Nearly all implants are now made of titanium, a biocompatible material that prevents rejection by the organism. The most commonly used implants are those with threaded intra-osseous screws with a cylindrical/conical shape, in the majority of cases left submerged under the gum for a specific period depending on the site.
Once positioned in the patient's bone, the implants become part of the bone itself. In other words osteointegration takes place which will only become total if specific protocols are followed, otherwise partial fibrointegration and loss of the implant could occur.
Implantology methods involve two main surgical techniques:
- Two-stage: the first "submerged", that is, with the insertion of the implant and sub-mucosa suturing, followed by subsequent reopening of the mucosa after 2-6 months and screwing of the "dental pilaster" onto the implant;
- One-stage: trans-mucosa insertion of the implant with the head emerging so that it can either be left to heal (in 2-6 months) by means of bone integration, or immediately screwed in using the relative dental pilaster, either temporarily or permanently, depending on the specific case.
Implants have a virtually unlimited lifetime (the longest studies are 25 years old), provided daily maintenance is carried out. The greatest risks faced by implants are:
- peri-implantitis during the immediate post-op period, meaning inflammation or infection of the structure around the implant itself with subsequent lack of osteointegration;
- incorrect loading of the implants with unsuitable crowns or prostheses, giving rise to bone re-absorption over time, with bone loss as far as the deepest spires of the implant, and possible loss of the same.
In implantology, laser is extremely effective on mucositis and peri-implantitis. The main reason is the bactericidal action of laser emission sources such as the KTP (532 nm), Nd:YAG (10640 nm) and diode (810 or 980 nm) on common bacteria caused by infections of the oral cavity. When used with specific protocols and correct exposure times, the treatment is effective without causing thermal damage to the peri-implantar tissues or mechanical damage to the implants.
By constantly exploiting the antibacterial action of these lasers the alveolar site can be decontaminated before inserting the implant. This prevents the risk of peri-implantitis, as well as the swelling and inflammation that normally occur after surgery.
An additional application is the exposure of submerged implants with CO2 laser. The extremely accurate and bloodless circular cut makes it possible to take a satisfactory impression immediately after the operculectomy. To carry out this laser-assisted procedure there must be a band of keratinised mucosa to guarantee the mechanical stability of the peri-implantar mucosa.