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Italian Academy of Osseointegration

WHAT IS IAO?

The Italian Academy of Osseointegration (IAO) is the result of the merging of two major dental scientific societies: the Italian Society of Oral Surgery and Implantology (SICOI) and the Italian Society of Osseointegration (SIO).
The aim of this Society is to spread a quality scientific message to dentists and help patients understand and recognize the value of implant-prosthetic treatments for oral cavity health. You can search for an Active Member (these are the leading and most experienced Italian implantologists), closest to your location, by clicking here.

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INFORMATION
AND INFORMED CONSENT

This cultural project, the pride of Prof. Guida's Presidency, was developed and realized during his Presidency of the Italian Society of Osseointegration (SIO), during the two-year period 2013-14. The project saw the involvement of other important institutional bodies.

The aim of the project was to produce a report that would allow patients to obtain adequate information on the implant-prosthetic treatment, and therefore be able to truly give an informed consent.

Since it is very timely, we hope that it can be increasingly used in the private-professional field by fellow dentists.

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MINISTERIAL
CLINICAL RECOMMENDATIONS

The clinical recommendations in odonto-stomatology published by the Ministry of Health have been prepared by experts in the dental disciplines and validated by a technical working Group coordinated by the Ministry of Health and representative of the main institutional, scientific and associative entities of the sector. Their main objective is to indicate the various therapeutic approaches, endorsed by scientific data, in such a way as to allow healthcare professionals to choose the best course for the patient's oral health needs. This also allows for a sharing of therapeutic goals between the dentist and the patient.

Clicking on the button below will link you to the ministerial site

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ANSWERS
TO YOUR QUESTIONS
ON DENTAL IMPLANTS

Dental implants are an important therapeutic option for many situations, ranging from the replacement of a single tooth to anchoring a mobile prosthesis.
Often, patients are not well-informed on implants.

This booklet tries to provide answers to the most frequent questions that patients ask.


INTRODUCTORY

QUESTIONS AND ANSWERS

  • WHAT IS A DENTAL IMPLANT?

    An implant is a screw, normally titanium, which is used to replace the root of a missing tooth. The implant is screwed into the maxillary bone where it will provide a valid support for a crown, a bridge, or another type of prosthesis, in order to replace one or more missing teeth.

  • WHAT IS OSSEOINTEGRATION?

    After implant insertion, the surrounding bone develops and adheres to the implant surface. This process of adhesion is called "osseointegration". When this does not occur or is lacking, the implant loses stability and is not successful.

  • WHAT ARE IMPLANTS USED FOR?

    Implants are used to replace one or more missing teeth, their function is to affix a crown, a bridge or a mobile prosthesis. The aim is to improve the oral health status, chewing ability and/or aesthetic appearance.

  • IS TITANIUM THE ONLY MATERIAL THAT CAN BE OSSEOINTEGRATED?

    Various materials can be osseointegrated, but the most used implants are made of pure titanium. Recently, metal-free implants of ceramic material (for example, zirconium oxide) have been introduced commercially, which may be an alternative to titanium, but long-term studies on their survival rate are not yet available.

  • WILL THE IMPLANTS FEEL DIFFERENT COMPARED TO NATURAL TEETH?

    Natural teeth are surrounded by the periodontal ligament which allows us to perceive the feeling of pressure when we are chewing. Implants are not surrounded by the periodontal ligament, so the pressure sensation may not be the same compared to natural teeth.

  • CAN DENTAL IMPLANTS HELP ME IMPROVE MY SMILE? WILL OUR OTHER PEOPLE KNOW THAT I HAVE DENTAL IMPLANTS?

    If you have lost one or more front teeth, dental implants are a great therapeutic option to help you improve your smile. In most cases, implant crowns have a very natural appearance, like real teeth. The implants bind to the bone and remain in a fixed position, allowing you to smile naturally and spontaneously so no one will notice that you have dental implants.

  • CAN THE IMPLANTS HELP ME TO PRESERVE MY NATURAL TEETH?

