Introduction:
Considerations by the implant dentist, the exclusion and inclusion criterion, and the outcome measures that determine the success or failure of the implant prosthesis. Dental patients often have great expectations, especially regarding the functional and esthetic outcomes post dental treatment. Patient satisfaction after replacing the edentulous area of the jaw holds vital importance to the dental surgeon, the prosthodontist, or the implant dentist to achieve effective or satisfying results for both doctor and patient.
What Are the Advantages of Immediate Rehabilitation?
Traditionally in dental implants, delayed loading or wait time longer than expected was seen more as an impediment (because the time taken for osseointegration of the dental implant varies from 3 to 6 months). However, in recent advances in modern-day implant dentistry, immediate rehabilitation holds crucial importance to the patient to allow them to return to their social life or working life as early as possible, despite the natural tooth loss or post-extraction.
What Are the Factors That Can Affect the Durability of Immediate Rehabilitation?
Though immediate rehabilitation after placement of dental implants would be widely preferred from doctor-patient perspectives, multiple factors impact the survival rates and long-term success of dental implants. The dentist knows that these factors cannot be ignored as clinical success in dental implants is purely proportional to the primary stability of the dental implant within the jaw bone. Any local or systemic cause or irritation or inflammation caused thus will not only lead to peri-implant bone resorption and result in bone loss consequentially. Bone loss can be of two types, horizontal or vertical bone resorption that affects the physiologic dimensions of the bone that impact the dental implant survival rates long term. Bone remodeling and operator tactility constitute the most critical factors, especially in immediate implant rehabilitation. Also, the dental surgeon or the implant dentist frequently makes it a point to follow up with the patient for regular dental checkups to understand and to help stabilize the dental implant during the first functional year after dental implant placement.
What Is the Procedure of Immediate Prosthetic Rehabilitation?
Informed consent should be obtained from the patient. Before dental implant placement, the dentist should complete accessory dental treatment protocols for all other teeth, including scaling, root planing, restorations, or periodontal therapy, if any. Dental implant placement is performed under local anesthesia with preoperative antibiotic prophylaxis (Amoxicillin and Clavulanic acid are given usually). After the total or partial thickness mucoperiosteal flap elevation and ridge preservation procedures, some implant dentists also underprepared the implant sites to increase the primary stability. Absorbent sutures are placed immediately for fixed screw prostheses. Dexamethasone can be injected up to 4 mg to reduce swelling and infection in the vestibular areas, if any, to minimize effects due to immediate rehabilitation and to facilitate proper healing. Ketorolac analgesic can be prescribed for three to five days, and specific oral hygiene protocols like rinsing the mouth twice daily with Chlorhexidine gluconate 0.2 % can be suggested from the day after implant surgery. Recall appointments are scheduled after 7 to 10 days, two weeks, followed by two, three, six, and 12 months to evaluate and assess or maintain implant stability (during the functional year of the prosthesis).
What Factors Affect Prosthetic Rehabilitation?
Inclusion Criterion:
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Patients with an unfavorable prognosis for dental implants are either due to systemic or local disease factors.
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Patients older than 18 years who have reasonable implant success rates.
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Patients with no relevant medical history or without any immunocompromised conditions.
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Patients who demand an immediate fixed prosthesis owing to their work nature or people with esthetic concerns.
Exclusion Criterion:
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Patients who require bone augmentation procedures before dental implant placement or bone grafts.
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Patients with general contraindications to dental implant surgery (by age, systemic disease, and local causes).
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Irradiations to head and neck areas.
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Patients who have a history or are previously or currently undergoing treatment for intravenous Bisphosphonate therapies.
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Individuals who are involved in substance or drug abuse.
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Immunocompromised patients or individuals, genetic disorders, etc.
What Is the Difference Between Ehc and Ihc Implant?
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External hexagon Connection Implants (EHC) - These implants were also called Branemark implants. These were used over decades by experienced dental surgeons in full arch rehabilitation through implants. However, the drawback of external hexagon connection implants is many that allows scope for prosthesis failure, which includes:
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Micromovements can occur due to high occlusal loads.
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"Fatigue fracture" phenomenon that occurs due to high-stress forces or inability to tolerate heavy masticatory forces.
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Abutment screw loosening.
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Bacterial contamination or leakage can be caused when the implant is rendered unstable or prone to higher stress (resulting in the ill effects mentioned above, eventually causing bacterial ingress, causing peri-implant disease, and bone loss ).
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Internal Hexagonal Connection Implants (IHC) - These implants have been developed over the recent decades after much research by implant dentists, and research indicates not only a more stable connection when the internal hexagonal connection is used but also case reports and documentation of patients on IHC implants show uniform stress distribution throughout the implant body. This, of course, as we have understood now, will distribute stress uniformly and leads to maintenance of implant stability and marginal bone preservation. Bacterial leakage or ingress is also considerably lessened in IHC implants. The breakthrough in implant dentistry is the introduction of " Platform switching " which aims to use abutments with a smaller diameter in IHC implants. However, despite the advantage offered by internal hexagonal connection implants, most implant dentists or researchers are varied in their opinions about the long-term clinical success and survival rates in full or partial arch immediately loaded dental rehabilitations.
What Are the Factors Causing Implant Failure?
The dental implant is considered a failure in case of consequences post procedure such as mobility or infection, pain, swelling, suppuration, or fracture of the prosthesis framework.
Conclusion:
To conclude, immediate prosthetic rehabilitation post dental implants though promising and ideally indicated to suit patient expectations, needs thorough preoperative control, operator tactility, ideal choosing of connection, and follow-ups to prevent hostile outcome measures.
