Implantology and Surgery
Implantology is a surgical-prosthetic technique that restores missing dental elements by means of a titanium screw that is positioned in the maxillary bone or in the jaw on which a device is subsequently attached to allow the housing of a porcelain crown (artificial tooth).
There are 2 possible methods of implanting the dental elements to be restored:
- IMMEDIATE LOADING OF IMPLANTS WITH RELATIVE ARTIFICIAL DENTAL ELEMENTS
- DEFFERED LOADING OF IMPLANTS IN VARIOUS PHASES
Both solutions are realized through the operating protocols of the most important scientific societies, and are an integral part of the clinical practice that doctors at our centre practice daily.
These protocols are implemented by us with the help of high quality and extremely selected materials and technology, as well as the use of Biomet 3i systems, which are among the most accredited worldwide
1 – IMMEDIATE LOADING
It provides the possibility of positioning the implants and immediately applying temporary, or if possible definitivedental elements.
It is possible to attach multiple or single elements and even a complete prostheses, as ALL-ON-FOR, which allows for a prosthesis of a complete arch on 4 implants.
Immediate loading is feasible in specific cases, after careful evaluation of:
- amount of bone present
- quality of the bone present
- aesthetic conditions
- characteristics of the masticatory function of the specific subject
Immediate loading is the primary choice where possible, otherwise deferred loading is performed.
2 – DEFERRED LOADING
There are 4 basic phases:
SURGICAL POSITIONING PHASE
RE-OPENING PHASE AND GINGIVAL CONDITIONING
The surgical phase involves the positioning of one or more titanium screws (implants) in the maxillary bone or in the jaw. 3 to 6 months must pass before moving on to phase 2, so that the implant is properly osseo-integrated in the bone.
Of fundamental importance are:
– Correct pre-operative evaluation with aids requested by the doctor.
– X-ray plates,
– CT scan,
The surgical technique MUST adhere to an accredited protocol that provides for the use of electronic equipment to control the method of implant insertion, to guarantee: – correct implantation – prevention of post-intervention infection – duration in time
The use of implants, that meet specific world directives in terms of quality and sterility is very important. Accredited and well-known systems give the possibility of receiving worldwide assistance. Our centre uses Biomet 3i implants, which are among the most accredited worldwide.
After the time determined by the doctor for the osseo-integration of the implant, the gingiva is opened and a device is placed on the implant that conditions the gingiva and prepares it for the future housing of the final crown.
After about 15 days, it is possible to start the last phase: the prosthetic phase.
The prosthetic phase may vary depending on whether it is the restoration of single elementsor of devices that completely replace a dental arch.
MAINTENANCE OF IMPLANTS
As with all medical therapies, the maintenance phase is also fundamental in implantology.
Checking the bacterial plaque is of fundamental importance for the maintenance of the implants over time. Professional home oral hygienetogether with scheduled checks-ups decided by the doctor are therefore important for the long-term prognosis of implants. Any previous periodontitis, if not checked, can negatively affect the results.
Teeth with periodontal lesions can act as reservoirs of pathogenic bacteria, with the risk of peri-implantitis. Therefore, in these cases periodontal therapy is recommended and its success checked before the start of the implant treatment.
WHY IS THE CHOICE OF THE IMPLANT IMPORTANT?
Dental implants are artificial titanium roots that are placed in the maxillary or mandibular bone to replace the roots of missing elements.
DENTAL IMPLANTS ARE MEDICAL-SURGICAL PRODUCTS, AND THEREFORE MUST BE CERTIFIED!
Also because from 13 June 1998, Italian law prohibits the marketing of all medical-surgical devices(therefore also dental implants) which do not comply with the quality standards established by the European Community protecting patients and implant surgeons.
WHICH PATIENTS ARE SUITABLE FOR IMPLANTOLOGY?
