For ages, the edentulous elderly population have been presented with very limited options, which is the traditional complete dentures. But now, due to the fast growing Dental Implant industry, Implant supported dentures, or also called Implant Overdentures, have become the new trend. There are advantages and disadvantages of dental implants and it is best to know about it before treatment.

Most often, a treatment plan for an edentulous patient is made keeping the cost factor in mind. The patient’s desires should be probed, and kept in mind while designing the prosthesis. Some patients have a very strong psychological need to possess a fixed prosthesis. The idea of having a removable prosthesis in their oral cavity, which can slip away, scares them.

On the other hand, there are other class of patients who, are not really concerned if the prosthesis is removable or fixed, unless, their specific need is addressed.

A rule in implant dentistry is to provide the patient with the most predictable, cost effective treatment that will not only satisfy the anatomical needs but also the personal desires.

In a completely edentulous patient, a removable implant supported prosthesis offers several advantages over a fixed implant restoration.

• The labial flanges, and the denture teeth, in the prosthesis improves the facial esthetics to a great extent compared to customized metal or porcelain teeth, in a fixed prosthesis.

• The labial contours of the removable restoration replaces the lost bone width and height, and also supports the labial sift tissues.

• Oral hygiene is not compromised.

• The prosthesis can be removed at night, which is beneficial for patients with nocturnal parafunctional habits.

• Fewer number of implants are needed, as opposed to a fixed design.

• Other complimentary surgeries, like bone augmentation is seldom required, with this prosthetic design.

• The treatment span is shorter.

• Comparatively less expensive.

• Daily home care, hygiene maintenance becomes easy.

Placement of dental implants, is a not a very easy and simple procedure for a dentist. It demands a high degree of skill.

Implant procedure, can be divided into the following phases,

* A thorough treatment planning,

* The implant placement procedure,

* Finally, implant restoration, which is the prosthetic phase.

Surgical planning

A detailed planning of the implant procedure is very important. Normally dentists, rush with the procedure without a definite planning, which leads to irreversible errors. The implant site needs to assessed, for the bone dimension, the bone density in the area. Even anatomic landmarks, needs to be evaluated, like the inferior alveolar nerve, maxillary sinus.

These need to be watched out, for, because they cause a major hindrance in the surgical procedure.

Orthopantamographs, and periapical radiographs are commonly taken prior to the procedure, but sometimes these 2-dimensional images, underestimate the actually bony contours. A 3-dimenaional CT scan, is of great help in such cases. They give the exact width, and length of the alveolar ridge where the implant needs to be placed. The use of  CT scan can increase the overall cost of the treatment.

Sometimes a acrylic stent, which fits well over the adjacent teeth, with drilled holes also help a great deal for the dentist to position and angulate the implant drills. This can be used professionals with less experience, and who are first timers.

Dental Implant Procedure

Traditionally an incision is made on the crest of the edentulous ridge.  Full thickness flaps are reflected, exposing the raw underlying bone. Newer systems these days, also provide with flapless procedures, wherin, flap reflection is not required. Instead a piece of mucosa is punched out. Flapless procedures are controversial. Some believe that, it reduces the recovery time, while some advocate that it increases complication rates, because it is a blinded procedure, and the bone anatomy cannot be visualized. A 3D pre-operative CT scan becomes mandatory.

Keeping the vital structures like the maxillary sinus, inferior alveolar nerve and mental foramen, the pilot drill is bored into the recipient bone. Preparing the implant site, that is the ostectomy, is done in several steps. It starts with using the smallest size drill, and gradually increasing to the desired size. The pilot hole is further expanded using the progressively wider drills. high speed drills, with copious amount of irrigation is necessary to avoid, temperature rise, and bone necrosis.

After placement of the implant body/fixture, the implant screw is tapped onto it, with a precise torque. If its a flap procedure, the flaps are replaced and sutured in place.

Healing time

The exact duration of waiting period, for maximum osseointegration to take place is controversial. In general 4-6 months is ideal for restoring the implant. Immediate loading implants are also available. But again they are controversial. Early loading of the implant can lead to implant failures. Because the healing is not complete, due to which the implant is not capable enough to take up the masticatory loads.

What is a One-stage, and two-stage surgery?

After placement of the implant fixture, a healing abutment or a cover screw is placed which flushes well with the implant surface. On placing the cover screw, the mucosa covers the implant while it integrates, and a second surgery is completed to place the healing abutment.

Two stage surgery is performed, after the healing phase, wherein the overlying mucosa is removed, and the abutment is screwed in.

In carefully selected cases, patients can be implanted and restored in a single surgery, in a procedure labeled “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.

Teeth have been naturally designed, to last a lifetime. Unfortunately it isn’t so. With the evolution in dentistry, missing teeth can be replaced. In the past, people with missing teeth had limited options namely, crowns, bridges, and dentures. Today, dental implants and implant over dentures offer an alternative cosmetic solution to most people.

