(photo) Example in which immediate loading was done in the lower arch because the bone was of good density, but not in the upper arch because it did not have sufficient stability. This is also an individualized work, according to the patient’s physiognomy.

What is the best material for implant arches?

Nowadays different materials are used to reconstruct the dental arches, each of which differs in quality and consequently has different guarantees of duration.

The definitive single material is zirconium which lasts at least 20 years.

Zirconium is known as “the artificial diamond” and is also used as a gemstone for jewellery.

This element makes it possible to create a very stable arch, furthermore, unlike other materials, it is also the most suitable for maintaining good oral hygiene thanks to the ease with which it can be cleaned.

Zirconium teeth do not change color and do not stick to bacterial plaque. The arches made in zirconium are very biocompatible and stimulate the gum, eliminating its unsightly shrinkage.

Zirconium combined with a thin layer of lithium disilicate / E Max gives the best aesthetic results that can be achieved.

The other materials such as resin, metal or ceramic are only excellent as temporary materials because their duration does not exceed 5 years.

So the story is simple, if you opt for a result that lasts for a lifetime, then cubic zirconia is the perfect solution.

Are the teeth screwed in or cemented?

 There are many myths about this topic, but the truth can be simplified by following these two rules:

1. In patients with perfect bone condition without tissue loss, the ideal solution is to screw-retained teeth.

2. On the other hand, for those with considerable bone loss or a drastic inclination of the latter, cemented teeth must be made.

Some dentists argue that once a screwed arch has been created, in the event of future problems, it can be unscrewed to remedy the problem. Yes, it is true that it can be unscrewed but it must be specified that in any case that arch cannot be reused if the implants have problems, as the implants have a precise positioning and the probability of inserting another implant in the exact same position is equivalent to zero. So there is no health or economic advantage to prefer screwed teeth over cemented teeth, it is simply an option that can be chosen or not by the dentist by evaluating the patient’s initial parameters. The advice is not to make specific requests regarding the technical work, perhaps requesting cemented or unconditionally screwed teeth. The collaboration between the two professional and competent figures of the surgeon and the prosthetist will be able to evaluate the best solution based on the individual case study. Each patient has such a uniqueness that the same work is never done on two different patients. To make the idea better, attention to the individual is equivalent to craftsmanship, while standard techniques are equivalent to mass-produced works by large multinationals.

 Is it possible to have implants without opening the gum? 

This is also possible. Through guided surgery and flapless surgery it is possible to have implants without cutting the gum, but also in this case the situation must be suitable and meet certain requirements. The main requirement is the lack of infections, cysts or granulomas to be cleaned in the fragment where the implant is to be inserted. The benefits of guided surgery are: no swelling, shorter duration of the operation and greater psychological tranquility.

Is it possible to have an implant immediately after the extraction? 

Absolutely yes, doing an implant immediately after extraction is ideal. In this case the extraction is done first and immediately after the immediate insertion of the implant thus preserving the bone structure. In this case, another fissure in the bone is not opened but the place of the extracted tooth is directly exploited, thus avoiding a further phase of the operation. This, in addition to being the most optimal solution for bone conservation, is also the most comfortable and fastest procedure for the patient. Immediate implantation is no longer a luxury but a necessity. 

(photo) Implant inserted immediately after the extraction of the molar. 

Fixed teeth with or without fake gum? 

To determine whether fixed teeth need fake gum or not, you must first evaluate the amount of bone available.

1. Fixed teeth without fake gum: In the ideal case where the amount of bone is sufficient and the gum has an optimal thickness. In this case the fixed teeth are composed only of the white zirconium of the crowns.

2. Fixed teeth with fake gum: In the unfavorable case where the amount of bone is scarce and the gum has receded. In this case, the fixed teeth are not only composed of zirconium, but a layer of pink ceramic is also added to fill the missing gum. 

(photo) Example of a zirconium arch with teeth without fake gingiva, type FP1.

Is it better to use single crowns or crowns attached in the shape of an arch? 

When we talk about single crowns or arches on implants we have to consider not only the biological factors but also the mechanical ones.

1. Biological factors: For reasons of hygiene it is better to make the crowns attached, thus avoiding the possible spaces between them where food residue could be deposited.

