Dental Implant

The modern Dental implants are great option for patients missing one tooth, several teeth or all natural teeth. Besides improving oral health, implants rightly qualify as part of cosmetic dentistry. A missing tooth can affect the jaw and lead to bone loss. It may also affect surrounding teeth by causing them to shift and affect a person’s bite. Missing teeth can place increased stress on the jaw that can lead to problems with the muscles and lead to the TMJ Disorder. People with missing teeth may also have difficulty chewing or be dissatisfied with their appearance. Men and women of all ages are self-conscious about their dentures, bridges or missing teeth. Teeth Implants resembling screws substitute teeth roots. They act as a secure anchor for artificial replacement teeth and eliminate the instability associated with surface adhesives and removable bridges. These screws are usually made of titanium or its alloy. The implants are bonded to the living bone structure of the jaw. Prosthetic crowns fastened with machined screws are placed on top of the implant to replicate the missing teeth.

Dental implants are made of materials that are compatible with human bone and tissue. As per the available scientific evidence the natural teeth absorb great amount of biting pressure per square inch. It has been observed that those who are wearing dentures for many years can hardly absorb more than 10 per cent of pressure than the original teeth. However, Dental implants can withstand 450 lbs. per square inch of biting pressure versus 540 lbs pressure by original teeth. The implants are surgically placed directly into or on top of the jawbone. Small posts are then attached to the implants which protrude through the gums. These posts provide stable anchors for artificial replacement teeth. Prosthetic options include single crown (cap) for one tooth implant, bridgework or implants retained Over dentures can be provided based on patient needs. The new tooth looks, feels, and performs just like your natural teeth. In appearance and in function, the dental implants are the closest thing to natural teeth and a good alternative to conventional dentures.

Implant Diagnostics
It is an important feature for the patient to undergo a comprehensive oral 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 (CAT scan) will be ordered to evaluate the condition of the jawbone and the location of nerves and sinuses. In certain specific cases of deformities in the upper or lower jaw there may be inadequate bone where the dental implants are to be placed. This defect may have been caused by periodontal disease stemming from lack of dental hygiene or many other reasons. Not only does this deformity cause problems in placing the implant, it can also cause an unattractive indentation in the jaw line near the missing teeth that may be difficult to clean and maintain.

Before implants are possible to be placed, the right options for a number of surgeries need to be performed. A decision can be taken depending on the individual needs of the patient. For example, patients must have the proper bone structure in the jaw to support the implants. Bone grafting may be used to increase the bone available in the jaw in patients with insufficient bone mass. Inferior alveolar nerve transposition may be used to move a nerve that may be in the way. Maxillary sinus lifts may allow the surgeon to avoid drilling into low-set sinus cavities.

The Dental Implant Procedure
The Implants placement procedure team may be composed of a surgeon (e.g., oral and maxillofacial surgeon, periodontist, prosthodontist, endodontist) and a restorative dentist (e.g., general dentist, prosthodontist). The surgeon is responsible for placing the implants while the restorative dentist is responsible for the crown, bridge or denture that the implant supports

  • INITIAL SURGERY - The surgery commences with administration of local anesthesia, and the gum is pushed back and in a precise and gentle way, the implants are placed in the jawbone. The gum is then sutured back. Sutures we use dissolve in your mouth within a few weeks. This phase of treatment could also be done while you are asleep. Most patients experience no major discomfort after the procedure. Within three to six months following step one, the bone in the jaw attaches to the implants, holding them firmly in place.
  • OSSEOINTEGRATION (HEALING) PERIOD - After successfully placing the dental implant fixture, it will be left undisturbed in the jawbone for a period of three to six months. During this time, the bone attaches to the implant and OSSEOINTEGRATION takes place. Depending on the case type, a temporary removable denture may be worn to preserve cosmetics of your smile.
  • ABUTMENT CONNECTION - The Osseo integration of the implant period differs from patient to patient. However, once it is complete, the surgeon exposes the top of the implant and attaches a post or abutment. This abutment passes through the gum and ultimately supports the new tooth. This small metal post or cylinder is attached to the implant that can be seen projecting through the gum. After this second surgical treatment, the gums take few days to weeks to heal.
  • FINAL PROSTHETIC RESTORATION - As a final step the dentist will take an impression of the implant for the lab technician to make the new implant-supported tooth (crown), bridge or whatever type of replacement indicated as per the original treatment plan. The final prosthetic tooth can be screwed to place or cemented. The new tooth is firmly anchored into the bone and gums, and will look and feel just like a natural tooth. Several fittings of the new teeth may be needed.

