+5.000

* There are several factors that affect the success rate of dental implants. System factor is one of them. Any general condition that affects bone turnover or wound healing must be carefully considered. It is from a recent review that smoking and radiation therapy (before or after implant placement) are associated with a higher risk of implant failure (35% and 70% respectively).

* With regard to other medical conditions, such as diabetes, it is increasingly clear that poor glycemic control is not an absolute contraindication to transplant therapy, provided that more time in integrating the implant.

* Other common systemic conditions that may alter treatment plan include: uncontrolled hypertension, oral anticoagulants, patients on bisphosphonate therapy, or patients with psychiatric conditions. In certain cases, the patient’s doctor’s permission is required.

Therefore, it is extremely important to complete a comprehensive evaluation before planning a dental implant.

It has been shown that smoking affects periodontitis by several mechanisms. Smoking has been shown to negatively affect oral microbial structure, suppress the immune system, and alter the microvascular environment, leading to disrupted healing. Smokers are more than twice as likely to fail a dental implant as non-smokers. In addition to lower implant success rates in smokers, rates of peri-implantitis (a condition synonymous with natural periodontitis) have also been shown to be high in smokers compared with non-smokers. no smoking.

Although smoking is not an absolute contraindication to dental implant therapy, it is the responsibility of the clinician to explain the higher risk of implant failure for patients who are current smokers.

The aesthetic analysis of a transplant patient should include the following elements:

• Patient smile line (high, medium and low) and gingival contour assessment;
• Assess gingival phenotype (thick or thin);
• Check tooth size and spatial distribution;
• Check the shape of the anatomical crown;
• Check the length and width ratio of the clinical crown;
• Examine the hard and soft tissue anatomy of the implant site;
• Bone height between bones (from radiographs);
• Assessment of occlusion (overjet and overbite)

In addition to a clinical oral examination that includes periodontal assessment, in some cases, adjunctive diagnostic evaluations such as imaging, wax-up, and clinical imaging are needed to support the diagnosis and/or treatment planning. Imaging typically includes: Peri-face radiographs, bitewing radiographs, panoramic radiographs, or CTCBs.

CTCB is more beneficial than radiography because it provides three-dimensional information about the proposed treatment site. It also allows the clinician to precisely determine the proximity of important anatomical structures [9]. Making a diagnostic wax-up allows the clinician to determine the need for additional site preparation, to inform the patient, and to provide surgical guidance [10]. Clinical imaging is very helpful in supporting the diagnosis, especially in pre-cosmetic cases to document the patient’s smile and also to discuss the case with colleagues.

The achievement of osseo integration is a biological concept that has been applied in implant dentistry. Long-term maintenance of bone around the integrative implant is critical to clinical success, and peri-implant bone remodeling plays an important role in long-term survival. It is believed that a number of factors may influence peri-implant bone resorption: local risk factors, surgery, implantation, post-rehabilitation, including systemic diseases, medications used to treatment of systemic diseases, genetics, chronic alcohol or drug use, and smoking status.

The widely accepted theory that physiological bone loss is related to the formation of a peri-implant biogap and should be understood as a physiological phenomenon. This is the shape of the bone where resorption occurs to accommodate soft tissue structures, with a longitudinal extension of 1.5 to 2 mm in the apical direction. Late or supplementary bone loss is characterized by marginal bone loss following bone fusion.

Various degrees of bone loss have been reported as acceptable. One study reported that gradual bone loss of 0.2 mm after the first year and ≤0.2 mm per year in subsequent years could be considered successful. Another study showed a bone loss of 2 mm between the time of installation and 5 years later. However, another, more recent study reported a 3 mm loss of bone crest for the abutment-implant interface after 5–20 years of operation. Although these studies considered tolerable bone loss up to 2 mm over the years. Furthermore, the relative importance of local and systemic factors in the development of alveolar bone resorption around sseointegrated dental implants remains controversial.

The impact of health risks on the outcome of transplant therapy is unclear, as there are several randomized controlled trials that assess health status as an indicator of risk. In principle, only patients with a physical condition according to the American Anesthesiology Society (ASA) criteria of class I (P1: a normal healthy patient) or II (P2: a patient with generalized disease) mild body) is eligible for an elective surgical procedure, such as a dental implant. The patient’s location, and surgical risks, should be weighed against the potential benefits of dental implants. For very serious and acute medical problems (ASA physical condition categories P3 to P6), calculating the risk of failure in affected subjects appears to be impossible because the Patients with such a condition almost never receive dental implants.

