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Dental Implants

Generality

A dental implant is a fixed prosthetic device, used to cover the space left free by one or more missing or extracted teeth.

The parts that make up the dental implants are substantially three: the endosseous screw, the abutment and the dental prosthesis.

The endosseous screw mimics the root of a real tooth, therefore it must fit into the mandibular or maxillary bone. The abutment is the connecting element between the endosseous screw and the dental prosthesis; it is also called a transmucous component, because it is closely related to the gingival mucosa. Finally, dental prosthesis is what takes the place of missing teeth; therefore, it is an artificial dentition.

The installation of a dental implant is a full-fledged surgical procedure, which generally involves local anesthesia and modest sedation. As with any surgery, there is a certain risk of complications.

The material of choice for dental implants is titanium in its pure form; in recent times, however, the use of zirconia dental implants is also taking place.

If managed properly, a well-installed dental implant can easily last 10-15 years. The prognosis, therefore, tends to be favorable.

What is a dental implant?

A dental implant is a fixed prosthetic device, composed of an artificial dental root, which can be inserted into the jaw or jaw, and one or more artificial teeth .

The purpose of a dental implant is to cover the space left free by one or more missing or extracted teeth, in the upper or lower dental arch.

The installation of a dental implant is, in effect, a surgical intervention .

IS THE DENTAL PLANT AND THE DENTAL BRIDGE THE SAME THING?

Many people confuse the dental implant with the dental bridge .

The error probably arises from the fact that the implant and dental bridge have the same indications.

Definition of dental bridge

A dental bridge is a fixed prosthetic device, which serves to cover the space left free by one or more missing or extracted teeth. For more details, read the dedicated article.

Features

The dental implant consists of three main parts: the so-called endosseous screw (or fixture ), the so-called abutment (or transmucosal component ) and the dental prosthesis (or artificial crown ).

  • The endosseous screw is the cylindrical and threaded dental implant element which, following its insertion in the mandibular or maxillary bone, will undergo the osseointegration process, ie the process of integration into the bone tissue.

    The solidity of the dental implant depends on the endosseous screw and its insertion into the bone tissue; for this reason, it constitutes the most representative portion.

    In a normal tooth, the endosseous screw is substantially equivalent to the root.

  • The abutment is the element of the dental implant that connects the endosseous screw to the dental prosthesis. After insertion of the dental implant, it represents the portion in close contact with the gingival mucosa; this explains why it also takes the alternative name of a transmucosal component.
  • The dental prosthesis is what replaces the missing or extracted teeth or. In fact, it is the external part of the dental implant, which has the task of covering the area without teeth.

It is important to remember that the size of a dental implant - in this case of the endosseous screw - varies depending on the amount of jaw bone or mandibular bone available: the more bone tissue is available and the longer the endosseous screw length; vice versa, there is less bone and the length of the endosseous screw is less.

Important note: what is osseointegration?

The term osseointegration defines the process of union between a bone and an artificial implant, such as the endosseous screw of dental implants.

Based on current knowledge, the aforementioned bonding process takes place only when the artificial plant is made of titanium or metals that are extremely similar to the latter.

POSSIBLE VARIANTS

There are at least two types of dental implant : the type in which the abutment is an integral part of the endosseous screw (the two elements form a whole, therefore they are inseparable) and the type in which the abutment and the endosseous screw are two parts separate, separate.

Of the two possible types of dental implants just proposed, the second most commonly used is as it is associated with simpler handling and facilitates any repairs to damage that one of the various parts may suffer from after installation.

WHAT DOES THE DENTAL BRIDGE DISTING FROM THE DENTAL IMPLANTATION?

Dental implant and dental bridge have different differences. Among these, one in particular is noted: while the dental implant provides its anchorage to the bones that normally support the human dentition (jaw or jaw), the dental bridge provides for its anchorage to the teeth delimiting the toothless area.

Indications

The installation of a dental implant is indicated whenever the lack of one or more teeth:

  • It compromises the masticatory function;
  • It affects the phonetic function;
  • It ruins the look of the smile, creating an aesthetic discomfort;
  • Risk of causing the displacement of adjacent healthy teeth.

Table. The purposes of a dental implant.

