Implantología dental avanzada y estética facial. Advanced implantology & facial aesthetics. Dr. Pablo Furelos.
For thousand years the man has dreamt of a way to substitute his dental losses. This old dream started to come true in the second half of the 20th century and it consolidated in the 21st century.
Dental implants are used to replace dental losses, constituting the solid base that will stand the new tooth.
The design of the dental implant is based on the shape of the natural tooth.
A natural tooth has two main parts, a visible one which is placed above the gums and is called crown, and the hidden one which is firmly placed in the maxillary bone and called root.
Due to the high degree of perfection reached by the materials used to create the artificial crowns, it is almost impossible to distinguish a dental implant from a natural tooth.
The hidden part of the dental implant is screw-shaped and it functions as the root of the natural tooth, being anchored to the bone.
It is curious that despite the several unsuccessful attempts that have taken place, the most useful system to anchor the tooth is the one similar to a common carpentry screw.
Dental implants can be used to substitute a tooth, several pieces or all the teeth. When the implant is properly placed, it can last in a comfortable way for an unlimited period of time, and that is our main goal. Bear in mind that some people have them since 30 years ago.
Many materials have been tested for its use in dental implants but nowadays titanium is the only one accepted.
This material is able to perfectly integrate into the bone due to its characteristics, something that other materials lack.
Our body has been designed to reject any strange element which could invade us and we have several methods to detect them. Firstly there are some proteins that are foreign to our body which are quickly eliminated. This allows us to be protected against bacteria and viruses, but it is also responsible for the rejection of grafts from other people. Secondly, metallic ions produce some modifications in our proteins, which lead to a defensive response and the ejections of the metallic agent.
When materials come in contact with biological fluids, they capture the oxygen and then oxidize, going through a process of ionization. By this process the external atomic layer goes through some changes that affect its union to the next atomic layer, which gets oxidized as well, releasing more ionized material. Those ions are unstable. In order to re-establish its stability they join the guest’s proteins, creating a metal-protein that is erroneously recognised by the organism as an invasive antigen (bacterium or virus). This triggers a reaction of the immunologic system. Lymphocytes multiply to fight the supposed to be invader.
The so called stainless steel, which also oxidizes, consists on iron, 14% nickel, 18% chrome, 2% manganese and 3% molybdenum. There are too many ions.
Titanium doesn´t go through this process; its first layer oxidizes but its union to the second layer of atoms that remains stable. This means no ionized atom is detached, so it is invisible to our biological defence systems. Tissues, as for example bones, repair their wounds without perceiving the aggressor and establishing a solid union with this invisible object. Such a lucky fact allows human beings to use this metal for several medical purposes, as for example dental implants.
That is why the term rejection is not suitable, because the human body has no capacity to reject something that cannot be detected.The process of placing the dental implant is very easy. A hole in the bone is carefully made in order to accommodate it. Although in some occasions it is possible to immediately place the implant, the most common thing is to put a provisional tooth.
Once it has been placed, a process of healing stars; this is the osseointegration of the tooth. The osseous cells grow, establishing solid bridges with the metallic part. This process lasts 1-4 months.
In very little occasions there is a growing of tissue around the implant which is different from the bone, the so called fibrointegration. It is painless but it doesn´t allow the union with the bone, so it is necessary to remove it and place it again.
Once the integration takes place, the provisional tooth and the closing screw are removed and replaced by the definitive tooth, which normally joins the implant through an interior screw.
In order to understand the complexity of a dental implant, we can compare it with the construction of a building. The structure that overhangs would be the tooth’s crown, while the part that is buried, that is the foundations, would be the dental implant. The building won’t be able to remain without these foundations.
Placing the foundations properly requires a careful study of the terrain which can consist of different materials.
Sometimes it is very rocky.
In other occasions it is sandy.
Likewise, the bone where the dental implant is to be placed may consist of different densities.
In some occasions it is very dense and this is not favorable because the number of vital cells is lower; those cells are the ones in charge of creating solid osseous bridges.
In other occasions the density is low, so is the number of vital cells.
Usually, a radiologic study is done in order to determine the quality of the bone; other factors such as age and gender are also taken into account.
In some occasions a scan is needed. Fortunately it is not necessary in many cases, as these kind of clinical tests are very aggressive.
Having all this information, we will decide which is the most adequate implant according to its design, length and thickness; experience is very important when making this decision.
What happens when we try to construct a building in a place where there is a fault in the terrain?
We are able to create complex sloping foundation systems to avoid that area.
It would be more logical to level the terrain filling it as to make it solid enough and then create the foundations for the building.
When working on implantology, we normally have to face the same problem. There is a lack of bone in the place we have chosen as the suitable one for the implant; we can fill it with bone implant and compensate for the loss. In a short period of time, the organism´s restoring elements will form a bone with a density which will be similar or superior to the one surrounding the bone. By this way we will be able to accurately place the dental implant on its proper angle, something basic for the implant to last long.
Bear in mind that placing solid and effective foundations is basic to hold up the building. If this fails, everything will collapse independently of its beauty.
That is why our clinic has specialized in placing solid bases to avoid future problems. This is not an easy task, as placing warrantied dental implants in a responsible way entails prolonged training and years of experience.
This is known as learning wave, a correlation between the number of implants that have been done and the success rate, which is extensive when talking about complex dental implants.
We are so sure about the durability of our treatments that we can offer you a timeless commitment.