Implants
Dr. Giuliani’s continuing education credits have focused in varied areas, one being continuing studies and procedural development in implant dentistry. With its multi-disciplinary use in single tooth replacement, anchoring dentures or used as the roots of a fixed bridge, Implant dentistry is becoming the preferred use over conventional dentures and bridges for its durability, comfort, and ease of cleaning.
A typical dental implant consists of a titanium anchor (resembling a tooth root) with a roughened surface. This surface is treated either by plasma spraying, etching or sandblasting to increase the integration potential of the implant. An osteotomy or precision hole is carefully created into the jawbone and the implant is inserted into this osteotomy.
Implant surgery is typically performed with local anesthesia by trained and certified clinicians. The most common treatment plan calls for several surgeries over a period of months, especially if bone augmentation (bone grafting) is needed to support implant placements. At the other end of the surgery scale, some patients can be implanted and restored in a single surgery.
A single implant procedure that involves an incision and “flapping” of the gum or gingiva (to expose the jawbone) takes about an hour, sometimes longer; multiple implants can be installed in a single surgical session lasting several hours.
Healing and integration of the implant(s) within the jawbone occurs over several months in a process called osseointegration. At the appropriate time, the restorative or cosmetic dentist or prosthodontist uses the implant(s) to anchor crowns or a prosthetic restoration containing several “teeth”. Since the implants supporting the restoration are integrated, which means they are biomechanically stable and strong, the patient is immediately able to masticate (chew) normally.
In an immediate function procedure, the gingiva is not flapped (Flapless). Instead, a small plug of gingiva is removed directly over the drilling site. The site is prepared and the implant is inserted. Then a temporary or permanent crown is immediately placed. Patients are cautioned to give their new tooth/teeth ample healing/integration time (weeks or months) before attempting normal mastication, but they leave with a new tooth filling the space they had on the same day as the surgery.
There are different approaches to placing dental implants after a tooth extraction. The approaches are:
- Immediate post-extraction implant placement.
- Delayed immediate post-extraction implant placement (2 weeks to 6 months after extraction).
- Late implantation (6 months after tooth extraction).
According to the timing of loading of dental implants, the procedure of loading could be classified into:
- Immediate loading procedure.
- Early loading (1 week to 12 weeks).
- Staged loading (3-6 months).
- Late loading (more than 6 months).
Most patients need the longer treatment plan, which has an excellent history going back many years. Prior to surgery, a panoramic X-ray will be taken so that calibrated measurements can be made from the image (to accurately locate “vital structures” such as nerves and the position of critical anatomical features such as the mental foramen, which is the transit point in the jawbone for the nerve which innervates the lip and chin).
Once properly torqued into the bone, a cover screw is placed on the implant, then the gingiva or gum is sutured over the site and allowed to heal for several months for osseointegration to occur between the titanium surface of the implant and jawbone.
After several months the implant is uncovered in another surgical procedure, usually under local anesthetic by the restorative dentist or prosthodontist, and a healing abutment and temporary crown is placed onto the implant. This encourages the gum to grow in the right scalloped shape to approximate a natural tooth’s gums and allows assessment of the final aesthetics of the restored tooth. Once this has occurred a permanent crown will be fabricated and placed on the implant.
An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rates for this procedure are now acceptable. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the implants at the same time as the surgery to place the dental implants.
