Indications and contraindications for the implantation

Indications and contraindications for implantation is set on the basis of general medical history and examination, assessment of emotional status and dental status of the patient.

INDICATIONS
Indications for dental implantation are:
1. Single defects dentition, when implantation would avoid dissection adjacent to the defect of the teeth.
2. Included defects of dentition, when using the implant can be avoided
dissection limiting defect teeth and removable prosthesis.
3. Limit the defects of dentition in which implants allows for
removable prosthesis.
4. Full edentia when using the implant can be made removable prosthesis or to provide a more reliable fixation of complete removable dentures.

CONTRAINDICATIONS
There are a number of diseases in which implantation, as well as any other planned surgery is contraindicated. They accepted include:
1. Chronic diseases in the stage of decompensation.
2. Disorders of coagulation and hemostasis.
3. HIV seropositive and any other infection.
4. Mental illness.
• There are also diseases, physiological and functional status, with
which only at a certain period of time execution of any operation may harm the health of the patient, or in this period the state of the organism will not achieve the positive results of surgical intervention.
These include:
1. Acute inflammatory diseases and acute viral infections.
2. Chronic infectious diseases (tuberculosis, actinomycosis, etc.).
3. Exacerbation of chronic diseases.
4. The high degree of risk of bacteremia (patients with prosthetic heart valves and had suffered bacterial endocarditis, rheumatic fever).
5. Recent infarct or stroke.
6. Pregnancy and lactation.
7. Treatment with drugs that have an adverse tissue regeneration (hormonal and chemotherapy, receiving immunosuppressive agents, etc.).
As a contraindication for dental implantation should be considered osteopathy, diseases that adversely affect bone formation, diseases of the central nervous system disorders, which leads to violations of bone metabolism, diseases in which significantly reduced resistance to infections, as well as certain diseases and conditions organs and tissues of the maxillofacial region that did not help achieve the desired result of implantation.

Osteopathy
Osteopathy in the vast majority of cases are not separate diseases, but represent a response of the bone tissue of some divisions of the skeleton to the influence of exogenous and endogenous factors. Usually occurring in the spine, pelvis and limb bones, less of the cranial vault. Changes in jaw bone tissue is rarely observed in generalized disease of the bone system.
The most common forms of osteopathy are systemic osteoporosis and
osteomalacia.

A. Osteoporosis
Osteoporosis – decrease in the total volume of bone tissue. There are primary and secondary osteoporosis.
For primary osteoporosis include vozrastzavisimye bone loss or osteopathy unknown etiology – postmenopausal, senile, juvenile, idiopathic osteoporosis.
Secondary osteoporosis is related to the underlying illness and may be the result of:
– Pathology of the endocrine system (hyperthyroidism, hypogonadism, hyperparathyroidism, in –
sulinozavisimy diabetes, hypercorticoidism);
– Rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis);
– Kidney disease (chronic renal failure, renal tubular acidosis, Fanconi’s anemia);
– Digestive diseases (malabsorption syndrome, chronic liver disease, status post resection of the stomach and small intestine, gastroduodenal anastomosis);
– Blood disorders (multiple myeloma, hemolytic anemia, thalassemia, systemic mastocytosis, leukemias and lymphomas);
– Genetic disorder (osteogenesis imperfecta, chondrodysplasia, dysostosis, Hypophosphatasia, Homocystinuria and lizinuriya).
The cause of secondary osteoporosis may be long-term use of some medicinal drugs (iatrogenic osteoporosis): corticosteroids, anticonvulsants, immunosuppressants, thyroid hormones, dilantina, barbiturates).

B. osteomalacia
Osteomalacia – a pathology of the skeleton, in which there is inadequate mineralization of organic bone matrix with continuing normal skeletal mass and volume of bone. The causes osteomalacia may be:
– Insufficient intake of vitamins in the organism (hypovitaminosis CHD);
– Violation of the metabolism of vitamin D (cirrhosis and chronic hepatitis, chronic renal failure, parathyroid hormone deficiency);
– Induction of microsomal enzymes by certain drugs, in
primarily barbiturates;
– A negative balance of phosphorus and hypophosphatemia due to malabsorption, excess parathyroid hormone, dialysis, use of antacid, long-term use of tetracycline and other osteotropic antibiotics, heparin, as well as lead poisoning and overdose of iron;
– Inhibition of mineralization of preparations containing difosfanaty, sodium fluoride, aluminum;
– Prolonged use of laxatives (may cause a deficiency of calcium, phosphorus and proteins).

