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Oral implantology is not only a proven and reliable solution, but is now considered a standard and indisputable treatment. The therapeutic arsenal available for full prosthetics has advanced considerably over the past few years. As of now, the use of implants is no longer an exception. A retrospective review of the use of implants for fully edentulous patients is sufficient to assert that when used in proper conditions by practitioners having an excellent knowledge of the surgical techniques, as well as prosthetic and occlusal, the medium and, long term results are acceptable. More often than not, prosthetic reconstruction on implants is an alternative to the classic solutions and is much more comfortable and functional for the.patient.
At the outset, we must bear in mind that the therapeutic objectives of dental prostheses are unchangeable: the restoration of the functions that have been altered by the loss of teeth, i.e. occlusion, aesthetics, speech, chewing, swallowing, intermaxillary relationship, preservation of the remaining anatomical structures required to house the prosthetic device and, of course, the physical and psychological comfort of the patient. It is also important not only to restore said functions
Whenever a new treatment plan is undertaken, completing a dental assessment is an essential preliminary step. This entails the evaluation of the initial condition of the mouth in preparation for the therapeutic decision. Utilizing the medical history, its purpose is to ascertain if any general pathology could interfere with or contraindicate the surgery. The pre-implant review consists of carrying out a medical examination which includes a clinical examination, a radiological phase and the production of impressions. From both a functional and an aesthetic point of view, the clinical examination is fundamental and necessary for the purposes of accurately determining the degree of difficulty. Radiological examinations are critical for evaluating pre-implant conditions as well as for the follow-up of the osseous integration (fusion between the bone and the implant). Certain situations render implants impossible and they must be strictly excluded.
These may be of a medical nature: an immunodeficient site, a systemic pathology, severe allergies, a risky medical treatment (anticoagulant therapy for example), certain cardiac conditions (cardiac valve diseases) or progressive pathologies are absolute contraindications.
They are sometimes of an anatomical nature: the quality of the gums, the density and the structure of the bone, the situation of the inferior alveolar nerves, the sinus volume.
Finally, they may originate with the patient: failure to understand the implications of the follow-up, negligence, inadequate hygiene and a low level of motivation all constitute contraindications.
Everything must combine to achieve an optimal result and the sum of all that information allows the practitioner to propose a specific solution. Finally, we must be aware that implant operations necessitate appropriate training on the part of the practitioner and strict discipline on the part of the patient.
Possible Choices
iepeniing upon his/her overall condition, the patient wi have a c nice of various options for the realization of an implanted prosthesis. Each of these options has its own set of advantages and inconveniences, both to the maxilla and to the mandible. The following methods are the most common for the mandible:
IMPLANTED PROSTHESIS WITH TWO IMPLANTS AND:
an independent press button attachment (locator)
This method allows the prosthesis to fasten itself to the implants just like a snap closure. The two implants are then placed in the anterior of the mandible. It is removable and, therefore, the patient is responsible for its maintenance. The stability and the retention that it provides are superior to what is found in a conventional prosthesis thanks to the anchoring of both implants into the bone, but are slightly inferior to what is provided by other implanted prostheses. The ball-attachments allow the prosthesis to move slightly and this may become a disadvantage for certain patients.
a bar-attachment in the shape of a horse shoe
The surgery consists in placing two implants in the anterior of the mandible and linking them with a bar in the shape of a horse shoe. The presence of several little clips increases both the retention and the stability. Since the prosthesis is completely removable, the patient can remove it by himself/herself. This bar has a rotation axis around it, which allows the prosthesis to move from front to back. Over time, this movement may create considerable stress on the implants and their components.
IMPLANTED PROSTHESIS WITH FOUR IMPLANTS AND A BAR-ATTACHMENT
With the addition of additional implants, this type of removable prosthesis becomes much more
retentive and stable than one which has only two implants. The prosthesis remains removable and the patient must be vigilant when cleaning it in order to avoid causing inflammation to the gum around the implants.
IMPLANTED PROSTHESIS SECURED ON FIVE IMPLANTS
This type of prosthesis known as fixed prosthesis is particularly indicated for the mandible in cases of severe resorption and hypersensitivity of the gum, since there is no contact between the prosthesis and the gum.
The prosthesis is completely fixed and only the dentist can remove it. It is very stable and very similar to the natural teeth from the point of view of both stability and retention. The degree of difficulty for cleaning underneath the prosthesis is a little higher.
The various treatment choices provide the patient with a degree of satisfaction which is almost identical from the point of view of stability, retention, chewing or aesthetics.
The patient has undergone the surgery. The objective during this period is to optimize the healing of the bone. Depending on the maxilla and the quality of the bone, this waiting phase (of healing) will take from two to six months. During this period of time, the patient wears his/her conventional prosthesis which the dentist will have previously adjusted on the implants using a soft material in order to avoid hurting the patient and to ensure a good chewing capability. This material must be changed as required.
After the Implants
Following the installation of the prostheses on implants, several points have to be managed:
The Risks: transitory paresthesia of the tower lip.
The Failures: mobility of the implant. In the short-term, this is the "failure of the osseointegration" of the implant. In other words, fusion does not occur between the bone and the implant. In the medium and long-term, the implant may be rejected due to the execution of a prosthesis that is not properly balanced, thereby causing a slow resorption (destruction) of the bone around the implant.
The Complications: they may occur at all stages of the treatment and represent an important part of the overall complications that are noted in implantology. They essentially consist of:
Fracture of the implant, a major complication which necessitates its removal and replacement with an implant which has a greater diameter. Fortunately, this does not occur frequently.
The unscrewing of one or several clamp tightening screws of the prosthesis or of the abutment screws. On occasion, the screws may break and their removal may be somewhat delicate.
Breakages of the prosthesis as well as of the retaining pieces may occur, thereby adding to the costs.
Hygiene: maintaining good gingival health is essential to the durability of the implants. A lack of hygiene on the part of the patient and an accumulation of bacterial plaque quickly induce an infiltration under the gum and cause crater formations around the implant. The gingival pathologies that are experienced usually occur later on and are similar to the gingivitis and periodontitis that are noted around natural teeth.
The Follow-Up: as is the case for all the other treatments, proper follow-up must be ensured after the treatment is completed. The failure to follow through with routine checkups may cause complications or even failure of the prosthetic treatment. The implanted prosthesis must be monitored by the dentist and must be changed as required, since it is subject to wear and aging just like a conventional prosthesis.
I understand that the design and structure of the prosthesis may be important factors in determining the success or the failure of the implant. I also understand that alterations made to this prosthesis or to the implant may lead to the loss of the prosthesis or of the implant. I have been advised that the osseous integration between the implant and the bone may fail and that it may become necessary to remove the implant. This may occur during the initial integration of the implant into the bone or at any time subsequently. I also understand that it will be necessary for me to have good oral hygiene and adhere to a schedule of routine visits to the dentist for verifications of the condition of the implants and of their prosthetic components.
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