Two steps can perform the treatment: surgical and prosthetic or aesthetics. In the first step (surgical), titanium dental implant is installed in the bone and covered by the gums. In the second step (or prosthetic aesthetics), after 2 to 4 months, there will be a small surgical access to the implant and are made molding procedures for manufacturing and installation of a dental prosthesis.

When we lose the teeth, the alveolar bone goes through a remodeling process and, consequently, a progressive bone loss occurs. Thus, the replacement with a dental implant is the way to stabilize and stop this continuous loss and to restore a satisfactory mastication and occlusion in the patient’s mouth, matching acceptable aesthetic patterns.

The oral rehabilitation with dental implants is carried out by a prosthodontist, who makes the planning, based on complementary exams, such as: x-ray and/or computed tomography to evaluate the amount of remaining bone, models of the mouth to determine the available space and blood tests to discard any systemic disturbances that may temporarily contraindicate the procedure.

For the placement of dental implant, it is necessary a minimum height and bone thickness that is compatible with the placement of implants of a good size, enabling the implant of a prosthetic crown with ideal aesthetic patterns.

When the bone reminiscent is not sufficient for the placement of dental implants, we have to use some alternative therapies, showing the advantages and disadvantages to our patients, besides the inherent risks of each procedure with its costs. Among the possibilities of treatment we can mention:

● Reconstruction of the bone tissue reabsorbed through bone grafting (Extra-oral, Intra-oral, Tissue Bank, Biomaterials and Tissue Engineering); See Video
● Placement of short Implants;
● Osteogenic Distraction (controlled bone expansion);
● Guided Bone Regeneration; See Video
● Zygomatic Implant.
There are several forms of oral rehabilitation with osteointegrated implants:

Conventional Implants

They are accomplished in two phases: in the first one (surgical phase) a microsurgery is carried out where implants are placed inside the bone. The stitches are removed in about 10 days. From this phase the implants are submerged in the bone tissue waiting from 2 to 6 months, then the physiologic process of osteointegration is finished. After the period of waiting, a microsurgery is done to expose the head of the implants and to go on with the placement of the healer or prosthetic pillar starting the laboratorial phase (prosthetic phase) which is the process of making prosthesis on implants that may last from 8 days to 2 months.

 

Dental implant in one surgical stage (without the second surgical access – single stage)

Another very viable alternative is to use implants with immediate loading aims to dramatically reduce the time of osseointegration of implants for 3 to 6 weeks. The company Straumann implants Switzerland, presenting research in implant dentistry since 1974, recent research has developed in order to optimize the surface implant, accelerating bone formation around it, increasing the contact area bone / implant and providing a osseointegration of implants greatly reduced time. This makes it possible to install the teeth over implants in a shorter time.

At the same time, the Straumann´s system single stage, prevent the second surgical access, providing faster, lesser morbidity and greater comfort to the patient.

Immediate loading dental implants

These are implants that are placed in selected clinical situations that allow the immediate placement of temporary aesthetics prosthesis (tooth) in resin, screwed in or cemented on the implants in a period of up to 72 hours. From that moment, the patient starts to chew properly with the prosthesis in order to readapt his/her mastication to that new oral apparatus and around 4 months a definitive prosthesis is made on the implants.

Not all the patients are eligible to this kind of oral rehabilitation, because some criteria are indispensable for the correct employment of the referred technique: excellent primary bone stability of the dental implants placed, good bone density and level of residual bone.

The advantages of the referred technique are: more comfort and the patient’s satisfaction, reduction of the time of treatment, restoration of an immediate aesthetics and mastication function and also there is no need for a surgery.

Treatment

Planning Implants with computer-based guidance

Nowadays, a new technique of oral rehabilitation is being introduced in the modern dentistry, it is the surgery guided by computer for the placement of dental implant. Such aid gives the procedure a high level of precision, allowing an excellent positioning of the implant, in relation to the prosthetic crowns, and this way leading to a better distribution of the masticatory loads and, consequently, to a longer life and more accurate prediction of the oral rehabilitation.

This procedure is applicable to specific clinical cases and with a precise diagnosis. It is a microsurgery, minimally invasive, without cuts or stitches, propitiating the patient, a greater comfort, not only during but also after the operation. There is only a few bleeding, minimum edema and lower infection risk, besides providing a fast tissue cicatrisation.

Having as base the function or immediate load, the guided surgery allows the patient to come back to his/her professional and social life faster, through the rehabilitation with temporary prostheses immediately after the surgery.
Types of Dental Implants

Implant of a tooth

Implanting a tooth consists three segments: the implant that substitutes the root of the tooth, the prosthetic pillar that will give support to the prosthetic crown and the prosthetic crown screwed in or cemented on the pillar. In special clinical situations we can install an implant with the placement of a prosthetic crown at the same time of the surgery (immediate load).

Short implants to avoid bone grafting

 

Implant of Multiple Teeth

The implants can support more mastication load than the natural roots of the teeth, consequently, several lost teeth can, sometimes, be substituted by a few implants. For instance, three lost teeth can be restored with two implants giving support to 3 dental crowns.

 

 

Totally Toothless

Branemark Protocol Type Prosthesis (fixed)

 

In cases where there is a loss of all the teeth of the jawbone and/or jaw, we can use from 4 to 6 implants, in the case of the jaw, giving support to 12 teeth, with a prosthesis screwed in the implants.

 

 

Overdenture Type Prosthesis (removable)

In the cases where there is a loss of all the teeth of the jawbone and/or jaw, there is a more economical alternative for rehabilitation with dental implant, it is the overdenture type prosthesis (removable) which is a prosthesis supported by the mucous membrane and retained in the implants that presents an unquestionable improvement in the stability and comfort of the total prosthesis in comparison with the conventional prosthesis. This rehabilitating option consists of 2 to 4 implants that are a support to a removable total prosthesis through systems of precise fitting in the base of the prosthesis.

Dental Implant is an artificial root that is implanted in the jawbone or jaw to guarantee the replacement of one or more lost teeth. Implants are made of a kind of metal called titanium that is accepted by the organism and does not cause rejection.