[Keys to success in implant osseointegration]

The potential utilization of osseointegrated implants should be considered in every treatment planning along with the knowledge of specialists-periodontists, implantologists, and prosthodontists. Prosthetic objectives of function, aesthetics, and maintenance should guide the implant procedure. The purpose of this article is to emphasize how periodontal procedures enhance the cosmetic result and ensure a successful long-term restoration. The search for the best position and orientation of the implant in the bone is guided by the prosthetic phase. Periodontal treatment or extraction of the residual teeth is performed before any placement of implants. Absence of infection and adequate apical bone are necessary to insure primary stabilization. Graft and membrane procedures are done prior to or simultaneously with implant placement. When placed immediately upon extraction, the long axis of the implant should line up with the incisal edge of the adjacent teeth. The compass technique can be performed when the opposite arch of the implantation is edentulous or partially edentulous. The healing abutment serves as a matrix for the gingiva to heal and must replicate the cervical diameter of the tooth. The 6-year results of a previous 5-year study have reconfirmed the results: Quality of bone is the determining factor in success rates; the deeper the bone, the lower the failure rate; a failure rate is most likely to take place during the first year after placement; a higher success rate is found in the mandible; and a higher success rate is found with HA-coated implants.