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Dental implants: Treatment plan

When one or more missing teeth must be replaced, dental implants are an optimal solution. It is a very simple method, that however requires some attention. Let's see step by step how a proper and secure treatment plan can be realised for the patient.

1: control of the patient's local and general health conditions

The first matter at hand is a check of the patient's health: diabetes, osteoporosis, systemic infections must be appropriately diagnosed, cured or compensated. The presence of infections on nearby teeth or on the gums must be excluded, or if there are other pathologies under way, the proper remedies must be carried out. As a matter of fact, when the gums became ill it may be possible that a sort of pouch form between the tooth and the gums themselves, the so-called periodontal pathologies. A space dug out from behind the bone that gathers the dental root now contains bacteria and pus. An implant inserted beside one of these pouches may become infected and fail due to an infection not dealt with. When in the mouth there are infections present in the gums or around dental roots, it is necessary that they be diligently cured  before carrying out any intervention, and in some cases, it is possible to decontaminate the area at the same time of the implant insertion by the use of an erbium laser, which destroys the bacteria present without harming the bone tissue.

2: assessment of the quantity and type of bone available

By means of various diagnostic tools the quantity and type of bone available are assessed. The most frequent are local radiography and panoramic radiography. These give us precious information regarding the quantity of bone available and the distance from nearby anatomic structures that must not be impaired, such as the mandibular nerve, the nerve which gives the lower lip its sensibility, the maxilla, the lateral nasal cavities that provoke sinusitis when inflamed, the roots of adjacent teeth that could be devitalised if damaged. Other analyses include teleradiography, which establishes a relation between the upper and lower teeth, the CAT scan, that is the computerised axial tomography that identifies volumes with utmost precision, the CBM, that is bone density measurement.

3: occlusal relationship

The type of mouth closure can determine many problems also in far off areas, such as neck pains, back aches, or headaches. Or even local problems such as bruxism, that is the continuous nocturnal tooth grinding or trap jaw, that is when the mouth is locked into a tense position during rest. The insertion of new teeth modifies the existent situation with improving or worsening effects which a dentist must  evaluate in order to avoid surprises.

4: surgical technique

At this point the implant can be inserted using the most suitable technique for the kind and quantity of bone available, and for the general and local health conditions. There are many possibilities. Let's  see some: implant inserted that soon after insertion  pops up on the surface (overlay technique) or left to rest under the gingiva (underlay technique). There is the implant insertion at the moment in which a tooth is extracted (post-extraction technique) or afterwards. With the realisation of a temporary prosthesis cemented over the implant (immediate load) or latter (delayed load). There is also the use of surgical lasers to improve surgery area sterility (laser-assisted surgery). The dentist must advise the patient about which technique is best suited for his present conditions, and thoroughly explain the various indications and counter-indications.

Up to a short while ago it seemed extremely important to wait from three to six, eight months to load the implant, that is to apply the new tooth over the new root. It was feared that the micro-movements would disturb the healing process thereby creating a gap in the fibrous  tissue between the bone and the implant. However, various studies have since then demonstrated that when he implant is well-fixed to the bone, without any bacterial contamination, it is possible to apply the tooth immediately and suddenly use it as an anchorage for mastication and to restore a pleasant aesthetic aspect. The implant must be fixed via a special device that screws it into its final position, with a force of circa 35 newton x  cm,  that is around three times the force that a human hand can exert. At the bottom line, the implant is extremely well fixed into the bone and it is so closely linked to it that masticatory forces can be soon sustained without waiting for the bone cells to surround the implant during the scar phase. The new tooth can thus be fixed over the implant soon after the intervention, hence allowing a more comfortable gum healing. One will be able to chew almost normally the same night of the intervention.

last update: 21 January 2008

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