Implants

An implant is a kind of titanium screw, fixed in the bone as the root of a natural tooth. The implant replaces the missing tooth without touching other teeth. This is why the practitioner adapts the length, the diameter and the shape to the clinical case thanks to a powerful radiological examination: 3D or scanner. The implant protocol First the practitioner must access the bone, releasing the gum. For this he makes an incision using a scalpel.

Implantology is an essential breakthrough that has improved the lives of thousands of patients. Indeed, it is often the optimal solution because: – this makes it possible to avoid unnecessarily sacrificing healthy teeth – it is the only possibility to avoid a removable prosthesis – the patient finds the comfort of the original teeth and thus a quality incomparable life – aesthetics are optimal – this avoids the bone loss associated with the extraction of a tooth. Clearly, a dental implant is the optimal solution if one or more teeth are missing. Thus, almost everyone can benefit from a replacement for his teeth, with a look and functions identical to those of a natural tooth. However, it is important to have completely completed bone tissue before placing a dental implant on a teenager.

Contraindication, so-called

The indication of placement of the implants will be done on a case by case basis, with the greatest caution.

  • A bone in insufficient quantity.
  • Some diseases of the lining of the mouth.
  • Periodontal diseases (loosening), it is necessary to clean the gums and stabilize the disease previously.
  • Severe bruxism (patient clenching teeth).
  • An occlusion report (between the upper and lower teeth) unbalanced
  • Infections with neighboring teeth (pockets, cysts, granulomas), significant sinusitis.
  • Poor hygiene of the mouth and teeth.

Of course, this whole list is not exhaustive and the contraindications remain at the complete discretion of the practitioner who will have examined you and questioned you.

The implantologist will, using drills adpate diameter, prepare the place in the bone. The implant penetrates the bone by forcing slightly. It is thus stabilized. After the implantation of the implant, the osseointegration phase will take place. Indeed, the implant, unlike the tooth, is completely fixed, that is to say stiff in the bone. The loading of the implant is generally delayed to allow the osseointegration phase (from several weeks to 3 months). Subsequently, a crown will be placed on this implant which will behave like an artificial root.

In certain clinical conditions, Dr. Olivier Azorin can perform immediate loading of an implant.

Immediate loading

The same day as the surgery (sometimes the next day, because of the time required for the realization of the prosthesis) the practitioner sets up a temporary resin tooth which foreshadows the future prosthesis. The patient leaves with a tooth. This technique is not usable in all cases, it requires in particular a good primary stability of the implant that is not obtained in all surgeries.

Absolute contraindications

Implants can not be placed in these situations:
If the patient has heart problems :
– Heart disease affecting valves (valvulopathies)
– Recent infarction
– Severe cardiac insufficiency, cardiomyopathies

Other cases :

  • Cancer in evolution, some bone diseases (osteomalacia, Paget, glass bones disease …)
  • Certain immunological diseases, immunosuppressive treatments, declared AIDS, pending organ transplant
  • Some psychiatric illnesses
  • Maxillary strongly irradiated (radiotherapy treatment)
  • Treatment of osteoporosis or certain cancers by biphospnonates (in tablets: ACTONEL®, FOSAMAX®, DIDRONEL®, LYTOS®, SKELID® … INJECTABLE ESPECIALLY: ZOMETA®, AREDIA® …), even several years ago.

It is likely that there may be complications (in case of oral surgery or implants) serious. (see the recommendations below)

Possible complications during implant placement

Immediate complications:

Anesthetic risk : Although, under local anesthesia in the vast majority of cases, the anesthetic risk is never zero. An allergy, extremely rare, is always possible. However, this type of anesthesia is widespread and “at risk” subjects are often already known.

Non-osteo-integration (called « rejection ») : It is translated in the weeks or months following the installation of the implant.
The material used is pure titanium, whose physical and biological properties are very well known and used for many years in orthopedic surgery (hip prosthesis, knee …). It is very well tolerated by the body and no rejection or allergy reaction has been reported so far.
The bone cells did not colonize the surface of the implant and it is mobile because not “welded” to the bone. It will then be necessary to deposit the implant. This is why we usually wait 2 to 6 months before making the final prosthesis on the implant.
The causes are not always identified, however, tobacco and hygiene play a significant role.
Overall this affects 5% of implants posed The 100% success does not exist for implant treatments.
However, if it is possible, you can put an implant in the same site a few weeks or months later, and often this second attempt is successful.

Infections : Post-operative infection is rare. It is either a neighboring abscess or (much more rare) a soft tissue infection around the jaw bone (an infection called cellulite) or sinus infection (sinusitis).
This is why antibiotic therapy is prescribed to you, that the aseptic conditions must be drastic and that we must avoid operating when the body is weakened (by another infection, poorly balanced diabetes …)

Hemorrhage : As with any oral surgery, there may be haemorrhage or hematoma, but this is not serious in the vast majority of cases.

Lesions of the nerves :

At the level of the lower jaw (mandible) there is the sensory nerve of the lip and the chin that travels in the bone (in the region of premolars and molars). This is why a scanner is also required to locate it, and sometimes, if the bone height is insufficient, you will be rejected for an implant placement in this area. Very rarely the nerve can be touched, during the pose (technical error, poor appreciation of the scanner, patient moving at the time of drilling …), or after a hematoma or edema compressive. This results in a decrease in the sensitivity of the lip and chin (not paralysis). Generally, by proper treatment, these disorders are reversible.

Exceptionally, there may also be a lesion of the lingual nerve that gives anesthesia of the edge of the tongue.

Late complications

Late failure – many years after insertion – may be due to mechanical factors, removal of the implant (such as for a natural tooth), poor hygiene or poor general condition.

This results in the loss of the implant (which no longer holds) or more rarely a fracture of it.

Hence the importance of a very rigorous hygiene and regular inspection visits.

Conclusions

Despite these risks and incidents, the placement of dental implants performed in good conditions by an experienced operator, is a reliable surgical procedure, simple, rare complications and inconsequential most of the time. However, it is a surgical act, and like any act, it is never innocuous.