Diseases violate osteogenesis
1. Thyroid
When thyroid gland, an increase (hyperthyroidism) or decrease
(hypothyroidism) thyroid production goromonov.
Excess thyroid hormone occurs in diffuse toxic goiter
(Graves’ disease), toxic nodular goiter (Plummer’s disease), an adenoma of the thyroid gland. Hyperthyroidism causes an enhanced structural adjustment bone, which predominates in bone resorption, and reduces the level of its mineralization.
Lack of thyroid hormones is a consequence of chronic thyroiditis
idiopathic atrophy of the thyroid gland, thyroidectomy. It may also be a case of deficiency of iodine in the diet and after treatment with radioactive iodine Graves’ disease.
Hypothyroidism inhibits the processes of adjustment of the bone.

2. Diseases of the parathyroid glands
The causes are hyperparathyroidism: adenoma and secondary hyperplasia of parathyroid glands due to chronic renal failure, hyperphosphatemia, hypocalcemia, malabsorption syndrome or lack of vitamin D. Hyperparathyroidism leads to a sharp activation of bone metabolism with a predominance of resorption.
Resorption of bone at the same time ahead of the formation of new bone tissue, there is a generalized osteoporosis. Typical for hyperparathyroidism is a partial or
Even with complete resorption mezhkornevyh partitions and walls of the alveoli of the teeth.
Gipoparatireoidizm is usually the result of surgical removal of parathyroid glands, as well as operations on the neck, when due to ischemia parathyroid glands may be a temporary gipoparatireoz. Gipoparatireoidoz reduces production of vitamin D.

3. Diabetes
Diabetes mellitus is divided into two categories – I type, or insulin-dependent diabetes, and
Type II, or insulin-dependent diabetes.
For Type I diabetes is characterized by a complete cessation of synthesis of insulin, which inhibits the metabolism, leading to the defeat of the small and large vessels and peripheral neuropathy. Insulin acts as an anabolic hormone, stimulates the synthesis of proteins, collagen, fatty acids and their esterification to form triglycerides. Lack of or inadequate action of insulin on target cells is a violation of nutrient uptake, accompanied by excessive use of endogenous energy reserves, which increases tissue catabolism, decreases cellular activity, resulting in a reduced ability to regenerate body tissue.
When insulin dependent diabetes mellitus, there are signs of osteopenia and microangiopathy, causing inflammation of bone marrow stroma (myelitis), which leads to disruption of proper metabolism of bone tissue. In addition, insulin deficiency decreases collagen development of osteoblasts, as well as the stimulation of osteoblasts, mediated by insulin and other growth factors (broken process osteoinduktsii).
With this type of diabetes in patients generated a certain amount of insulin, but
often insufficient to maintain adequate glucose homeostasis and prevention of hyperglycemia.

Type II diabetes is usually found in people with overweight, the main goal of treatment for this – its reduction. Many patients who have reached a significant reduction
body weight through diet and exercise, normalized their blood glucose levels. Sometimes when the ineffectiveness of diet such patients injected insulin to prevent hyperglycemia.
In type II diabetes angiopathy and metabolic disorder of bone are rare.

4. Pituitary diseases associated with insufficient (hypopituitarism) or excessive (giperpituitarizm) production of hormones (oxytocin, somatotropic, thyrotropic, adrenocorticotropic, and some others). In most cases of pituitary pathology is a consequence of benign tumors of the hypothalamic-pituitary region (kraniofaringoma, pituitary adenoma, meningioma). When giperpituitarizme develop acromegaly, pituitary – Cushing, rarely hyperthyroidism, with hypopituitarism – malnutrition, adrenal insufficiency and hypothyroidism.
Thus, pituitary diseases involve the defeat of several target organs, such as thyroid, adrenals or gonads, which are responsible for
metabolism of bone tissue.

5. Pathology adrenal
Manifestations of disease of the adrenal cortex caused by over-elaboration of cortisol (pituitary – Cushing), aldosterone (primary aldosteronizm), androgen
(congenital adrenal hyperplasia), and inadequate release of cortisol and aldosterone (Addison’s disease).
Pathology of the adrenal glands may be due to hyperplasia of the adrenal cortex,
ectopic production of adrenocorticotropic hormone by the pituitary and some tumors (carcinoma of the pancreas, lung and bronchus), prolonged treatment with glucocorticoids in asthma, arthritis and other diseases.
Hormones of the adrenal glands, on the one hand, the slow differentiation of osteogenic
cells into osteoblasts, reduces the stimulating effect of growth factors and inhibit
calcium absorption in the intestine. On the other hand, these hormones increase bone resorption.
Thus, adrenal disease, characterized by excessive production of glucocorticoids significantly inhibit osteogenesis.

6. Blood diseases
Hematopoietic tissue and blood cells are in close functional connection with
bone tissue and its elements. Therefore hemoblastosis cause not only diffuse infiltration of bone marrow, but also the focal destruction of the spongy layer of bone and
Violations of the regeneration of bone tissue. The defeat of the bone tissue can be observed
with Hodgkin’s disease (Hodgkin’s disease), thalassemia, leukemia, hemolytic anemia.


