Crown on implant

Advantages

• • Aesthetic and durable solution to replace a missing or very damaged tooth;
  • The implant allows the chewing forces to be better distributed and, in this way, the adjacent teeth to be retained for a longer period of time, preventing them from moving into the vacant space;
  • The implant helps to slow the resorption of alveolar bone caused by the loss of a tooth. Indeed, when a tooth is no longer in the mouth, the part of the alveolar bone that held it back is no longer stimulated and it gradually deteriorates;
  • The two main components of an implant, the artificial crown and the implant itself, cannot be affected by dental caries;
  • The implant crown can be installed on both the maxilla and mandible;
  • Restores a good occlusion, which may have been affected by the loss of a tooth;
  • Does not involve dietary restrictions;
  • Allows to restore the phonetics, in case the latter could have been affected by the loss of a tooth;
  • Adjacent teeth do not need to be cut, unlike a bridge;

• The success rate of an implant-supported crown is very high;
• The intervention is simple and safe.

Risks and consequences of not treating

• Tilt of the neighboring teeth;
• Extrusion of the antagonistic teeth;
• Bone resorption;
• Gingival recession;
• Alteration of the masticatory function;
• Increased risk of dental caries due to additional spaces where food debris and bacteria can be stored.

Postoperative indications

Please note that these recommendations are provided for information purposes only and that the best recommendations are those of your dentist or specialist who performed the surgery.

The following is a list of the most common recommendations from practitioners:

• Take prescribed or recommended analgesics;
• Take the prescribed antibiotics;
• Do not eat or drink during the first 2 hours after surgery;
• Avoid drinking straw, spitting and smoking;
• Avoid touching the intervention site (with fingers or tongue);
• Apply ice in 20-minute periods every hour for 24 to 48 hours;
• Avoid brushing teeth near the wound for a few days;
• Avoid intense sporting activities as recommended;
• Avoid foods that are too acidic, very hot, salty or vinegar;
• In case of bleeding, apply a sterile compress to the wound or a moist tea bag and maintain pressure for 15 minutes. When lying down, keep your head elevated by adding an extra pillow;
• If they have been used, the stitches are fragile. Some are melting, some are not. It is necessary to be informed of the specific care according to each case. It should be noted that sutures often fall off by themselves. Do not pull on the wires, do not cut them;
• The recovery period following surgery varies from person to person depending on the complexity of the surgery and how the patient complies with post-operative advice;
• Allow about two days of rest following surgery. The swelling will usually peak during this period;
• The discomfort associated with surgery often occurs within the first five days.

Restrictions

Some patient conditions are contraindications to implantology surgery, as the complications that may occur can be serious or even fatal. Contraindications are classified into three categories:

• absolute contraindications: dental implants cannot be considered;
• relative contraindications: dental implants can only be considered after a specific problem has been solved;
• local contraindications: dental implants can be considered with additional precautions for mouth or jaw problems.

The following blocks present a non-exhaustive list of the most frequent absolute, relative and local contraindications. It includes information about the risks of placing dental implants in these conditions, as well as possible solutions. It should be noted that only a specialist can accurately assess a patient’s eligibility for implantology, based on information gathered during the initial consultation with the patient and known contraindications.

Absolute contraindications:

• Major allergies (more specifically to anaesthetics used during surgery)
  • Risks: Increased postoperative swelling, anaphylactic shock, death.
  • Solutions: Find an anesthetic that is tolerated by the patient, find an alternative to conventional dental implants.
• Patient’s early age
  • Risks: Insufficient space to insert the implant into the alveolar bone, insufficient space in the mouth for the artificial crown of the implant, resumption of the procedure when growth ends.
  • Solutions: Wait until the jaws have stopped growing, which can be at 17 or 18 years of age, and find an alternative to conventional dental implants.
• Patients with a condition requiring organ transplantation
  • Risks: Post-operative infection due to long-term treatment with anti-rejection drugs that suppress or slow down the immune system, failure of osseointegration.
  • Solutions: Find an alternative to conventional dental implants.
• Immunocompromising diseases such as AIDS or patients with weakened or suppressed immune systems
  • Risks: Failure of osseointegration, postoperative infection.
  • Solutions: Find an alternative to conventional dental implants.
• Osteoporosis and other bone diseases
  • Risks: Failure of osseointegration, premature loss of the implant, jaw fracture.
  • Solutions: Find an alternative to conventional dental implants.
• Evolving cancers
  • Note: This refers to cancers that are not in remission. Cancers that have been treated with biphosphonates or that have required radiotherapy treatments in the jaw area also have a contraindication.
  • Risks: Failure of osteointegration, postoperative infection, osteoradionecrosis, slower or altered healing.
  • Solutions: Cancers with radiotherapy: use rigorous asepsis during the procedure, under general anesthesia, and work with the radiotherapy team to find an alternative to conventional dental implants.
• Cardiovascular diseases (e. g. recent heart attack, valvulopathy, severe heart failure)
  • Risks: Death.
  • Solutions: Find an alternative to conventional dental implants.