  • It restores the masticatory function and the phonetic function, where these are compromised due to the lack of one or more teeth;
  • Restores the smile to a normal appearance, where the absence of one or more teeth disfigures the aesthetics of the mouth;
  • Prevents the movement of healthy teeth adjacent to the toothless area;
  • It allows the correct distribution of the so-called bite force on the teeth.

CAUSES OF LACK OF ONE OR MORE TEETH

A tooth gap - that is, a missing area of ​​one or more teeth - may depend on:

  • A serious and incurable tooth decay, which made it necessary to extract the tooth or teeth concerned;
  • A severe fracture not only of the crown, but also of the root of one or more teeth;
  • Important dental abscess;
  • Old age;
  • Severe periodontitis, which has made dental extraction indispensable.

Requirements

For the installation of a dental implant, it is absolutely essential that gums and maxillary or mandibular bone tissue are in good health.

ALTERNATIVE

If the prerequisites for installing a dental implant do not exist, the alternative to the latter consists of the aforementioned dental bridge.

Dental implant or dental bridge? Short summary of when the first to the second is preferable.

  • The dental implant is the best choice for those patients whose teeth adjacent to the gap are perfectly healthy or extremely sick and in which the jaw and jaw are in excellent health.
  • The dental bridge is suitable for those patients in whom the teeth adjacent to the gap are in fair condition (but not optimal!) And the jaw and the mandible are subject to bone resorption.
  • The good health of the jaw or jaw is essential to be able to insert the life that is part of the dental implant.
  • The excellent health of the teeth adjacent to the gap makes the dental implant preferable to the dental bridge, because, according to dentists, it is not worth subjecting perfectly healthy teeth to teeth (NB: filing of teeth adjacent to the tooth gap is a obligatory passage of the dental bridge installation).

Preparation

In general, people for whom a dental implant is to be installed must undergo a radiographic ( X-ray ) examination of the mouth before the procedure.

Providing information related to the anatomy of the maxilla and mandible (the so-called dental impressions ), this radiographic examination is used by the dentist to create a dental implant suited to the needs of the patients and to accurately plan the various stages of the future installation intervention.

Without performing an X-ray examination of the mouth, the realization and application of a dental implant would be impossible.

Sometimes, even if very rarely, radiographic examination of the mouth may not be sufficient; in the aforementioned circumstances, it is essential to carry out a TAC.

WHAT TO DO IN THE EVENT OF GENERAL ANESTHESIA?

As a rule, the installation of a dental implant involves local anesthesia, associated with a modest sedation . However, in particularly serious circumstances, it may be necessary to resort to a much more powerful and sedative anesthesia: general anesthesia . The general anesthesia consists, essentially, in inducing the sleep of the patient, who remains unconscious for the whole duration of the procedure.

General anesthesia is a practice that requires, as a preparatory measure, complete fasting starting from the evening before the day of the installation procedure (if the latter is held in the morning).

Another note difference between dental implant and dental bridge

Unlike the dental implant, the dental bridge is not a surgical type practice.

Installation procedure

The procedure for installing a dental implant begins with the accommodation of the patient in a special dental chair or on an operating table and with the subsequent local anesthesia (in most cases). Then, it continues with the insertion of the various components of the dental implant (focal point of the procedure) and ends with the immediate discharge of the patient.

INSERTION OF THE DENTAL IMPLANT: THE MAIN STEPS

The insertion of the dental implant in the desired location is a rather complex operation, the main steps of which are, in order, the following:

  • The incision of the gingiva and the lifting of a flap of the latter, in order to expose the underlying maxillary or mandibular bone;
  • Bone drilling to support the endosseous screw;
  • The insertion of the endosseous screw in the hole just created. This is the most delicate moment of the whole procedure. The final solidity of the entire dental implant depends on a good insertion of the endosseous screw;
  • The coupling to the endosseous screw of the other elements constituting the dental implant.

It should be noted that the last step can take place either immediately after the insertion of the endosseous screw (in this case, the dentists speak of "immediate loading") or at a distance of a few weeks from the insertion of the screw, when the process is in progress of osseointegration.

In other words, therefore, the insertion of the dental implant can take place in a single session or in two separate sessions.

COURSE OF ANESTHESIA

The effects of local anesthesia vanish within a few hours. Their disappearance also coincides with the complete recovery of sensitivity at the level of the mouth.

On the contrary, the effects of general anesthesia can last for a whole day, if not longer than 24 hours.

