In order to receive an implant-prosthetic treatment, a number of conditions should be met:
- A good condition justified by a laboratory test record (full blood counts, thrombocytes, glycaemia, urea, creatinine, bleeding time, coagulation time, hepatic transaminases), eventually a medical reference letter from the family physician with diagnoses and medication (if applicable);
- Thorough oral hygiene;
- Forbid smoking;
- Local conditions needing treatment prior to dental implants: gum inflammations, plaque on adjacent teeth, cavities or infections at the level of the roots of adjacent teeth;
- Clinical and radiological examination to determine the amount of bone available for insertion of dental implants depending on the width, length and height of the dental ridge and on the position of adjacent anatomical structures that must be avoided (maxillary sinuses, nasal cavities, mandibular canal, etc.);
- Establish the appropriate treatment plan in terms of number and distribution of dental implants, of the future structure of the prosthetic construction, of necessary bone augmentation with the choice of surgical techniques customized for each particular case (sinus, lifting, addition of bone).
Implants are inserted into the bone through surgery under local anesthesia possibly potentiated, which will cut the gum, that is removed to reveal the bone, in which holes are drilled for implants by using increasing diameter cutters. The intervention end up with suture and the stitches are removed 11-12 days after surgery.
After surgery a local edema (swelling) occurs, which is why cold compresses are recommended, along with appropriate medication. Post-surgery drug treatment includes antibiotic, anti-inflammatory which has also a soothing effect of eventual pains, eventually neurotropics for restoring sensitivity of certain areas or nasal drops for interventions on the nasal mucosa or of maxillary sinuses.
Locally, thorough hygiene is maintained and the feeding is performed on the opposite side and has a medium consistency with lots of liquids – dairies are consumed with a straw until the removal of stitches. Once inserted into the bone the implant requires a period of about 4-6 months (even 8-9 months when massive bone additions have been made) for healing the bone around and embedding of the implant into the bone, during which time the implant is under the gum without being subject to further works. If the patient has to wear denture, this will be padded on the inside with a soft material in order not to transfer the pressure over the bone and over the implant.
When the healing period is over, the gum above the implant is removed and then a healing device around which the gum is partially healed is mounted. Few days later, one may take the dental impression for the work to be made to the implants. After completing the work on the implants, the oral hygiene must be very thorough, because the surface of implants retains 4 times more bacterial plaque than natural teeth, and the risk of infection of the gum and of the bone around implants is high without appropriate hygiene.
At regular times (2-3 months in the first year, then every 6 months) the checkup is made and eventually cleaning and scaling (compulsory) in order to prevent infections around the implants. For cleaning, the use of dental irrigator is very useful.
Works supported by natural teeth and implants are basically a compromise solution, as the teeth have a certain degree of physiological mobility, while implants are rigidly fixed into the bone, the connection between the two structures affecting in time the integration of implants. Such a work may be recommended by the dentist in a very small number of cases.
Besides ,the number and distribution of implants should be carefully studied. Basically, in back teeth each dental root should be replaced by an implant. The dentist is the one who assesses the minimum number of implants necessary to insure the resistance of the work, the stability at bone level and maintaining the integration of implants (a lower number of implants than necessary may lead to failures hard to remedy and to undue expenses).
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