Implantology is now a certainty: in a short time and without pain, a lost natural root can be replaced with a new one made of titanium, which will restore function and aesthetics to the mouth.
Osseointegrated implantology
Implantology has now reached a level of scientific and clinical reliability that is no longer questionable, and an implant can be used to solve various problems: from restoring a single element, to replacing several elements, to stabilizing a total prosthesis that is no longer manageable.
The procedure consists of performing the normal anaesthesia that is used for usual dental treatment, and then cutting the gum and placing the implant in the bone. At the end of the procedure a few stitches will put the gum back in the right position. The procedure is quick, painless and has undoubted advantages, allowing a missing tooth to be replaced without touching the adjacent teeth, assuming they are still present.
The healing period for an implant normally varies from 3 to 6 months, and is still considered a prerequisite for direct bone apposition on the titanium implant surface, without the interposition of fibrous connective tissue. Numerous authors have shown how early loading of implants (i.e. with a waiting time shorter than the above-mentioned times) is possible in certain situations, not necessarily resulting in the formation of connective tissue interposed between the implant surface and the bone. Therefore, in some selected cases, an implant can be used after a shorter waiting time, especially thanks to current systems of objective verification of primary implant stability (use of resonance frequency).
Implant failure is almost always due to excessive micro-movements at the bone-implant interface during the healing phase. Of course, another possible cause is an infection of the site or inadequate preparation of the site itself, which can lead to bone necrosis.
It should be remembered that since the implant is made of titanium (or at least it should be the operator’s concern to make sure that it is!), it is not possible to have the dreaded rejection. What can happen, as described above, is that there is a lack of bone integration, and the interface with the implant is occupied by connective soft tissue, which will then ‘throw out’ the implant, considering it a foreign body, as it would with a splinter or a thorn. It is important to know, however, that even in the event of failure, being occasional and episodic, it will almost always be possible to place the implant in the same place again, trusting in a better outcome.
Post-extraction implantology
It consists of the insertion of an implant immediately after tooth extraction and not after the traditional waiting time for healing; this is a widely studied surgical technique that is very predictable today. With post-extraction implants, the maintenance of the soft tissue profile is favored, the volumes of the bone ridge (which is subject to resorption following tooth extraction) are preserved and, at the same time, the overall duration of the treatment plan proposed to the patient is reduced. Several studies have shown that the success rate of this type of procedure is superimposable to that of traditional implantology treatments (with implant insertion in a healed bone site), although always slightly lower and with some greater risk of failure.
The advantages offered by this surgical technique are basically two:
- it avoids the second surgery to place the implant in the now healed post-extraction bone site (2 to 4 months after extraction);
- it reduces the time between extraction of the tooth and prosthesis, thus decreasing the period of edentulousness and the patient’s total treatment time.
Immediate loading treatment
In this case, the implant is inserted and, instead of waiting for the normal healing period, the provisional abutment and temporary tooth are placed immediately. This is only possible when the missing element is not the last tooth but is located between other teeth, in order to reduce the loading. The care of the operator will be to eliminate all contact of this temporary element with neighbouring or antagonist teeth.
“All-on-four” implantology
With the help of radiological evaluation software, the doctor can plan the entire procedure in advance, pinpointing with extreme precision the most effective position for implant placement within the bone. For completely edentulous patients, one of the possible techniques that can be proposed is the all-on-four technique. This technique identifies four anchorage points within the oral cavity that guarantee almost perfect stability of the future prosthesis and complete respect for the distribution of masticatory forces. This operation is very often performed without a surgical flap. The number of implants is dependent on the bone condition. The main drawback is the reduced number of teeth (second premolar, or at most first molar), but justified by the reduced amount of bone present, without proceeding with regenerative techniques. This technique, certainly innovative and very up-to-date, has the limitation of being decidedly more expensive than other similar ones and of being strongly linked to precision in design. In the event of incorrect assessments, in fact, the risk of failure is much higher.
