Dental Implants

 
A dental implant is an artificial root that is implanted to a person’s jaw to replace a missing tooth.  A replacement tooth is then placed on the artificial root, which mirrors the look and feel of a tooth. It is the most advanced method of replacing missing tooth / teeth. It is relatively more expensive too.
 
Apart from replacing missing teeth, dental implants are also used in stabilizing loose dentures and also for taking support / anchorage in orthodontic treatment. Modified dental implants are also being recently used for supporting prostheses (eye, ear, nose etc.) after surgical procedures, wherever they are indicated.
 
A lot of research is taking place in the field of dental implants and new designs, techniques and procedures are being devised simplifying as well as bringing down the costs of dental implant procedures.
 
Dental implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason. They look and feel very natural such that you may even forget about your loss of tooth/teeth. If you have one or more teeth missing and wish to eat your favorite foods, increase your chewing ability, and improve your appearance, speech, and self-esteem, then you are a candidate for dental implants.
 
These high-tech prostheses are actually more tooth saving than traditional bridgework, since implants do not rely on neighboring teeth for support.
 
As per the available scientific evidence, natural teeth absorb great amount of biting pressure – approximately 540 lbs/sq. inch. On the contrary, those who are wearing dentures can hardly absorb more than 10 per cent of this pressure. However, dental implants can withstand 450 lbs./sq. inch biting pressure without any problems, whatsoever.

 
 
Dental implants are made from surgical-grade titanium alloy (Ti 6Al-4V ELI) to exacting specifications. The alloy is absolutely compatible with human body tissues. 


 

 

 

Slide 8

History of Dental Implants

In 1952, a Swedish orthopedic surgeon named Per Ingvar Branemark was studying bone healing on rabbits. He found that Titanium inserts in bone was found to get attached to bone. He found that Ti was bio-compatible and integrated well into bone. He termed the phenomenon "osseo-integration". Thus the thought process on dental implants was initiated. Several researchers over a period developed various types of implants which were tried, tested and perfected. Now, we have an excellent series of dental implants which have almost overcome all the disadvantages which were associated with implants till the recent past.

 

What can Dental Implants do?

* Replace one or more teeth without affecting adjacent teeth
* Support a bridge and eliminate the need for a removable partial denture
* Provide support for a denture, making it more secure and comfortable
* Provide anchorage (support) for orthodontic movement

Advantages of Dental Implants Over Dentures or a Bridge

* Every way you look at it, dental implants are a better solution to the problem of missing teeth.

* Esthetic: Dental implants look and feel like your own teeth! Since dental implants integrate into the structure of your bone, they prevent bone loss and gum recession that often accompany bridgework and dentures. No one will ever know that you have an artificial tooth.

* Tooth-saving: Dental implants don't sacrifice the structure of your adjacent teeth as a bridgework because neighboring teeth are not altered to support the implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health!

* Confidence: Dental implants will allow you to once again speak and eat with comfort and confidence! They'll allow you to say goodbye to worries about displaced dentures and messy denture adhesives.

* Reliable: The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement. 

Assessment of patients requiring dental implants

Basic medical examination and fitness is necessary prior to the dental implant procedures. Blood and urine investigations are carried out. In case the patient is under medical treatment for certain conditions such as diabetes, hypertension, cardiac disease etc., a physician's clearance is sought prior to the procedure.

Thorough dental examination in order to assess the nature of existing teeth of the patient is done apart from dental Xray procedures including OPG (Ortho Pantomogram), Digital IOPA (Intra oral periapical radiograph) and Bitewing Xrays. In certain situations, CT imaging is also carried out to assess the nature and condition of the jaw bones and their relation of important anatomic structures such as the maxillary sinuses and the inferior dental nerves.

