Modern procedures in dental implantology

Dentalna implantologija grana je dentalne medicine koja obuhvaća znanja iz područja oralne kirurgije, parodontologije i stomatološke protetike. Zauzima značajno mjesto u suvremenoj dentalnoj medicini. Naime, dentalni implantati sve češće su terapija izbora za nadoknadu izgubljenih zuba kod djelomično i potpuno bezubih pacijenata, ali i kod onih sa značajnim gubitkom koštanog tkiva zahvaljujući mogućnosti augmentacije kosti i regeneracije mekih tkiva. Cilj je implantoprotetske terapije nadomjestiti zube koji nedostaju sa svrhom uspostavljanja oralne funkcije i estetike. Preoperativna dijagnostika, planiranje terapije i operativni postupci u suvremenoj dentalnoj implantoprotetici povezani su s napretkom tehnologije. Digitalno trodimenzionalno CT/CBCT snimanje i upotreba CAD/CAM sustava naslijedili su analognu dvodimenzionalnu dijagnostiku te omogućili bolje razumijevanje složene prirode implantološke kirurgije i protetike. Postoji nekoliko tehnika ugradnje dentalnih implantata. Najzastupljenija je konvencionalna (tzv. free-hand) metoda. Razvojem računalne tehnologije u kliničku uporabu uvode se statička i navigacijski vođena (dinamička) tehnika postavljanja dentalnih implantata. Uspjeh implantološke terapije definiran je postignutom oseointegracijom, ispunjenim funkcionalnim i estetskim zahtjevima, izostankom intraoperativnih (ozljeda donjeg alveolarnog živca, perforacija dna nosne šupljine ili maksilarnog sinusa, kompresijska nekroza, krvarenje) i postoperativnih komplikacija (resorpcija marginalne kosti, lom dentalnog implantata, periimplantitis). To se ostvaruje detaljnim razmatranjem položaja suprastrukture tijekom preoperativnog planiranja i postizanjem preciznog postoperativnog položaja tijela dentalnog implantata. Nakon postavljanja dentalnog implantata potrebno je registrirati i analizirati njegov planirani i ostvareni položaj te kvantificirati postojeću pogrešku. Suvremeni postupci u dentalnoj implantologiji imaju svoje prednosti u usporedbi s konvencionalnom metodom, ali postoje i određeni nedostatci koji ukazuju na potrebu za njihovim razvojem kako bi se implementirali u širu kliničku praksu.Dental implantology is a branch of dental medicine that includes knowledge in the field of oral surgery, periodontology and dental prosthetics. It holds a significant place in modern dentistry. Dental implants have become a treatment option widely used for the replacement of lost teeth for partially and completely edentulous patients, but also in patients with severe bone loss due to the possibility of bone augmentation and soft tissue regeneration procedures. The goal of dental implant surgery is to replace missing teeth for the purpose of establishing oral function and aesthetics. Preoperative diagnostics, therapy planning, and surgical procedures in modern dental implant surgery are associated with advances in technology. Digital three-dimensional (3D) imaging using CT/CBCT and the use of CAD/CAM systems have inherited analog twodimensional diagnostics and provided a better understanding of the complex nature of implant surgery and prosthetics. There are several techniques for implantation of dental implants. The most common of these is the conventional (free-hand) method. With the development of computer technology, static and navigation-guided (dynamic) implant placement techniques are being introduced into clinical use. The success of implant therapy is defined by the achieved osseointegration, functional and aesthetic requirements, absence of intraoperative (inferior alveolar nerve injury, perforation of the nasal cavity or the floor of the maxillary sinus, compression necrosis, bleeding) and postoperative complications (bone marrow resorption, dental implant fracture, periimplantitis). This is accomplished by detailed consideration of the position of the suprastructure during preoperative planning and by achieving a precise postoperative position of the dental implant fixture. After placing the dental implant, it is necessary to register and analyze its planned and achieved position and quantify the error. Modern procedures in dental implantology have their advantages compared to the conventional method. Nevertheless, there are certain disadvantages that indicate the need for their development in order for them to be implemented in wider clinical practice