Orthodontics ● Dental Implants ● Cosmetic dentistry

Nanda Dental Care

Replacing missing teeth with implants.

Restoring missing teeth with dental implants is more like getting a third set of teeth. It is just like a natural tooth , which has a root which integrates into the Jaw bone , and on this strong foundation a crown is given.

Dental Implants are of various types, there is also a technology difference. It is critical to choose the right type of Implant that best serves your needs.

· Replacement of single missing tooth

· Replacement for multiple missing teeth

· Stabilizing mobile  dentures with the help of implants

For totally edentulous patients implants can be a great option for fixed teeth

Dental Implants

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What Are Dental Implants?

 

Dental implants are replacement tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth.

dental implant is a "root" device, usually made of titanium, used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth.

Virtually all dental implants placed today are root-form endosseous implants, i.e., they appear similar to an actual tooth root (and thus possess a "root-form") and are placed within the bone (endo- being the Greek prefix for "in" and osseous referring to "bone"). The bone of the jaw accepts and osseointegrates with the titanium post. Osseointegration refers to the fusion of the implant surface with the surrounding bone. Dental implants will fuse with bone; however, they lack the periodontal ligament, so they will feel slightly different from natural teeth during chewing.

Dental implants can be used to support a number of dental prostheses, including crownsimplant-supported bridges or dentures.[1] They can also be used as anchorage for orthodontic tooth movement.

What Are the Advantages of Dental Implants?

There are many advantages to dental implants, including:

· Improved appearance. Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.

· Improved speech. With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that teeth might slip.

· Improved comfort. Because they become part of you, implants eliminate the discomfort of removable dentures.

Easier eating. Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.

· Improved self-esteem. Dental implants can give you back your smile and help you feel better about yourself.

· Improved oral health. Dental implants don't require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.

· Durability. Implants are very durable and will last many years. With good care, many implants last a lifetime.

Convenience. Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing dentures, as well as the need for messy adhesives to keep them in place.

How Successful Are Dental Implants?

Success rates of dental implants vary, depending on where in the jaw the implants are placed but, in general, dental implants have a success rate of up to 98%. With proper care (see below), implants can last a lifetime.

Can Anyone Get Dental Implants?

In most cases, anyone healthy enough to undergo a routine dental extraction or oral surgery can be considered for a dental implant. Patients should have healthy gums and enough bone to hold the implant. They also must be committed to good oral hygiene and regular dental visits. Heavy smokers, people suffering from uncontrolled chronic disorders -- such as diabetes or heart disease -- or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis. If you are considering implants, talk to your dentist to see if they are right for you.

What Is Involved in Getting a Dental Implant?

The first step in the dental implant process is the development of an individualized treatment plan. The plan addresses your specific needs and is prepared by a team of professionals who are specially trained and experienced in oral surgery and restorative dentistry. This team approach provides coordinated care based on the implant option that is best for you.

Next, the tooth root implant, which is a small post made of titanium, is placed into the bone socket of the missing tooth. As the jawbone heals, it grows around the implanted metal post, anchoring it securely in the jaw. The healing process can take from six to 12 weeks.

Once the implant has bonded to the jawbone, a small connector post -- called an abutment -- is attached to the post to securely hold the new tooth. To make the new tooth or teeth, your dentist makes impressions of your teeth, and creates a model of your bite (which captures all of your teeth, their type, and arrangement). The new tooth or teeth is based on this model. A replacement tooth, called a crown, is then attached to the abutment.

Instead of one or more individual crowns, some patients may have attachments placed on the implant that retain and support a removable denture.

Your dentist also will match the color of the new teeth to your natural teeth. Because the implant is secured within the jawbone, the replacement teeth look, feel, and function just like your own natural teeth.

 

How Painful Are Dental Implants?

Most people who have received dental implants say that there is very little discomfort involved in the procedure. Local anaesthesia can be used during the procedure, and most patients report that implants involve less pain than a tooth extraction.

After the dental implant, mild soreness can be treated with over-the-counter pain medications.

 

How Do I Care for Dental Implants?

