Implants and Oral Surgery

Implants

In recent years, Implantology has been the specialty of Dental Medicine that has undergone the greatest technical and scientific advances and is also one of the treatments most sought after by its increasing reliability.

Implants consist of replacing the natural tooth by placing an “artificial root” in titanium. This root allows to support a new tooth (crown). This process has two phases. In the first one, the Implant itself is placed (which corresponds to the root of the new tooth). In the second phase, after the implant osteotomy (correct acceptance and integration of the implant by the bone), which lasts about 3 to 4 months, the crown is placed on the implant. The implants allow to obtain the replacement of one or more teeth, as well as of all the teeth, being its placement painless. Placement of the implants takes, in most cases, between 15 and 60 minutes, depending on the number of implants to be placed per session and the particular case. Implants are safe and reliable, being identical to natural teeth in terms of aesthetics and comfort. They are also called the “3rd generation” of the dentition.

Implants are made of Titanium. They replace the lost tooth root, on which a crown will be placed. They can substitute only one tooth, several teeth or the totality of the teeth in a jaw (for the total edentulous)
They have the approximate shape of a dental root, being placed inside the maxillary bone.

After a few weeks, the person’s bone joins the implant (osseointegration or osseointegration), forming a unique structure, and are therefore called Osseointegrated Implants.

Osseointegration is the stable and functional union between the bone and a titanium surface. This phenomenon occurs after insertion of the implant into the bone and migration of the bone cells to its surface.

This concept of Osseointegration was introduced in the 1960s by Per-Ingvar Brånemark. It involves the anchoring of an implant by the formation of bone tissue around the Implant, without growth of fibrous tissue at the bone-implant interface.
After implantation, the implants remain in the bone at rest for a period varying from 3 to 4 months, so that the biological phenomenon of osseointegration (direct bone union to titanium) occurs, after which the implants are “uncovered” and a dental prosthesis is connected to the implant by means of a secondary part called “abutment”

After placing the implants how long do I have to wait to have my new teeth?
The protocol that was originally developed clearly says that we should wait four months for implants placed in the mandible (lower jaw) and six months on the maxilla (upper jaw). Recently, research has been done with the purpose of reducing the waiting time for the installation of the prosthesis.

Is there a danger of “rejection”?
The success rate of the implants osteointegráveis ​​is high, having several scientific studies proving its effectiveness even after many years in masticatory function. There is, however, a small possibility of Implant loss (no osseointegration), around 2 to 5% of cases, usually shortly after the post-implantation rest period. In these cases the implant is easily removed, and a new implant can be replaced in place.

Prosthesis:
After the healing period of the Implants begins the preparation of the prostheses that are the replacements of the crowns of the teeth that were lost. The prosthesis is a replica of a natural tooth and will be screwed into the Implant.

There are two types of Implant Prosthesis: 1) Fixed or 2) Removable.
1) Fixed prostheses on implants are made so that they are no longer removed, or removed only by the doctor (bolted or cemented). System used for single, multiple or total cases.

2) Removable dentures on implants should always be removed by the patient for hygiene. The latter are attached to the implants through attachments or fittings, which serve to retain the prostheses during their use. System used only for total dentures (Overdenture).

After a tooth extraction, the alveolar bone that supported the tooth, suffers a reabsorption that increases with the time. This resorption may be so pronounced that it would later make it impossible to place the Implant for “lack of bone”. For this reason whenever a tooth loss is suffered, it should be restored in the shortest time, also to avoid the changes of position of the remaining teeth that will tend to move.
When many teeth are lost all the bone of this jaw suffers a generalized atrophy compromising the facial esthetics and leading to the premature aging.
With Implants placed, as soon as possible after tooth extraction, this problem is solved avoiding the loss of bone support tissue.
Mandibular bone, immediately after dental extractions and years later, completely reabsorbed.

Dental Implants are the ideal option for those who want to replace some, or even all of their teeth. Substitution of a molar. Replacement of all teeth. Statistics indicate that more than 500,000 dental implants are performed worldwide annually, and the success rates are approximately 95 to 100%.

How long does an implant last?
Theoretically, an implant lasts forever, as long as the patient:
1 – have good quality and quantity of maxillary bone;
2 – has good healing and regeneration capacity;
3 – do not have parafunctional habits, such as bruxism;
4 – do not smoke;
5 – and most importantly, that the patient maintain excellent oral hygiene around the Implants, politely maintaining the transition between the crown and the Implant.

