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 endosseous screw mimics the root of a real tooth, therefore it must fit into the mandibular or maxillary bone tissue. L"abutment it is the connecting element between the endosseous screw and the dental prosthesis; it is also called the transmucosal component, because it is in close relationship with the gingival mucosa. Finally, the dental prosthesis is what takes the place of the missing teeth; therefore, it is a 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 gaining ground.
If handled 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, consisting of an artificial dental root, which can be inserted into the maxilla or mandible, 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, to all intents and purposes, a surgical intervention.
ARE THE DENTAL IMPLANT AND THE DENTAL BRIDGE THE SAME?
Many people confuse the dental implant with the dental bridge.
The error most likely arises from the fact that the implant and the 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 information, read the dedicated article.
Features
The dental implant consists of three main parts: the so-called endosseous screw (o fixture), the so-called abutment (or transmucosal component) and the dental prosthesis (or artificial crown).
- There endosseous screw it is the element of the cylindrical and threaded dental implant which, following its insertion into the mandibular or maxillary bone, will undergo the process of osseointegration, 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 essentially the same as the root. - L"abutment it is the element of the dental implant that connects the endosseous screw to the dental prosthesis. After the 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 transmucosal component.
- There dental prosthesis it is what replaces the missing or extracted tooth (s). In fact, it is the external part of the dental implant which has the task of covering the toothless area.
It is important to remember that the dimensions of a dental implant - in this case the endosseous screw - vary according to the amount of maxillary or mandibular bone available: the more bone tissue is available, the greater the length of the endosseous screw; vice versa, the less bone there is and the shorter the length of the endosseous screw.
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.
According to current knowledge, the aforementioned joining process takes place only when the artificial implant is made of titanium or metals extremely similar to the latter.
POSSIBLE VARIATIONS
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 separate, separate parts.
Among the two possible types of dental implant just proposed, the most used is the second, as it is associated with simpler management and facilitates any repairs to damage that one of the various parts may undergo after installation.
WHAT DISTINGUISHES THE DENTAL BRIDGE FROM THE "DENTAL IMPLANT?"
Dental implant and dental bridge have several differences. Among these, one in particular should be noted: while the dental implant provides for its anchoring to the bones that normally support the human teeth (mandible or jaw), the dental bridge provides for its anchoring to the teeth delimiting the toothless area.
Indications
The installation of a dental implant is indicated whenever one or more teeth are missing:
- Impairs the chewing function;
- It affects the phonetic function;
- It spoils the appearance of the smile, creating an aesthetic discomfort;
- It risks causing displacement of adjacent healthy teeth.
Table. The purposes of a dental implant.
- It restores the chewing function and the phonetic function, where these are compromised due to the lack of one or more teeth;
- It restores a normal appearance to the smile, where the absence of one or more teeth disfigures the aesthetics of the mouth;
- Prevents the displacement of healthy teeth adjacent to the toothless area;
- It allows the correct distribution, on the teeth, of the so-called bite force.
CAUSES OF THE LACK OF ONE OR MORE TEETH
A gap dental - that is a "missing area of one or more teeth - can depend on:
- A severe and incurable caries, which necessitated the extraction of the affected tooth or teeth;
- A severe fracture not only of the crown, but also of the root of one or more teeth;
- Major dental abscess;
- Old age;
- Severe periodontitis, which made dental extraction essential.
Requirements
For the installation of a dental implant, it is absolutely essential that the gums and the maxillary or mandibular bone are in good health.
ALTERNATIVES
If the prerequisites for installing a dental implant are not met, the alternative to the latter consists in the aforementioned dental bridge.
Dental implant or dental bridge? Brief summary of when the first is preferable to the second.
- The dental implant is the best choice for those patients where the teeth adjacent to the gap they 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 where the teeth adjacent to the gap they are in fair condition (but not optimal!) and the maxilla and 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, since, according to dentists, it is not worth filing perfectly healthy teeth (NB: filing the teeth adjacent to the dental gap is an obligatory step in the installation of the dental bridge) .
