Implants

Options for tooth replacement are:

1. Dentures and partial dentures: the types of removable dental appliances that stay in place with a suction force, denture adhesive, mini-implants and dental wiring.

2. Bridges or fixed partial denture: a type of tooth replacement that requires adjacent teeth to support one or more artificial teeth. The supported teeth called  "abutment."   The abutment must be free of dental decay, periodontal disease and strong enough to support the new false tooth.

3. Implant: surgically placed different types of screws into the jawbone to act as an anchor for a false tooth or denture. The dentist may use this approach in various combinations such as using the implant with a full denture, partial denture, and bridge. The implant made of Titanium, a bio-compatible material.

Dental implant restoration

Implant components

Professor Per-Ingvar Branemark was the first to discover implant in 1956. A dental implant is the most recent improvement in tooth replacement.   The Dentist may place implants in the jaw bone so that it can fuse with natural bone anytime after the completion of bone growth. Certain medical conditions, such as cancer, diabetes or periodontal disease, may require additional treatment before placing the implant. 

The dentists who perform dental implant restorations are Prosthodontist, Periodontist, Oral Surgeon, Oral and Maxillofacial Surgeons, and general dentist who has training in implant restorations.

Types of Implants 

1. Endosteal implants - The implant surgically placed within the jawbone, with a post protruding into the oral cavity.  It is the most common one with different shapes, e.g.,  screws, blades, and cylinders.  Endosteal implants used as an alternative to bridges and removable dentures.
2. Subperiosteal - The implants placed on top of the jawbone and underneath the gums. This type of implant has a framework with the post protruding from the gums and act as an anchor for the prosthesis. It is useful for a patient who has minimal bone height and can not wear conventional dentures.
3.  Transosteal - The implants, either, u-shaped frame or pin, placed through the jawbone and gums of the patient with severe mandibular atrophy.

The dental implant placement procedures after consultation and site selections are:

Root-form implant or
traditional implant

1) Jaw preparation
Jaw preparation for root-form implants sometimes called conventional form implants.  The dentist incises the gums to expose the bone, prepares a hole in the bone the exact size of the implant in the determined area.  In many instances, dentists use surgical guides created a base on the CT scan when placing dental implants. Mini Dental implants don't require jaw preparations.

Mini dental implants  (SDI or Small Dental Implants) have a diameter of approximately 2.0mm with various length. SDI made of Titanium with added Aluminum alloy to enhance strength. They are not a replacement for regular root-form implants. Mini implants are the effective way to secure lower denture that would otherwise be unwearable in elderly people, small or degrade jaw bone or people who are not qualified to have regular root-form implants.

The placement of the mini dental implant is less complicated than the root-form implants.  The dentist twists mini implant into the prepared hole in a jawbone. The method is flawless and minimally invasive procedure.

In the upper jaw, with opposing lower natural teeth, a combination of mini implants and traditional implants may be necessary. 
 
2) Placement of the implant screw.
The dentist places a screw the same size as the prepared hole into the jawbone. After the screw is in place, the dentist sutures the gum tissue over the implant to secure it in place and place a protective cover on top of the screw. In some cases, the dentist may place dental Implants immediately after tooth extraction.

Mini Implant

3)  Waiting period.
The surgical site takes about 4-6 months to heal, and osseointegration occurs.  Osseointegration is the process that the jawbone bond to the surface of the dental implant (Titanium screw) and the implant becomes a permanent fixture in the jawbone.

Osseointegration is a major factor influencing the success or failure of the implant.  According to the publication by International Journal of Biomaterials;  current research studied the improvement of the interaction between bone and implant surface that can accelerate Osteogenesis and increase bone strength.  Researchers address the role of titanium implant surface treatment, cell interaction, and chemical or topographic modification.

4) Placing abutment
After the bone heals, the dentist replaces a protective cover screw on top of the implant with a post that becomes an abutment for a crown, bridge or denture. A small screw holds the abutment (post) to the implant.  The dentist may modify the abutment to make it suitable for a permanent crown.

If the purpose of the implant is to stabilize and retain a removable denture; the dentist may use a different abutment that is more suitable than the standard abutment without any modification.

5) Taking an impression and crown cementation. 
The dentist takes an impression of the abutment, the same method used when fabricating crowns on natural teeth,  sends the impression to a dental laboratory.  A licensed dental technician fabricates the crown and sends it back to the dentist.  The dentist examines the crown for fitting and makes the necessary adjustment before cementing it on the post (abutment).  

6) Maintenance. Good oral hygiene is importance to maintain proper fusing between the implant and bone structure.  In a healthy person with excellent oral hygiene care, an implant restoration can last more than 20 years.

MDI - Mini Dental Implants in lower denture

Implant abutments for a bridge

                                                                             

Implants have their pros and cons:

Pros:

1. Implant provides patients with one more selections of tooth replacement
2. In a patient who has loose full lower denture due to minimal alveolar bone height, the mini implants assist stabilizing the denture
3. The implant is very successfully if the dentist carefully selects the patient based on:
   
   • Quality of bone that is good for implant
   • Location in patient's mouth
   • Patients' oral hygiene
   • Patient's overall health
4. Patients do not experience tooth sensitivity or tooth pain after the placement of an implant
5. Since the implant resembles the natural tooth, patient adapts to it quickly 
6. More esthetic than bridge
7. An alternative to bridge if there is not enough abutment for bridge work
8. No caries or root canal concern
9. Implant helps preserve the height of the surrounded bone

Cons:

1. More costly than bridge
2. In some cases, bone augmentation is necessary
3. Time-consuming; after the dentist places the implant, the patient has to wait 4-6 weeks for bone to be healed (additional three more months if bone augmentation is required) before having the crown
4. Risk of infection during and after bone surgery
5. Risk of the dentist accidentally damages the nerve during implant surgery
6. Higher failure cases compare to bridge
7. The crown on posterior implant must be narrow, to protect the implant from stress
8. Due to other factors involve, not all patients can have implants, for example:
   
   • Patients with metabolic bone disease
   • Patients with diabetes
   • patients taking medication for osteoporosis
   •  patients with autoimmune disease that result in impairment of bone repair mechanisms

Home care after implant surgery:

• First 24 hours:
  1. Drink plenty of liquid 
  2. Eat only soft foods
  3. Apply ice packs on the cheek correspond to the implant area for 20 minutes on and twenty minutes off.  
  4. Avoid rinsing unless following dentist's instruction
  5. Biting on a gauze pad if some bleeding occurs. Consult with your dentist if bleeding continue.
• After 24 hours:
  
  1. return to the usual diets except hot spicy foods
  2. Apply moist heat
• First two weeks; gently wipe the surgical site with gauze or a cotton swab.
   
• After two weeks:
  
  1. Use a soft-bristle toothbrush to brush the area gently
  2. Avoid flossing at the surgical site for four weeks
• After four weeks:
  1. Brush and floss normally 
  2. Avoid chewing on the surgical side until the gums heal.  Consult with your dentist before chewing on the implant
  3. Use oral rinse and medication according to the instruction by the dentist 
  4. Keep physical activities to a minimum until the gums heal 
  5. If you have partial denture or full denture; consult with your dentist when you can wear them

 Factors that may cause implants to fail are:

• Use of tobacco products can cause gum disease around the implants
• Untreated periodontal disease 
• Uncontrolled diabetes 
• Cancer patients who are on chemotherapy
• Prolong use of antibiotics or steroid drugs for chronic conditions
• Poor oral hygiene
• Persons who habitually clench or grind their teeth 
• Poor preparation for implants
• Improper patient selection