Implant-prosthetic treatment is used to replace one or more missing teeth. The implants currently used are generally made of pure titanium or, in latest-generation implants, of titanium alloy. These artificial structures simulate the missing tooth root and are inserted directly into the bone, either in the upper part (maxilla) or in the lower part (mandible) of the mouth; thereafter, a prosthesis is placed on these artificial roots, thus restoring the chewing function.

To date, implant treatment has a high success rate and is widely recognized as a reliable therapy by the national and international scientific community. Compared to fixed bridges, the implant technique has the advantage of preventing problems such as periodontitis, sensitivity and/or caries of the teeth adjacent to the missing one, since the implant limits bone hypotrophy to the areas surrounding the implant itself. In fact, it should be noted that edentulousness inevitably leads to a condition of tissue hypotrophy, thereby causing not only aesthetic but also functional damages to adjacent teeth and preventing the possibility of subsequently inserting implants. While implant-prosthetic treatment is currently considered the elective therapeutic strategy, it cannot always be performed on all patients. In fact, the choice of this treatment requires an in-depth clinical evaluation of the subject, particularly their general health, as well as an accurate instrumental examination to assess the state of the jaw bone.

What are the indications for dental implantation?

Tooth replacement implants are recommended both to restore proper chewing function and for aesthetic purposes. Generally, the implant-prosthetic technique is indicated for the treatment of the following conditions:

single edentulism, the lack of a single tooth;

multiple intercalation edentulism, that is when more than one tooth is missing between two teeth;

distal edentulism, when the missing teeth are the posterior teeth of an arch or a hemiarch;

total edentulism, a condition in which all teeth are missing.

What are the contraindications to dental implantation?

There may be in some cases contraindications that prevent the use of implant therapy. These can be associated with the patient’s health or the implant site condition. The former may depend on risk factors directly related to the subject, such as the presence of certain systemic diseases for which surgical procedures are contraindicated. For example, the osteoporotic patient who regularly uses bisphosphonates, who would need to discontinue treatment for several months before being able to undergo an implant-prosthetic treatment. There are also conditions which, despite not being absolute contraindications, require an ad hoc evaluation by the professional, such as diabetes or tobacco smoking. Furthermore, the choice of implant therapy also depends on the age of the subject: for example, treatment is not recommended before puberty. There are also contraindications associated with the implant site, such as poor oral hygiene or the presence of ever treated periodontitis. In these cases, tissue sanitation treatments are carried out prior to or simultaneously with surgery. Moreover, an essential condition for implantation is the presence of adequate tissue to support it, as insufficient bone volume may be a contraindication to therapy.

In many of these cases, however, bone hypotrophy can be coped with bone regeneration techniques, implemented prior to or when placing the implant.

Finally, there is an innovative solution that uses the cheekbone as the anchor point for the implant: we are talking about zygomatic implants, which we will discuss in the next article.

References

-Nissan J. Implant-Supported Overdentures: Benefits and Risks.Oral Rehabilitation for compromised and elderly patients.2019, chapter 11:183-191, 2019. 

-Debby H et al. Medical contraindications to implant therapy: Part II: Relative Contraindications. Implant dentistry, 2007. vo. 16, n 1:13-23.