    Loss of one or more teeth in one part of the mouth can lead nearby teeth to shift. In general, our teeth tend to constantly move both to the front and to the other arch, unless they are held in place by something, normally the adjacent and opposite teeth. Moving teeth can cause differences in the gum height and profile, making the adjacent teeth more prone to periodontal disease and/or cavities. Teeth that have shifted can also negatively affect chewing, as well as the general appearance of your face and smile. Dental implants can replace missing teeth, and thus preserve the remaining teeth.

  • CAN I CHEW ON AN IMPLANT AS I DO ON MY NATURAL TEETH?

    Crowns on implants have a very natural feel, and in most cases feel similar to real teeth. Teeth on implants remain affixed in the bone and allow normal function and chewing. However, it must be noted that natural teeth are surrounded by the periodontal ligament, which gives the sensation of pressure during chewing and biting, while implants do not have a periodontal ligament, therefore the sensation of pressure may not be identical.


QUESTIONS AND ANSWERS ON

DIAGNOSIS

  • I AM ALLERGIC TO TITANIUM. CAN I STILL BE A CANDIDATE FOR INSERTION OF IMPLANTS?

    Dental implants are normally made of pure titanium. Titanium allergy is very rare and has been documented in very few cases. In case of major allergies it is however, possible to insert an implant of another material which will then be assimilated by the bone and can be osseointegrated.

  • CAN IMPLANTS BE INSERTED IN BOTH THE UPPER AND LOWER JAW? CAN TWO PROSTHESES ON IMPLANTS ENGAGE IN CHEWING WITHOUT RISKS, LIKE NATURAL TEETH?

    Implants can be inserted into both the upper and lower jaw. Teeth lost in both arches can be replaced with prostheses affixed on implants. Implants in the upper and lower jaw can easily engage in chewing, but the wear of crowns and bridges on implants is different from the wear of natural teeth. To minimize the possibility of damaging or losing implants it is important for the dentist to regularly check the chewing function.

  • I AM A PATIENT WITH PERIODONTAL DISEASE. CAN I ALSO BE CANDIDATE FOR IMPLANT TREATMENT?

    Yes, patients with periodontal disease can receive implants, but it is important that periodontal disease affecting the remaining natural teeth is adequately treated before implant insertion. It should also be noted that the risk of complications related to implant treatment appears to be slightly higher in patients with periodontal disease.

  • I LOST MY TEETH DUE TO THE PERIODONTAL DISEASE, CAN IMPLANTS STILL BE A TREATMENT OPTION?

    Yes, implants can still be a viable treatment option even if you have lost teeth due to periodontal disease, but it is important that periodontal disease involving the remaining teeth is treated.

  • CAN PERIODONTAL DISEASE AFFECT IMPLANTS?

    Periodontal disease affecting natural teeth can increase the risk of infection around implants. Therefore it must be treated before placement of the implants.

  • AM I A CANDIDATE FOR IMPLANT TREATMENT?

    Most people who are in good health, or have systemic diseases under control, are good candidates for implant treatment.

  • ARE THERE ANY CONTRAINDICATIONS TO IMPLANTS?

    There are rare contraindications to implants, but it is possible that you may not be a candidate for implant treatment if you are taking certain drugs or your general health is compromised.

  • I AM A DIABETIC. CAN I STILL BE A CANDIDATE FOR INSERTION OF IMPLANTS?

    Yes, diabetes is not a contraindication to implant treatment. In any case, diabetes must be well-managed before treatment is started. In addition, the active member of the IAO who will be treating you may prescribe antibiotics to avoid any risk of post-operative infection. Sometimes, your dentist will also recommend a longer healing period before affixing the prosthetic load.

  • I AM TAKING BIFOSPHONATES FOR OSTEOPOROSIS. CAN IMPLANTS STILL BE INSERTED?

    In many cases, implants can be inserted even if you are taking oral bisphosphonate therapy, as concluded by the International Consensus Conference. In contrast, intravenous bisphosphonate therapy is an absolute contraindication to any type of oral surgery.

  • I TAKE ANTICOAGULANT DRUGS. CAN I STILL BE A CANDIDATE FOR INSERTION OF IMPLANTS?

    Anticoagulant therapy is generally not a contraindication for simple oral surgery, including implant placement. More complex procedures, such as bone and soft tissue grafts, can still be performed after consultation and consent by the doctor, and possibly by temporarily suspending or modifying the therapy.