Dental implants require the same care as real teeth, including brushing, flossing, and regular dental check-ups

 

Surgical procedure

Surgical planning

Prior to commencement of surgery, careful and detailed planning is required to identify vital structures such as the inferior alveolar nerve or the sinus, as well as the shape and dimensions of the bone to properly orient the implants for the most predictable outcome. Two-dimensional radiographs, such as orthopantomographs or periapicals are often taken prior to the surgery. Sometimes, a CT scan will also be obtained. Specialized 3D CAD/CAM computer programs may be used to plan the case.

Whether CT-guided or manual, a 'stent' may sometimes be used to facilitate the placement of implants. A surgical stent is an acrylic wafer that fits over either the teeth, the bone surface or the mucosa (when all the teeth are missing) with pre-drilled holes to show the position and angle of the implants to be placed. The surgical stent may be produced using stereolithography following computerized planning of a case from the CT scan. CT guided surgery may double the cost compared to more commonly accepted approaches.

Basic procedure

In its most basic form, the placement of an implant requires a preparation into the bone using either hand osteotomes or precision drills with highly regulated speed[20] to prevent burning or pressure necrosis of the bone. After a variable amount of time to allow the bone to grow on to the surface of the implant (osseointegration), a crown or crowns can be placed on the implant. Unlike conventional dental implants, Mini dental implants may be loaded immediately and still have a high survival rate (94%).[21][22] The amount of time required to place an implant will vary depending on the experience of the practitioner, the quality and quantity of the bone and the difficulty of the individual situation.

One-stage, two-stage surgery

When an implant is placed, either a 'healing abutment', which comes through the mucosa, is placed or a 'cover screw' which is flush with the surface of the dental implant is placed. When a cover screw is placed, the mucosa covers the implant while it integrates then a second surgery is completed to place the healing abutment.

Two-stage surgery is sometimes chosen when a concurrent bone graft is placed or surgery on the mucosa may be required for aesthetic reasons. The latter is usually important where an implant is placed in the "aesthetic zone". This allows more control over the healing and as a result the predictability of the final result.[28] Some implants are one piece so that no healing abutment is required.

In carefully selected cases, patients can be implanted and restored in a single surgery, in a procedure labelled "Immediate Loading". In such cases a provisional prosthetic tooth or crown is shaped to avoid the force of the bite transferring to the implant while it integrates with the bone.

Surgical timing

There are different approaches to place dental implants after tooth extraction. The approaches are:

1. Immediate post-extraction implant placement.

2. Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction).

Late implantation (3 months or more after tooth extraction).

According to the timing of loading of dental implants, the procedure of loading could be classified into:

1. Immediate loading procedure.

2. Early loading (1 week to 12 weeks).

Delayed loading (over 3 months)

Immediate placement

An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rates for this procedure are now acceptable. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the implants at the same time as the surgery to place the dental implants. Because one of three implants requires a minimum addition of bone tissue, surgical techniques for underlying bone augmentation are currently under a large scale development.

Most data suggests that when placed into single rooted tooth sites with healthy bone and mucosa around them, the success rates are comparable to that of delayed procedures with no additional complications.

Teeth in a Day

"Teeth in a day", "All-on-four", "Fast and fixed" are similar surgical concepts whereby implants are placed on the same day and a fixed prosthesis is attached to them. This allows the patient to leave with a fixed solution as opposed having to make do with a removal temporary prosthesis whilst the implant osseointegrates with the bone. This concept is appropriate for completely edentulous jaws where either the teeth are to be extracted or have already been removed.

 

Use of CT scanning

Description: http://upload.wikimedia.org/wikipedia/commons/thumb/c/c8/CT_Scan_for_Dental_Implants.jpg/200px-CT_Scan_for_Dental_Implants.jpg

CT scan of the lower jaw. This shows eight dental implants superimposed over the lower jaw in areas of maximum bone and four teeth that will be extracted.[32]

When computed tomography or, more specifically, cone beam computed tomography or CBCT (3D X-ray imaging) is used preoperatively to accurately pinpoint vital structures including the inferior alveolar canal, the mental foramen, and the maxillary sinus, the chances of complications might be reduced as is chairtime and number of visits. Cone beam CT scanning, when compared to traditional medical CT scanning, utilizes less than 2% of the radiation, provides more accuracy in the area of interest, and is safer for the patient. CBCT allows the surgeon to create a surgical guide, which allows the surgeon to accurately angle the implant into the ideal space.

