When correct procedures are followed, basically every patient can receive implant treatment. However, risks of complications or dental implant failures rise with the number of negative parameters carried by the patient. Such parameters are for example bad hygiene, periodontitis, smoking, diabetes, ostheoporosis and many others. The more negative parameters the patient brings along to the dentist’s or dental implantologist’s office, the more complicated his/her treatment is and a more radical solution may be opted for (e. g. extraction of all affected teeth). However, reconstruction with the use of implants along with special implant and prothetic works is able to ensure excellent and stable functional and aesthetic results.
In public as well as among experts there are some often discussed contraindications which are necessary to be described:
A. Osteoporosis versus implant treatment
Osteoporosis is a disease with the main symptom being porous bone. This condition is not an obstacle for placing dental implants at all. The ability of osseointegration of the implant into ostheoporotic bone is absolutelly identical to the ability of healing the implant into healthy bone. From emergency surgery we know that the fracture of an ostheoporotic bone heals as well as that of a healthy bone. If the bone breaks again, this always happens in different region from the original fracture. This is due to the fact that completely healthy and solid bone union develops in the region of healing and it is actually not possible to identify ostheoporosis in this region anymore. A similar process of integration takes place in case of dental implants. The only essential condition is an experienced dental implantologist who masters specific surgical and implant techniques which are necessary for the application of the implant into the affected bone. The dental implantologist has to opt for a suitable shape and screw of the implant. Surface adjustement is also important as it must be suitable for porous bone; and last but not least we cannot omit bone preparation (e. g. bone spreading, bone condensig, special ways of augmentation etc.).
B. Diabetes versus implant treatment
If diabetes is compensated appropriately, no significant restriction in the area of implant dentistry exists. These patients are approached exactly the same way as healthy patients. In these patients, however, the importance of good quality dental hygiene must be stressed. It is inevitable to choose and suggest every patient such form of dental hygiene which will not only be effective but also comfortable for them. There are functional alternatives available also for ‘lazier‘ patients, e. i. such patients who do not consider the use of dental floss, single and interdental brushes convenient. For patients who certainly wish to fully take care of their ‘new‘ teeth, effective solutions such as water flosser or interdental brush in combination with highly effective chemical substances are suggested; and these are recommended to each patient individually.
C. Smoking versus implant treatment
If a smoker follows dental hygiene and does not have periodontitis, it is possible – under certain conditions – to perform implant treatment in such a patient. In this case, however, professional and individual approach of a dental implantologist is very important.
D. Pregnancy versus implant treatment
Since dental reconstruction, e. i. implant treatment is not an acute intervention in the majority of cases, it is generally not performed in pregnant women. On the other hand, if a situation when a dental implant intervention in a pregnant woman might be considered arises, it is possible to perform such treatment in the second trimester. This simple surgical intervention can be performed in this period of pregnancy if satisfactory health condition of the patient is guaranteed. However, as mentioned above, there must be an adequate reason. During the first and third trimesters such interventions are not performed in order not to endanger the health of the embryo or foetus.
Removal of implants
Removal of implants is indispensable only in a very low percentage of patients. Most often this intervention is a consequence of untreated peri-implantitis. Since patient’s own teeth can be affected by periodnotitis, implants can be affected by a similar disease – peri-implantitis . It’s an inflammatory disease which affects the surroundings of the implant and if not treated, it can gradually cause the loss of bone in which the implant is fixed.
However, early diagnostics and immediate treatment can prevent implant removals. In most patients peri-implantitis begins as the inflammation of the gum tissue closely surrounding the tooth neck, or the crown which is attached to the implant (peri-implant mucositis). In this stage peri-implant mucositis can be treated rather easily. But in case the inflammamtion progresses and affects deeper parts (contact spot implant/bone), the disease becomes more serious and requires consistent and thorough treatment. This must be initiated immediately after the identification of the disease and it is necessary to proceed individually.
In the treatment of peri-implantitis various devices as well as chemical substances are used, e. g. curettes, special ultrasound devices, Vector, ozone, special chemical agents, water flosser, ultrasound brushes, Rotadent, etc.
In a few cases inflammation in the area of the implant can cause damage in such an extent that conservative treatment is not possible. In such case it is necessary to perform surgical intervention where the implant surface is disclosed and cleaned with special agents which affect the implant surface mechanically, as well as chemically and physically. This method enables to remove all undesirable tissue, residues and microorganisms. The surroundings of the implant must be carefully treated too. We must reach such a condition where there is no tissue altered by inflammation left around the implant.
If bone loss, bone defect is too extensive it is necessary to substitute it with customized bone replacements. Thorough treatment with no inflammatory signs of the bone defect as well as its surrounding mucosa tissue is ensured with the help of augmentation materials having specific chemical, physical and biological characteristics.
When the dental implantologist exhausts all the above described procedures and the peri-implantitis disrupts the stability of the implant in a fatal way, only then it is inevitable to remove the implant. Removing a screw implant is usually a simple surgical intervention and in most cases it is not necessary to use a scalpel at all. A problem might arise if old and unsuitable types of implants, which cannot be removed without seriously destroying the surrounding bone, were implanted to the patient. (Note: Such case has never occured in the practice of Dr. Jurkovič, PhD. as he has been using state-of-the-art implant methods and systems when treating his patients.) In that case it is fundamental to inform the patient about the situation and offer alternatives of the subsequent treatment before the implant is removed. Significant attention must be taken into account when considering satisfaction of the patient and selection of such treatment procedure which will guarantee the patient full rehabilitation and functionality.