IMPLANTOLOGY – MYTHS AND THE REALITY

Dental implantology, at present, is one of the fastest developing fields of stomatology. It is an interdisciplinary field embracing several specialties, like stomatological surgery, prosthetics, and orthodontics and other. Implantology should be treated as a process of treatment, in which – I think – the key part is played by diagnostics and planning of treatment.

Thanks to implantology we have incomparably better therapeutic possibilities for rehabilitation of the dental system, as we are able to give the so-called ‘third teeth’ to patients – to a given extent, off course.

During 12 years of practice in implantology, I had the opportunity to systematically follow the changes that have been occurring in this field. Today, many so-called cannons of treatment are out of date, because the development in implantology turned out to be so fast and give so much possibilities that we can approach many issues in a completely different way. It is a very positive phenomenon; however, it is dangerous too, as in the wrong hands, it may harm instead of help patients.

For us – doctors – but also for patients, the amount of information about implantology, which often is, unfortunately, only slogans of companies manufacturing dental implants that only care about selling their product, may be a trap that will cause irreversible complications. Reliable scientific reports based on many years of documented research must be distinguished from sales gimmicks.

There is a great number of topics that could be discussed in relation to the above problem.

New products and materials, tools, surgical procedures, prosthetic solutions, and new technologies.

I would like to focus on just several of them that are related to the contemporary trends in implantology. They raise interest in both medics and patients, but they also cause confusion and controversy.

Immediate implantation

It is placing implants immediately after tooth extraction. This procedure is used when a tooth, e.g. break in such a way that it cannot be rebuilt prosthetically, and the state of the oral cavity makes it necessary to immediately restore the tooth ( crown) without damage to neighbouring teeth. In place of the lost tooth an implant is inserted that will serve as an abutment for the crown.

There are certain defined contraindications for such procedure, e.g. inflammation of the bone tissue in the vicinity of the implantation site, the lack of sufficient amount of bone, bad bone quality, etc.

After excluding obvious contraindications it is up to the doctor to decide whether to place the implant immediately or proceed in two stages, carrying out procedures saving the alveolar process. Today, we have dental implants of different shapes and structure, we can use various surgical procedures using biomaterials that allow for rebuilding bones and soft tissue. Thanks to this we can carry out implantation immediately after extraction. However, immediate implantation is a difficult surgery that requires experience. Inappropriate placing of the implant in the alveolar process (too deep, too shallow, lip-oriented, etc.) usually ends in one of the worst failures, i.e. a complication in the form of terrible aesthetics of the prosthetic crown, especially in the front area of the oral cavity. Imagine an implant located in place of an upper incisor, uncover on several millimetres, with gingival atrophy, and a crown half as long as the neighbouring tooth. The implant is perfectly integrated with the bone tissue. Procedures of removing such implants using bone trephine, with the removal of surrounding bone tissue plus the following surgeries regenerating the bone tissue and the soft tissue are all just saving a hopeless situation.

I do use immediate implantation, but only in special cases, taking into account not only the amount and the quality of bone, but also the structure of the gingiva, the gingival scalope, how high the lip line is, what the bite conditions are, what the aesthetic demands of the patient are, how will the patient cooperate with me in further treatment. There are many factors influencing the final effect. Our preparation, surgery planning and carrying out the procedure properly based on awareness and skill resulting from experience is crucial here. The answer to the question whether to do immediate implantations is: yes we can, but only after considering other treatment options.

Flapless implantation

This procedure consists in inserting an implant into the bone without incising the mucous membrane of the gingiva.

It may be called, in other words, a blind procedure.

Is this perverse? We do, in fact, have very modern preoperative diagnosis methods at hand. With specialist software, after making tomographic images depicting the anatomy of facial bones, a surgery of implantation can be prepared virtually and proceed with immediate prosthetic restorations. This often simplifies, or even enables, making surgery, sometimes big, without incising the gingiva, so without the painful effects of the surgery in the form of swelling, haematoma, and post surgical pain. It is a great method, but we must remember it is not good for everyone and in every case. It cannot replace traditional procedures completely, because during surgery many unpredictable situations may occur that may not be foreseen in the diagnostic stage. Computed navigation system is a device that is perfect for assessing possibilities for implantation and, in my opinion, should be used for this purpose to as great an extent as possible.

In other cases ‘teeth-in-an-hour’ procedures without using advanced diagnostic imaging techniques can be carried out in extraordinarily favourable anatomical conditions, when after a regular examination we are almost 100% sure what is the shape of the alveolar process. Such cases are, in my opinion, sporadic.

Immediate loading of the implants with a prosthetic construction. “Teeth in an hour”

In other words, immediately after inserting the implants into the bone, we prepare and fix restoration in the form of prosthetic crowns or bridges on the implants. It is not about the difference between one hour and one day, but about the fact that a patient does not have to wait for several months for his new teeth on implants, meanwhile using temporary prosthetic restorations, which are often very uncomfortable and cause many problems and much discomfort.

Today, such procedure is highly predictable and acknowledged as a standard method, but we must remember that only in certain conditions. Not every patient can be offered this kind of treatment, and slogans advertising it as a basic procedure are very harmful. Several conditions of the oral cavity must be examined before we load implants. We should remember that the integration of implants with the bone tissue is a dynamic process of biological changes in the area surrounding the implant lasting several weeks, so given criteria must be met to carry out this procedure.

Above all, an implant inserted into a bone must be stabilised very well. We call it – primary stabilisation. That means it cannot respond in micromovements to occlusion forces. Generally speaking, the amount and quality of the bone in the alveolar process must be sufficient for the desired effect. If the protocol of procedure is maintained, the results are highly predictable. We must therefore remember about proper classification of a patient for a treatment.

Summing up, implantology today gives us ever-newer possibilities, but we should use them wisely, so that our proceeding is not only stunning, but most importantly effective and predictable, for the good of our patients.

I have touched only several matters regarding modern implantology. Being aware of the fact that we sometimes exist in a jungle of various, sometimes contradicting, information, I will answer your questions with pleasure during consultations.

My telephone number: +48 600 316 216 and my e-mail address:

Piotr Majewski