The typical sensations that people subjected to general anesthesia experience in the 24 hours following surgery are: sense of dizziness and / or confusion, poor receptivity to stimuli, nausea and vomiting. These are not serious problems, however it is good that the patient asks for the support of a relative or a trusted friend, at least until the day following the installation of the dental implant.

Activities strongly discouraged after general anesthesia:

  • Drive or operate machinery;
  • Perform jobs of a certain precision and danger for yourself and for others;
  • Drink alcohol.

POST-OPERATIVE WARNINGS

With the disappearance of the effects of anesthesia, the patient may begin to experience pain in the mouth. To cope with this painful sensation, you can take a painkiller, such as paracetamol or ibuprofen.

For at least the first seven days following the installation of the dental implant, dentists advise their patients to take soft foods and avoid foods or beverages that are too hot.

To reduce the risk of infection (a risk that exists as an incision has taken place in the gingiva), it is essential to follow a prophylactic antibiotic therapy .

HEALING AND RECOVERY

The healing and recovery times from a dental implant installation are extremely variable and depend on several factors, including:

  • The patient's general health status;
  • The state of health of the bone used to insert the endosseous screw;
  • The extension of the dental prosthesis;
  • The attention that the patient shows towards the dental implant during the osseointegration period.

Materials

According to dentists and experts in the field of dental prostheses, the material of choice for the realization of a dental implant is titanium in its pure form . What makes titanium the best material for dental implants is its high mechanical strength and high biocompatibility .

For some years now, there has been an alternative material to titanium in pure form: zirconia .

Like pure titanium, zirconia also enjoys good mechanical strength and more than satisfactory biocompatibility. However, several studies have shown that the performance of dental implants in zirconia is lower, compared to the performance of titanium dental implants.

Therefore, at the moment, a titanium dental implant always remains the first choice.

Duration and management

A dental implant can perform its functions without problems for at least 10-15 years, provided that the patient takes extreme care of his oral hygiene, cleans the dental prosthesis with the appropriate tools and, finally, undergoes maintenance checks fixed with the attending dentist.

To be able to jeopardize the duration of a dental implant, even in spite of an excellent management and cleaning, are: a dental prosthesis that includes a large number of artificial teeth (for example, total prostheses have a duration definitely lower than 10-15 years mentioned above), the appearance of a periodontal disease that compromises the ability of the mandibular or maxillary bone to support the endosseous screw, osteoporosis and radiotherapy .

Comparison between dental bridge and dental implant, regarding management

Compared to the dental implant, the dental bridge requires much more attention from the point of view of oral hygiene. This is why it has a greater tendency to last less.

CLEANING

The cleaning of a dental implant is quite simple and resembles that of normal teeth.

In any case, before or after the installation intervention, a member of the dental staff or the same dentist will expose to the patient all the methods of managing the dental implant, in order to guarantee the latter a long life.

Currently, for cleaning dental implants there are special brushes, made with materials (eg: Teflon) that preserve the integrity of the various constituent elements.

Risks and complications

The installation of a dental implant includes a series of generic risks and complications, which can take place during or after any surgical procedure, and a series of specific risks and complications, which characterize peculiarly the surgical operation in question.

GENERAL RISKS AND COMPLICATIONS

Among the risks and complications of a generic type, are:

  • Infections;
  • Excessive blood loss;
  • Swelling at the level of the jaw or jaw;
  • Post-operative pain;
  • Allergy to anesthetics used during the procedure.

SPECIFIC RISKS AND COMPLICATIONS

The specific risks and complications are distinguishable in two categories: short-term risks and complications and long-term risks and complications.

Among the short-term problems, there is above all the lack of osseointegration of the endosseous screw .

Among the long-term problems instead, they deserve a quote:

  • The episodes of peri - implantitis ;
  • The rupture of the crown (or dental prosthesis);
  • The loosening of the endosseous screw ;
  • The fracture of the endosseous screw or abutment ;
  • The misalignment of the teeth, due to phenomena of bone resorption of the jaw or jaw.

Prognosis

Thanks to advances in dental medicine, dental implantation is a reliable prosthetic device with a generally favorable prognosis.

One of the main causes of dental implant failure is the poor osseointegration of the endosseous screw. The bad osseointegration of the dental implant may depend on operational errors or management errors.