Implantology is the branch of dentistry aimed at replacing lost dental units in their root portion, the coronal portion to be rehabilitated by classical prosthetic techniques.
It is the solution of choice in the treatment of edentulous spaces, with the implant placed intraosseously maintaining its activity and preventing further resorption.
Bone resorption is a natural process that occurs in edentulous ridges. The lack of force transmission to the underlying structures due to the loss of dental units causes visible changes.
If at the beginning the bone ridges are high, rounded, well represented, succeeding to give retention to the prosthetic work, in time they decrease in height, become sharp and jeopardize the treatments.
The specialist will clinically assess the condition of the patient’s edentulous ridges and with complementary examinations (X-rays, CBCT) will be able to determine the level of remaining bone and the possibility of implant prosthesis.
Indications for implant prosthesis
– Edentulous: missing teeth can be compensated for by several types of prosthesis. Implants are indicated for those who wish to improve aesthetics and who have the bone required for the operation.
– Patient’s refusal to wear a removable prosthesis: for some patients, the psychological impact of a removable prosthesis can be resounding, as they are unable to adapt to hygiene procedures or to having the prosthesis removed every evening.
– Limited number of remaining teeth that cannot support a fixed prosthesis: following extensive edentations, when the number of remaining tooth units is small, a fixed prosthesis will overload the periodontium of the remaining teeth causing migration, infection or mobility. Patients who do not want full dentures may opt to supplement the number of teeth with implants, which will allow a fixed denture to be anchored.
Indications for implant prosthetics
Edentulous: missing teeth can be compensated for by several types of prosthesis. Implants are indicated for those who wish to improve aesthetics and who have the bone necessary for the operation.
Patient’s refusal to wear a removable prosthesis: for some patients, the psychological impact of a removable prosthesis can be resounding, as they are unable to adapt to hygiene procedures or to having the prosthesis removed every evening.
Limited number of remaining teeth that cannot support a fixed prosthesis: following extensive edentations, when the number of remaining tooth units is small, a fixed prosthesis will overload the periodontium of the remaining teeth causing migration, infection or mobility. Patients who do not want full dentures may opt to supplement the number of teeth with implants, which will allow a fixed denture to be anchored.
Stages of implant-supported dentures – the healing layer
After analyzing the situation in the oral cavity and establishing the diagnosis and a viable treatment plan, the first stage is the application of the endodontic implant. Being made of a biocompatible material, the implant will be left in place for a period of 2 to 6 months, during which time the bone will gradually deposit hard tissue around it.
Role of the healing cap or gingiva formers
The implant inserted into the bone will be covered by the gum lining over time. To avoid further uncovering surgery after the 2-6 months of osseointegration, a cap or screw will be inserted at the implant, the coronal level of which is at the mucosal surface and visible in the oral cavity. The gingiva will heal around the applied cap, thus maintaining direct access to the implant level only by unscrewing the gingiva.
The gingiva formers can be inserted after implantation of the root support, taking the place of the healing screw, or at the end of 2-6 months, when osseointegration is almost complete.
The lower portion of the gingiva formers is fixed to the implant by screwing, while the upper portion can be of various designs designed to retain a temporary crown.
The role of the healing cap or gingiva formers is to guide optimal healing of the gum following implant insertion surgery. This stage is important to be carried out as accurately as possible to allow for the most accurate impression later.
Once bone integration has been achieved, the impression and final crown capping can continue. In between each of these further stages, the healing layer will maintain the desired boundaries between the implant and the gum lining, preventing capping.
Implant treatment is complex, involving several stages that extend over a longer period of time and can be tiring for the patient. Aesthetic and functional results, however, argue in favor of choosing this therapeutic solution.