Complementary procedures

Bone grafting will be necessary in cases where there is a lack of adequate maxillary or mandibular bone in terms of front to back (lip to tongue) depth or thickness; top to bottom height; and left to right width. Sufficient bone is needed in three dimensions to securely integrate with the root-like implant. Improved bone height—which is very difficult to achieve—is particularly important to assure ample anchorage of the implant's root-like shape because it has to support the mechanical stress of chewing, just like a natural tooth.

A wide range of grafting materials and substances may be used during the process of bone grafting / bone replacement. They include the patient's own bone (autograft), which may be harvested from the hip (iliac crest) or from spare jawbone; processed bone from cadavers (allograft)Which is demineralised; bovine bone or coral (xenograft); or artificially produced bone-like substances (calcium sulfate with names like Regeneform; and hydroxyapatite or HA, which is the primary form of calcium found in bone) or calcium phosphosilicate which is available in a mouldable putty form. The HA is effective as a substrate for osteoblasts to grow on. Some implants are coated with HA for this reason, although the bone forming properties of many of these substances is a hotly debated topic in bone research groups. Alternatively the bone intended to support the implant can be split and widened with the implant placed between the two halves like a sandwich. This is referred to as a 'ridge split' procedure.

Bone graft surgery has its own standard of care. In a typical procedure, the clinician creates a large flap of the gingiva or gum to fully expose the jawbone at the graft site, performs one or several types of block and onlay grafts in and on existing bone, then installs a membrane designed to repel unwanted infection-causing microbiota found in the oral cavity. Then the mucosa is carefully sutured over the site. Together with a course of systemic antibiotics and topical antibacterial mouth rinses, the graft site is allowed to heal (several months).

The clinician typically takes a new radiograph to confirm graft success in width and height, and assumes that positive signs in these two dimensions safely predict success in the third dimension; depth. Where more precision is needed, usually when mandibular implants are being planned, a 3D or cone beam radiograph may be called for at this point to enable accurate measurement of bone and location of nerves and vital structures for proper treatment planning. The same radiographic data set can be employed for the preparation of computer-designed placement guides.

Correctly performed, a bone graft produces live vascular bone which is very much like natural jawbone and is therefore suitable as a foundation for implants.

For dental implant procedure to work, there must be enough bone in the jaw, and the bone has to be strong enough to hold and support the implant. If there is not enough bone, more may need to be added with a bone graft procedure discussed earlier. Sometimes, this procedure is called bone augmentation, or guided bone regeneration. Mini dental implants are particularly useful in the endentulous arch with minimal remaining bone facio-lingually. In addition, natural teeth and supporting tissues near where the implant will be placed must be in good health.

In all cases careful consideration must be given to the final functional aspects of the restoration, such as assessing the forces which will be placed on the implant. Implant loading from chewing and parafunction (abnormal grinding or clenching habits) can exceed the biomechanic tolerance of the implant bone interface and/or the titanium material itself, causing failure. This can be failure of the implant itself (fracture) or bone loss, a "melting" or resorption of the surrounding bone.

We must first determine what type of prosthesis will be fabricated. Only then can the specific implant requirements including number, length, diameter, and thread pattern be determined. In other words, the case must be reverse engineered by the restoring dentist prior to the surgery. If bone volume or density is inadequate, a bone graft procedure must be considered first

Computer simulation software based on CT scan data allows virtual implant surgical placement based on a barium impregnated prototype of the final prosthesis. This predicts vital anatomy, bone quality, implant characteristics, the need for bone grafting, and maximizing the implant bone surface area for the treatment case creating a high level of predictability. Computer CAD/CAM milled or stereolithography based drill guides can be developed for the implant surgeon to facilitate proper implant placement based on the final prosthesis' occlusion and aesthetics.

Treatment planning software can also be used to demonstrate "try-ins" to the patient on a computer screen. When options have been fully discussed between patient and surgeon, the same software can be used to produce precision drill guides.. A data set is then produced and sent to a lab for production of a precision in-mouth drilling guide.

