Overview of Dental Implants
A dental implant is a method used to replace missing teeth. It’s an important part of modern dentistry, especially for people who are missing all or some of their teeth. Compared to traditional fixed partial dentures, dental implants offer several advantages:
1. They are highly successful, with a success rate of over 97% after 10 years.
2. They can reduce the risk of cavities and root canal problems in nearby teeth.
3. They help maintain bone at the site of the missing tooth.
4. They can lessen the sensitivity of neighboring teeth.
A dental implant is a piece made of man-made materials. It’s inserted into the mouth beneath the skin covering (mucosa) and/or the thin layer covering the bone (periosteum) and/or inside or through the bone itself. Its job is to hold and support dental prosthesis, which is a device to replace missing teeth.
Implant dentistry is the second oldest branch of dentistry, with oral surgery being the oldest. Around the year 600, Mayan people used pieces of shells as implants to replace teeth in the lower jaw. In the early 19th century, a gold implant tube was inserted into a fresh tooth extraction site. Over the years, different types of implants have been developed, leading to the modern dental implants we have today.
In 1967, blade implants were introduced, which are now known as endosseous implants. Dental implants became a fundamental aspect in dentistry thanks to Dr. Branemark, who introduced the concept of osseointegration. This is the direct and rigid connection of the implant to the bone without any tissue in between.
Anatomy and Physiology of Dental Implants
Before a surgeon places an implant, they need to know exactly where certain important structures are in your body to ensure the surgery is performed accurately and safely. This helps prevent any accidental injuries or complications from the surgery. Some of the important factors to consider include the location of certain areas in your mouth like the mandibular canal (the canal in your lower jaw) or the maxillary sinus (a space in your upper jaw), the thickness of the bone plates in your jaw, and how dense these bones are. These considerations are crucial in determining the best type of implant for you and where it should be placed.
In the upper part of your mouth, there are a few important structures. These include the floor of your nasal cavity, the nasopalatine canal (a structure at the front of your mouth), and the maxillary sinus at the back. Sometimes, these structures can get damaged, such as the maxillary sinus getting a hole in it. If this happens, doctors can use shorter implants and perform procedures to lift your sinus and reinforce your bone to help correct the problem.
When placing an implant in your lower jaw, one of the most important areas to be careful of is the inferior alveolar canal. This canal contains important structures like a nerve and an artery. If these get damaged during surgery, it can cause pain, changes in sensation, or excessive bleeding. To prevent injuries like these, doctors need to know exactly where your inferior alveolar canal is and what it looks like before they place an implant.
Why do People Need Dental Implants
There are several situations where dental treatments might be necessary. Here are a few examples:
1. A patient with partial edentulism, which means they have lost some of their teeth, might need treatment if they have intermediate gaps or free-end edentulism. The latter is also known as Kennedy class 1, which refers to a specific pattern of tooth loss where the person is missing all of the teeth in the back of their mouth.
2. Another situation is if a person doesn’t feel satisfied with their existing complete dental prosthesis. A dental prosthesis is an artificial replacement for missing teeth. If it’s unstable and doesn’t fit properly in the person’s mouth (this is what ‘non-retentive’ means), they might wish to have it replaced or adjusted.
3. In some cases, an individual might have a removable partial prosthesis. This is a dental appliance that replaces one or more missing teeth and can be taken out of the mouth for cleaning. If this prosthetic device is still in good condition but other teeth are lost or deteriorating, the person might need treatment to maintain the use and function of the partial prosthesis.
When a Person Should Avoid Dental Implants
There are certain reasons that can totally stop a person from getting a medical treatment. Here are a few:
• If the person is currently very sick or has a very severe health problem or abnormality, they may not be able to undergo the procedure.
• If a person has an uncontrolled metabolic disease, it can make the treatment risky.
• If the person has an infection or disease in their bones or soft tissues, they can’t get the treatment.
There are also several other conditions that don’t completely stop the treatment, but might make it risky:
• Diabetes and osteoporosis can interfere with how well the treatment works.
• If a person has unusual habits, or if they have HIV or AIDS, they may not respond well to the treatment.
• Use of bisphosphonates (a type of medicine which can weaken the jaw bone) can make it risky.
• Undergoing chemotherapy or radiation treatment for the head and neck can interfere with the results of the procedure.
• If a person has behavioral, neurological, psychiatric, or social disorders, the treatment might not be suitable for them.
Equipment used for Dental Implants
The equipment and parts needed for dental implant surgery include:
- One-use syringes
- One-use surgical blades
- Towel clips
- A tool called a periosteal elevator that helps to move tissues away from a surgical area
- A dental implant surgical kit that contains different types of drills
- A machine called a physiodispenser with a surgical handpiece for operation
- The dental implant itself
- A cover screw
- A healing abutment, which is a piece that goes on the implant to help your gums heal
- A needle holder
- Forceps with teeth for holding tissues
- Surgical scissors and sutures (strings used in surgery to close wounds)
- A soft tissue punch tool used in surgeries where no flap of skin is created
The types of dental implants and materials used can vary:
- Endosteal implants: These are placed into the jawbone. The most common type is a root form implant.
- Subperiosteal implants: These have a structure that is placed under the skin covering the jawbone.
- Transosteal implants: These implants go through both sides of the jawbone.
Dental implants can be made from three types of materials:
- Metals
- Ceramics
- Polymers/plastic materials
When an implant is placed, there can be three different types of responses from the body:
- Biotorerant: The implant is surrounded by fiber-like tissue. An example is stainless steel.
- Bioinert: The implant is firmly and directly attached. Titanium and its alloys are examples.
- Bioactive: These implants allow new bone to form on their surface. A common example is hydroxyapatite.
Who is needed to perform Dental Implants?