2. Mechanical factors: In this case, considering the ideal distribution of masticatory forces, the implants should be loaded in groups. Consequently, the ideal solution would be that of the crowns attached in the form of an arch.

How do you maintain ideal hygiene with dental implants? 

The most important thing that determines the duration of dental implants is oral hygiene. Maintaining proper oral hygiene is very simple, it is a matter of cleaning your teeth 2 times a day with the dental irrigator which has the task of spraying water and air between the gums and teeth, thus removing any possible food residue. In the link you will find some examples of these products and how to use them: https://youtu.be/yzrEKvLWG2U 

How do systemic bone problems affect dental implants?

 The systemic bone problems are mainly: vitamin D deficiency, osteoporosis and bisphosphonates. Systemic bone problems are not a contraindication for dental implants.

Patients with osteoporosis and those taking bisphosphonates can have dental implants done, following the specific protocol for these pathologies. Vitamin D is essential for dental implants and must be within the norm (>30 ng/mL). Patients with poor bone quality can be treated with vitamin D and calcium supplements to help integrate the implant into the bone.

How does smoking affect dental implants?

Smoking patients must be aware of and seriously consider the risks of smoking for dental implants.

Smokers have a 90% higher risk than non-smokers that implants will fail.

It is absolutely forbidden to smoke after the operation, because smoking causes delayed healing and failure of the implants.

How do diabetics react in the case of implants?

Approximately 5-6% of the population suffers from diabetes, a disease which, in addition to the already known problems, causes delayed wound and implant healing. Diabetic patients who keep their disease under medical supervision and who regularly take their prescribed medications are treated in the same way as non-diabetic patients and therefore pose no risk.

For subjects with advanced diabetes, however, a specific protocol must be followed and also in this case, diabetes must absolutely not be considered a contraindication for dental implants.

Can implants be done during pregnancy?

There is no contraindication and no risk in doing implants during pregnancy.

From what age can dental implants be done?

Before the age of 17 it is contraindicated because the teeth and the bone are always changing and moving.

(photo) 19-year-old patient, born premature, with broken teeth, we underwent total rehabilitation of the arches with dental implants.

In what situation can implants not be done?

The only situation in which implants are prohibited concerns cases of malignant tumors of the mouth and bone.

What are specific dental implants?

1. Zygomatic implants: these are very long implants that are inserted into the zygomatic bone. This type of implant is very stable as it is anchored in one of the strongest bones of the skull. Usually 1-2 right implants and 1-2 left implants are needed.

2. Nasal implants: these are implants that are inserted into the nasopalatine canal which runs from the nasal cavity to the palate. Usually only one implant of a large diameter is placed.

3. Pterygoid implants: these are implants that are used in the posterior areas of the mouth. These types of implants are the most important and used because usually the bone is missing more in the area of ​​the molars. The bicortical anchorage, i.e. both in the alveolar bone and in the pterygoid bone, makes it one of the most stable implants.

4. Palatal implants: these are dental implants that are placed between the maxillary sinus and the palate, this area is practically the strongest. The place of the palatal root of the molars and premolars is usually used as a reference point.

How to determine if you need a fixed or semi-fixed prosthesis?

In cases where the bone loss is extreme and the distance between the two arches is more than 60 mm, a semi-fixed prosthesis, also called bar prosthesis or overdenture, is indicated for mechanical reasons. Usually 3-4 implants are needed for the upper arch and 2-3 for the lower one, which are inserted in the anterior area of ​​the arch.

Semi-fixed prostheses:

1. They are fixed in function: that is, when the patient talks, eats, rests, goes out and carries out all daily activities.

 2. They are mobile when they need to be cleaned, easily removed with a click mechanism.

Can dental implantology be considered cosmetic dentistry? 

Through dental implants it is possible to create works of a high aesthetic level. The implant is a structure made up of different compartments that imitate: tooth, root and crown, and the perfect harmony of these components leads to a very natural aesthetic result. It is important to underline that the aesthetics is not characterized only by the “white crown” but by its naturalness and the delimited contours of the gum. When total rehabilitation of the arches is performed on implants, all the tissues are replaced: teeth, gums and bone, and at the same time the support of the cheeks and lips is automatically improved, thus improving the features of the face.