A recent publication states that elective dental treatment for patients classified as P4 or higher should ideally be deferred until the patient’s health is stable and improves to at least P3.

Systemic diseases can affect oral tissues by increasing their susceptibility to other diseases or interfering with the healing process. In addition, health conditions can be treated with medications or other therapies that can potentially affect the implantation of teeth and tissues.

A medically compromised patient may be described as a person whose physical or mental characteristics are distinct from those of the same age. In these types of patients, the risk of interactions between their disease and transplant surgery is higher, which means higher medical risks. A thorough and thorough medical examination will help not only to determine the specific measures that must be taken for a medically compromised patient, but also to perform an estimate of the patient’s risk. The system recommended by the ASA (American Association of Anesthesiologists) for dental patients is commonly used to determine patient risk. These classifications and medical history allow the dentist to identify systemic disease and the expected success rate in medically compromised patients who will be restored with dental implants. It seems that medical control of the disease is more important than the disease itself. This evidence demonstrates the need for personalized medical examinations.

To achieve and maintain successful integration over time, which is the goal and outcome of successful transplant therapy, the indications and contraindications must be carefully balanced. Therefore, the selection of the appropriate patient is a key issue in treatment planning.

Contraindications can be divided into local and systemic/medical. In a recent Consensus Conference, it was proposed to break down general/medical risk factors into two groups:

• Group 1 (very high risk). Patients with serious systemic diseases (rheumatoid arthritis, osteomalacia, osteoproliferative defects), immunocompromised patients (HIV, immunosuppressive drugs), drug addicts (alcohol) and disease non-compliance (psychological and mental disorders).
• Category 2 (significant risk). Patients with bone irradiation (radiotherapy), severe diabetes (especially type 1), severe bleeding disorders/bleeding trends (hemorrhage, drug-induced anticoagulation), and heavy smoking habits .

Other authors have recommended certain groups of patients or conditions as relative contraindications for dental implants [25]:

• children and adolescents
• epileptic patients
• a tendency to severe bleeding
• risk of endocarditis
• risk of osteonecrosis
• risk of heart attack.

Other reported relative contraindications include adolescence, aging, osteoporosis, smoking, diabetes, interleukin-1 genotype-positive, HIV-positive, cardiovascular disease, hypothyroidism, and comorbidity. Crohn’s [22].

In more recent studies, the following diseases and conditions have been examined for an increased risk of implant failure: scleroderma, Sjögren’s syndrome, neuropsychiatric disorders/Parkinson’s disease, lichen ruber planus / oral lichen planus, HIV infection, ectodermal dysplasia, long-term immunosuppression after organ transplantation, cardiovascular disease, Crohn’s disease, diabetes, osteoporosis, oral bisphosphonates, and radiation therapy use to Treatment of oral squamous cell carcinoma.

Recommended absolute contraindications for implant placement (serious and acute medical conditions for which implant therapy is always considered contraindicated) include: acute infection, severe bronchitis , emphysema, severe anemia, uncontrolled diabetes, uncontrolled hypertension, abnormal liver function, nephritis, severe mental illness, conditions at risk of major bleeding, endocarditis myocardial infarction, recent myocardial infarction and cerebrovascular accident, heart valve transplantation or surgery, deep immunosuppression, aggressive treatment of malignancy, drug abuse, and intravenous bisphosphonate use. However, there is little or no evidence to support most of these conditions.

The overall success of implant placement and restoration depends on careful patient selection and a comprehensive treatment plan. If the patient is indeed a candidate for transplant therapy, a systematic process for specific evaluation should be followed. This chapter presents some of the most common anatomical structures that clinicians should consider when planning procedural implant therapy.

Evaluation of the appropriate anatomical site along with resuscitative propagation will optimize the final outcome. This involves visualization of the 

appearance and location of the final implant-assisted restoration. Not only is this important for future planning of the ideal implant placement, but it can also aid in the diagnosis of hard and soft tissue deficiencies prior to implant placement.

Joint diagnostic embryos will allow assessment of excess teeth, residual dentures, existing occlusion and available space in a favorable position to receive the implant.

