Effect of Tongue Thrust on Implants Integration

Abstract

The human tongue is a muscular organ with a variety of life-important functions. Mastication and swallowing, taste, and speech are vital functions. From the analysis of the lingual function, clinical considerations during the oral-pharyngeal phase of swallowing, the tongue thrusts anteriorly and laterally, creating enormous pressure. If it applies to freshly inserted dental implants, it could be leading to early implant failure. Different authors have calculated this pressure between 20 and 200 kPa, depending on tongue volume, producing resultant torsion forces on implant abutment. The work aims to understand the importance of the destabilizing action of the tongue in the post-operative period. When the use of implants resting in quiescence for a long time under the gums is not possible, because of anatomical reasons (for example: thin ridge), or: immediate loading is planned, the action of the tongue must be considered. We are proposing some solutions to the problem to improve therapeutic safety: 1)Attach immediate provisional prostheses to existing adjacent teeth. 2)Immediately upon implants insertion, rigidly connect implants. 3)When an immediate loading protocol is implemented, the operator should follow the guideline, taking care to apply correctly balanced axial forces, without any lateral stress. Our professional experience, based on over 10.000 clinical cases performed during 35 years, confirms that, with implants emerging in the oral cavity, handling in proper way the tongue thrust during the healing period makes the difference. All what has been here implemented about this subject, represents the development of the legacy left by Prof. Ugo Pasqualini, an Italian dentist who, since the seventies, has been deepening the topic of the risks tied to the intra-oral stresses acting on the emerging part of the implants.