We live in awkward times: with the emergence and success of Dental Implants, we are witnessing a liberalization of dental extractions, along with aggressive marketing that tries to convince people that, after an intervention in which all the teeth are extracted and a series of Implants placed, you will feel like new, eating apples and never have tooth issues again in your life.

Nothing could be further from reality: if there are cases in which this type of intervention is certainly justified, there are many in which the patient’s teeth could and should be kept,natural teeth continue to be the best implant in the world. Keeping natural teeth as long as possible should be our goal.
Implants are the end of the line, we can always go from a natural tooth to an implant, but not the other way around. So that’s what I stand for, even as an Oral Surgeon that places many Implants: preserving natural teeth as much as possible.

That said, what factors should be taken into account when considering dental implants:

Patient Factors

Quantity and quality of bone present, existence of contraindications or factors that reduce the success rate ( smoking habits, Periodontal Disease, Diabetes, etc).

Physician’s Factors

Must be an experienced oral surgeon.

 

Dental implants

There are countless brands on the market with a vast array of prices and quality, it is the surgeon’s obligation to choose a brand that guarantees quality, even if more expensive, since it is a material that will remain permanently in the patient’s bone.

So, after this introductory note, we move on to a more detailed analysis of what dental implants are, what they are for, and most importantly, under what conditions they should be used.

 

What are Dental Implants?

Implants are artificial titanium roots (metal with excellent biocompatibility) that are placed in the bone, creating a solid base on which to place either an individual tooth (Example: loss of the 1st lower right molar) or more extensive rehabilitations (Example: bridges or total rehabilitations), functioning in a very similar way to natural teeth.

Dental Implants were undoubtedly one of the great advances in the area of rehabilitation and oral health. They must be used judiciously so that their success rate is high. On the other hand, we must never forget that, being a fantastic solution for when there is no tooth or when it can’t be saved, they should not be used until all possibilities of preserving the natural tooth or teeth have been exhausted.

 

What are Implants for?

Dental Implants will restore function and aesthetics, replacing missing teeth without the need to touch neighboring natural teeth. This point is a huge advantage in relation to traditional fixed prosthesis techniques in which the anchorage is made, not in the bone, as in the case of implants, but in neighboring natural teeth, which therefore have to be grounded down (which should be avoided mainly if we have good bone conditions).

Subtitle:

• On the left side, the replacement of the central incisor was performed with a bridge on which the two neighboring teeth on which the bridge was cemented were worn down.
• On the right side we see the replacement of the same tooth with an implant anchored in the bone where a crown will be placed.

 

Advantages of Dental Implants

– Preserve the bone

When a tooth is extracted, we do not just lose the tooth: from the moment of extraction, a process of bone resorption begins, which has very marked functional and aesthetic consequences, which can even be dramatic (especially when several teeth are involved).

When we place an implant, we will prevent this resorption to some extent.

 

– Decrease overload on remaining teeth

As extractions are carried out, the remaining teeth are forced to withstand the masticatory forces of the missing teeth, thus suffering an important overload that will determine a decrease in their survival. By replacing missing teeth with implants we are reversing this process.

 

–Advantages of Dental Implants in relation to Removable Prosthesis:

Anyone who has a removable prosthesis (denture) knows how much better it is to have a fixed structure, which doesn’t feel like a foreign body, has no unsightly metal hooks, has perfect stability and far superior chewing efficiency. On the other hand, there is the psychological effect: anyone who has a prosthesis involving the most visible teeth knows how sad it is to see yourself toothless every time you remove your prosthesis to clean it or to sleep.

There is also the “domino” effect that removable prostheses often have, as decay often affect the teeth that support the hooks, which, over the years, will lead to extractions that would be avoidable.

 

Success Rate and Contraindications

 

Nowadays, as long as the surgery is performed by an experienced surgeon using good quality implants, implants have a very high success rate (ranging from 95 to 99%).

There are, however, factors that reduce this success rate, which may even be contraindications to the placement of implants;

• Serious systemic diseases
• Patients undergoing radiotherapy of the zona
• Uncontrolled diabetes
• Age: children and young people up to 16-18 years old (we have to wait for the end of bone development)
• Pregnancy
• Tobacco: decreases the success rate, especially in heavy smokers (1 to 2 packs a day)
• Uncontrolled Periodontal Disease. etc…

 

Phases of Treatment with Dental Implants

Examination and diagnosis:

• Clinical History,
• Observation,
• Radiographic exams,
• Laboratory tests

Surgery:

• It can be done with local or general anesthesia. Always in a sterile field.
• An incision is made in the gum (the length of which depends on the number of implants to be placed) and, with calibrated drills, the bed for the implant or implants is created, and the Implants placed.
• Then the gum is sutured.
• In some cases, it is not necessary to make an incision in the gingiva, placing the implant through it, with no need for stitches. (Example: rehabilitation with implants)
• Analgesics, anti-inflammatories, topical disinfectants and, in many cases, antibiotic coverage are prescribed.
• The patient returns within 1 week to 10 days for observation and stitches removed.

 

Immediate Load:

In favorable cases, we can place provisional crowns on the implants (immediate loading) (example: loss of the upper left central incisor) which will be replaced by permanent crowns after the osseointegration period.

 

Osteo-integration period:

After placing the implant, there is a period of osseointegration that varies between 3 to 6 months, in which the organism will form new bone around the implant, integrating it and allowing the implant to withstand masticatory loads.

 

Impressions and Rehabilitation:

After the osseointegration period, impressions are taken for crowns/bridges or complete rehabilitation . These structures are screwed to the implants, functioning and looking like natural teeth.

 

Maintenance

The long-term success of implants, like other dental treatments, depends on good oral hygiene and it is important that the person understands how vital his/her role is in this area.
In addition, the patient should come for an appointment 6 months or, at the most, every year.