Benefits of Implants:
The most obvious benefit is in the instant improvement of masticatory ability and function.
People with dentures are shown to chew only 20% of the strength they would have with their natural teeth, whereas people with implants can chew at 85% to 95% of the strength they would have with their own teeth.
But there are many other benefits. A common problem in using dentures is the lack of stability (particularly of lower prostheses). They are balanced between the tongue, the muscles and the lips. No one imagines the suffering for these people.
The insecurity resulting from the loss of natural teeth can be eliminated using the Implants.
For many people the real discomfort is having to wear a removable prosthesis. Implants can address this issue as well.
Anyone who wears dentures knows how important teeth are. The gingiva and the alveolar bone serve as a support for the lips and cheeks and the lower part of the face. The loss of these important structures gives the appearance of premature aging and this in many people causes anguish and loss of self-esteem.
Implant-supported dentures can slow down the aging process and improve self-esteem.
The functional benefits are obvious, but for many people, the aesthetic and emotional benefits are more important, or more important than the others.

Does it hurt to put the implants?
No. Patients usually surprise themselves and say they expected it to be worse. In addition, psychologically it is more comforting for the patient because he feels that he will be rehabilitated, he will gain something (contrary to what happens when the patient is going to make a tooth extraction).
Obviously this is a surgical procedure so there are rules and a protocol to follow.

The loss of teeth and the emotional factor:
For humans the teeth signify strength, aggression, affirmation, and active attitude and so losing them can cause insecurity and anxiety. Therefore the teeth help in the extension of the concept “I”.
The birth of teeth is important in psychic organization and its loss may have unfavorable consequences for the emotional life of the individual.

The self-esteem of the individual is directly related to the self-image, which has of itself and the ideal image that society imposes. In this society the smile announces well-being, joy, security, satisfaction with self and others.
Inhibition of the smile has consequences, decreases self-esteem, prevents the demonstration of joy and acceptance, hampering social interaction.
In functional terms, tooth loss results in imbalance of masticatory function, swallowing, speech and aesthetics.
The replacement of the teeth through implants aims at a return to appearance, aesthetics and function. It aims to overcome body failure, a resource back to the image that it had and wanted to continue having.
In order to achieve healthy implants, with good aesthetic and functional results, bone quality is fundamental, ie it is necessary that the dental arch bone supports or supports the placement of the implant.
Experiments in the area of ​​gum treatment have shown that smokers, especially those who smoke in excess, have a greater resorption, provided they have periodontal disease.
Smoking causes peripheral vasoconstriction, which can affect the early stages of healing, an important period in which the implant should remain inert and protected, in order to ensure good soft tissue (gingiva) healing. In addition, smoking raises the temperature that, together with the smoke, irritates the tissues that are healing.

Is oral hygiene so important?
Statistical studies indicate that, among the few cases of implant failure, the overwhelming majority is caused by a lack of adequate hygienic care and the consequent formation of microbial plaques between the artificial roots (Implants) and gums giving rise to “Periimplantite” inflammation of the gingiva around the implants, bleeding, suppuration and rapid bone loss).
How should I take care of implants after treatment? Can complications related to implants exist?
The implants, as well as the natural teeth and gums, must be very well cleaned using the usual devices: dental floss, oral irrigator (water jet), brush and brush.
The main biological complication is Periimplantite (disease that affects the bone and the gingiva around the implant).
The most frequent biomechanical complications are the fracture or loosening of the small screws that join the prosthesis to the implant. Dental materials (like any other) are subject to wear and tear and therefore require maintenance.
Implant fractures can occur, although they are very rare.
Most important is daily oral hygiene and regular maintenance visits to prevent, diagnose, and treat any change early

Oral Surgery

It is the area of ​​the Dental Medicine that is dedicated to the diagnosis and surgical treatment of certain diseases / problems of the oral and maxillofacial region.

In the surgical area, the most frequent acts are: dental extraction, extraction of the tooth included (tooth that did not have its normal eruption having been retained in the maxillary bone), apical cyst enucleation, apicectomy, dental crown exposure for orthodontic traction, and lengthening of the labial or lingual brake, incisional or excisional biopsy of lesions of the hard or soft tissues of the oral cavity. These surgical acts are performed under local anesthesia, however there are more complex situations that require the use of general anesthesia in the Operative Block.