Analiza wybranych czynników klinicznych i anatomicznych w podjęciu decyzji: ząb czy implant. Przegląd piśmiennictwa. Część II. Aspekty implantologiczne i protetyczne

*Michał Szadowski¹, Andrzej Wojtowicz¹, Ewa Iwanicka-Grzegorek²

Summary
Implant treatment is a reliable and acceptable solution for the reconstruction of the lost tooth. It is caused by the development of implants and its high survival rate. The success of treatment depends on the regeneration of architecture and location of the lesion, tooth mobility, and other factors. This paper is intended to help in the creation of an treatment algorithm of teeth with uncertain prognosis with particular emphasis on implant and prosthetic aspect. In the process of decision-making one of the most important factors is a comprehensive approach to the treatment plan. Most of the failures of implantation is associated with impaired osseointegration and requires the removal of the implant. Prevention of periimplantitis is crucial for the result of implant rehabilitation. The main reason of periimplantitis is bacterial infection. Bacterial flora of the peri-implant sulcus in case of periimplantitis is similar to that seen in gingival crevices of adjacent teeth. In cases where an increased risk of implantation failure occurs, the best solution is to keep patients own teeth as long as possible to avoid of extraction and subsequent implantation. From the prosthetic point of view the main factor of tooth salvage or its extraction is the remaining amount of crown tissue and its strategic value in relation to the rest of the teeth and the patient’s expectations. When planning only a single crown on the tooth with uncertain prognosis, and the whole arch is intact, it may be acceptable solution, especially when the alternative treatment would require implant placement with additional augmentation procedures. When a tooth with uncertain prognosis is in a strategic position of the long-span reconstruction a change of treatment plan should be considered. In this case extraction of uncertain tooth and treatment with single crowns and short span bridges supported by implants or patients own teeth will be a better solution.

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