Introduction
According to dentist penang, dental implant is one of the tooth replacement options. Their use in the treatment of total and partial edentulism has evolved into an important aspect of dentistry. Dental implants provide a lot of benefits over fixed partial dentures in general.
- A high rate of success (above 97 percent for 10 years)
- A reduction in the likelihood of caries and endodontic issues developing in neighbouring teeth
- Increased bone preservation at the edentulous site
- Sensitization of neighbouring teeth decreased
A dental implant is a device composed of alloplastic materials that is surgically inserted into the oral tissues underneath the mucosa and/or periosteum, as well as into or through the bone, to provide retention and support for a fixed or removable dental prosthesis.
Physiology and Anatomy
Prior to implant placement, a thorough understanding of anatomical landmarks and their variations is critical to ensuring a precise surgical operation and protecting the patient from iatrogenic problems. The exact examination of unique anatomical parameters such as the location of the mandibular canal, maxillary sinus, cortical plate width, and existing bone density, among others, is critical for implant selection and planning the most suitable implant site in the present clinical state. The nasal floor, nasopalatine canal, and maxillary sinus are all significant anatomical features in the maxilla. A frequent consequence is iatrogenic sinus perforation. This issue may be resolved by using short implants and performing a sinus lift and bone augmentation treatment.
When putting an implant in the mandibular arch, the most critical anatomical consideration is the position of the inferior alveolar canal, which houses the inferior alveolar nerve and artery. Damage to these important tissues during implant implantation may result in discomfort, impaired sensation, and excessive bleeding, among other complications. Thus, prior to implant implantation, it is critical to ascertain the position and structure of the mandibular canal.
Indications
- Patients who are partially edentulous and have intermediate gaps or free-end edentulism.
- When a patient is dissatisfied with the stability and retention of his or her present conventional full dental prosthesis.
- To protect detachable partial prosthesis that are already in place.
Contraindications
Exceptional Contraindication
Acute sickness, the degree of a defect or aberration, uncontrolled metabolic disease, pathology/infection of the bone or soft tissues
Contraindications Relative
Diabetes, osteoporosis, parafunctional behaviours, HIV/AIDS, bisphosphonate use, chemotherapy, head and neck irradiation, and behavioural, neurogenic, psychosocial, and psychiatric diseases
Equipment
The armamentarium (which includes equipment and various implant components) that is utilised during the surgical implantation of a dental implant is as follows:
- Syringes disposable
- Surgical blades that are disposable
- Clips for towels
- Elevator periosteal
- Surgical equipment for dental implants (containing different drills)
- Physiodispenser in conjunction with a surgical handpiece
- Implant dental
- Screw cover
- Abutment that promotes healing
- Holder for needles
- Forceps with toothed tissue-holding teeth
- Scissors, sutures for surgery (in flap surgery)
- Pinch of soft tissue (for flapless surgeries)
Implant types and materials
- Endosteal
- Subperiosteal
- Transosteal
Endosteal implants puncture just the maxilla and mandible’s cortical plate. The root shape implant is the most often utilised endosteal implant. The subperiosteal implant is composed of an implant substructure and a superstructure in which a custom cast frame is positioned immediately under the periosteum. The transosteal implant is inserted between both cortical plates.
Implants are classified into three types of materials:
- Metals
- Ceramics
- Polymers
Personnel
Dental implant therapy is usually recognise to be restorative in nature. Preoperative communication and collaboration between the restorative dentist, periodontist, dental technician, and implant surgeon are widely acknowledge in contemporary implantology. The predicted result of intraoral rehabilitation in terms of function and aesthetics may and must be identify and manage before to the surgical operation, in collaboration with the whole restorative team (the periodontist, surgeon, restorative dentist, laboratory, and patient). Interprofessional collaboration is critical to the success of implant-retained restorations.
