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Dental Implants
Modern-day dental implants were discovered by Per-Ingvar Branemark, in the year 1952, he was a Swedish orthopedic surgeon.
What are Dental Implants?
An implant is a screw made of titanium or in some cases zirconium. It is placed in the jawbone surgically which then integrates with the natural bone and acts as a root of the missing tooth. this than provides a strong foundation for the restoration.
What are the types of Dental Implants?
Surgically there are two main types of implants.
Subperiosteal: This is rarely used nowadays, they were mainly used to hold dentures in place, these are placed on the jawbone and not within it, with their metal head exposed. These were mainly used in areas with thin or insufficient bone.
Endosteal: This is the main form of modern dental implants being placed worldwide. These are placed within the jawbone and are completely submerged. Hey are much more stable and give a very aesthetic result. For most of the cases this is the implant of choice.
Am I an ideal candidate for implants?
Dental implants can be done for most patients, however few things to be kept in mind are:
Bone Health- The quality and quantity of remaining bone after losing the teeth is of utmost importance. There should be sufficient amount of at least average quality of bone should be present. This is important to provide stability and retention to the implant. A CBCT scan can be done to provide an excellent report in 3 dimensional and is a great aid in implant planning.
General medical history- Of the patient, in most cases implants are not contraindicated except in malignant uncontrolled hypertension. Thyroid patients who are on bisphosphonate therapy. Cancer patients who are on radiation therapy in the head and neck region are usually not good Candidates for implants. This is because radiation can many a times severely affect the bone quality.
What are the steps involved?
First Sitting: A detailed consultation and in-depth discussion with the implantologist. After this, facial and intramural photographs are taken along with an impression.
Scan: 3D computer guided and highly precise CBCT scan is advised, which along with the computerized implant software is used in the implant planning.
Second Sitting: In this sitting the surgical procedure is carried out involving extractions if required and surgical implant placement. In some cases where immediate loading can be done, like where adequate bone strength is there.
Final Sitting: During this time the implant head is exposed, and the final restoration is completed.
What are the types of dental implants?
Implants can be done for a single missing tooth or several missing teeth and also in completely edentulous patients wherein implant supported dentures can be given.
Immediate loading implants also known as teeth in a day. In this after surgically placing the implants a temporary crown or bridge is cemented on the same day. This is only done in cases when the implant stability and the bone strength is good.
Two stage Implants - in this the implants are place in one sitting following with a healing cap or a cover screw is placed ant the gums are closed. This gift the body to heal and the bone to form around the implant thereby resulting in osseointegration. Then the final crown or bridge is placed after 6 to 12 weeks.
Mini Implants- these are smaller and narrower than the regular implants. They are mainly used to stabilize dentures.
All on 4 or 6 - this is an alternative to placing a top or bottom set of replacement teeth, called a full arch. Four or six dental implants are placed in available bone, avoiding the need for bone grafting. Special abutments are used so that a temporary set of replacement teeth can be placed the same day.
It is of utmost import dance for the patient to be on a soft diet until the final dentures are given.
What are the pros and cons of this treatment?
Like every surgical or dental procedure implants have certain pros and cons:
The advantages are:
Dental implants are fixed in the bone and not removable.
Implants have the best aesthetics and appear like natural teeth.
They maintain the integrity of the jawbone and soft tissues.
They are very comfortable for the patient for chewing and mastication.
Adjacent healthy teeth are untouched unlike a fixed bridge.
Patient can get a new tooth or teeth in a single sitting with Immediate loading.
The disadvantages are:
Regular cleaning and maintenance of the implant and surrounding tissues are very important or else it can result in implant failure due to infection in the gums.
Implant rejection: In some cases, the body does not accept the implant as a foreign body reaction. This results in implant loosening and loss.
In rare cases, if the implant is placed too close or impinging on vital structures or nerves it can lead to pain and partial paraesthesia or loss of sensation in the surrounding soft tissues.
In certain cases, implant surgery is not straightforward and requires certain surgical manipulations like:
Ridge augmentation or enhancement where there is deficient bone height and width due to bone loss. Various techniques used are bone grafting or enhancement using bone graft material.
Sinus lift: In certain cases when the sinus margin is very close or is low, that is close to the ridge margin, in such cases first the sinus floor needs to be lifted or elevated to create space in the bone to place the implant.