Definitions and Descriptions

Implantology is that particular branch of dentistry that concerns with replacing the missing teeth with artificial titanium roots that -anchored into the bone- are able to hold up a single tooth, groups of teeth or funging as attachment for holding a complete denture in place.
The use of implants allows to keep the nearby natural teeth untouched because the replacement does not involve the latter with any kind of preparation compromising their integrity nor using them as pillars for the use of hooks or attachments of any kind that would compromise their stability. Implants can be placed in any chosen moment: immediately after extraction or many years later, with the only condition that the bone thickness be enough to offer stability. Anyway, special surgical techniques are available to consent implantations in almost any bone condition.

Titanium is a metal that is characteristic for having a high tolerability, and is therefore used in the construction of orthopedic prosthesis.

Titanium pillars today are threaded manufacts, more or less shaped like a screw, mostly cylindrical or conic, with variable length and diameter in order to adapt themselves to the various bone configurations they have to be inserted in.

Their surface is treated in a way to enhance the possibility of osteointegration (the total binding to the bone environment). Dental implants must be produced and packaged conforming to the E.U. norm and they come together with a certificate that can be envisioned and preserved by the patient for his own guarantee.

Pioneer dentists' implantology, very often based on home designed implants built with various shapes and metals, has come to a definite end and, together with that, a large part of the past insuccess rate that worries many potential patients.

The best modern implants work together with a rich series of connection accessories for the artificial tooth that will sustain it in a way to ensure a good hygenical maintainance and an optimal aesthetic result concerning the gum's contouring. This is a decisive feature for success in smile uncovered areas.

The rejection of the implant DOES NOT EXIST, being there no possibility of unfavourable immune reaction as may happen in etherologal transplants (from donors). Complications concern 4% of the cases in which the osteointegration does not occur and the implant is expelled. This generally happens in the two months following the surgery and is painless. After three/five weeks a new implant can be done in the same site

The main reasons leading to failure or the factors that contraindicate an implant have to be underlined.

a) Patients that have not successfully been educated to an extremely high hygenical standard or have at the same time no intention of doing a precise professional hygenical follow-up, must not receive implantology. The reason for this, is that an implanted unit offers less resistance to plaque infection than a natural tooth, due to its different supporting tissues. The tooth is connected to the bone by means of the periodontal ligament, which is absent on the implant's surface that osteointegrates instead, meaning that the bone connects directly on it. Supporting bone is particularly delicate on both teeth and implants, but in this last case, it's only protected by a short gum belt around the implant's head, being the natural periodontal ligament totally lacking.
For this very reason the plaque, once bypassed the gum protection, easily makes its way along the implant spreading infection deeper down. Infection resitance biology is therefore slightly worse even if some recent studies suggested that being the bacteria involved in implant infections different from those usually present in periodonthitis, this should indicate no relation between the disease and an eventual implantological risk. While we wait for research to give us more precise information on these issues, common sense compels us to have the maximum degree of hygenic care for our implantoprosthetics.

b) Patients affected by some general diseases like non compensated diabetes, coagulation disturbancies and under radiotherapy should not receive implants. Generalized ostheoporosis is no absolute contraindication because the jaw is generally the most spared by this pathology. In these cases, the failure is foreseeable and so we should most properly speak of impossibility of success during the diagnostic stage to avoid a sure surgical failure.

Among the X-ray exams required to evaluate the possibility of actually executing implants we can indicate the orthopantomography, integrated in some cases by a Maxillo facial CAT or Dentalscan. Antibiotical and antinflammatory coverage must be started one day before surgey and be carried out for 6 days.

On the day of the surgery, a pause from work or duty is required, while generally the next day the patient can get back to his normal occupations. It's considered a good norm to alert the dentist about any drugs and medicines that are being taken, before the surgery day, in order to adjust the therapy if needed.

During the first week after the implant it is reccomended to avoid smoking, drinking alcoholics, chewing on the wound and it is necessary to accurately brush the neighbouring teeth avoiding to disturb the healing area. In the following weeks these procedures must be set forth taking care of alerting the dentist about any alteration in the surgucal area, be it pain or pulsation.

The surgery is done in a normal dental office under coverage of a local anesthesia and is completely painless. According to the situation and the implant type, it can be done in one single act (leaving a small portion of the implant emerging over the gum to connect it with the tooth), or in two acts, being the second surgery way more easy than the first (a tiny incision done to expose the upper part of the implant in order to connect it to the oral cavity and link it to a porcelain, composite resin or glass polymeric crown).
We speak of partial immersion in the first case, of total immersion in the second, referring of course to the gum covering or not the fixture, because the same is sunk in the bone in both cases. After the surgery a variable lapse of time, not more than four months must be waited before prosthetizing the implant, or better said for loading the implant with an artificial tooth.
The connection happens in more than one way according to the implant type, the patient's necessities and the dentist's habits and is generally a cementing or a tightening through a screw. In some of the most aesthetic cases like the frontal area, an immediate load can be performed by inserting the implant and a provisional tooth at the same time, later substituting the tooth with a definitive crown when osteointegration has occurred.

After prosthesizing, an accurate cleaning with toothbrush and paste has to be carried out plus, the use of dental floss at least once a day is reccomended, especially around the bridge pillars and at the implants' neck, rinsing with antiseptics afterwards.

Following these simple rules is the best guarantee to preserve gums and implants health for a long time. The durability of the work will ultimately depend on daily application of hygenical procedures.

Implants have a very long life (studies up to now indicate 25 years, but there appear to be even better perspectives) if a daily hygene is performed, however the most dangerous risks for them are:

Perio-implantithis: an inflammation and infection of the structures near the implant with following loss of ostoeointegration.

Incorrect implant prosthetic load with wrongly built crowns or bridges causing a bone reabsorption in time that follows the implant's spires and ending with the possible loss of the implant itself.

To avoid possible implant failures, a good fixed or mobile prosthesis is necessary, occlusally well balanced (correct chewing interaction), a perfect hygene must be carried out and periodical controls at the dentists' have to be done. One more thing to be said is that smoking affects negatively both osteointegration and durability of implants.