Implantology

implantologia

For implantology (dental) means that set of surgical techniques aimed at rehabilitating functionally a patient suffering from total or partial edentulism through the use of dental implants namely metal elements surgically inserted into the bone mandibular or maxillary, or above it but below the gingiva, acts in turn to allow the connection of dentures, fixed or mobile, for the return of the masticatory function. Such plants can be of different shapes inserted in various locations with various techniques and then connected to the prosthesis with different timing.

Currently the plants are almost all made of titanium. The most used are those endosseous screw-type, in the majority of cases left submerged under gingiva for a substantial period, depending upon the location. The dental implant is then divided in endosseous and iuxtaossea, the latter employing only grid systems with fixed non-submerged stump and then by location and method of load osteointegrabili if made of cobalt-chromium-molybdenum or osteointegrabili if made of titanium and inserted with appropriate surgical techniques favoring bone formation above their structure.

That is endosseous estremamaente more widespread, uses implants (implant body proper) of cylindrical / conical more or less threaded externally and with internal connection varies conformation for the emerging part (abutment) and more rarely cylinders or cones non-threaded outside but with similar systems of internal connection to the abutment screws full of one body (body implant and abutment made from solid and therefore without any connection) blades and needles. Depending on the surgical protocol will then submerged implants and (transmucosal), based on the timing of use (functionalization) we have immediate loading, early, deferred.

The endosseous implant is basically divided into two main schools: the Italian and Swedish. The implantation of the Italian school is historically earlier, less common but conceptually it is still just as important as the second. The Italian School is due the introduction of the first implant specifically designed for immediate loading, the introduction of the titanium in the production of the plants (Stephen M. Tramonte), the introduction of area than on biological implant bodies, and the welder intraoral (PL. Mundane).

The Swedish school should be the method of "osseointegration", first developed by Per-Ingvar Branemark, based on the delayed loading and intended to make it more controllable success of implant treatment: involves the use of endosseous implants and screw connection prosthetics, with delayed loading, or waiting 3-4 months in the mandible and 5-6 in the jaw. The original Branemark protocol has been modified in various ways as well as the facilities used to shorten the time of retirement of the plants and ultimately the general time of treatment. The Swedish school has produced important innovations both in production technology and in surgical techniques is: adoption of the surface treatments for implant bodies, techniques of bone tissue regeneration is both mucosa, techniques augment both vertically and both horizontally and in general all those surgical techniques designed to make the most appropriate implant site all'inserzioni of these systems, by their nature far less adaptable to the anatomical conditions of the plants of the Italian school.

The most common material used for the production of implants is titanium in commercially pure form or in its alloys for dental use, biocompatible material that does not involve reactions by the body (popularly but erroneously known as rejection). The plants, placed in the bone of the patient, will be strongly incorporated in it by physiological mechanisms of bone regeneration, ie the osseointegration will take place both in the case of deferred load (Swedish school) and both in case of immediate loading (Italian school).

History
The history of implant has its roots in the mists of time and do not know exactly when shone for the first time the idea of ​​inserting an artificial tooth in a socket to replace a lost tooth. What is certain is that you did. Come to us from ancient archeological finds which testify of interesting listings of pieces of worked shell, or bone mineral. More recently, in the nineteenth century, multiplied attempts to achieve implantological but the inadequacy of materials, surgical techniques, means anesthetics, the absence of antibiotics and the total lack of knowledge occlusal decreed inevitably failure . In the first half of the twentieth century, there has to a great flowering of attempts much more concrete and numerous patents. To remember the Adams patent of 1938 the first submerged plant, very similar to the next Branemark and experiences of Formiggini considered by some the father of modern implantology (1947). In 1961 appeared the first system specifically designed for immediate loading (Tramonte) with respect to biological area and in 1964 was introduced to the titanium implant (Tramonte). In the 60s and 70s appeared the important histological studies Pasqualini. In 1972 Garbaccio developed the theory of bicorticalism and designed its system. In 1975 he conceived the Mundane intraoral welder (sincristallizzatrice). At the end of the seventies, thanks to studies on osseointegration spread the plant submerged Branemark, that solved some problems of prosthetic implants immediately loaded. Since that time the implants submerged spread wide for ease, hitherto unknown, with which even inexperienced operators could initiate implantology; submerged plants multiplied and changed at the fastest pace in an attempt to correct some defects chronically plagued them Despite the great success. Collaterally implantology was meanwhile developing reconstructive surgery are now able to solve many of the bone problems that greatly restricted the use of submerged implants. The modern implantology, it is of immediate load or load deferred, discipline is widely proven and reliable, able to solve almost all problems of edentulism, functional or aesthetic they are.

Types
Osseointegration and fibrointegrazione

At the present state of knowledge attach to the word osseointegration the meaning of a union between bone and implant which remains stable under the load and adapted to ensure the masticatory function in the absence of clinical signs or symptoms, and the word fibrointegrazione the meaning of a partial failure that allows the plant to survive it suffers in operation for a few years with the gradual loss of stability and increased noise related (pain to pressure, inflammation of the soft tissues, etc.). [1]

The plants have different shapes: a cylindrical body and prosthetic connection, threaded cylindrical, conical, threaded conical, without prosthetic connection made of one-piece block; blade needle and grid much less used for their inherent difficulties, but adequate to resolve situations particularly difficult and where we can not use techniques of bone reconstruction.