  • CAN IMPLANTS BE INSERTED DURING PREGNANCY?

    During pregnancy, oral surgery, including implant surgery, is not indicated, because some complications may arise and antibiotics and/or anti-inflammatory therapies may be necessary.

  • I HAVE CARDIOVASCULAR DISEASE. CAN IMPLANTS STILL BE INSERTED?

    There are only some absolute contraindications related to cardiovascular disease: for example, implant placement cannot be performed within six months of a heart attack. It is always advisable to view recent cardiology documentation before proceeding with planning of the procedure.

  • IF I HAVE THE OSTEOPOROSIS, CAN I STILL BE A CANDIDATE FOR THE INSERTION OF IMPLANTS?

    Yes, osteoporosis is not a contraindication to implant placement. Some scientific studies have compared implant survival rate in patients with and without osteoporosis, with findings of no significant differences. However, treatment with bisphosphonates should be considered when planning treatment.

  • I AM OVER 80 YEARS OLD. CAN IMPLANTS STILL BE INSERTED?

    Yes, if there are no general contraindications for oral surgery, implants can be inserted in patients over 80 years old. There is no increase in the failure rate in most cases.

  • I AM A TEENAGER AND I BROKE A TOOTH. CAN AN IMPLANT BE INSERTED?

    Dental implants are appropriate only once facial bones have completed their growth to achieve a better aesthetic and functional result. The IAO active member treating you will identify the best procedure to be implemented while it is not possible to insert the implants.

  • I HAVE HYPERTENSION, CAN I STILL RECEIVE IMPLANT SURGERY?

    Hypertension is a contraindication to implant surgery only if not compensated and not managed. A patient on antihypertensive drug treatment can undergo implant placement without any complications. The active IAO member who will be treating you will take care to communicate with the Cardiologist for planning of the procedure

  • I HAD A HEART ATTACK, CAN I STILL UNDERGO IMPLANT SURGERY?

    In patients that have experienced a heart attack, oral and implant surgery should be delayed 6 months after the acute phase. After a period of at least 6 months, in the absence of further systemic/local complications and with the consent of the Cardiologist, it is possible to proceed with the insertion of implants.

  • I HAD A STROKE, CAN I UNDERGO IMPLANT SURGERY?

    A stroke occurs when a brain artery becomes obstructed or damaged and breaks, resulting in different outcomes. Based on the extent of the event and the drug therapy administered, your IAO active member treating you will assess whether you are eligible for implant treatment.

  • CAN AN IMMUNODEPRESSED PATIENT UNDERGO IMPLANT SURGERY?

    Immunosuppression greatly increases the risk of post-operative infections, thus whether the patient is a candidate for implant surgery should be carefully assessed on a case-by-case basis. The IAO active member treating you will provide you with all the necessary information to safely face the surgery.

  • CAN A PATIENT UNDERGOING RADIO/CHEMOTHERAPY UNDERGO IMPLANT SURGERY?

    In a patient with a neoplasia in progress and undergoing radiation therapy and/or chemotherapy, dental implants are contraindicated for up to 2-3 months after treatment. It must also be noted that the use of radiation therapy at the head-neck level involves waiting at least 12 months from the end of the therapy, before being able to proceed with the insertion of implants.

  • IS IT NECESSARY TO PERFORM BLOOD TESTS BEFORE IMPLANT SURGERY? IF SO WHICH?

    The evaluation of some blood parameters is essential only in case of specific pathologies, such as diabetes, kidney and liver failure, infectious diseases, or administration of anticoagulants. The IAO active member treating you will indicate which tests are necessary based on your medical history.

  • WHICH RADIOGRAPHY TESTS MIGHT BE NECESSARY BEFORE THE INSERTION OF AN IMPLANT?

    It may be necessary to perform an orthopantomography or a CT scan. The orthopantomography (or panoramic radiograph) is a first stage test; if this should not be sufficient, it is possible to perform a CT scan, which provides more information on bone thickness and quality. Thanks to these tests it is possible to reduce operator risks and proceed to correctly perform the surgery. After insertion of the implant, it is always advisable to perform an intraoral control radiograph, to check its correct positioning.