Replacement of missing teeth is important to maintain a healthy balance not only in the oral cavity but also to your general health. Loss of teeth not only impairs the chewing ability of the individual, but also other problems like,

* Movement of neighboring teeth, like tipping

* Crowding of teeth

* Shrinkage of gum tissue

* Disturbed occlusion, due to changed tooth positions, which can also lead to food impaction, dental calculus or tartar formation & bad breath

* Collapse of jaw bone.

Missing tooth, also means missing root. Natural tooth root provides support to the jaw bone, and gum tissue. A dental implant replicates the root of the natural tooth, which fuses very well with the jaw bone, and meets the functional demand, similar to a natural root. This prevents further damage.

Lets have a quick glance at the advantages and disadvantages of  a dental implant,

ADVANTAGES

After the healing process, the dental implant fuses completely with the jaw bone, forming a single functional unit. This increases the chewing efficiency of the individual.

The appearance, function of a dental implant is as good as your natural tooth.

The site, where the implant is placed, further bone loss, and jaw shrinkage does not take place. The bone volume, and dimensions are maintained.

Denture wearers, always dread, that their dentures, might give way while eating or speaking. This is not the case with implants.

Since implants are placed in sites where, teeth are missing, the adjacent teeth are not touched. Neighboring natural teeth need not be altered, which is the case with bridges. This ensures long term stability, and durability.

Oral hygiene and maintenance with dental implants is easy.

Facial appearance is restored, avoiding a sunken face look.

DISADVANTAGES

Dental implant procedures call for a major investments, which is not free of risks.

The entire treatment regime, is time consuming compared to other modalities, like bridges and dentures.

Frequent and several visits to the dentist is needed.

A well kept follow up routine is necessary for every implant patient.

It is technique sensitive, hence the skill of the practitioner is important.

Other complications are common with any other surgical procedures, like pain, bruising, swelling.

Hence, before deciding to undergo the implant procedure, a close and critical assessment of the pros and cons of the same is important.

Tooth loss, is something that none of us look forward to, and the most dreaded. Loss of  a tooth has a considerable impact on the psychology of an individual. The effect is a deep seated one, much more than we can comprehend.

Dentistry offers several options for the replacement of missing tooth, of which dental implants is the most recent and the most considered treatment option.

WHAT IS A DENTAL IMPLANT?

Dental Implant is a  titanium screw or a cylinder, which is available in various sizes, and various biomaterials, and is placed in the edentulous site.  The implant fixture is surgically placed in the jaw bone, and heals gradually by a process called “osseointegration”. This implant fixture replicates the root of the natural tooth. After considerable time has elapsed post healing, a dental prosthesis is placed on the top most part of the implant fixture, which resembles the natural tooth anatomy.

PARTS OF A DENTAL IMPLANT

Implant fixture –

Its an insert that provides firm anchorage for the restoration. It is screwed into the jaw bone, providing a fixed platform, onto which the abutment is screwed. During the healing period, the jaw bone grows into, and around the implant fixture threads, thus strengthening  the jaw bone, and preventing further bone loss, in the edentulous site. Implant fixtures come in various shapes, sizes, materials, and widths.

Abutment –

Implant abutments provide, support to the dental crown. It is the interface between the crown and the implant fixture. It is screwed onto the top most part of the fixture. abutments come at preformed at set angulations, from manufacturers in different platform sizes, or they can also be custom made.

Crown –

Crowns are the top part of the restoration. The part that is visible in the oral cavity. They replicate the original teeth, to provide a biting surface and aesthetic appearance.

WHAT CAN DENTAL IMPLANT DO?

Replace one or more teeth, without affecting neighbouring teeth

support a bridge, and eradicate the need for a removable partial denture.

support a complete denture, which is an implant supported one, hence making it more stable, secure and comfortable for the patient.

TYPES OF IMPLANTS IN USE

Endosteal (placed within the bone) – This type of implant is used as an alternative to bridges or removable dentures. This is the most commonly used implants pattern. It is availbale in various types, including screws, cylinders or blades.

Subperiosteal (on the bone) – These are placed on the bone surface and not within. It is secured, using metal framework’s posts protruding through the gum to hold the prosthesis. these implant are mainly used by those patients, who are unable to wear conventional dentures, and have minimal amount of residual bone height.

IDEAL IMPLANT CANDIDATE

An ideal implant patient is the one who is in good oral and general health. He should not be suffering from any systemic illness, which could compromise the implant procedure outcome.

Adequate bone height and width is mandatory for implant placement. apart from the bone volume the bone quality is also very important for implant placement. Bone density varies in different areas in the jaw. If the bone density is poor, or more porous, which can be evaluated by various imaging modalities, placing an implant becomes doubtful. Nonetheless, these defects can well be reversed by various complementary surgical procedures, like bone grafting, and the treatment plan can thus be well tailored in the best interest of the patient.

Individuals with habits like, smoking, or who consume tobacco in any form, are poor candidates for implant procedures. And they should be well informed about the reduced percentage of implant success in their case.