Preparation
Generally, people who are planning to have a dental implant installed must undergo a radiographic examination (X-rays) of the mouth before the procedure.
Providing information on 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 patients and to accurately plan the various stages of the future installation procedure.
Without performing an X-ray examination of the mouth, making and applying a dental implant would be impossible.
Sometimes, even if very rarely, the x-ray examination of the mouth may not be sufficient; in the above circumstances, it is essential to perform a CT scan.
WHAT TO DO IN CASE OF GENERAL ANESTHESIA?
Normally, the installation of a dental implant requires local anesthesia, associated with a modest sedation. However, in particularly serious circumstances, it may make it necessary to resort to a much more powerful and sedative anesthesia: general anesthesia. General anesthesia basically consists in inducing the patient to fall asleep, who remains unconscious for the entire 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 to be held in the morning).
Another notable difference between dental implant and dental bridge
Unlike the dental implant, the dental bridge is not a surgical type of 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, as follows:
- The incision of the gum and the lifting of a flap of the latter, in order to expose the underlying maxillary or mandibular bone;
- The drilling of the bone used 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 attachment to the endosseous screw of the other elements making up 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, dentists speak of "immediate loading") or after 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 wear off within a few hours. Their disappearance also coincides with the complete recovery of sensitivity in the mouth.
On the contrary, the effects of general anesthesia can last for a whole day, if not even for more than 24 hours.
The typical sensations that people subjected to general anesthesia experience in the 24 hours following the operation 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 ask for the support of a relative or a trusted friend, at least until the day following the installation of the dental implant.
Activities strongly advised against after general anesthesia:
- Driving or operating machinery;
- Carry out work of a certain precision and danger for oneself and for others;
- Drink alcohol.
POST-OPERATIVE WARNINGS
As the effects of the anesthesia disappear, the patient may begin to feel pain in the mouth. To cope with this painful sensation, they can take a pain reliever, such as acetaminophen or ibuprofen.
For at least the first seven days following the installation of the dental implant, dentists advise their patients to eat soft foods and avoid too hot foods or drinks.
To reduce the risk of infection (risk that exists because a gingival incision has taken place), 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 general state of health of the patient;
- The state of health of the bone responsible for the insertion of the endosseous screw;
- The extension of the dental prosthesis;
- The attention that the patient shows towards the dental implant during the period of osseointegration.
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. To make titanium the best material for dental implants are, above all, its high mechanical resistance. and its high biocompatibility.
For some years, there has been an alternative material to titanium in pure form: zirconia.
Like pure titanium, zirconia also has good mechanical strength and a more than satisfactory biocompatibility. However, several studies have shown that the performance of zirconia dental implants is lower than 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 the maintenance checks set with the attending dentist.
To be able to compromise 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 decidedly less than 10-15 years indicated above), the onset of 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. It is for this reason that it has a greater tendency to last less.
CLEANING
Cleaning a dental implant is quite simple and is very reminiscent of that of normal teeth.
In any case, before or after the installation intervention, a member of the dental staff or the treating dentist himself will show the patient all the ways of managing the dental implant, in order to guarantee the patient 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 the surgical operation in question.
GENERIC RISKS AND COMPLICATIONS
Generic risks and complications include:
- Infections;
- Excessive blood loss
- Swelling in the jaw or jaw
- Post-operative pain;
- Allergy to anesthetics used during the procedure.
RISKS AND COMPLICATIONS OF A SPECIFIC TYPE
Specific risks and complications can be divided into two categories: short-term risks and complications and long-term risks and complications.
Among the short-term problems, the lack of osseointegration of the endosseous screw is particularly noteworthy.
On the other hand, among the long-term problems, they deserve a mention:
- 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 of theabutment;
- Misalignment of the teeth, due to bone resorption phenomena of the maxilla or mandible.
Prognosis
Thanks to advances in dental medicine, the dental implant represents a reliable prosthetic device with a generally favorable prognosis.
One of the main causes of dental implant failure is poor osseointegration of the endosseous screw. Bad osseointegration of the dental implant may depend on operational errors or management errors.