QUESTIONS AND ANSWERS ON

SURGERY

  • IS THE INSERTION OF THE IMPLANTS PAINFUL? AND WILL I FEEL PAIN FOLLOWING SURGERY?

    No. Local anesthesia is performed before surgery, so that there is no unpleasant sensation during insertion. Any slight discomfort following the surgical phase can be kept under control with normal analgesic treatment.

  • ARE THERE ANY RISKS IN THE SURGICAL PROCEDURE FOR INSERTION OF THE IMPLANTS?

    As in all surgical procedures, there is a certain degree of risk, linked to numerous factors, including the area to be treated. Minor complications are generally transient and can be managed: hematoma, bleeding, swelling, and pain. There are a few major complications associated with implant surgery, but these events are very rare.

  • WHAT IS THE HEALING TIME AFTER INSERTION OF THE IMPLANTS?

    Normally, implants require a healing time between two to four months before a prosthesis can be affixed. Under some particular conditions, following well defined protocols, the prosthesis can be affixed to the implant at the same time that they are inserted. Such procedure is called immediate loading.

  • WHAT IS AN IMMEDIATE IMPLANT? WHAT IS AN IMMEDIATE LOAD?

    An immediate implant is a surgical procedure where the dental implant is positioned during the same session in which the tooth is extracted. Immediate loading is the term used in cases in which a crown is placed on the implant the same day (or in any case within 48 hours) in which the implant is inserted.

  • DURING THE PERIOD OF TREATMENT, CAN I CONTINUE TO DO THE SAME NORMAL ACTIVITIES WITHOUT ANY PROBLEMS?

    Yes, even if it is better to suspend sports for the first two weeks after surgery, particularly if it is very intense.

  • WHAT HAPPENS TO GUMS AND THE ALVEOLAR PROCESS WHEN A TOOTH IS MISSING?

    Immediately after the extraction of a tooth a blood clot forms in the alveolus, namely the space previously occupied by the root. In the following weeks, the blood vessels and the cells of the alveolar wall form new bone, filling the alveolus, and the soft tissue cells form the new gum, covering it; however, the healing process is normally associated with reabsorption and reduction of both bone and soft tissue. The amount of tissue lost depends on various factors, including individual biology and the degree of tissue trauma resulting from extraction.

  • CAN YOU PREVENT THE LOSS OF TISSUE FOLLOWING A DENTAL EXTRACTION?

    When possible, tissue loss following a dental extraction is minimized by limiting trauma to the bone and soft tissues and avoiding bone tissue removal during extraction. In some cases the empty alveolus may be filled with a bone graft immediately after extraction.

  • CAN RECEDING BONE BE REBUILT?

    Receding bone can be reconstructed through the placement of bone grafts. Autologous bone, meaning bone taken from a second surgical site of the same patient, or other types of bone grafting materials (substitutes), can be used. The amount of bone receded, the location of the bone defect, and the conditions of the overlying soft tissue, have an impact on the chosen material and technique.

  • I HAVE BEEN TOLD THAT I MUST UNDERGO A LIFTING OF THE MAXILLARY SINUS. WHAT DOES THIS MEAN?

    A sinus lift is a surgical procedure that raises the inside of the maxillary sinus and places bone graft material into which the implants will be inserted. A sinus lift is often necessary in the area of ​​the premolars and molars of the upper jaw since the height of the bone is reduced after tooth loss. Usually it is an outpatient intervention. In some cases, the implants can be positioned at the same time as the sinus lift procedure.

  • WHAT ARE THE ALTERNATIVES TO MAXILLARY SINUS LIFTING?

    Alternative approaches involve the use of short implants that can be placed in the residual bone below the sinus membrane. Another possibility is the use of angled implants placed in an anterior and posterior position with respect to the sinus membrane.

  • WHAT SHOULD I DO ON THE DAYS BEFORE INSERTION OF AN IMPLANT?

    The insertion of dental implants does not preclude the carrying out of any activity before surgery. During the days before surgery, the patient will be able to carry out any type of activity, without these affecting the success of the treatment. The patient's continuation of current drug treatment is essential; the IAO current member treating you will take care to interface with your health care provider if the suspension of drug treatment should become necessary.

