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GENERAL INFORMATION ON DENTAL IMPLANT TREATMENT
Objective of dental implants
After losing teeth, the supporting bone segment is no longer essential and begins to gradually disappear (Misch, 2008). Once this begins, the missing portions can be replaced with removable dentures or fixed bridges; this process enhances visual appeal, corrects speech impediments and improves mastication. However, complications can occur when replacing living tissues with artificial apparatuses. Dentures have been shown to decrease the efficiency of the chewing process, initiate additional bone loss and often experience inadequate retention (Knowles, 1958). Furthermore, dentures may require additional support, which affects the healthy teeth that are in close proximity to them (Jivraj, 2006).
A viable alternative has been developed involving the insertion of dental implants; placing implants in the jaw bone provides the extra support needed to sustain a false tooth or set of teeth. Implants such as these gradually integrate themselves into the existing bone structure, firmly attaching the false teeth to the bone similar to a tooth root. Following tooth extraction, immediate dental implant placement ensures preservation of the jawbone and possibly prevention of additional bone loss (Soydan et al., 2013; Urban et al., 2012). Consequently, due to gradual bone decay, dental implants should not be delayed. Implant placement after significant bone loss may still be possible, but with increased difficulty and additional surgical procedures such as bone grafting.
Dental implant procedure
At the outset, the condition of the jawbone will be evaluated to determine an appropriate treatment plan, if one is available. Evaluation procedures may include x-rays, photographs and/or teeth replication using a model. Initial evaluations may identify the need for CT scans of the jaw to verify the availability and location of residual bone structures. A final decision regarding placement will occur at the time of the surgical procedure, to be determined by the actual jaw structure.
Dental implant placement
Dental implants can be inserted using one of two methods, described below. These methods include immediate and delayed insertion, based on the occurrence of tooth loss.
Immediate dental implant insertion places the implant in the mouth immediately following tooth extraction. This approach allows for the preservation of bone structure, in addition to a decreased treatment phase (Kinaia et al., 2014; Donati et al., 2015). Actual treatment procedures will depend on the quality and quantity of bone present after tooth extraction. A delay of several months may be necessary to allow for the formation of healthy bone, if an infection is discovered during the surgical procedure (Kohen et al., 2015; Altintas et al., 2016). Implantation procedures could be delayed 6 – 10 weeks.
Delayed dental implant insertion places the implant in a region containing bone loss, due to prior tooth extraction or tooth loss.
Treatment options may involve a combination of the aforementioned insertion methods; treatment time is based on the quantity and location of the inserts. Without jeopardizing the final outcome, efforts are made to reduce the time required to complete the procedure.
Anesthesia for dental implants
Local anesthesia is utilized during dental implant procedures.
Following dental implant insertion
Mild discomfort and swelling may occur following insertion. Swelling will be contingent on the quantity of implants and the occurrence of further surgical procedures. Slight bruising may be present in the area, but will recede gradually within a week of the procedure. Increased swelling may occur due to actions such as smoking and pre-existing medical conditions that affect the healing of soft tissues. The appearance or color of the gums around the affected area may change over time; the gums in this region may also turn white for a short period, but will regain their color within two weeks after the surgery.
The stitches may be removed 10 – 14 days following the procedure, providing the soft tissues have healed sufficiently. Dentures may not be possible during this time.
Unless immediate or temporary implants are feasible, the dental implants will be left undisturbed for a minimum of three months; this allows time for the implants to firmly attach to the jawbone. The top of the implant and some metal may be visible through the gums. The area should be examined by a dental professional if this occurs, but it is normally harmless.
Tooth creation procedures
After an initial recovery period, typically 3 – 6 months, a follow-up procedure may be required to uncover the dental implant and confirm firm attachment to the jawbone. However, if a dental implant does not connect firmly to the jawbone, then it will be removed immediately.
