Stomatolog y

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6.2 Indication, Contraindication

Indication and contraindication to the use of dental implants is closely connected with ways of implanting them to the jawbone. Even though dental implants present a significant and irreplaceable improvement in dental care, they are not a method that could be used under all circumstances, for all patients. It is still considered to be a non-standard treatment which can be chosen only under certain conditions. Several viewpoints are to be considered. The basic characteristic of an implant is creation of an artificial dental pillar at jaw’s alveolar tissue which allows for further mounting of a denture assuring full teeth functions. However, dental implants should not be used for the sake of themselves without taking into an account the state of other teeth, implant’s expected lifetime, and other local and general medical conditions. Installing dental implants should not lead to premature loss of natural teeth or to decrease in dental care, under any circumstances. Implantation into jawbone’s alveolus is a large or small surgical intervention into an organism and has to be respected as such.

Introduction of a dental implant has to be performed lege artis, with proper expert erudition, after a special training, with special instrumentation and equipment. It should be performed under a local or general anesthesia, after appropriate anamnesis and analysis of a patient’s general health condition and local conditions as well.

Indications may be as follows:

  • single gap in the alveolus after a lost tooth

  • large gap at frontal or distal parts of the alveolus where an implant would serve as an inserted pillar either alone or linked to adjacent teeth

  • shortened dental arch at which an implant is used as a complementing independent pillar or an end pillar for bridges

  • a toothless jaw, where implants are utilized as pillars for a bridge or hybrid removable denture.

In general, blade-like, metal, extension implants are used mainly at narrow alveoli. Cylindrical, screw-like implants find their use at stronger alveoli of toothless jaws.

Contraindications from the local point of view:

  • insufficient strength of alveolus

  • mucous inflammation or fibrous alterations that do not assure an implant’s stability

  • unsatisfactory topographical and anatomical dimensions, e.g. position canalis mandibularis, relatively large jaw cavity, extreme alveolus atrophy, anomalous occlusal intermaxillary conditions, defects of jaws, macroglossia.

Contraindications in terms of general health conditions can be either relative or absolute.

Relative contraindications:

  • ongoing infectious states

  • chronic pathological states of decompensation

Absolute contraindications:

  • systemic bone diseases

  • endocrinologic diseases

  • diseases of the hepatopoietic system

  • rheumatoid diseases

  • heart conditions

  • nephritis or nephrosis

  • liver cirrhosis

  • allergies

  • immune system disorders

Among other important factors are a patient’s psychological condition, motivation, ability to cooperate during the implantation preparation phase, as well as further caring of dentures (fixed or removable) carried by dental implants.

Without a perfect anamnesis, local analysis and without meeting all requirements for indication or contraindication, it would not be possible to utilize dental implants successfully for the treatment of dental defects.

7. Orthopedics of Jaws

Orthopedics of jaws (orthodontics) is the dental specialty and practice of preventing, diagnostics and correcting irregularities of the teeth, relationships of dental arches and anomalies of the oro-facial area. Orthodontic care is a part of the dental care provided for the generation of young people. It has a preventive character and contributes to formation of functional and esthetic qualities of the oro-facial system.

7.1 Orthodontic Anomalies

Among orthodontic anomalies belong defects of positions of individual teeth, groups of teeth, defective mutual relationships of dental arches, and defects in the build or growth of the facial skeleton. Cleft disorders form a separate group of anomalies.

The frequency at which orthodontic anomalies occur is high at present times. In our population, more than one half of school-age children are affected by ailments of occlusion. Not every aberration found has to be treated. Therapy of tiny irregularities that do not hamper the teeth functions or personal visage would not be beneficial.

Etiology of orthodontic anomalies. Many factors contribute to appearance of these anomalies. Among general causes of orthodontic anomalies there are heredity, growth rate, physical constitution, diseases, diet, function of endocrine glands. Dental caries, premature loss of teeth, functional defects are the local causes of orthodontic anomalies. From the etiology viewpoint, orthodontic anomalies can be further divided into congenital and acquired ones.

Congenital anomalies can be either hereditary or appear during intrauterine development as a result of harmful influences. These influences can be toxic chemicals (drugs), physical (X-ray irradiation, radioactivity), viral infections (rubeola). Hereditary disorders include anomalies in number, shape and position of the teeth. A primary position of the tooth germ, the shape and size of jawbones are genetically determined as well. An example of a hereditary dominant disease is progenia.

Acquired anomalies appear after a child’s birth by effects of internal and external influences. Internal causes include metabolic disorders, rachitis, endocrine disorders etc. External factors are for example: various bad habits, such as sucking fingers, putting foreign objects inside the mouth, biting of lips, the tongue, cheeks, breathing by mouth etc. These habits are long-term forces that may unfavorably influence position of the teeth, shape of alveolar ridges, mutual relationship of jaws, growth and development of the oro-facial system. Dental decays and premature losses of teeth may lead to formation of orthodontic anomalies, too.

Prevention of orthodontic anomalies.

The basis of prevention of orthodontic anomalies is the care about healthy and harmonic development of children and their oro-facial system. It begins by the mother and child care during pregnancy. Very important is also a mother’s healthy lifestyle and environment, as well as avoiding all influences which could negatively affect her pregnancy. Postnatal prevention and prophylaxis are tasks for parents, a pediatrician and later for a pedo-stomatologist. Right diet is highly important for proper development of children’s oro-facial system. Breast-feeding is preferred against an artificial feeding at nursing age. At later age, care has to be paid to the food composition and texture. Employing functions of the chewing system has an essential influence on right development of the oro-facial system and prevents from various bad habits to occur. If bad habits still appear, it is mandatory to quit them with aid of simple shielding devices or muscular exercises. An important part of prevention of orthodontic anomalies is avoidance of dental decays and systematic sanative care of the teeth. Premature losses of teeth lead to weakening of the functional fitness of the teeth, shifts of neighboring teeth into gaps and loss of space for cutting of the permanent teeth. This all depends on cooperation of parents, a pediatrician and pedo-stomatologist, as well as proper health education.

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