Dentistry: Implantology – current techniques |19 July 2021

In the following interview, Seychelles NATION talks to Stefano Rosso, owner and director of ITALDENT dental clinic in Seychelles who shares with us his knowledge about dental implantology as well as the current techniques used when it is not possible to place implants due to an insufficient quantity of bone.

Seychelles NATION: What is dental implantology?

Stefano Rosso: Implantology is a branch of dentistry that deals with replacing one or more teeth in the maxillary and mandibular arches where they are missing, by grafting titanium structures (usually screws).

The procedure consists of opening the gum after anesthesia. Subsequently, the implant site is created with special drills. At this point, the implant is placed, which is a titanium screw.

There are different sizes of these screws, both in length and in width, depending on the amount of bone available in height or width. The implant screw is entirely hollow and threaded, later we will see why.

At this point, a screw cap is placed in the implant, then the gum is closed with sutures and it is allowed to heal.

After about four months, the cap is removed and a metal pin screwed into the implant (abutment) is placed. Finally, you can proceed to place the crown. The work is thus finished.

Seychelles NATION: You mentioned that it is not always possible to place implants as a sufficient quantity of bone is not always available. Tell us more about this.

Stefano Rosso: In fact after the loss of teeth, the bone of the dental arches tends to atrophy to the point that it is no longer possible to graft implants.

Until a few years ago, implantology was resolved here and it was not possible to put fixed teeth where the bone was not sufficient and it was necessary to resort to removable prostheses. Now, however, there are some surgical techniques that allow to reconstruct the lost bone.

Sinus lift

This is a technique that involves the upper jaw in the posterior region, corresponding to the premolars and molars.

In this case, under anesthesia, after opening the gum, a vestibular bone window is opened, the internal mucosa of the maxillary sinus is detached and a mixture of synthetic bone and the patient's own bone is placed inside the breast, in order to obtain a minimum height of 10-12 mm. At this point it is possible to place the implants. Finally, the operating site is closed.

This technique allows to graft implants where normally there would be no part of the paranasal cavities.

In this case, it is necessary to wait a minimum period of six months so that the bone graft and the implants are strengthened. After this period, it will be possible to proceed with the patient's prosthesis using ceramic crowns.

Bone regeneration

In some cases the bone may be sufficient in height but not in width, so after having done the anesthesia, the site is opened by ungluing the gum.

A mixture of the patient's own bone and synthetic bone is then grafted into the site to be reconstructed. Everything is then covered with a collagen membrane and finally the gum is closed. The collagen membrane serves to ensure that the new bone does not reabsorb during the healing phase.

After six months you can proceed with the implant following the standard rules.

Split crest

This is an alternative technique to the previous one. Also in this case we have little bone in width and much more in height, the classic bone called "knife blade".

This is a solution that guarantees an increase in thickness of up to 5mm. After the usual gingival opening we will proceed to the vertical and vestibular cut of the bone, and by means of special chisels we will proceed to the surgical separation of the bone crest in the vestibular (external) direction. Having gained a few millimetres, the implants can be grafted.

After a few months, as usual, the patient can be restored.

All on four

This is a very useful technique for cases of total edentulism. We proceed with the insertion of four implants in the superior or inferior facial regions. Two implants (the anterior ones) are placed straight. The two lateral implants, on the other hand, are placed at an angle between 30 and 40 degrees, so as not to touch sensitive anatomical areas such as the superior maxillary sinus or the inferior mandibular nerve.

After sometime, a metal and resin prosthetic structure is created with all the missing teeth and a part of false gum. This structure is screwed into the implants. In this way, a complete and fixed dental arch, both upper and lower, will be obtained.

It should be noted that in all these surgical techniques, a part of the synthetic bone and a part of the patient's own bone are used. Normally the bone is taken from the operative site, but in cases where a large quantity is needed, it can also be taken from the patient's hip or jaw.

For further information, contact ITALDENT:

-          Address: Sunshine House, Providence, Mahe

-          Telephone: 4 373 588 or 2 559 663

-          Email: rossostefano1@gmail.com

Image sources: Stefano Rosso

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