Diseases of the central nervous system

A. Mental illness and neuroses in schizophrenia, paranoia, senile
dementia, Alzheimer’s disease, lack of mental development (lack of motivation) and other diseases, leading to a deterioration of intellect or distortion of the psyche, it is impossible to apply a model of partnership and conduct adequate treatment.
By contraindications should also include some forms of psychoses and neuroses, in –
example dismorfofobiyu and especially kantserofobiyu. Experience has shown that sooner or later find a dentist or «professional», which, because of ignorance or lack of the concept of professional ethics, and iatrogenic diseases of the patient would make the original «hypothesis» of communication with the implantation of cancer. As a result, a patient suffering kantserofobiey, and with it the doctor who carried out the implantation, will be doomed to a long mental and physical torment, unjustified removal of implants and prosthetics irrational, for example,
removable, after which a greater degree than after any other method of dental prostheses can predict the development of tumors in the tissues of the prosthetic bed.
It should also be borne in mind that some forms of psychoses and neuroses are the consequence or symptoms of endocrine diseases. For example, depression may be the result of excessive production of cortisol adrenal cortex and hypothyroidism and in hyperthyroidism and hyperparathyroidism often observed emotional lability, and violations of intellectual activity.

B. Alcoholism and drug
Alcoholism and drug addiction are not only mental changes, but also a number of somatic disorders that affect bone formation. As the pathophysiological mechanisms of Osteopathy in alcoholism are considered important malabsorption dlyakostnoy tissue minerals, amino acids and vitamin D; metabolic vitamin D because of cirrhosis and other liver pathology;
increased elimination of calcium in the urine, the potential for excessive production of adrenocortical hormones.


Disorders, which can cause metabolic disorders of bone

1. Cancer
Oncological diseases require priority, serious treatment. Dental
implantation, of course, can not be done until then, has not been achieved predicted remission. However, achieving stable remission, or even a full recovery, some therapies used in oncology, pose several problems for implantation. First, it is radiation and chemotherapy.
In acute local reactions (edema, inflammation) irradiation causes a chronic
side effects, particularly radiation osteopenia, necrosis of bone tissue in the affected area, the local secondary osteoporosis, and reduces the ability of bone to regenerate.
Local irradiation to a total dose exceeding 15 Gy of radiation leads to bone demineralization.
Drugs used in chemotherapy, has significant side effects on organs and tissues, are actively involved in osteogenesis. Virtually all groups of cytostatics suppress the activity of bone marrow, plyuropotentnyh (including osteogenic) stem cells and cause general intoxication of the organism.
It is believed that a significant toxic effects and metabolic disorders as a result of chemotherapy may be cut short after 6 – 8 months after treatment.


2. Systemic diseases of connective tissue
For this disease include systemic lupus erythematosus, dermatomyositis, syndrome
Segrena.

The pathogenesis are changes in humoral and cellular immunity. Direct influence of this group of diseases on the livelihoods of the bone tissue has not yet proven. It is believed that with this pathology can occur violation of osteogenesis and osteoporosis due to the development of secondary hyperparathyroidism and because of these diseases with glucocorticoids, heparin and indirect anticoagulants.
There is also a team of inborn systemic diseases of connective
tissue, inherited in an autosomal dominant pattern: Knista syndrome, Hurler, Menkes, Gaucher disease, Niemann – Pick, various types of congenital dysplasia and dysostosis. They are accompanied by fairly severe osteopathy.

3. Allergic diseases implant, made from non-biological, biotolerantnogo material, in principle, should not cause an allergic reaction. However, a small number of people, certain metals can cause allergic
so-called metallozy. Consequently, we can not totally exclude the emergence
allergic reaction to titanium, used to produce virtually all dental implants. In addition, prosthesis on implants as the base metal prostheses are used alloys containing cobalt and chromium, which have sufficiently high relative to other metals allergenic potency. Therefore, the presence of allergy to metals should perform the necessary tests to determine the feasibility of implantation and the use of different metals for the prosthesis.
In some allergic diseases, such as serum sickness, severe
During bronchial asthma and hay fever, Lyell syndrome, Stevens Johnson — has long been used corticosteroid hormones that cause changes in bone metabolism.

