Surgery and implantology
Osseointegrated implants: "New teeth"
Dental implants are the ideal alternative to treat the loss of teeth. Undoubtedly, they represent a great evolution in the field of dentistry and, besides the constant knowledge about the behaviour of hard tissue (bone) and soft tissue (gums) around them, they allow an important enhancement of their predictability.
Normally, teeth stimulate bone around them, and this way bone is maintained. The problem arises when we lose one or more teeth, because then the bone atrophies and disappears slowly.
As years go by, bone disappears in the facial third, and one of the main causes of that is dental loss.
The bone loss associated with dental loss represents a problem, because if we let the bone of the maxillae to keep reducing, the oral rehabilitation becomes extremely difficult, requiring bone regeneration procedures which are more unpredictable and complicated. The best way to achieve the most biological situation is the use of osseointegrated implants.
Certainly, the fact of replacing the teeth and molars that have been lost, makes possible the recuperation of the dentition functions (chewing, speaking, aesthetics, stabilisation of the neighbour molars…) without applying unnecessary loads to the rest of the teeth, like a removable appliance or a traditional bridge would do.
In reality, the more bone we can maintain, the better the prognosis of the implant that we are going to place. For this reason, after loosing a tooth, it is advisable to avoid that too much time goes by without treating that loss with an implant. Today, even if the bone situation is appropriate, it is advisable to extract the tooth and place the implant in the same moment, to prevent the bone loss (immediate implant).
Implantology is, without any doubt, one of the areas of dentistry that has evolved more recently. We see the development of more comfortable, trustable and aesthetic techniques. Today, if the case requires it and the existing bone allows it, it is possible to extract all teeth, place the implants and the prosthetic reconstruction of a whole arch the same day. In Clínica Dental Padrós-Creus Muntaner we have the experience and necessary technology to perform those complex immediate load cases.
The success of treatment is, without any doubt, in a good planification and study of every case. We work with CBCT-New Tom, which gives us x ray images that allow as to evaluate both bone height and width precisely. We analyse bone density and prevent exactly the difficulties that can arise during the surgical act. It is, thus, a really beneficial way to observe how is exactly the bone of each patient, both in 3D and in relation to bone quality, before the intervention.
Besides, the use of guided surgery splint allows us to place the implants in the most indicated place for the future prosthodontic rehabilitation.
Where a significant resorption has taken place, it is important to regenerate bone and, frequently, it is necessary also to enhance the soft tissue with gingival grafts. In Clinica Dental Padrós-Creus Muntaner we take care of those aspects as a base for the predictability of implants in the long term.
Once the implants have been placed, it is necessary to wait for them to osseointegrate, before the placement of the definitive prosthesis. The degree of osseointegration is controlled objectively with Ostell ®. With the numeric value this device gives us, we know if the implant is ready to be loaded with the prosthetic restoration.
The prosthodontic structures designed over the implants have to be as hygienic as possible. In Clínica Dental Padrós-Creus Muntaner, if the case permits it, we work with intermediate pillars and threaded restorations. The intermediate pillars are elements that thread the implant’s head, and allow to work with the prosthesis at the gum level without invading it. The threaded prosthesis can be disassembled to clean it periodically, and thus control the peri-implant tissues.
But what is really most important about implants is their posterior care. We insist a lot with the hygienic procedures and the required periodic controls. We try to teach the techniques to correctly maintain healthy implants through time. Peri-implantitis is the greatest enemy of implants; it causes the loss of bone and, with time, if it is not treated, the loss of the implant. We stress the fact that implants are a great alternative in cases of teeth loss, but its care is paramount since the placement, the prosthetic system that we use and its posterior maintenance to guarantee its stability in the long term.
PRGF is a discovery that has a huge transcendence in the clinical procedures. It has surprising applications in periodontics, oral surgery and implantology. It is a system with a great potential, as it uses the growth factors included in the alfa globules of the human platelets.
After the extraction of a small quantity of blood from the patient (and not 500 cc as in other systems), different fractions are obtained from the plasma. Platelets and growth factors are used to stimulate the regeneration and formation of the teeth.
There are some factions which are richer in fibrine, and that allow us to obtain an immediate closure of the wounds and accelerate its cicatrisation.
This way, with a simple punction similar to the one used for blood analysis, we can favourably modify the procedure of wound healing, the regeneration of the periodontium and the osseointegration of implants. Besides, as the extracted blood is from the patient, allergies or other types of problems can be easily ruled out.
Dr. Eduardo Anitua, from Vitoria, has been the main person to promote this revolutionary technique, which has recently been included in the treatment of different pathologies in other clinical specialties, like for example traumatology, sports medicine, etc. with a high success.
In Clinica Dental Padrós-Creus Muntaner we trust this technique since It was implemented, and our experience with it is consolidated.