 

Success rates

Dental implant success is related to operator skill, quality and quantity of the bone available at the site, and the patient's oral hygiene. The consensus is that implants carry a success rate of around 95% - 98%.

One of the most important factors that determine implant success is the achievement and maintenance of implant stability. Other contributing factors to the success of dental implant placement, as with most surgical procedures, include the patient's overall general health and compliance with post-surgical care.

Dental implants can help stop periodontal diseases from forming. This is because gaps formed by missing teeth can cause periodontal disease and infections that may affect a person’s ability to eat or speak. It is very important to fill in any gaps to prevent the adjacent and opposing set of teeth from shifting positions or causing further damage to the mouth.

Failure

Failure of a dental implant is often related to the failure of the implant to osseointegrate correctly with the bone, or vice-versa. A dental implant is considered to be a failure if it is lost, mobile or shows peri-implant (around the implant) bone loss of greater than 1.0 mm in the first year and greater than 0.2 mm a year after.

Dental implants are not susceptible to dental caries but they can develop a condition called peri-implantitis. This is an inflammatory condition of the mucosa and/or bone around the implant which may result in bone loss and eventual loss of the implant. The condition is usually, but not always, associated with a chronic infection. Peri-implantitis is more likely to occur in heavy smokers, patients with diabetes, patients with poor oral hygiene and cases where the mucosa around the implant is thin.

Contraindications

There are few absolute contraindications to implant dentistry. However, there are some systemic, behavioural, and anatomic considerations that should be assessed.

There is new information about intravenous and oral bisphosphonates (taken for certain forms of breast cancer and osteoporosis, respectively) which may put patients at a higher risk of developing a delayed healing syndrome called osteonecrosis. Implants are contraindicated for some patients who take intravenous bisphosphonates.

The many millions of patients who take an oral bisphosphonate (such as Actonel, Fosamax and Boniva) may sometimes be advised to stop the administration prior to implant surgery, then resume several months later. However, current evidence suggests that this protocol may not be necessary. As of January 2008, an oral bisphosphonate study reported in the February 2008Journal of Oral and Maxillofacial Surgery, reviewing 115 cases that included 468 implants, concluded "There is no evidence of bisphosphonate-associated osteonecrosis of the jaw in any of the patients evaluated in the clinic and those contacted by phone or e-mail reported no symptoms."

The American Dental Association had addressed bisphosphonates in an article entitled "Bisphosphonate medications and your oral health," In an Overview, the ADA stated "The risk of developing BON [bisphosphonate-associated osteonecrosis of the jaw] in patients on oral bisphosphonate therapy appears to be very low...". The ADA Council on Scientific Affairs also employed a panel of experts who issued recommendations [for clinicians] for treatment of patients on oral bisphosphonates, published in June 2006. The overview may be read online at ada.org but it has now been superseded by a huge study—encompassing over 700,000 cases—entitled "Bisphosphonate Use and the Risk of Adverse Jaw Outcomes." Like the 2008 JOMS study, the ADA study exonerates oral bisphosphonates as a contraindication to dental implants.[47]

Bruxism (tooth clenching or grinding) is another consideration which may reduce the prognosis for treatment. The forces generated during bruxism are particularly detrimental to implants while bone is healing; micromovements in the implant positioning are associated with increased rates of implant failure. Bruxism continues to pose a threat to implants throughout the life of the recipient.[48] Natural teeth contain a periodontal ligament allowing each tooth to move and absorb shock in response to vertical and horizontal forces. Once replaced by dental implants, this ligament is lost and teeth are immovably anchored directly into the jaw bone. This problem can be minimized by wearing a custom made mouthguard (such an NTI appliance) at night.

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 needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease. Recent developments now allow us to treat almost any case with dental implants.

 

WHAT IS A DENTAL IMPLANT PROCEDURE LIKE?

This procedure is a team effort. Depending on your specific condition and the type of implant chosen, we will create a treatment plan tailored to meet your needs.

Replacing a Single Tooth   If you are missing a single tooth, one implant and a crown can

replace it.

 

Replacing Several Teeth   If you are missing several teeth, implant-supported bridges can replace them.

Replacing All of Your Teeth   If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them.

WHAT CAN I EXPECT AFTER RECEIVING A DENTAL IMPLANT?

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