Most people agree that dental implants are usually done to repair teeth. It’s critical that before the surgery, everyone involved, including the tooth repair specialist (restorative dentist), the gum specialist (periodontist), the dental technician, the surgeon who will place your implant, and you, the patient, communicate with each other. This teamwork ensures that the look and function of your restored teeth are just the way it’s intended to be even before the surgery begins.
Effective teamwork among these professionals is important to successfully complete the dental implant procedure. Remember, this team isn’t just about the medical experts – you, as the patient, are a crucial part of this team. Together, you can expect the best results for your new dental implants.
Preparing for Dental Implants
Before placing an implant to replace a lost tooth, a dentist first draws a plan that will cater to the patient’s needs, much like how a building architect designs a building before laying down the foundation. The dentist first designs the replacement tooth, and then calculates how much bone is available, and where the supporting parts of the implant should go.
When considering a patient for a dental implant, the dentist checks for any existing medical conditions. These could be heart conditions like high blood pressure or heart failure, blood or bone diseases, hormone imbalances like diabetes or thyroid disorders, or if a patient is pregnant.
The dentist also takes a series of detailed and precise X-rays to understand the patient’s oral structure better. These images help the dentist plan the surgery accurately and give the best results for the replacement tooth. There are many types of X-rays used in dentistry, like Periapical, Panoramic, Occlusal, Cephalometric, and even CT scans. Cone Beam CT (CBCT) is especially useful for dental applications.
The surgery to place the dental implant needs to be performed in a clean and sterile environment. The procedure involves making a hole in the bone where the implant will be placed. This is done with a special tool called an ‘osteotomy drill’. It’s important to keep the area cool and the drill sharp to minimize injury to the bone. The drilling is done slowly and carefully, making sure that the bone does not get too hot (above 47 degrees Celsius). Overheating can cause bone damage and the implant may not integrate well. This is especially a consideration with a type of bone known as D1 bone.
How is Dental Implants performed
Surgical procedures: There are three main types of surgical methods that have been used over the years for replacing lost teeth: (1) two-stage, (2) one-stage, and (3) immediate-loading.
In the two-stage procedure, this is the first part: the metal piece (implant body) that’s going to act like your tooth root is placed beneath the gums. It’s left there for a few months (2 to 3 months if it’s on your lower jaw and 3 to 6 months if it’s on your upper jaw) while your bone heals around it. In the second stage, your doctor will make a cut in your gums to attach a bit on top of your new “tooth root”. This part sticks out of your gums and will hold your new tooth.
In the one-stage procedure, both the “tooth root” and the part that holds your tooth are put in at the same time. After your bone has healed and become strong enough, the dentist replaces this top part with a permanent one. There’s no need for another surgery to access your gums.
The immediate-restoration approach is the fastest. Here, the “tooth root” and the tooth-holder are placed at the start. Then a replacement tooth (usually temporary) is immediately attached to this holder.
Each method has its own benefits and can depend on your specific situation. Your doctor will discuss what’s best for you and your healing.
Possible Complications of Dental Implants
When you have surgery, sometimes unexpected things can happen both during the operation itself and afterwards when you’re healing up. For example, during dental surgeries the thin layers of bone that line the inside of your mouth might get punctured. If the doctor made a wider hole than they intended to, they might use a larger dental implant, or if necessary, they might fill the hole with a graft from your own body and then try again.
Another issue that can come up during surgery is bleeding from the lower part of the mouth, which could be caused by damage to the main blood vessels in that area. It’s very important to handle everything carefully while the surgeon is preparing the bone for the implant to avoid this.
A nerve could also be injured during surgery, which could cause numbness, tingling, or overly sensitive feelings in the area. It’s typically best to play it safe and avoid getting too close to the main nerve in the lower jaw.
One common problem that can occur after surgery is the incision or surgical cut opening up. The dentist may need to adjust a temporary replacement tooth if it’s causing problems, and they’ll usually ask you to rinse your mouth with a special antiseptic mouthwash a few times a day. If the healing process is taking longer than expected, your dentist might trim the tissue around the edge of the wound. If the dental implant gets exposed while the area is healing, the dentist will avoid trying to cover it back up, and may make more space under your replacement tooth.
If the implant moves around while it’s healing, this is unusual and may indicate a problem, especially if there’s a clear space around the implant on X-rays. If this happens, or if you have other signs of a problem like pain, an unusual amount of fluid around the implant, or lots of bone loss around the implant, the dentist will likely have to remove it. Implants that are put in the wrong position can also be problematic, as they won’t be able to support replacement teeth properly. In general, a successful dental implant should last for many years, with an 85% success rate after 5 years and 80% after 10 years.
What Else Should I Know About Dental Implants?
Modern dentistry’s goal is to restore you to a normal appearance, comfortable use of your mouth, good looks, clear speech, and overall health, no matter the damage or disease to your mouth and jaw system.
As people now live longer, more and more individuals have minor or major dental problems. This ensures the need for advanced types of dentistry, like dental implants, for years to come. Dental implants, which are artificial tooth roots that provide a permanent base for replacement teeth, are getting more popular. They are especially useful for replacing individual teeth, particularly in the back part of your mouth. Instead of removing healthy tooth structure and capping two or more teeth — which could increase the risk of tooth decay, require therapy (endodontic therapy is the treatment of the tooth’s root), and link teeth with false ones (known as pontics), potentially decreasing your ability to clean your teeth thoroughly and promoting the buildup of bacteria — an implant could just replace the one missing tooth.
So far, the acceptance of dental implant procedures is at an all-time high. The current trend is to broaden the use of implant dentistry as until it becomes a regular practice in all dental offices for supporting both permanent and removable false teeth as the first choice for tooth replacements.