In this category can be included: young people who have concluded their growth phase, usually 16 years for females and 18 years for males, who lack some permanent teeth (they have not erupted because the tooth germ is not present). Patients who have lost some teeth due to trauma, within the framework of a healthy dentition. Patients who have already performed extensive oral rehabilitations with fixed bridgesin the past but require reconstruction and the pillars (teeth on which the prosthesis rests) do not guarantee durability. Patients with partial (skeletal) or total (complete dentures) removable prostheses, who for functional, aesthetic or psychological reasons need a fixed prosthesis. There are no age limits. However, the actual psycho-physical condition must be assessed for each clinical case.
IS LOCAL ANESTHESIA SUFFICIENT?
In most cases, the operation can be performed under local anaesthesia. If necessary, the patient undergoes conscious sedation to reduce the level of anxiety and increase his state of comfort. In our centre, this practice is performed by anaesthesiologists specialized in this practice, thus offering maximum safety for our patients.
The operating room is adequately prepared to perform oral surgery. We also use special equipment that allows us to check the patient’s comfort level throughout the operation.
In particularly complex cases or due to the particular health conditions of the patient, it is advisable to operate under general anaesthesia in protected structures where the clinicians of our centre are accredited.
ARE THERE ANY RISKS RELATED TO IMPLANTOLOGY?
The risks and complications, from a general point of view, are comparable to a common dental surgical treatment if the patient is in good health. If during the diagnostic phase, clinical data that need further investigation emerge, the collaboration of other specialists will be requested. Local risks and complications are greatly reduced by making a precise diagnosis and by using radiographic images such as CT (Computed Tomography). However, when operating near nerve endings, a slight tingling sensation can sometimes persist for a few weeks, at most for a few months. This occurrence is rare and in some cases may be permanent. However, it occurs more frequently when operating at jaw level and is inherent in the surgical technique. Hematomas are more common in elderly patients. Swelling must not cause concern: this occurrence cannot be considered a complication but a factor of the normal post-operative course. Anti-inflammatory drug treatment will limit swelling. For each individual area operated, all information on possible risks and specific complications will be provided.
IS THE TREATMENT PAINFUL?
No. If surgery is carried out in a clinic, local anaesthesia is used with anaesthetics specially developed for oral surgery. These anaesthetics are very effective and produce deep anaesthesia. The patient feels no pain. After the surgical phase, analgesic-anti-inflammatory drugs will be prescribed that can effectively control the possible onset of post-operative pain.
HOW CAN YOU CONTRIBUTE TO THE GOOD OUTCOME OF THE IMPLANT?
It is in the patient’s interest to scrupulously follow all the indications provided by the clinicians and comply with the reminders arranged by the clinician, as well as communicate news of any change in the general state of health that may affect the presence of the implants. With an average number of 3-4 annual check-ups and observing a constant and correct habit of home-hygiene the implant and the prosthesis will be conserved.
If the site, that will host the implant, is found to have a bone deficiency, biocompatible osteo-inductive material will be grafted, which interacting with the existing bone, will form a new compact and stable bone tissue. Membranes are used to support the graft according to each specific case. These allow the material to be kept in their specific position.
After complete healing and integration of the “new” tissue with the “old” one, it will be possible to position the implanton that site.
MAXILLARY SINUS LIFT, SUMMER TECHNIQUE AND LATERAL TECHNIQUE
When the placing of an implant in the upper arch is foreseen, a quantitative and qualitative assessment of the bone available in the area that will host the implant is required. If the quantity of bone is not sufficient, it will be necessary to proceed with a “sinus lift”.
This type of intervention consists of the insertion of biocompatible osteo-conductive materialinside the maxillary sinus. The inserted material will integrate with the pre-existing bone creating a single bone block that will perfectly accommodate the implant.
There are two types of techniques for maxillary sinus elevation, which can be used according to specific clinical case:
- Summer technique or crestal access technique: this technique is used when the regeneration of a reduced volume of bone is necessary, using the implant site as a way of access to the maxillary sinus.
- Lateral access technique: this technique is indicated when a large bone volume is needed. Access to the maxillary sinus is obtained by opening a small “window” through the gum.
Thanks to new technologies and the high technical skills of our specialized surgeons, the intervention is minimally invasive with reduced post-surgery problems.