Preparation
Implant placement should be guide by the patient’s restoration objectives. Similar to how an architect designs a structure before laying the foundation, the prosthesis should be develop first. After the prosthesis is producing, the abutments, implant bodies, and available bone needs for supporting the intended restoration may be identify.
Cardiovascular problems (hypertension, congestive heart failure, subacute bacterial endocarditis, etc. ), endocrine disorders (diabetes mellitus, thyroid abnormalities, etc.), pregnancy, blood disorders, and bone diseases, among other things, are assessing medically.
A thorough and precise radiographic examination gives the important surgical and prosthetic information for the venture’s success. Dental implant imaging utilises a variety of imaging modalities.
- Radiography of the periapical region
- CT (computerised tomography) (medical CT and cone beam CT)
- Radiography of the occlusal cavity
- CT Interactive
- Radiography of the cephalad
CBCT is quite useful in dental applications.
All implant treatments need normal sterile surgical preparation. The objective is to keep mechanical and thermal damage to the bone to a minimum. Osteotomies should be perform under an abundance of cold saline and with sharp, fresh osteotomy drills operating at a high torque and moderate speed. The drill sequence should be incremental. To minimise permanent alterations, the bone temperature should not surpass 47 degrees during an osteotomy. When the temperature surpasses 47 degrees Celsius, bone necrosis and integration failure might ensue. The D1 bone is the most prone to overheating.
Technique
Surgical protocols: Over the years, three surgical techniques have been used: Two-stage surgery, one-stage surgery, and immediate-loading surgery. The two-stage surgical technique starts by inserting the implant body under the soft tissue, where it remains until the bone begins to recover (usually 2 to 3 months for mandible and 3 to 6 for maxilla). The second step of surgery involves reflection of soft tissues in order to connect a permucosal device or abutment. The implant body in the bone and the permucosal part above the soft tissue are both implant concurrently in a one-stage surgical procedure until initial bone maturation occurs. The implant’s abutment then replaces the permucosal portion, obviating the requirement for further soft tissue surgery. The immediate-restoration procedure involves implanting the body and prosthetic abutment during the first surgery, and then attaching restoration (usually transitional) to the abutment.
Complications
Numerous difficulties and issues may arise during and after surgery. During the process, perforated buccal or lingual plates are seen. If the preparation is elliptical/eccentric, a broader implant may be utilise if feasible. If this is not possible, pack the osteotomy with autogenous graft, compress it, and re-implant. Bleeding in the mouth floor might occur as a result of a lingual or facial artery damage. As a result, extreme caution must be use during osteotomy preparation. Injury to the nerves may result in altered nerve sensations such as anaesthesia, paresthesia, or hyperesthesia.
The most often seen surgical complication is incision line retraction. It is necessary to correct the design of the detachable interim prosthesis. If the granulation process exceeds two weeks, epithelial margin trimming may be performe. Implants that become expose during the healing process should not be attempt to be cover with tissue. Rather than that, the denture is forcibly relief over the implant exposed region. Although implant movement during healing is uncommon, it can occur, usually accompanied by a radiolucent zone surrounding the implant. Whatever the reason, the implant should be remove immediately.
Clinical Importance
Modern dentistry’s purpose is to restore a patient’s normal profile, function, comfort, aesthetics, speech, and health regardless of the stomatognathic system’s atrophy, illness, or damage.
On average, people are living longer. This fact, along with an existing patient base suffering from minor and significant tooth disorders, ensures the future of implant dentistry for multiple generations of dentists. Dental implants are increasingly being utilise to replace single teeth, particularly in the mouth’s posterior areas. Rather than removing healthy tooth structure and crowning two or more teeth, which increases the risk of decay, a dental implant may be use to replace the single tooth.
Last but not least, implant dentistry has now been recognise by organise dentistry. The present trend toward increasing usage of implant dentistry will continue until every restorative practise routinely utilises this technique for abutment support of fixed and removable prostheses as the preferred alternative for all tooth replacements.
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