The use of slides and diagnostic waxes to determine anatomical comfort and danger zones is important during the initial planning process. This diagnostic wax-up will help determine the number and position of teeth to be replaced, implant placement, angle, relationship with remaining teeth and bite.

relationship with opposing dentistry. A turpentine slide can be prepared from finished diagnostic wax for use as radiographic and surgical slides.

Implant stability can now be assessed by a variety of tests, such as reverse torque, implant bone contact, micro-mobility, and resonance frequency analysis (i.e. injury). implant stability number or ISQ). Ostell device was developed in 1999 by Integration Diagnostics Ltd (Sweden). This method allows to evaluate the stability of the implant by measuring the frequency of vibrations of the implant on the bone. ISQs range from 0 to 100. Implants with an ISQ of 70–85 are considered very stable (acceptable), 65–70 are moderately stable (single-stage approach), and 60–65 is minimally stable (two-stage approach). The Osstell device can be used to assess baseline stability, postoperative follow-up stability, and to diagnose adverse effects of overload in the early stages. ISQ has been shown to provide a standard and predictable method for assessing biological changes in the relationship between bone and implant. Torque is the rotational friction between the implant and the bone and is usually measured in centimeters newtons. Torque describes the shear friction of the implant head in the bone as well as the friction between the implant surface in the bone. Seat torque is measured when the torque is fully plugged in, while reverse torque is used to test the friction between the implant and surrounding bone, but it carries the risk of negative effects. to the process of bone integration.

There is no doubt that dental implants have revolutionized tooth replacement therapies. During the past decades, implant therapy has evolved into a successful treatment for partial and total edema. Traditionally, to minimize implant failure, bone-integrated dental implants are inserted in a two-stage process. The implant sinks completely under the soft tissues and heals over a period of 3–4 months for the lower jaw and 6–8 months for the upper jaw.

Fundamentally implant stability and lack of micro-migration are considered to be two of the key factors required to achieve a predictable high success rate of an integrated dental implant.

In the early 1970s, based on the principle of self-association as described by Schroeder and colleagues. These histological studies in monkeys show that non-buried titanium implants achieve fixation in bone characterized by direct bony junction with exposed implant. Since then, different materials and surfaces have been tested for improved physical and biomechanical properties, biological principles, and ultimately clinical applications, with promising results. short and long term appointments.

Over the years, these observations with non-buried implants have been confirmed by numerous experimental studies. Longitudinal follow-up studies have also suggested that high early success rates can also be achieved using a single-stage approach.

With this approach, flaps are sutured around the polished neck of the implants, after placing them, avoiding the need for a second surgical intervention.

With a two-stage approach, the implants completely sink under the soft tissues once placed, and they heal over a period of 2 to 6 months. By using this method, the implant will not move during the healing process.

The two-stroke implant site is used to minimize micro-mobility during healing and the risk of unwanted biting force transfer to the healing bone at the implant surface (which can lead to soft tissue encapsulation) , and thus to increase the likelihood of successful bone integration.

However, two-stage surgical intervention (usually a minor one, unless soft tissue elevation is necessary) to connect the implant to the abutment holds the future restoration. In addition, after the second intervention, several weeks of healing are required for the soft tissues to stabilize around the trans-gingival abutent to allow for predictable esthetic outcomes.

When the one-stroke approach is used, flaps are sutured around the polished neck of the implant, avoiding the need for a second surgical intervention.

Alternatively, a one-stage technique can be achieved by immediately connecting a transiently healing abutment to a two-piece implant that protrudes through the soft tissue in a manner similar to a monolithic implant. Various controlled clinical trials comparing implants placed according to the oneversus two-stage procedure show that implants performed with the one-stroke approach can also achieve a high success rate.

The single-stage implant placement procedure offers several clinical advantages, such as avoidance of second-stage surgery, shorter overall healing and treatment times at reduced patient costs, crown ratio more favorable root-based and direct access to the shoulder at the soft tissue level, allowing a simple prosthetic approach with cementitious or screw-retained implants.

Several researchers have studied tissues beyond the implant margin in non-submersible and non-submerged implant systems and demonstrated that, regardless of the surgical installation procedure (one or two stages), the implant exhibited only a small amount of marginal bone loss radiographically, which also did not differ between the two single-stage and two-stage implantation protocols.

In addition, the degree of marginal bone after rehabilitation appeared to remain stable regardless of whether the implant was placed in a one- or two-stage surgical procedure.

