IMPLANT INDICATIONS AND CONTRAINDICATIONS
- Introduction
Implant-supported prostheses are more comfortable and discreet than removable prostheses, and they also preserve the jawbone and keep existing teeth healthy. Fitting a bridge in particular requires cutting the adjacent teeth to support it, and therefore part of the enamel.
Another disadvantage is that the bone around the missing tooth will gradually resorb. Finally, compared to a removable prosthesis, there is better comfort, better functionality, and even, for the complete removable prosthesis, stability and normal chewing, as well as a feeling of belonging.
- Indications
- Lack of retention of an adjunct prosthesis
- Instability of an adjunct prosthesis
- Functional discomfort with removable prostheses
- Psychological refusal to wear an auxiliary prosthesis
- Parafunctional habits that compromise the stability of an adjunct prosthesis
- Inadequate location and number of residual pillars
- Absence of dental abutment to make a fixed prosthesis
- Single edentulism with healthy adjacent teeth
- Dental agenesis.
- Request for conservative therapy (refusal to mutilate healthy teeth)
- Need for orthodontic anchorage to achieve movements at the level of the same arch, interarch movements, movements of the bone bases
- Contraindications
Relative or absolute contraindications (CI) are related to conditions for which the surgical procedure is risky or interferes with tissue healing.
- Absolute contraindications
- Heart diseases at risk and at high risk of infective endocarditis.
- Recent heart attack.
- Severe heart failure.
- Congenital and acquired immunodeficiencies (AIDS)
- Patients treated with immunosuppressants or long-term corticosteroids.
- Conditions requiring or expected to require organ transplantation.
- Cancers in development.
Bone metabolism disorders: osteomalacia, Paget’s disease, osteogenesis imperfecta
- General contraindications relating to
- Diabetes: it increases the risk of impaired healing and postoperative infection. In insulin-dependent diabetics
(type 1) poorly balanced healing is more frequently impaired and infectious complications increased. However, if the patient is properly controlled and antibiotic prophylaxis is carried out, there is no particular operative risk.
- Pregnancy;
- Anticoagulant treatments: These patients should be treated with the usual precautions. Before any intervention, it is recommended to consult the therapist concerned in order to continue, stop or modify the treatment.
- Autoimmune diseases: Lupus, Rheumatoid arthritis, Scleroderma, etc. Long-term corticosteroids have been associated with impaired healing and an increased risk of postoperative infection. They can also disrupt bone metabolism. Asepsis must be rigorous and antibiotic prophylaxis will be necessary.
- Seropositivity: If implant placement represents a formal IC for patients with a declared AIDS stage, for patients with signs of immunodepression, particularly those whose LT4 is lowered, implant placement should be discussed and the benefit/risk ratio must be measured.
- Heavy smoking: Smoking is considered a factor in implant failure. Heavy smokers are at increased risk of impaired healing and bone metabolism.
- Psychiatric illnesses, psychological disorders. Certain psychiatric conditions may represent a CI for implant surgery.
- It is also very important to detect patients with unrealistic aesthetic demands. The higher the aesthetic demand, the more cooperative the patient must be and fully aware of the difficulty, constraints and duration of the treatment.
- Drug addicts, alcoholism. Treatments that require rigorous long-term maintenance should be avoided. These drugs also alter the healing process.
- Cervical-facial irradiation. The main danger is osteoradionecrosis. Irradiation causes early side effects on tissues and late effects on bone metabolism. Bone vascularization is impaired even after a single low-dose radiotherapy. Susceptibility to infection is increased. Healing is impaired especially in the mandibular bone because of its composite structure and reduced vascularization.
IMPLANT INDICATIONS AND CONTRAINDICATIONS
- Local contraindications
- Oral dermatoses:
candidiasis, eczema, lichen planus, leukoplakia, erosions must be treated before implant placement. - Periodontal diseases:
Periodontal pathogens present in natural teeth can colonize the peri-implant sulcus (Malmstrom, Fritz, Timmis, Van Dyke 1990).
The risk of developing peri-implant infections is higher in patients with periodontitis, especially aggressive forms. It will therefore be necessary to clean up the periodontium and stabilize the disease before considering implant treatment.
- Bruxism.
A patient who is a bruxomaniac or has lost his or her natural teeth through fracture should be considered at significant risk. The intensity of the forces developed during chewing as well as parafunctional habits can have significant repercussions on the stability of implant components. This risk is amplified if the occlusal forces are not distributed along the axis of the implant. Bruxism can therefore, in certain cases, constitute a definitive local contraindication to implant treatment. - Limited bone volumes and proximity of anatomical structures.
In the maxilla, in the presence of significant resorption, the proximity of the nasal fossae and sinuses can limit or even contraindicate the placement of implants. - In the mandible, the anatomical structures to avoid are the mental foramen and the mandibular canal. All these structures must be left at a distance of 2 mm from the drilling, but this value is empirical. However, with the progress of implant surface treatments that increase primary fixity and the improvement of bone grafting or sinus filling techniques, it is becoming possible to use increasingly shorter implants with limited bone volumes.
- Unfavorable occlusion:
The absence of posterior wedging or incisal guide must be corrected before considering implant therapy in order to harmoniously distribute occlusal contacts. - There must also be a sufficient intermaxillary distance or crest-antagonistic arch distance to provide adequate prosthetic space (6 mm seems to be a minimum).
- Presence of surrounding bone lesions:
This may include: Periodontal and endodontic
lesions of adjacent teeth. The presence of periapical granulomas and cysts. Sinus pathologies. Impacted teeth. - Poor or neglected oral hygiene.
IMPLANT INDICATIONS AND CONTRAINDICATIONSIMPLANT INDICATIONS AND CONTRAINDICATIONS
- conclusion
Despite these risks and incidents, the placement of dental implants carried out under good conditions by an experienced operator is a reliable, simple surgical procedure, with rare complications and most of the time without consequences.
However, it is a surgical procedure, and like any procedure, it is never trivial.
IMPLANT INDICATIONS AND CONTRAINDICATIONS
Baby teeth need to be taken care of to prevent future problems.
Periodontal disease can cause teeth to loosen.
Removable dentures restore chewing function.
In-office fluoride strengthens tooth enamel.
Yellowed teeth can be treated with professional whitening.
Dental abscesses often require antibiotic treatment.
An electric toothbrush cleans more effectively than a manual toothbrush.