Disease and reduces the
resistance to infections
Immuno — congenital or acquired disease, developing as a result of various changes of the immune response:
– Defects of the complement system (volchanochnopodobny syndrome and systemic lupus erythematosus, Segrena syndrome, rheumatic disease, polymyositis, oykilodermiya, recurrent severe infections caused by gram-pyogenic and flora, recurrent meningo-and gonococcal infection,
tion);
– Phagocytic disorders (chronic granulomatous disease syndromes
Shediac – Higashi and Job);
– Humoral deficiency syndromes (agammaglobulinemia Bruton, common Variable immune deficiency, selective deficiency IgA);
– Cellular immune deficiency syndrome (hypoplasia of the thymus and parathyroid glands);
– Human immunodeficiency virus, which leads to progressive destruction of the immune system and eventually lead to Acquired Immunodeficiency Syndrome (AIDS).

9.2.6. Pathological status of maxillofacial and oral cavity
The presence of leukoplakia, stomatitis, xerostomia, caries, periodontitis and periodontal disease is not
allows for implantation because of the high risk of inflammatory complications. You will need to undertake rehabilitation of the oral cavity and the appropriate treatment – both local and general, if the pathology is a common symptom of the disease (eg, some forms of stomatitis, and xerostomia).
In addition, several anatomical and functional disorders, such as macroglossia, malocclusion, temporomandibular disorders-mandibular joints also require pre-treatment or to be taken into account and incorporated into the treatment plan adentia with the implantation.

Contraindications kdentalnoy implantation are also bruxism and poor oral hygiene.
Significant atrophy of bone jaw and unfavorable anatomical conditions at the present time can not be regarded as a contraindication to implantation. Modern methods and tools used in dental surgery and dental implantology, allow for implantation in almost any anatomical conditions. Therefore, the question of the possibility or impossibility of implantation when insufficient bone is rather a problem of professional level than a contraindication.

. Absolute, relative CONTRAINDICATIONS AND FACTORS
RISK
In determining the possibility or impossibility of implantation should be
install:
1) when the prevailing risk of harm to a patient’s health advantage over
implantation;
2) actually it theoretically and practically to achieve the desired result of implantation;
3) is dominated by whether the benefits of dental prosthesis on implants of the theoretical and practical risk to the health of the patient;
4) What physiological, parafiziologicheskie condition and lifestyle of the patient may disrupt the process of integration or cause the disintegration of dental implants.
Absolute contraindications to implantation imply the presence of disease and
certain states of the organism, when surgical intervention is an obvious risk to health, as well as when there is treatment for intractable diseases, which make it impossible to achieve positive results of implantation
Treatable diseases, as well as pathology,
whereby homeostasis can be stabilized and disavow caused by a disease, pathological condition or medication changes in the organs and systems of the body due to modern treatment methods can be classified as a relative contraindication.

Some diseases, whose treatment can lead to violations of temporal bone formation or function of organs and systems responsible for metabolism of bone tissue and the body’s resistance to infection, but prisohranyayuscheysya opportunities and the apparent feasibility of non-removable prosthesis on implants, can also be considered relative contraindications to implantation. For example, cancer. When stable remission implantation may be one of the links in the integrated rehabilitation of cancer patients. Another example can serve as a systemic disease of connective tissue syndrome Segrena can achieve the desired result of implantation with the right of its planning,
adequate drug therapy for primary disease and the symptomatic treatment of xerostomia.
In absolute and relative contraindications can distinguish disease, whose treatment should be carried out in parallel with implantation, or implantation
be regarded as one of the methods of treatment. This is usually dental
pathology: malocclusion, temporomandibular dysfunction syndrome mandibular joints,
periodontitis and periodontitis, which can create some problems, so they can be considered risk factors. This is not a contraindication, but only those diseases that pose some difficulties to achieve the projected results, statistically reduce the efficiency of implantation and can cause treatment failure. Risk factors should include unfavorable anatomical conditions that require additional surgical interventions or non-standard
approaches to treatment, as well as lifestyle, the patient’s age, his intellectual level and emotional status.

People have different lifestyles.
Some overly concerned about the standards of its shape and pace yourself a strict diet, which may lead to abnormal bone metabolism (anorexia nervosa, causing osteoporosis). More from overeating obese, which can cause metabolic disorders and various diseases. Someone casually refers to his health, neglected the maintenance of proper oral hygiene, tobacco abuse, alcohol, coffee, which can also lead to a breach of bone metabolism and contribute to the development of osteoporosis.
Risk factors can be attributed to some periods of human life. For example, the disintegration of the implants can occur in women during pregnancy or
after 45 years due to changes in hormonal environment during the development of climacteric
syndrome. It should also be borne in mind that the elderly chances of success of implantation may be lower due to reduced intensity of metabolic processes.
In addition, in some cases, emotional lability of the patient’s unrealistic aesthetic demands, sverhozhidaniya treatment, as well as the inability to understand the level of ownership may create some difficulties in achieving the desired result of treatment, and sometimes serve as sufficient grounds for denial of implantation.