Implantology is a dental surgery branch that deals with treating edentation (lack of teeth). Dental implants are used as an alternative to prosthetic treatment (dental bridge or denture, depending on the clinical case) with the advantage of saving neighbouring teeth (which should be prepared and included in dentures, although showing no affection), replacing the tooth root, helping to maintain surrounding bone levels within the aesthetic and functional limits and to ensure optimal comfort (in chewing and speech). Implants can also be used as an adjunctive technique for anchoring and stabilising complete dentures when, due to insufficient remaining bone support, it is considered that they would not present sufficient retention with simple and correct prosthesis techniques.
The success rate of implants is very high (about 90%). Some patients have dental implants for over 30 years.
The implant is made of titanium, with a purity of 99.2 %. It’s the same material used for orthopaedic implants which is very biocompatible and allows assimilation by the body through natural bone growth on implants. There is no risk of a defensive reaction caused by the body in contact with the implant, the risk of developing an infection around the implant is similar to that of a natural teeth. Therefore, the success of the procedure is highly dependent on the patient’s excellent oral hygiene, and it is even desirable for the patient to quit smoking. It is also very important for the patient to have a good health, and meet some local conditions necessary for the correct insertion of the implant: the bone where the tooth will be implanted must be healthy and tall and thick enough, so as to ensure good support.
Thus, to assess the possibility of receiving a treatment which involves the insertion of implants, further examination is required:
- Blood sugar level
- Serum calcium
- Bleeding time
- Clotting time
- Uric acid
Imaging exams: It is necessary, at first, to have a panoramic radiograph (which includes an overview of the whole oral cavity, jaw bone and mandible) and the implantologist may require a CT scan to visualise details which are not visible on simple radiography. Nowadays there is also the possibility of performing CT scans per sector, and this significantly reduces costs.
The first session will involve consultation, together with a detailed history, the diagnosis based on the X-rays and the development of a treatment plan, as well as making prints with which some study plaster models will be made, which the implantologist will use, together with the CT scans to thoroughly plan the surgical procedure itself, and the prosthetist will be looking for an implant post-insertion treatment plan.
In the coming sessions the periodontal infection control, irrecoverable tooth extraction, scaling and root planning as the antimicrobial therapy will be conducted.
After these procedures are completed the implants will be inserted. This will be done under local anaesthetic, similar to that for tooth extractions. Therefore, the intervention is completely painless, with a variable length in time, depending on the number of implants inserted, in average for 1-2 implants about 60 minutes are needed.
The addition of bone is a complementary procedure that can be performed in the same session to compensate for the lack of bone matter in the jaw bones and can be achieved by adding natural, artificial or synthetic bone. For the success of the procedure, it is extremely important that the bone in which the implant is inserted has the appropriate width and height, Thus, the bone addition is of high importance for the subsequent dental implant given that the ratio between the length of the dental implant and the coronal part must be at least 1:1.
In some cases minor pain might occur when the anaesthetic effect wears off, pains will be soothed with painkillers that will be prescribed by your implantologist.
In general, the clinically patient to whom a small number of dental implants are inserted, in the days right after surgery no general facial appearance changes are noticeable, possibly only a slight swelling and the implant will not be visible and can only be highlighted with X-rays.
The prosthetic treatment can be done immediately after the insertion of dental implants, early application at 1-10 weeks after the insertion of dental implants or delayed application, more than 3 months after the dental implant insertion.
Given the particular characteristics of each patient, there may be situations where one can opt for a more rapid prosthetic work, thereby aiming to reduce working time and the time required until treatment is completed.
It should, however, be known that the immediate and early application of the prosthesis, without waiting for the completion of osseointegration could lead to a failure. Therefore, the optimal timing for applying the prosthetic work is very important.
The full cure period, between 2-6 months, will be followed by the application of coronal part, ceramic or zirconia crown, which mimics natural teeth. The application of ceramic or zirconia crown is a distinct phase of treatment and should not be confused with dental implant itself.
Thus, after this period, you will have to schedule an appointment with the prosthetist who will perform the dental work considering the clinical situation created.
After the prostheses have been done and attached (provisional only, they will never be cemented permanently) several requirements must be fulfilled that will ensure the success of the whole operation:
- Hospitalization for sanitisation: you have to present yourself regularly (every three months) in the dental office doe control and sanitisation.
- It is mandatory: brushing your teeth every morning and evening, additionally using dental floss, interdental brushes and mouth disinfectants (mouthwash with chlorhexidine or listerine). It is also indicated to use mouth showers, your doctor can help you choose and order one according to your needs.
Beware of foods that contain kernels. The implants are inserted directly into the bone without ligaments with sensors for regulating natural chewing force and cannot transmit information on biting pressure to the brain. Therefore it is possible to bite so strong on hard foods that dislocation of the implant in the bone can be caused.