The information a patient needs to give a dentist prior to dental implant consultation appointment should ideally include the following:

1. A brief medical history plus information on the drugs he/she is on at present.

2. Latest blood reports (including the blood sugar levels)

3. Blood Pressure values

4. Digital Xrays - Ortho pantomogram (Panorex) - mandatory. Digital IOPA Xrays, if available, would be beneficial.

5. Photographs of the area(s) of missing teeth with adjacent gums and teeth (low resolution images are sufficient)

6. The dental complaints of the patient.

7. Reason for the loss of the tooth / teeth (eg. Trauma / Progressive Mobility / Gum disease / Decay  etc. )

8. Does the patient suffer from gum diseases including bleeding gums, spongy and swollen gums etc.?


How are dental implants placed?

There are two distinct phases for every implant procedure – the first is the surgical procedure for placement of the implant (usually done under local anesthesia) and the second is the prosthetic procedure to load the implant(s) with missing tooth/teeth.

There are distincly two types of dental implants - the two piece (the traditional dental implant which requires two surgical steps - here the root portion of the implant is first buried and the "abutment" which supports the tooth is fixed onto the root portion in a later stage) and the single piece (Both the root portion and abutment are fused into one single implant - the advantage is that only a single step surgical procedure is required).

The posts (abutments) protrude through the gums. These posts provide stable anchors for artificial replacement of teeth. 

A key to implant success is the quantity and quality of the bone where the implant is to be placed.

Bone insufficiency

If there is insufficient bone or if the bone quality is poor, various bone enhancing procedures may have to be performed prior to the implant placement. These include procedures such as bone-grafting, bone-substitute grafting, Guided Tissue Regeneration (GTR), sinus-lift & ridge-modification procedures. “Inferior alveolar nerve trans-positioning” may have to be employed to move a nerve that may be in the way.

Sinus Lift / Augmentation: The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality. The close proximity to the maxillary sinus is one of the factors leading to this problem. Sinus augmentation can help correct this problem by raising the sinus floor thereby providing provision for increased bone height providing an ideal scenario for placement of dental implants.

Ridge Modification: Deformities in the upper or lower jaw can leave you with inadequate bone to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.

However, with the introduction of the revolutionary dental implant system called the BOI (Basal Osseo Integration) implants, all complex procedures required to overcome bone deficiencies can be eliminated as BOI implants offer excellent solutions in complex situations associated with bone deficiency.

Steps in dental implant surgery

INITIAL SURGERY - The surgery commences with administration of local anesthesia. If you are really scared about the surgery procedure or if several implants are to be placed in a single sitting (ie involving major surgical work), general anesthesia may be required. The gum tissue is surgically pushed back to expose the jawbone where the implant is to be placed. Surgical stents may be used to assist in guiding the placement of implants at the right place. The implants are placed into bone as previously planned. The gums are then sutured back. Absorbable sutures do not require removal whereas non-absorbable ones have to be removed after about a week. Check Xrays are taken at various stages to confirm the position of the implant(s). Most patients experience no major discomfort during or after the procedure. Some patients do report minor pain and swelling immediately after the procedure but most experience no change in their daily routines. Pain medications and/or antibiotics along with antibacterial mouthwashes are usually given after the procedure. Usually soft food intake is recommended during the healing process.

A temporary denture may be given if necessary, to ensure that the patient is able to smile confidently. If the bone into which the implant has been placed is excellent in texture and favorable in all respects, “immediate-loading” implants may be considered, eliminating a waiting period for loading of the implants with permanent crowns / bridgework.
 

 


HEALING (OSSEOINTEGRATION) PERIOD – After successfully placing the dental implant, it has to be left undisturbed in the jawbone for a period of three to six months. During this phase, the surrounding bone attaches and integrates onto the implant surface by a process called “osseo-integration”. During this phase, most patients do not experience any disruption in their normal day-to-day activities.

