We talk about Implantology, but, how does the surgery develop in order to insert implants (" Fixtures") ? and how long after can the artificial teeth (supported by them) be placed?
After an accurate preliminary diagnostic exam, with the study of the x-rays and the casts obtained by the impressions taken in the patient' s mouth, and with a clinical exam to exclude impediments to the use of implants, we can insert them.
This is an out-patient treatment, with local anestesia, it is not painful and goes on about 1 – 1 ½ hours, depending on the grade of difficulty and the number of implants to insert.
At the end of the surgery a suture is usually taken and the patient can go home, prescribing him antibiotics, anti- inflammatories, mouth rinses with chlorexidine and applying an ice bag on his face.
After 1 – 2 weeks it is possibile to take off the suture, then the patient comes back to our office just to be checked out.
After a variable time from 3 to 6 months, we proceed with the second "prosthetic" step, re-opening the implantary sites, taking the impressions and manufacturing the earlier planned prosthesis.
It is necessari to wait about 3 -6 months without loading the implants, in order to allow the developement of a direct and intimate connection of the surface of the fixture with the bone, a kind of "bone corn", without the interposition of any connective tissue. This phenomen is called "Osteointegration".
Recent studies demonstrated how the implants could be also loaded immediately after insertion, in particolar situations (Immediate loading).
This is possible when the quantity and quality of the bone allow to insert a number of fixtures having immediately a good "primary" stability, and when these implants have their surface treated to be "bio-active", that is able to stimulate the bone growth.
So, for example, if an arch of the mouth is completely lacking in teeth, it is possible to perform the "Immediate loading" applying a fixed circular bridge in 24 -48 hours, more easily in the lower jaw, where the quality of the bone is better, because it is more more dense and solid, and where the dimentions allow to insert at least 5 -6 fixtures 13 -14 mm. long.
Obviously, where some of these requirements are missing, other ones are needed to substitute them, so, if we speak about an edentulous upper jaw, with a worse bone quality (for instance, more spongy), we need to insert a larger number of implants (7 -8) or they must be longer, in order to have a better immediate stability.
With the view to perform the Immediate loading, an excellent organisation is needed.
The dental office and the technician laboratory must dedicate a whole dayto the patient; in fact, the same morning after the surgery, the dentist must immediately take the impressions, the technician must personalize the abutements of the implants and build the bridge on them.
The patient comes back in the afternoon, or maximum the day after, to fix the prosthesis and, as it is not possible to check it out, everything must accurately be planned before.
The advantages of this method are intuitive: the patient can immediately have his relation life again, speak, smile and chew too, not waiting months eating semiliquide food and not suffering the trouble ( and the cost) of a provisional prosthesis wich is often mobile and painful.
Another situation where the Immediate loading is indicated is when single crowns or bridges on implants are planned in anterior areas, where a few teeth are missing and aesthetics is important. Here the procedure is easier, if the bone is preserved, and the advantages are easily intelligibile.