  • WHAT SHOULD I DO ON THE DAYS AFTER INSERTION OF AN IMPLANT?

    The insertion of dental implants does not create any absolute debilitation of the patient, but there are some precautions to be taken into consideration; in the hours following the surgery it is necessary to rest, avoid exertion, or excessive physical activity. During the initial 24 h, it may be necessary to take analgesics and to use ice on the areas affected by the surgery, according to the indications of the IAO active member who performed the procedure. Starting on the second day, it is useful to rinse with Chlorhexidine-based mouthwashes.


QUESTIONS AND ANSWERS ON THE

PROSTHESIS

  • WHAT ARE THE TREATMENT OPTIONS FOR THE REPLACEMENT OF A SINGLE TOOTH?

    There are various possibilities to replace a single missing tooth, and not all involve the use of implants.

    An implant can be inserted in the space left by a single missing tooth, and subsequently, a crown can be attached to it.

    The teeth adjacent to the missing tooth can be involved: these are filed and used as support pillars for a bridge, which is then cemented on them.

  • WHAT ARE THE TREATMENT ALTERNATIVES FOR THE REPLACEMENT OF TWO OR MORE MISSING TEETH?

     There are various alternatives to replace two or more missing teeth and not all of them involve the use of implants.

    1. Implants can be inserted into the edentulous area (toothless), to which individual crowns or a bridge are subsequently affixed.
    2. The teeth adjacent to the lost teeth can be involved: depending on their condition and position, these can be filed and prepared as pillars to support a bridge.
    3. Another option to replace multiple missing teeth is a removable prosthesis with dental support, which is often uncomfortable and has the disadvantage of not being permanently affixed.
    4. A dental support bridge is not suitable if too many adjacent teeth are missing, thus, as an alternative, implants can be inserted and used to support a permanent bridge, or a removable prosthesis.
  • WHAT ARE THE TREATMENT ALTERNATIVES FOR THE REPLACEMENT OF ALL THE TEETH?

    Missing teeth can be replaced in various ways:

    1. with a removable prosthesis supported by two or more implants
    2. with a permanent prosthesis, supported by four or more implants
    3. with a removable prosthesis with a mucous membrane support, without any type of anchoring
  • WHAT ARE THE ADVANTAGES OF REPLACING MISSING TEETH WITH IMPLANTS?
    1. The permanent prostheses supported by implants normally ensure the same comfort and feeling as natural teeth.
    2. A removable prosthesis that replaces one or more teeth can still provide an excellent level of comfort, especially if stably affixed on the implants.
  • WHAT MATERIALS ARE USED FOR PROSTHESIS ON IMPLANTS?

    Once the implant has been inserted, a restoration will be placed on it (a crown, a bridge or a removable prosthesis). Mobile prostheses are normally made of resin. Fixed restorations (crowns and bridges) may have a ceramic-coated metal core, or may be made entirely of high-strength ceramic material. Both cases ensure an excellent aesthetic and functional result.

  • WILL I HAVE A PROVISIONAL CROWN, A BRIDGE OR A REMOVABLE PROSTHESIS DURING THE HEALING PHASE OF THE IMPLANTS?

    Yes, in most cases a temporary crown or a bridge can be attached to the implants during the healing period. A treatment alternative may be a temporary removable prosthesis.

  • WILL THE PROSTHESIS BE SCREWED OR CEMENTED?

    Both techniques are widely used and effective and each has advantages and disadvantages: your IAO active member treating you will choose the most appropriate technique for your case.

  • WILL THE PROSTHESIS BE PERMANENT OR REMOVABLE?

    Both permanent and removable implant prostheses work well. The removable prosthesis supported by implants are normally easier to clean because they can be easily engaged and disengaged by the patient and are normally less expensive. In the event that significant bone receding has occurred, these can restore speech and facial profiles effectively without the need for additional surgical procedures. Permanent prostheses with an implant support are the best solution in many cases; most people prefer to have a permanent restoration that does not have to be removed, although this type of restoration is harder to clean and more expensive.