These observations led to the conclusion that the surgical procedure did not affect the outcome of implant therapy and that there was no significant difference in the change in periimplant bone level between the two surgical procedures.

The time of extraction and Implant placement is classified as follows:

• Type 1, immediate implantation
• Type 2, early implant placement – 6–8 weeks after extraction to allow soft tissue healing on the extraction site
• Type 3, late implant placement – 3–4 months after tooth extraction
• Type 4, complete implant placement – usually more than 4 months of healing after extraction

Immediate implant placement is defined as the placement of an implant immediately after tooth extraction and as part of the same surgical procedure.

Teeth that are indicated for extraction and immediate implant placement are usually diagnosed as incurable for at least one of the following reasons: endodontic failure, internal and/or extrinsic root resorption, root fracture or deep tooth decay below the pulp. A tooth targeted for immediate implant placement should not present with any defects.

In practice, however, a tooth with an incurable diagnosis will often be related to compromised tooth anatomy.

Careful examination of the target tooth is important to ensure that immediate implant placement is indicated.

Immediate implantation site has been well documented, and predictive ability is often similar to that of traditional staged implantation.

However, when reviewing the literature and clinical practice, it is important to note that implant survival and the esthetic outcome of immediate implant placement in the esthetic area should be evaluated separately.

Incorrect implant selection, incorrect implant placement, unfavorable extraction cavity anatomy and surrounding soft tissue structures, and untested soft and hard tissue remodeling/regeneration can lead to to cosmetic complications.

According to the Osteology Consensus Report, transplantation leads to a high success rate. Indications related to single implant placements include molar positions which have limited indications for anatomical reasons and premolars as the most favorable position due to anatomical situation and aesthetic needs. low america. In addition, critical assessment of gum and bone structure, hard and soft tissues, and smile contour is essential for cosmetic implant placement.

A list of clinical indications and absolute/relative contraindications for immediate implant placement has been described.

For indications, many factors are involved in local and systemic health

of the patient include:

• Whole-body healthy patient,
• Enough soft tissue,
• Enough hard tissue,
• Face is intact
• Thick tissue.

Absolute contraindications include:

• Damaged systemic disease,
• Regarding the maxillary sinus,
• History of taking bisphosphonates,
• History of periodontal disease,
• No intact lip bones, and
• There is an active infection.
• Heavy smokers are relatively contraindicated for immediate implant placement.

Advantage:

• Preservation of soft tissue and bone structure.
• Reduce the number of dental appointments.
• Reduce the number of surgical procedures.
• Rapid recovery of the area at the implant site.
• Avoid raising the lid.
• Use all currently available bones.

Defect:

• Sensitive technique for the idea of implantation of three-dimensional spatial positioning.
• Increased risk of infection and other related failures.
• The lead is more difficult to achieve.
• Differences in implant morphology and socket preservation may affect initial stability.
• Primary stabilization is mainly performed in the apical region.
• Optimal cosmetic outcomes in patients with a thin profile can be unpredictable.

Bone regeneration/resorption after tooth extraction is very unpredictable. And placing the implant immediately into the extraction socket has little or no effect on alveolar bone resorption/regeneration. The literature includes reports of bilateral tissue volume loss, midface depression, and papillary height loss after immediate implant placement.

Bone grafting into the space between the implant body and the alveolar wall of the extraction socket has been shown to significantly reduce horizontal alveolar bone loss.

Various graft materials have been studied, including natural bone grafts, whole grafts and xenografts, and all have shown promising results.

The use of connective tissue grafts has also been shown to have a positive effect by increasing the soft tissue thickness and the degree of soft tissue increase.

The capless approach is a less invasive and less traumatic option for immediate implant placement. Immediate temporary and foundational transformation also has some positive effects on the final cosmetic outcome by reducing bilateral tissue volume loss, midface depression, and papillary height reduction.

Orthodontics prior to implant placement can immediately improve esthetic results.

The potential benefits of tooth extraction in orthodontics are:

• It increases the height and width of the parietal bone and gingival tissue covering, reducing the negative effects of alveolar resorption and resorption after tooth extraction.
• It reduces or minimizes the gap between the implant and the extraction socket.
• It enhances initial stability on the implant by growing alveolar bone outside the root apex; and
• It makes tooth extraction easier by loosening the teeth.