At this time, a post or abutment will be attached to the exposed implant to support the temporary apparatus. The interim denture, bridge or crown will remain in place for approximately two months while it reconciles itself with the gum and forms a tight seal with the implant. While the abutment may be visible during this time, the final product will be constructed to cover any exposed metal or implant to improve the overall visual appearance. To accomplish this, teeth impressions will be made of the mouth prior to concluding the restoration.
Treatment timing
Total treatment time will depend on the individual specifications of each procedure; the volume of obliged work and complexity of procedure will affect this time greatly. Dental implants and the accompanying artificial teeth must be prepared based on each individual’s specifications and created from scratch; this process can be time consuming. To maintain the highest quality product, the modus operandi must be precise. This precision may require numerous appointments to prefect the final product, prior to fitting the apparatus permanently. Therefore, it is pertinent that the dentist be informed of all future engagements or travel plans. Prior notice must be provided as early as possible to avoid scheduling complications.
Dental implantation failure
Extensive planning and evaluation make dental implant failures rare; problems are generally identified and remedied prior to beginning the procedures. However, in the event that a dental implant does fail, replacement is possible once the defective implant is removed and the site has sufficient healing time (Wang et al., 2015; Quaranta et al., 2014). The initial implant will be loose and easily removed, thus easily replaced; yet, the second implant would require additional recovery time to attach to the jawbone once inserted.
Factors affecting dental implant success
Consumption of alcohol has been shown in several studies to decrease the success rate of dental implants (Alissa et al., 2012; DeDeco et al., 2015). In addition, consumption of tobacco products have also been shown to decrease success rates (Clementini et al., 2014; Moraschini et al., 2016; Ata-Ali et al., 2015). Alcohol and tobacco also have adverse effects on healing rates and initiate post-operative infections.
Allergies present a small risk during dental implant procedures; 1.0 – 1.5% of all patients develop allergic reactions to the Titanium in the implants (Hosoki et al., 2016; Goutam et al., 2014; Muller et al., 2007). Once allergies present themselves, the dental implants are removed and replaced with ones constructed of Zirconium; replacement incurs an additional fee.
Dental implant life span
In favorable environments, dental implants will last 10 – 20 years (Lekholm et al., 2006; Misch et al., 2008). After this time, the implants may need to be replaced. Wearing more rapidly than the rest, the crown may need to be replaced every 5 – 10 years (Pietursson et al., 2007; Torabinejad et al., 2015).
Thus, dental crowns are guaranteed for 5 years, while dental implants are guaranteed for 10 years. To qualify, dental apparatus must be appraised regularly by a dental professional and maintained by a dental hygienist a minimum of every six months. At home, recommended oral care must be followed.
Maintenance of dental implants
Dental implants must be reviewed and maintained consistently; they require care and attention equal to natural teeth. After the treatment, recall and adjustment appointments are required to check and adjust the dental implants if needed.
Hereafter, dental checkups are required at six month intervals; these appointments assess the condition of the dental apparatus and any remaining natural teeth. Regular hygiene appointments must also be scheduled to remove the build-up of plague; this can lead to problems with the gums and possibly loss of bone around the implantation area. This loss may lead to the loss of natural teeth located near the dental implants.
Maintenance of natural teeth is extremely important if they remain in combination with false teeth. Infection or loss of natural teeth puts unneeded and unwarranted strain on dental implants caused by the increase in workload.
Dental implant risks
Complications and side effects are possible, in regards to surgery, medications and anesthetics; these include pain, swelling, infection or discoloration of the treatment area. Additional side effects include numbness in the lips, cheeks or teeth. It is impossible to determine the duration of these side effects; they may also become permanent. Other complications to be aware of are: vein inflammation, natural tooth injury, bone fractures, healing delays, drug and/or medication allergies, recession of the gums, and irregular gum shape; in case of bone augmentation the main risk is infection of the augmented area, losing the graft material, extended bone loss.
Initials
REFERENCES
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