Dental Implants: Treatment and Indications

What are dental implants?

Dental implants are artificial roots that can serve as supports for replacing missing teeth.

In principle, anyone with one or more missing teeth can receive implants, knowing that there are other alternatives such as partial or complete removable dentures or classic fixed prostheses.

Why place an implant on a tooth?

Placing a dental implant is an essential procedure to restore the chewing function, aesthetics, and oral health of patients who have lost a tooth. Unlike removable dentures or bridges, dental implants offer a permanent and stable solution by replacing the root of the missing tooth. This not only preserves the integrity of other teeth by avoiding damage to adjacent teeth, but also stimulates the jawbone, thus preventing bone loss that can occur after tooth loss. In addition to functional benefits, dental implants also help improve the aesthetics of the smile, restoring confidence and comfort to those who wear them. By restoring the ability to eat, speak, and smile without worry, dental implants improve the patient's overall quality of life. Furthermore, they are designed to last a long time, offering a durable and reliable solution for replacing a missing tooth, making them a popular and effective choice for restoring a healthy and complete smile.

The treatment

Pre-operative examination

First, it is necessary to carry out an examination and diagnosis:

• mouth examination;
• clinical history;
• radiographs;
• additional examinations required by the dentist according to the needs of each patient;

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Surgical phase

The surgical phase consists of two steps:

• First step: The placement of dental implants. Using a very precise technique, dental implants or fixtures are inserted into the bone. The operation lasts between 1 and 2 hours and is normally performed under local anesthesia. Patients generally do not experience any significant discomfort during or after the operation. In edentulous jaws, between 4 and 6 dental implants are normally placed, as in this case it is not necessary to place an implant for each tooth;
• Second step: The second step is performed after a healing period of 3 to 4 months, depending on whether the implants are placed in the lower or upper jaw. This period is essential to allow osseointegration, i.e., the permanent fixation of the implants to the bone. At this stage, a small operation is performed to connect sections called abutments to the dental implants. These are then used to fix the complete prosthesis at a later stage. During the osseointegration phase, a temporary prosthesis or bridge can be used, mainly for aesthetic reasons;

Today, this second step is usually not necessary, as the dental implant is firmly fixed in place and the healing abutment is fixed during the same procedure.

Prosthetic phase

Once the gum has healed from the second surgical phase (approximately fifteen days), the prosthetic phase begins. A series of mouth impressions are taken, followed by 1 to 4 visits to the dentist to assess the fit, function, and appearance of the new teeth.

Obviously, all these steps must be properly planned in advance.

The new prosthesis will require regular care and check-ups in the same way as natural teeth, because although the new teeth do not suffer from caries, problems can occur where they emerge from the gum.

Indications and contraindications for dental implants

Indications

If a person with fully replaced teeth has problems because they are mobile and cause discomfort when eating, speaking, laughing or kissing, or for other reasons, this is a reason to choose implant-supported prostheses, whether fully fixed or using an overdenture.

An overdenture is a removable prosthesis held in place by a number of implants.

Other important indications are missing back teeth, when patients do not want to use a prosthesis with "clasps", or when there are intermediate spaces.

Before placing implants, the mouth must be healthy, free of plaque and tartar, with all cavities filled, no infected areas, healthy mucous membranes, and any periodontal disease under control.

Contraindications

The first contraindication stems from unrealistic expectations on the part of the patient. For this reason, it is necessary to carry out a serious study and inform the patient of the problems related to their case, knowing what can be achieved in terms of function and appearance, as well as the limitations they may have.

Patients suffering from serious systemic diseases, significant mental disabilities, drug use habits (including heavy smokers and alcoholics) should not have implants. Implants have been shown to fail more frequently in smokers. It is very important that the patient does not smoke, or smokes less than 5 cigarettes a day. Tobacco reduces blood flow to the oral tissues (bone and gums), reducing the amount of oxygen supplied to the area, which poses a risk to the osseointegration of implants.

It may be more difficult for us to place implants in people whose jaws are severely retracted or whose bone quality is poor, as they occupy a certain space and require a minimum width and height. In these cases, it may be necessary to perform a bone graft beforehand.

In the back of the upper jaw, very low maxillary sinuses (hollow spaces on either side of the nose) can also hinder the placement of implants. In the lower jaw, the anatomical location of the inferior alveolar nerve can pose problems due to its proximity to the future implant, hence the need to reduce the length of the implant or use other techniques to avoid damaging it.

It is also necessary to take into account the patient's type of occlusion: patients who clench or grind their teeth at night can cause implant failure due to excessive pressure. It is therefore important to establish as detailed a diagnosis as possible, analyzing all clinical, functional and aesthetic parameters.

Do dental implants pose rejection problems?

It has been scientifically demonstrated that, under carefully controlled conditions, titanium can integrate into living bone without causing inflammation of the surrounding tissues. This process, during which bone cells connect to the surface of the titanium, is called osseointegration. The bone accepts the titanium as if it were part of the body, producing a "biological weld" and growing around it. It is important not to confuse rejection with possible complications.

What are the complications and pain following the placement of a dental implant?

The placement of a dental implant is generally a safe and effective procedure for replacing a missing tooth. However, like any surgical procedure, it can be accompanied by certain complications and discomfort. Immediately after the procedure, it is normal to experience mild pain, swelling, and sometimes bleeding at the implant site. These symptoms are usually temporary and can be alleviated with medications prescribed by the dentist or oral surgeon. Some people may also experience bruising around the treated area.

Regarding complications, although rare, they can include infection at the implant site, rejection of the implant by the body, nerve damage, or poor integration of the implant into the jawbone. These problems can lead to persistent pain, discomfort, and sometimes the need to remove the implant. It is therefore essential to follow the post-operative instructions provided by the dental health professional to minimize the risk of complications and promote quick and painless healing. It is also recommended to maintain good oral hygiene and attend regular follow-up appointments to ensure the long-term success of the dental implant.

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