Aldo Vangjeli
O.M.F Surgeon, Albania
Biography
Abstract
Before any surgical intervention with the purpose of setting dental implants, the implantologist should not only do a general analysis of the case but first and most important thing is to do the detailed study of the region or area over which the intervention will take place. So, the implant-prosthetic rehabilitation requires that alveolar crusts must have enough bone in good quality and on which we can work. But this is not always possible. Different factors influence this inadequacy which in some cases is an obstacle that should be treated seriously by the physician.
Purpose: The main focus of this paper is the detailed analysis of the factors causing bone atrophy and not only the specification of it according to the jaws but also the detailed study by specific regions as well. Alternative methods to overcome obstacles whether or not surgical will not be treated only theoretically but will also be illustrated with clinical cases that have been performed after patients' consensus. Dental elements loss causes artificial shortage of biomechanical bone stimulation, which is of utmost importance in maintaining its physiological volume. Such loss results in bone absorption which may be hidden in the first 6 months, but then it continues with a bone loss of about 0.1 mm per year.
In the upper jaw, the absence of teeth causes the reduction of the bone thickness between the maxillary sinus and the alveolar ridge up to 1mm. In such situations, the maxillary sinus pressure pushes the bone floor down. By the other hand, the present inflammation causes a generalized or localized thickening of the sinus membrane. Surgical maxillary sinus floor elevating is one the pre-implant reconstructive surgical techniques. When this technique is correctly done it does not significantly affect the physiology of maxillary sinus.One of the auxiliary ways for implant placement in the alveolar ridges with horizontal dimension loss is the osteotomy of the alveolar process (split ridge). The alveolar split ridge method has advantages over the grafting, because it significantly reduces the time of the treatment. Also bone compression and increasing trabecular density are other advantages of this technique. Intercortical space filling is done with autograft, allograft or xenograft. In generally, these surgical auxiliary techniques are used during interventions for atrophic bone implantation.
Material and Method: In this paper I have used my personal theoretical-practical experience in the surgical treatment of patients who had undergone atrophic bone surgery for a period of several years. In this paper we will present some clinical cases treated at our clinic. Clinica case:The MS 50-year-old patient appears in our clinic after a failed implant surgery on both jaws. The panoramic graph gives this view. It is snapped into the upper jaw and after its prosthesis the control chart gives this view. The patient rightly needs to replenish the lower jaw. Bone atrophy is expressed both in length and width. There is a correctional intervention that is performed using the autologous bone graft, while the beneficial membrane is also used from enriched plasma.
Results: The results of the interventions were not only positive but the success limits were equal to the placement of simple implants. We cannot fail to mention that in all cases horizontal augmentation and post-stratigraphic implant management is accomplished through directed regeneration of the bone (GBR - guided bone regeneration). The main purpose of these procedures is to ensure long-term implant sustainability through successful and predictable bone regeneration with as few complications and additional surgical stages as possible.
Conclusion: The bone volume determines the individual evaluation criteria for the selection of the reconstructive technique that influences since in the beginning the selection of the best procedure for the morpho-functional restoring of soft and hard tissues and having the utmost care in aesthetics of implant prosthetics. The available techniques in implants surgeon hands, to obtain enough bone volume for implants’ positioning, are numerous and often sophisticated. Their implementing in implant surgery is the main duty of the doctor who takes over the surgical treatment of the patient.