Agenesis (absence of development) of the upper lateral incisorsJune 24, 2019
Dental implants and complicationsOctober 29, 2019
When one or several teeth are missing, the remaining arch gap can be replaced by one or several dental implants.
An implant is a titanium piece, in the shape of a screw, which is inserted into the maxillary bone, replacing the lost tooth. A ceramic crown, a dental bridge or a removable acrylic prosthesis is placed on this piece.
The implant treatment has 2 stages:
- The screw insertion stage is a surgical intervention under local anesthesia, during which the titanium screw is inserted in the bone. It will remain in the bone for 4-6 months in order to become integrated in the bone, i.e. the maxillary bone grows on the titanium surface and includes it inside the bone, ossifying it. Thus, the implant will become fixed inside the bone and will not move.
- The prosthetic phase - on the rigid screw in the bone which has become integrated inside the bone, the ceramic dental crown part is applied.
Implants increase the patient’s quality of life. They are more effective and more advantageous than the traditional methods of replacing missing teeth, because they eliminate the need to polish the teeth next to the empty space, mostly healthy teeth.
For it to be successful, implant treatment should only be applied to patients that meet certain general and local health related conditions.
The decision to extract a tooth and replace it with an implant is not as simple as it may seem.
We must take into account the differences that exist between the natural tooth and the titanium implant replacing it. A healthy tooth has major advantages compared to a titanium implant:
- the tooth has a smoother movement inside the alveolus, due to the periodontal ligaments supporting it like in a hammock and mitigating pressures. The implant is rigid and in direct contact with the bone, without ligaments.
- the tooth has sensitive nerve receptors which convey information about food, hot, cold, regulate by reflex the muscular forces applied onto it; the implant is inert, has no nerves and conveys no information about what is happening around it. This is why implant crown fractures are quite frequent, because there is no reflex protection to excessive forces applied to it.
- the tooth maintains the bone and gums around it; Atrophy of the bone and gum around the implant is a phenomenon that always occurs and that cannot be stopped. An implant should never have priority over a tooth that can be successfully recovered.
The maxillary bone where the implant is inserted has to be enough in size and properly mineralized. Thus, interventions to increase the quantity of bone must be performed before applying the implant (bone additions)
General conditions limiting the use of implants:
- Uncontrolled diabetes mellitus, where glycaemia values are not normalized and carefully controlled.
- Osteoporosis of the maxillary bones. There is no direct correlation between the osteoporosis of maxillary bones and that of other bones in the body. In order to check the condition of the alveolar bones, radiology investigations must be carried out in this area.
- Cytostatic treatment or radiotherapy for malignant tumors.
- Long-term treatment with biophosphonates, particularly intravenous.
- Anticoagulant treatment or blood conditions involving hemorrhages.
- Smoking increases the risk of failure for implant treatment, 3-4-fold compared to non-smokers.
- Untreated periodontal disease, with periodontal pockets and inflammation is an absolute contraindication in relation to the application of implants. They can only be applied after the correct treatment of the periodontal infection.
- Bruxism (grinding and clenching of the teeth) creates powerful and non-physiological forces. It increases the risk of complications.
- An improper mouth hygiene - unremoved food residues lead to an increase in the number of bacteria and to inflammation around the implants and the teeth. Gingivitis and peri implantitis occurs, with the risk of losing the implant.