Dental implants have become a routine procedure for replacing missing and also compromised teeth. This treatment enhanced the practice and at the same time, the philosophy of the dental office. Dental implants are a new option for restoring your smile and they offer a long-lasting tooth while preserving the natural structure of the adjacent teeth. It is very important to consider the fundamentals of implant therapy not only following the new techniques and applying new treatment approaches. All dental professionals no matter what is their specialty are compelled to gain knowledge in the field of dental implants and also to continue their education as more and new information becomes available.
Clinical evaluation of the patient who is a candidate for dental implants
According to many studies, dental implants and their prostheses which are retained have marked a great success over the past decades. There are so many successful cases in which partially edentulous patients were treated with dental implants. But, with the implementation of bone augmentation techniques, patients with inadequate bone density have a good option to be restored with implant-restored prostheses. It is good to know that any patient with edentulous jaw is a candidate for implants.
The main goal of dental implant therapy is to satisfy the desire of the patient to restore one or more missing teeth in a secure, aesthetic, and long-lasting manner. In order to achieve this point, the dental clinician correctly diagnoses the dentoalveolar condition and also the overall mental and physical health of the patient.
Case types and indications
It seems that the patients with fully edentulous jaws would benefit the most from the therapy with dental implants. These types of patients would satisfy both conditions of function and aesthetic. This case could be solved with an implant-assisted removable prosthesis or the second option is an implant-supported fixed prosthesis. The original idea for the fully edentulous arch was a fixed-bone-anchored bridge. For this type of construction, the dental practitioner would need five to six implants in the anterior area of the maxilla or the mandible to support a fixed, hybrid prosthesis. However, the stability of the implant-retained overdenture could not be compared to the rigidly attached, implant-supported fixed prosthesis but, the increased stability and retention over conventional dentures is an important benefit for the patients who wear dentures. The most important thing is that implant-supported and implant-assisted prosthesis protect the alveolar bone from bone loss caused by the long-term usage of removable prostheses that are covering directly the alveolar ridges.
Partially edentulous patients
. Multiple teeth: The most important thing, in this case, is that implant-supported restorations replace missing teeth without the need for alteration the adjacent teeth. This means that the preparation of the natural teeth becomes unnecessary. Single tooth: Those patients with a missing single tooth no matter if it is in the anterior or posterior area, are another type of patients who have benefited from the dental implant therapy. Replacing a single tooth with an implant-supported crown is an amazing way to restore the occlusion than preparing two adjacent teeth and creating a dental bridge.
Standard Implant Surgery Procedure
In this paragraph would be presented the general considerations of implant surgery. There are two principles of implant surgery and they are the following:
– Patient preparation
– Implant site preparation
A dental practitioner makes the initial marking of the implant site with a special round bar. He uses a 2-mm twist drill in order to establish the depth and align the dental implant. After this step, a guide pin should be placed on the site of the osteotomy just to confirm the position and the angulation. Then, the dental worker uses a pilot drill to increase the diameter of the coronal aspect of the osteotomy site. After this, the final drill is used which is a 3-mm twist drill so the dentist could finish the preparation of the osteotomy site. Later, a countersin drill is used in order to widen the entrance of the recipient site and at the same time to allow the subcrestal placement of the dental implant collar and cover the screw. Finally, the implant is placed into the prepared osteotomy site with the help of a handpiece or more exactly a handheld driver. At the final step, a cover screw is placed and soft tissues are closed and sutured.
After all these steps and after several months of recovering period, comes the second-stage in implant surgery. The objectives of second-stage implant surgery are the following:
– To uncover the submerged implant without damaging the surrounding bone
– Controlling the thickness of the soft tissue which surrounds the implant
– Preserving the keratinized tissue around the dental implant
– Facilitating oral hygiene
– Ensuring proper seating of the abutment
– Preserving the aesthetics of the soft tissue.
Beside the standard option, there are new advancements in dental implant therapy. With the technology evolution there is a new way of placing implants which is more precise outcome with.
We talk about Straumann gonyx device for scan and surgical template fabrication by the dental lab. This is Straumann guided surgery software which makes the things easy and simple.
It is very important to follow and comprehend the basic guidelines to achieve osseointegration. All fundamental protocols must be followed for the implant placement, which represents the first stage, and the implant exposure surgery which describes the stage two. These basic steps apply to all implant systems.
Dental workers have to pay close attention to all detail and follow clear protocols using gentle and skillful surgical techniques in all cases. They need to practice this even in the simplest cases. This would help in maintaining the implant rate success high.
Which technique would be chosen depends on every individual case. One-stage treatments offer simplicity and may be adequate and quicker for patients. The dental clinician has better control of the contours of the soft tissue which maximize the aesthetic results. The two-stage procedures are more common in patients with bone loss and they require bone augmentation procedures.
The stability of the implant at the time of placement is essential and first of all, it depends on biologically based and skilled surgical procedures. In the future, new technologies would be presented and measuring the implant stability would become more applicable and the whole protocol would become more available.