The plants most commonly used, the most clinically tested and verified with more international protocols published in leading scientific journals, are those endosseous using delayed loading protocols, but all plants osteointegrano, provided that they are made of titanium. The word "osseointegrated" refers to facilities and "osseointegration" refers to the surgical technique (once intended to distinguish the delayed loading protocol that would produce osseointegration in immediate loading protocol that would produce fibrointegrazione and then implant failure) is no longer used in This makes sense because we now know that an intervention implant is made according to the protocol in deferred load, according to both the immediate loading protocol, results in osseointegration, however, provided that the implants are made of titanium. It is therefore the titanium to produce particular that union between implant and bone called osseointegration.

In contrast to other countries, in Italy the phenomenon is spreading plant low cost. These systems are widespread in our country because of their lower cost, to be offered for sale only need a self with which the CE mark is required and in most cases have no, or minimal, clinical trials, with obvious risks to the success of therapy and long-term health of the patient. [3] It is therefore increasingly important to ask your dentist a transparent information, together with a written estimate, concerning the proposed implant therapy.
Methods of implantology

The methods of implantology mainly involve two surgical techniques:

two stages: in two phases, the first "underground", ie insertion, suturing the submucosa and subsequent reopening of the mucosa after 2-6 months and screwing the "pillar tooth" on the system;
Stage one: implantation, which is left transmucosal, shows the head of the implant, so you can heal or leave (again for 2-6 months) for bone integration or load immediately, with a special dental pillar, either temporarily or final, as appropriate. Of course, plants are required to block one-stage implants immediately loaded.

Professional legitimacy

Normally the dentist, ie the degree in Dentistry, or the surgeon, graduated in Medicine and Surgery, registered at the dentists, who deal with dental implants. in Italy there is a professional specialist in surgery odontotomatologica, in France, for example, there is a "University Diploma in Implant Surgery and Prosthetics (DUCPI), it is recommended that the dentist unskilled exceed the natural barrier of the maxillary sinus to place systems. surgery preprosthetic and preimplantare, ie the preparation of the alveolar bone and the prosthesis insertion of dental implants are made by the dentist (dentist or surgeon) or a surgeon specializing in oral surgery and maxillofacial surgery.'s Masterplan of each implant-prosthetic rehabilitation is still the exclusive domain of the dentist, defined as enrolled dentists. surgeries Being highly specialized, it is good practice to verify that the professional who will run them possess adequate training and experience plus the aircraft necessary, checking on the website of the National Federation of the Associations of Doctors and Dentists (FNOMCeO) [30].

Some European insurance companies require, by the professional that inserts plants, demonstrable experience before accepting a bill for both the patient and for the implantologist.
Operational protocols

L '"implantologist" dentist and / or surgeon then creates a seat in the bone of the patient (in correspondence with the new tooth to be replaced or to be entered from scratch), through a series of calibrated bone cutters, subsequently to insert a dental implant endo- marrow. Because the system is osteointegri you need a good primary stability, mobility, or anything of the order of a few microns (depending Brunsky et al.). The bone-implant interface is therefore of the order of millimicrons, otherwise the system does not hold up to the load and must be removed.

According to some implantologists (Linkow) may be acceptable for the subsequent reloading with a crown also fibrointegrazione (phenomenon of inclusion defensive body which incorporates the foreign body in a fibrous capsule). Technically the system has failed and the surgery was not successful, but in some cases can be realized stays of plants fibrointegrati for years and with full satisfaction of the patient. Nevertheless, the fibrointegrazione represents a failure.

Currently, the systems most used are those of Swedish school, insertable with delayed loading protocol, with surfaces treated with various technologies, to encourage a better control of all parameters and the highest degree of predictability of the implant success. Typically the masticatory load with fixed prosthesis occurs at a later time, after 3/4 months for the jaw, after 5/6 months for the upper jaw. In some cases, but not in all, it is possible also an immediate loading of the plants, in order to do what is necessary, however, the respect of some basic criteria:

the presence of a certain amount of bone,
the primary stability of implants once inserted,
good support periodontal (gum)
the absence of bruxism (grinding teeth) or severe malocclusion,
the presence of a well-balanced occlusal (chewing correct occlusal plane).

It should also clearly a serious assessment of the specialist, who will assess appropriate examinations and tools for the coexistence of all these factors, otherwise the choice will fall on a technical "traditional" one ("underground" or "underground"), or with plants requiring a waiting time longer, but more secure, for the masticatory load.

The ski school Italian immediate load, and the related surgical techniques, give success rates comparable with those obtained with delayed loading, but involve a learning curve longer and require more experience. Bring, however, the patient can have temporary teeth already fixed to the end of the session surgical implant insertion even in those cases in which plants with Swedish school would be forced to carry the load deferred.

The plants have an almost unlimited life (the longer studies have 25 years), if you make a daily maintenance: the biggest risk they run the installations is:

immediately after surgery, the peri-implantitis, which is an inflammation and infection of the structures around the implant, resulting void osseointegration;
by incorrect loading of the plants themselves, with crowns or prosthesis is not correct, that can create a bone resorption over time, with loss of bone up to the loops deepest plant, with the possibility of loss of the same. To avoid these potential implant failures is therefore necessary to a good prostheses, fixed or mobile, well balanced in terms of del'occlusione (correct occlusal balance), have a good daily oral hygiene and make regular visits.

It should also be said that smoking, and diabetes may compromise both the osseointegration both the duration of the plants.

The implants can replace a single tooth (crown on implant), a group of teeth close together (bridge on implants), an entire dental arch, or may serve to stabilize a full denture upper or lower (overdenture)
Criteria for implant success

Absence of persistent pain related to the implant site
Absence of recurrent infection
Lack of mobility of the plant
Absence of radiolucency around the implant

Taken from Wikipedia

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