Advances in Dental Implants Technology
With the recent technological advances the Immediate Loaded Implants, Same Day Implants, One Day Implants, Teeth in an Hour, are becoming possible. Not all implant systems are suitable for same day implants, nor all patients are good candidates for same. It is actually the sufficient jawbone that makes it happen. Lately, some surgeons have been using a one stage technique where a healing abutment is attached to the implant at the time of insertion, thereby eliminating the need for a second uncovering procedure. After a period of healing, the restoration (e.g., crown, bridge, and denture) is attached to the abutment. Sometimes, the restoration is immediately attached to the implant (referred to as immediate loading implants, same day implants, one day implants) but this may not be feasible in all cases.

Immediate Loading Implant Procedure
With the new possibilities in sight, permanent or temporary prosthetics may be loaded immediately during the same treatment visit when the dental implants are surgically placed, but only for certain cases. In Step2, the implant, which is placed, has an additional component which protrudes through the gum tissue. The extension of the implant then does not become covered over during the healing phase. Step3 (above) is therefore not needed. Step4 is readily achieved (3-6 months later) by unscrewing the additional component which was placed at the surgery and replacing it with the type of insert that is needed for your case. New prefabricated components now enable shorter treatment time and make it possible to give the patient an esthetic appearance during the whole treatment period. These prefabricated components are made to fit practically all types of mandible and enables adjustments to be made in meeting individual esthetic and functional needs, as used in dental makeovers or reconstructive dentistry. One from the many examples, Nobel Direct™ implant by Nobel Bio care is machined from a single piece of titanium, incorporating both implant body and an integral fixed abutment. It is one of the recent offerings in the ultimate form of simplicity and tissue friendliness, taking implants progressively closer to traditional crown & bridge therapy.

Sinus Lift/Sinus Augmentation
Most important for an implant to be successfully placed is the quantity and quality of the bone. The most difficult area is upper back jaw, where it is often experienced to have insufficient bone quantity and quality. The loss of bone in that area could be due to periodontal disease or tooth loss in extraction. If sinuses are very large and implants could not be placed, bone grafting is done first. In this procedure, the width and height of the bone is expanded from within the implant site thereby creating a new sinus floor necessary bone for the implant. A 6-9 month period allows the bone graft to mature is followed by the conventional placement of the implants. A variety of graft materials can be used in these procedures. In our experience, the best source of bone is the patient's own (autogenously) sources.

After the implants are placed, an additional healing period is required. In some cases, the implant can be placed at the same time the sinus is augmented. Another technique used in certain cases with a moderate amount of bone is to use an astrodome and tap the bone gently with specially designed instruments going from the bony ridge inward (towards the sinus) and elevate the floor prior to placement of the implant. Sinus augmentation has been shown to greatly increase your chances for successful implants that can last for years to come. The surface of the implant is generally rough. This creates more surface area for bone to bond to. It may be coated with hydroxyl apatite, which is a substance found in natural bone. Scientists are also researching other substances for coating implants, such as special proteins that further encourage Osseo integration.

Implant Systems Options
Depending on the patient’s preferences and more importantly, right selection by the dentist as per diagnosis, the implant systems can be finalized from Branemark, Nobel Bio care USA, Nobel Bio care Sweden, Zimmer, Center pulse, Bicon, Dentsply/Frialit GmbH, UNITI IMPLANT SYSTEM from Holland, Straumann ITI, Biotech, Biocon, BioHorizons, Biolok, Osseotite, Oraltronics, IMZ, E-Zee, Sargon Dental Implants, IMTEC, Pitt-Easy, Camlog, Life core Prima Implant System, Alkalosis, AstraTech, Calcitek, Sulzer, Straumann ITI (proposed) etc. These are available in Hex, Internal Spline, Tapered Screw Vent, and now Triangular Telescoping Technology with Nobel Bio care, as also advanced quality offering from other popular implant system.

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