Relative contraindications:

• Smoking, drug and alcohol abuse
  • Risks: Post-operative infection, much longer healing and healing time, more complex healing process, decreased effectiveness of the immune system required to fight gum and bone disease, failure of osseointegration.
  • Solutions: Stop smoking, drinking alcohol or consuming before the intervention, at least one week after the intervention and ideally throughout the recovery and even beyond.
• Pregnancy
  • Risks (for the fetus): use of local or general anesthesia, taking x-rays.
  • Solutions: Wait until after delivery to perform implant surgery.
• Poorly controlled or uncontrolled diabetes
  • Risks: Post-operative infection, development of periodontal or dental diseases, much longer healing and healing times.
  • Solutions: Control diabetes, use strict asepsis during surgery, take antibiotics before the procedure to minimize the risk of infection.
• Disease requiring anticoagulants to thin the blood
  • Risks: More heavy and uncontrollable bleeding (during and after surgery).
  • Solutions: Consult the doctor who prescribed the anticoagulants to find out if they can be stopped or modified before and during surgery, take extra precautions during the procedure to avoid bleeding.
• Autoimmune diseases (e. g. lupus, rheumatoid arthritis, etc.)
  • Risks: Post-operative infection, much longer healing and healing time.
  • Solutions: Take antibiotics before the procedure to minimize the risk of infection, use strict asepsis during the procedure.
• Some untreated psychiatric or psychological problems
  • Risks: Danger to the safety of the surgeon or patient during the procedure, patient dissatisfaction with the final result due to unrealistic expectations.
  • Solutions: Evaluate the psychiatric or psychological problem to determine if it can be controlled by medication (in consultation with the patient’s treating physician), find an alternative to conventional dental implants.
• Other diseases (e.g., severe sinusitis, seropositivity)
  • Risks: Post-operative infection, much longer healing and healing time.
  • Solutions: Wait for the disease to heal, as in the case of sinusitis, find an alternative to conventional dental implants.
• Lack of motivation of the patient to respect the treatment plan and post-operative follow-up
  • Risks: Failure of osseointegration, postoperative infection, much longer healing and healing time.
  • Solutions: Make the patient aware of the strict discipline necessary for successful dental implant placement, find an alternative to conventional dental implants.

Local contraindications:

• Bruxism (clenching or grinding of teeth
  • Risks: Premature wear of the artificial crown on the implant or of the implant itself, failure of osseointegration.
  • Solutions: Wear braces to prevent damage to teeth and implants at night, find an alternative to conventional dental implants.
• Unfavourable position of the lower alveolar nerve and other anatomical structures of the mandible
  • Risks: Loss of sensation (paresthesia or numbness) in various parts of the face, such as the lower lip and chin, if the lower alveolar nerve is affected during the procedure.
  • Solutions: Take extra precautions before installing an implant in the mandible with 3D X-rays and other measurement tools, find an alternative to conventional dental implants in the mandible.
• Unfavourable anatomy of the maxillary sinuses
  • Risks: Perforation of the maxillary sinuses when the implant is placed.
  • Solutions: Properly evaluate the position of the maxillary sinuses and take the necessary precautions to place dental implants in the maxilla, perform sinus elevation, find an alternative to conventional dental implants in the maxilla.
• Poor oral hygiene or infection of teeth adjacent to the implant site
  • Risks: Post-operative infection, much longer healing and healing time, more complex healing process, failure of osseointegration.
  • Solutions: Treat affected teeth before the procedure, treat existing dental infections, improve oral hygiene habits before the procedure.
• Lesions in the mouth (oral dermatosis)
  • Risks: Post-operative infection, much longer healing and healing time, more complex healing process.
  • Solutions: Treat the lesion before the procedure, use strict asepsis during the procedure.
• Dental malocclusion
  • Risks: Insufficient space to insert the implant into the alveolar bone, insufficient space in the mouth for the artificial crown of the implant due to teeth that have fallen into the edentulous space or an excessive eruption of antagonistic teeth in the edentulous space, premature wear of the artificial crown on the implant or the implant itself, damage to the roots of healthy teeth adjacent the implant.
  • Solutions: Do an orthodontic treatment before placing the implant.

*Orthodontic treatment is not a contraindication to dental implants. However, if a patient is considering the installation of dental implants in the presence of dental malocclusions, it is important to consult an orthodontist first. The orthodontist will be able to determine the best time to do the implantology treatment so as not to interfere with the orthodontic treatment, as a dental implant cannot be moved by any orthodontic movement. In addition, orthodontic treatment may, in some cases, prevent the need for dental implants. The patient will therefore benefit from consulting an orthodontist in the first place!

Alternative solutions

• Fixed bridge