  • MY DENTIST TOLD ME THAT THE IMPLANT SUPPORTED PROSTHESIS WILL ALSO HAVE AN ARTIFICIAL GUM PART. IS THIS CORRECT?

    Yes, in some cases it is necessary to add an artificial gum part to compensate for anatomical and aesthetic defects due to the loss of hard and soft tissue resulting from the extraction of the natural tooth.


QUESTIONS AND ANSWERS ON

MAINTENANCE

  • WHAT ARE IMPLANT PATHOLOGIES?

    Implants can be affected by infections, called peri-implantitis, which are often treated as periodontal disease that affects the remaining teeth. The initial inflammation affecting the gum around the implant is called peri-implant mucositis, and can be reversible if appropriate treatment is established. If the inflammation of the soft tissue is accompanied by loss of bone around the implant, a peri-implantitis is established. This condition must be treated by your IAO Active Member and his/her team: surgery is often necessary to restore healthy conditions.

  • HOW LONG DO THE IMPLANTS LAST?

    The implants have a high survival rate. The most recent studies indicate that 90% of the implants placed in past years are still functionally valid today. Proper long-term oral hygiene and regular checks by your dentist are essential for long-term implant success.

  • WHAT ARE THE POSSIBLE COMPLICATIONS THAT CAN OCCUR WITH IMPLANTS?

    Implants can face some complications, which can be managed by the reference dentist.

    1. Loss of bone: partial bone loss may occur around the implant. Regular checks from your implantology dentist can avoid and treat major bone receding.
    2. Infection: infections around the implants are normally caused by poor oral hygiene. To prevent infections, implants should be periodically subjected to professional cleaning by your dentist or hygienist. Proper home oral hygiene twice a day is essential. If you are a patient with periodontal disease, you should also follow a periodontal maintenance program.
    3. Implant Failure: An implant may be lost due to multiple causes including infections or fractures. Sometimes osseointegration does not occur. In many cases it may still be possible to replace the failed implant with a new one.
    4. Fracture of the implant: fractures of the implant occur rarely (in less than 1% of cases). This type of complication can occur more easily in patients with parafunctional activity (bruxism or tooth grinding).
    5. Complications related to the prosthesis: ceramic crowns or permanent bridges on implants can break. Small chipping of ceramic is more frequent on implants than on natural teeth due to the lack of periodontal ligament, and the reduced ability to absorb pressure shocks. Fractures of crowns, bridges, and prosthetic screws, rarely occur. This type of complication is more frequent in patients with parafunctional activity (bruxism or tooth grinding).
  • HOW DO I TO CLEAN MY DENTAL IMPLANTS?

    Dental implants are cleaned in the same manner as natural teeth: it is very important to clean between one implant and another, or between the implant and the adjacent teeth using special interdental brushes jointly with dental floss.

  • I MUST UNDERGO TREATMENT FOR PERIODONTAL DISEASE AFFECTING MY NATURAL TEETH, SHOULD THIS TREATMENT ALSO INVOLVE THE IMPLANTS?

    It is important to check the implants and soft tissues around them. Periodontal disease patients have a greater risk of developing implant-related complications. Treatment for periodontal disease must be immediate, and must also involve peri-implant tissues if affected by inflammation.

  • AFTER THE IMPLANT TREATMENT, HOW OFTEN MUST I GO TO MY DENTIST FOR A TOOTH CLEANING?

    Your IAO Active Member will put you on a maintenance program that is appropriate for your needs: a check-up is recommended every six months, but in case of problems, your IAO Active Member could reduce the time interval between check-ups.

  • DOES CIGARETTE SMOKE INFLUENCE THE PROBABILITY OF SUCCESS OF THE IMPLANT TREATMENT?

    Smoking increases the risk of implant-related complications, as well as increasing the risk of developing periodontal disease around natural teeth. However, implants can also be inserted in most smoking patients, but it is recommended to stop smoking before the implant treatment in order to obtain better results.

  • DOES SMOKING INFLUENCE THE LOSS OF BONE AROUND THE IMPLANTS AND NATURAL TEETH?

    Smoking appears to increase the risk of inflammation and bone loss around implants. Therefore, quitting smoking is an important step in obtaining a good state of oral health.

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