; 2017. 208 p.

Zhad'ko S.I., Gerasimenko F.I., Kolbasin P.N. Clinical indicators of the Schiller-Pisarev test after implant placement in orthopedic patients with chronic nicotine intoxication. Krymskii terapevticheskii zhurnal. 2011; 2: 94-96.

Renvert S., Aghazadeh A., Hallstrom H., Persson G.R. Factors related to periimplantitis - a retrospective study. Clin Oral Implants Res. 2014; 25: 522-529.

Сметник В.П., Бурдули А.Г. Андрогены и костная ткань // Проблемы репродукции. 2011; 5: 110-115. [Smetnik VP., Burduli A.G. Androgens and bone tissue. Problemy reproduktsii. 2011; 5: 110-115. (In Russ.)|

Руденко Э.В., Буглова A.E., Руденко E.B., Самоховец О.Ю. Медикаментозное лечение остеопороза у взрослых: уч.-метод, пособие. Минск: БелМАпО; 2011. 36 р. [Rudenko E.V., Buglova А.Е., Rudenko E.V., SamokhovetsO.Yu. Medikamentoznoe lechenie osteoporoza u vzroslykh: the textbook. Minsk: BelMAPO, 2011. 36 p. (In Russ.)]

Furst U. Treating early periimplantitis with antimicrobial photodynamic therapy (aPDT). European Journal for Dental Implantologist. 2008; 1: 335-43

Майкл С. Блок Дентальная имплантология: хирургические аспекты. Перевод с английского, под общей редакцией М.В. Ломакина. Москва: МЕД прссс-информ, 2015. | Maikl S. Blok Dcntal'naya implantologiya: khimrgichcskie aspckty. English transL, Lomakin M.V., editor. Moscow: MED press-inform; 2015. (In Russ.)]

Zigdon-Giladi H., Machtci E.E. Jurnal of Clinical Pcriodontolog. 2015; 42 (1): 89-95.

Vcrcd Y., Zini A., Mann J. Teeth and implant surroundings: Clinical health indices and microbiologic parameters. J. Quintessence International. 2011; 42: 339-344.

Wcnz H. J., Bartsch J.. Wolfart S. & Kern M. Osscointcgration and clinical success of zirconia dental implants: a systematic review. International Journal of Prosthodontics. 2008; 21: 27-30.

Михальченко Д.В., Яковлев А.Т., Бадрак Е.Ю., Михальченко А.В. Проблема воспаления в периимплантитных тканях и факторы, влияющие на его течение / / Волгоградский научно-медицинский журнал. 2015. № 4(48). С. 15-17. |Mikhal'chenko D.V., Yakovlev А.Т., Badrak E.Yu., Mikhal'chenko A.V. The problem of inflammation in pcriimplantitnyh tissues and factors affecting its course. Volgogradskii nauchno-meditsinskii zhurnal. 2015; 4 (48): 15-17. (In Russ.)|

Каламкаров А.Э., Саввиди К.Г., Костин И.О. Основные закономерности возникновения патологических изменений в костной ткани при ортопедическом лечении пациентов с использованием дентальных внутрикостных имплантатов / / Институт Стоматологии. 2014. № 2(63). С. 45-47. | Kalamkarov А.Е., Sawidi K.G., Kostin 1.0. The main patterns of the occurrence of pathological changes in bone tissue in orthopedic treatment of patients using dental intraosseous implants. Институт Стоматологии. 2014; 2 (63): 45-47. (In Russ.)].

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