 
ABUTMENT CONNECTION - The osseo-integration period of implants differ from patient to patient. However, once it is complete, the surgeon exposes the top of the implant and attaches a small metal post termed “abutment”. In this minor surgical procedure, the abutment that will support the restoration is attached. This surgery is less invasive than the first, but still may require local anesthesia. An incision is made in the gum to expose the head of the implant. Then, the “cover screw” is replaced with a “healing abutment”, which protrudes above the gum. This allows the gum to heal in the correct shape around the abutment before the crown, bridge or denture is attached. Since this is not as extensive as the surgery to place the implant, the patient will typically feel less discomfort. However, the dentist will still usually prescribe pain medications and recommend soft food during the healing process. This abutment passes through the gum and ultimately supports the new tooth. The abutment can be seen projecting through the gum after fixation. After this second minor surgical treatment, the gums take few days to weeks to heal.

FINAL PROSTHETIC RESTORATION – This is the final step in the implant procedure. An impression of the abutments is made for the lab technician to make the new implant-supported crowns / bridgework. The final prosthetic tooth/teeth may be screwed into place or cemented. The new tooth/teeth are firmly anchored into the bone and gums, and will look and feel just as natural teeth.


Are You a Candidate for Dental Implants?

The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is required to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.

It is extremely important for the patient to undergo a comprehensive examination to determine if he or she is a good candidate for the procedure. The dentist will evaluate the patient’s medical and dental history. X-rays and sometimes a computerized axial tomography scan (CT scan) will have to be carried out to evaluate the condition of the jawbones including the texture and quality of bone available for implant placement. Radiographic imaging also helps in assessing the location of adjacent nerves and sinuses. Medical problems such as uncontrolled diabetes mellitus will certainly cause failure of dental implants.

Meticulous treatment planning is extremely important for undergoing dental implant procedures.

What Can I Expect After Implant Treatment?

As you already aware, your teeth require conscientious home care as well as regular dental visits. Dental implants are like your own teeth and will require the same intensity of care. In order to keep your implant clean and plaque-free, brushing and flossing still apply!

After treatment, periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to ensure they are healthy and functional.

 

What is the latest in implant treatment?

Dental implants have been evolving over years. Dental implants of the modern day have become more refined, predictable and simple. Nowadays, we have options to carry out single stage, immediate loading implants. It is also possible to place dental implants in patients in whom it was not possible earlier due to anatomical reasons such as proximity to vital structures (especially the sensory nerves supplying the lower jaw – the inferior alveolar nerve and the maxillary sinuses).

Implants systems such as the KOS (King of Singlepiece), the BCS (Basal Cortical Screw) and the BOI (Basal Osseo Integrated) implants are the recent introductions into the world of dental implants which are extremely predictable, simple and highly economical. These implants also present with a unique opportunity where they can be splinted to adjacent teeth unlike the previous ones (delayed loading) where this splinting could not be done. By judicious use of these implants, super-fast & immediate loading bridges can be offered to patients (happens within 3 days as against 3 months with regular implants!) in addition to avoidance of sinus lifts, bone grafts etc. which are essential components of two piece implantology.


"One's objective should be to get it right, get it quick, get it out, and get it over. You see, your problem won't improve with age. "        -                                - Warren Buffett

           

- Dr. Prasanth Pillai K S, MDS FICD

Oro-Maxillofacial Surgeon & Implantologist

 

Dental Implant Cases - click on this link to view outlines of a series of dental implant cases

Press releases  - given in relation to a Dental Implant workshop conducted at Saraf Hospital by Dr. Sigmar Kopp, Germany (Head of Faculty of the International Implant Foundation)

        (1)   The New Indian Express (English)

        (2)   Malayala Manorama (Malayalam)

Want to know more on Implant Dentistry? Visit: www.ImplantDentistry.in

Want to know more about Single Piece Dental Implants, please visit: www.SinglePieceImplants.com

Subpages (1): Dental Implant cases
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Dr Prasanth Pillai,
Mar 27, 2010, 6:48 AM
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Dr Prasanth Pillai,
Apr 15, 2010, 4:44 PM
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Dr Prasanth Pillai,
Apr 15, 2010, 4:18 PM
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Dr Prasanth Pillai,
May 8, 2010, 7:08 PM
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