Immediate Prosthetic Rehabilitation in Implant Dentistry

Introduction:

Considerations by the implant dentist, the exclusion and inclusion criterion, and the outcome measures determine the implant prosthesis's success or failure. Dental patients often have great expectations, especially regarding the functional and esthetic outcomes post-dental treatment. Patient satisfaction after replacing the jaw's edentulous area is vital to the dental surgeon, the prosthodontist, or the implant dentist to achieve effective or satisfying results for both the doctor and the patient.

What Factors Affect the Choice of Loading?

The decision between instant and delayed loading is influenced by several factors. The most important factor is the patient's jawbone condition. Patients with adequate bone mass and quality are frequently excellent candidates for loading immediately.

Additional variables include the patient's general health, the implant's placement, and their capacity for healing. Aesthetic and lifestyle factors also come into play; some patients might desire immediate loading for more rapid aesthetic results.

The dentist's experience and comfort level with each procedure also influence the choice. To guarantee the implant's durability, immediate loading necessitates an exact surgical procedure, which not all dentists can perform.

What Are the Advantages of Immediate Rehabilitation?

Traditionally, in dental implants, delayed loading or waiting 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 implant dentistry, immediate rehabilitation holds crucial importance to the patient, allowing them to return to their social life or working life as early as possible, despite 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 a doctor-patient perspective, 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 of irritation or inflammation will thus not only lead to peri-implant bone resorption but also result in bone loss. Bone loss can be of two types: horizontal or vertical, which affects the physiologic dimensions of the bone and impacts 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 implant dentist frequently makes it a point to follow up with the patient for regular dental checkups to understand and help stabilize the dental implant during the first functional year after placement.

What Are the Factors That Affect the Loading Time in the Immediate Implant?

A few factors that may affect the capacity to load right away are

• Implant-related treatment regimens.

• Bone loading stresses.

• Surgical trauma.

Modeling and remodeling can change the cortical and trabecular components of alveolar and residual bone. Remodeling enables bone healing following injuries or allows the bone to react to its immediate surroundings.

Although the bone is often lamellar, woven bone may develop during healing. Lamellar and woven bone are the two primary forms of bone tissue typically seen surrounding a dental implant. Around a dental implant, the two primary forms of bone tissue are lamellar bone and woven bone. The most vital type of bone is lamellar bone, which is highly mineralized and organized. Woven bone is unorganized, immature, less calcified, more robust, and more flexible than other bone types. The rate at which woven bone forms can reach up to 60μm (micrometers) each day, while lamellar bone can form as low as 10μm per day.

What Is the Procedure of Immediate Prosthetic Rehabilitation?

The steps are as follows

• Informed consent should be obtained from the patient.

• Before placing dental implants, the dentist should complete accessory dental treatment protocols for all other teeth, including scaling, root planing, restorations, or periodontal therapy, if necessary.

• Dental implant placement is performed under local anesthesia with preoperative antibiotic prophylaxis (amoxicillin and clavulanic acid are usually given).

• 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 the effects of immediate rehabilitation and facilitate proper healing.

• Ketorolac analgesics can be prescribed for three to five days. Specific oral hygiene protocols, like rinsing the mouth twice daily with Chlchlorhexidineuconate (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 prosthesis's functional year).

What Factors Affect Prosthetic Rehabilitation?

Inclusion Criterion:

• Patients with an unfavorable prognosis for dental implants are either due to systemic or local disease factors.

• Patients older than 18 years who have reasonable implant success rates.

• Patients with no relevant medical history or without any immunocompromised conditions.

• Patients who demand an immediate fixed prosthesis owing to their work nature or people with esthetic concerns.

Exclusion Criterion:

• Patients who require bone augmentation procedures before dental implant placement or bone grafts.

• Patients with general contraindications to dental implant surgery (by age, systemic disease, and local causes).

• Irradiations to head and neck areas.

• Patients who have a history or are previously or currently undergoing treatment for intravenous bisphosphonate therapies.

• Individuals who are involved in substance or drug abuse.

• Immunocompromised patients or individuals, genetic disorders, etc.

What Is the Difference Between an EHC and an IHC Implant?

• External Hexagon Connection Implants (EHC) - These were also called Branemark implants. These were used over decades by experienced dental surgeons in full arch rehabilitation through implants. However, the drawbacks of external hexagon connection implants are many that allow scope for prosthesis failure, which include:

• Micromovements can occur due to high occlusal loads.

• "Fatigue fracture" is a phenomenon that occurs due to high-stress forces or inability to tolerate heavy masticatory forces.

• Abutment screw loosening.

• 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, peri-implant disease, and bone loss ).

• Internal Hexagonal Connection Implants (IHC) - These implants have been developed over the past few decades after much research by implant dentists. Research indicates not only a more stable connection when the internal hexagonal connection is used but also that case reports and documentation of patients on IHC implants show uniform stress distribution throughout the implant body.

What Are the Factors Causing Implant Failure?

The dental implant is considered a failure in the event of consequences post-procedure, such as

• Mobility.

• Infection.

• Pain.

• Swelling.

• Suppuration.

• Fracture of the prosthesis framework.

Conclusion:

Accurate diagnosis and case selection are necessary for implant placement planning to take place immediately. The different technologies at our disposal today can be used to accomplish adequate planning. However, it is crucial to keep in mind that any changes made to the position of the prosthesis during the planning process may compromise the outcome, changing the biomechanics, occlusion, and aesthetics. Planning will require a comprehensive clinical evaluation that includes an assessment of the interarch relationship, gingival morphology, smile line, gingival margin positions, and conditions of supporting tissue.