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PROFESSION

PROSTHETIC IMPLANTS

The 1970s saw the birth of modern dental implantology with the introduction, by the Swedish Prof. Per-Ingvar Brånemark, of dental prosthesis (titanium screws approximately 4 mm in diameter) called endosseous implants which were used to substitute the roots of missing teeth. These issues tend to create a continuous relationship with the bone in which they are inserted (Osseointegration) resulting therefore in fixed, stable, and painless ideal supports for fixed prosthesis. The success rate is around 95%; rejection does not exist (thanks to the absolute biocompatibility of titanium), thus in cases of a lack of osseointegration we speak of failure and not rejection. With the techniques of microsurgery and tissue engineering, in unsuccessful cases, it is possible to reposition an implant in the same place, or to regenerate the bone in sites in which there is not a sufficient amount to immediately position the implants.

Microdentistry has get ready, in the course of the last 20 years, a new philosophy of treatment in prosthetic implants. This philosophy is in agreement with criteria of minimum invasiveness towards patients, most of which were developed or perfected in the Institute. Such knowledge and clinical protocol represents a unique legacy, not published, but shared within an international clinical network of excellence. This philosophy of work has thus come to be called MICROINVASIVE IMPLANTOLOGY.

TRADIZIONAL IMPLANTOLOGY

1 - An ample cut on the gums is necessary with successive detachment of the tissues (periostium, mucous membrane and muscles) from the boney base;
2 - It causes the re-absorption of uncovered bones;
3 - It easily provokes pain;
4 - It increases the risk of edema, bleeding and hematoma in post-surgery;
5 - It uses burs to aggressively drill a hole into the bone at a high speed, with little respect for the biology of the tissue;
6 - It allows for the insertion of implants only in anatomic areas where there is an abundant amount of bone;
7 - It reconstructs the anatomy of the jaw with the grafting of bones from other areas of the body: hip, tibia, fibula, calvaria;
8 - It requires a wait of many months for implants to be started. Patients are often left without teeth or with removable prosthesis, which is irritating and dangerous for proper osseointegration;
9 - It causes post-surgical pain which often doesn’t respond to painkillers;
10 - It causes a slow tissue recovery.

MICROINVASIVE IMPLANTATION

1 - Incision and decollement of soft tissues are not always necessary;

2 - It always reconstructs the bone in order to support the implants at the same time as the extraction of the teeth;

3 - It prepares the implantation site with a low rotation speed of the bur, respecting the structure and the vitality of the bone;

4 - It allows for the positioning of the implants with little necessity for bone grafting, or with regeneration made in the same session;

5 - It does not require long wait time for the positioning of the prosthesis on the implants, but instead it is often possible to do everything in a short time frame (a few hours or days). (Immediate loading);

6 - Thanks to the use of the operating microscope it is possible to have complete control of the relationship between the implantation site and the surrounding anatomical structure;

7 - It permits implantation immediately after the removal of a tooth, even in the presence of infections, which are controlled with sophisticated decontamination techniques;

8 - It allows for the treatment of potential inflammation and/or infections of the periimplant tissues (mucositis and periimplantitis);

9 - It reduces the necessity of sutures allowing the achievement of a more profound contact between soft tissues and implants: in this way penetration of bacteria in the surgical injury is avoided;

10 - It reduces or eliminates post-surgery pain;

11 - It reduces or eliminates post-surgery edema;

12 - It permits a rapid healing of tissues, thanks to biostimulation.

Thanks to laser assisted periodontal treatment, which allows for a check of all infections present in the oral cavity, we now have the possibility of inserting implants even in patients with serious periodontal infections. The implants can also be inserted in alveolus in the presence of inflammation, thanks to laser treatment of the alveolus itself; in cases in which a post-extraction implant is not undertaken, the laser treatment is still carried out and bone regeneration thanks to the insertion of bone grafts. This allows us to have a sufficient amount of tissue afterwards that we are then able to insert an implant, avoiding bone atrophy at the site of the extraction, but above all without needing to carry out other surgical operations in order to detect the bone.

All radiographic exams necessary to start the surgical treatment can be made within the office.

The implants can be either submerged, that is inserted below the oral mucous membrane, and in this case a second session is required to uncover them; or transmucal, when they emerge from the mucous membrane, and so a healing screw is introduced in order to prepare the mucous membrane for the insertion of the prosthesis. In both cases it is necessary to wait about 3-4 months, in order to allow for the complete osseointegration of the implants. There is also the possibility of inserting both the implants as well as the corresponding prosthesis in a short period of time (immediate loading), therefore allowing for quick restoration of function and esthetics.

Microinvasive implantology does not always foresee the exposure of the bone (access strip), and this allows for: a minimally invasive surgery to be carried out, a minor post-surgery, easy healing, the absence of suture, and profound contact between the soft tissues and the implants, in this way avoiding that the bacteria works its way into the oral cavity and therefore causing the surgery to fail.

The absence of bone is not even an obstacle for the positioning of the implant, because that which is missing can be reconstructed thanks to a bone regeneration technique, which foresees the use of synthetic grafts and of autogenous growth factors. The bone can also be recovered from the area where other implants have been put (thanks to a special surgical technique) or from other areas of the oral cavity (when a large amount of tissue is necessary).

The use of the operating microscope facilitates a full check of the anatomical structure permitting the execution of difficult regeneration techniques in extreme situations, for example the raising of the jaw cavity: with this technique we are able to insert bone grafts between bones and the mucous membrane that covers the cavity, in order to proceed with the insertion of the implants even in areas originally lacking boney tissue.

SOME EXAMPLES OF CLINICAL CASES

Case n° 1 - Man, 82 years old

Preoperator

Postoperator after 4 years