The term avulsion refers to the extraction of a dental element for bacterial reasons (caries and periodontal disease) or for physical-mechanical reasons (invalidating bad positions or trauma).
The extraction is performed by a specialized surgeon, who after careful analysis of the specific case, will adopt the most appropriate technique and makeovers.
WISDOM TEETH DISODONTIASI
This means an incorrect positioning of the third molar, the “wisdom tooth” which is not in perfect axis like the others. In some cases, it can be tilted (mesio or disto inclined) in an almost horizontal position disturbing the second molar, which can be damaged by erosive phenomena caused by the pushing of the wisdom tooth.
In such cases, the only possible solution is preventive avulsion. There are also less serious clinical forms with partial eruptions, called semi-inclusions, responsible for inflammation of the area surrounding the tooth, called peri-coronaritis. This occurs because the patient is unable to clean the area properly.
The technique is of fundamental importance for the success of the intervention and for eliminating post-operative discomfort. Our specialized operators have acquired decades of experience in this field. Their experience is supported by the use of new technologies that allow these treatments to be carried out safely and to predict the post-operative situation.
The low surgical impact, thanks to experience, techniques and technologies, allows multiple operations to be carried out on the same patient at one time. So after an adequate diagnosis, it is possible to intervene, for example, where needed, in the elimination of all 4 wisdom teeth, with only relative trauma and therefore limiting the post-operative effects. These interventions, being of longer duration, often require conscious sedation.
Conscious sedation is recommended for long interventions or for patients with accentuated emotionality. It provokes a tranquilizing effect, an amnesic sedative and additive for the local anaesthetic. It improves the patient’s comfort, facilitates the surgeon’s work and reduces post-intervention problems . This technique enables patients to remain alert and able to collaborate, responding to commands even if in a slowed-down manner.
The well-equipped operating room is of fundamental importance for performing interventions in safety. At our centre, specialized assistants set up the operating room in compliance with all applicable protocols, allowing the surgeon to operate in complete sterility, eliminating the possibility of contamination of the area where the intervention will take place.
THE ABSENCE OF A TOOTH
Chewing is a very complex function and requires the integrity of all the components to participate: muscles, bones, tendons and teeth. The latter must have normal positions, both in the upper and lower arches, so that they can act like a key in a lock. When the arches are not intact, chewing is altered. For example, if an element is missing in the lower arch, the antagonist upper tooth will not find the right contact when the arches touch.
Even those teeth close to the missing one, no longer have contact points and tend to tilt, thus losing the normal correct occlusal relationships. This entails the extrusion of the element with the real risk of tooth loss or, in any case, of its mechanical congruity.
This highlights both the harmfulness of the absence of a tooth and the importance of its replacement, before the situation worsens as mentioned above.
INSTRUCTIONS TO FOLLOW AFTER AN INTERVENTION
- ICE: Apply ice externally, in correspondence with the operated part, only in the hours immediately following the intervention. Application lasting about 30 minutes, at intervals of 15 minutes, for a total of 4 applications.
RINSES: Do not use any type of rinse for the first 24 hours. Spit out the small amounts of blood in your mouth and drink something cool.
- BLEEDING: In case of subsequent bleeding, apply a moistened gauze pad and compress for 15-20 minutes. Repeat the operation if necessary. If the bleeding persists, contact my surgery during office hours (02 49.81.593) or, out of surgery times, go to the nearest hospital Emergency Unit
- FOOD: Take cold liquid or semi-solid foods during the first 24 hours. Subsequently, also soft foods can be eaten that do not traumatize the operated area. Avoid hot drinks and alcohol for the first 24 hours
- ORAL HYGIENE: Suspend brushing the teeth for the first 24 hours IN THE AREA IN WHICH THE INTERVENTION TOOK PLACE.
- Then brush the dental arches avoiding the part near the surgical wound
- EXTERNAL MODIFICATIONS: A swelling of variable size, in correspondence with the operated area is part of the normal healing processes. Generally, this phenomenon can also appear on the second or third day
- PHARMACOLOGICAL THERAPY: Take any drug therapies prescribed in the correct way.