Dental Implants

Implants are surgical prosthesis, made of titanium or ceramic and performs the function of a root. Implants are surgicaly placed inside the bone and It serves as a artificial root to replace a missing tooth or to support a complete denture.

How does an Implant work?

Osseointegration: This is very critical for implant success. It is a process of bone bonding with implant over time. When the implant is positioned inside the bone, bone directly attaches itself by growing all around the surface of implants. So that implants become stable and firm enough to hold a dental crown or bridge or a denture.

Types of dental Implant

  • Based on position of implants
    • Endosteal implants
      • Endosteal implants are positioned inside the bone. Their shape may be screw or cylindrical or plate form. They are most commonly performed implant system.
    • Subperiosteal implants
      • Subperiosteal implants are positioned inside the gums over the jaw bone. Advised mainly for the patient with minimum bone height. Subperiosteal implants lacks the stability of endosseous implants
  • Based on number of surgeries
    • Two stages surgery
      • First stage surgery – Implant is placed inside the bone and a screw cap is connected to the implant. Gums are sutures back to completely close the implant.
      • Second stage surgery – Tissues are reflected on the implant placed site and a abutment (metal post) is connected to the implant and the wound is closed. Abutment is a small metal post protruding out of gums to holds or supported the  dental prosthesis.
    • One stage surgery – Abutment and implant placement is done as one step. It avoids the necessity of second surgery.

When can dental implants ideally placed after tooth extraction?

  • It varies from patient to patient.
  •  It can be done either,
    • Immediate placement on the day of extraction
    • After short interval of one month after delayed placement of implant after 3 months

Replacement of the missing teeth – scenarios

  • Loss of single tooth

 can be replaced by placing single implant and placing appropriate crown.

  • Multiple missing teeth

can be replaced by first analyzing number of implants required to support the prosthesis. Number of implants depend on amount of edentulous space (missing tooth space) available. Accordingly, multiple implants are placed as a bridge (single unit with multiple dental crowns). This cannot be removed by patient.

  • Complete loss of all teeth

            

can be replaced by placing multiple implants to place a fixed bridge which cannot be removed by patients or implants can support a complete denture in which abutment is shaped as a ball or button or magnet. It gives more stability to the denture.

Bone graft

Success of implants depend on quality and quantity of bone. In patients with inadequate bone, bone grafts might be necessary. Bone graft may be either autograph (taken from patient) or allograft (donor or synthetic graft)

Sinus lifting

When the quantity of bone in the upper jaw between premolar and molar is inadequate, a sinus lifting or sinus augmentation procedure is done. During this procedure sinus is gently lifted to new position and space created is filled with bone graft thereby making sure there is adequate bone for implant placement.

Dental Implant placement – surgical procedure – Conventional Method

Dental implants are usually done in local anesthesia. Hospitalizations are not required.

Patients general health will be completely examined clinically and blood investigations will be done to make sure that he/she is fit to undergo minor surgery. Patients with uncontrolled diabetes or poor immunity are not ideal patients for this procedure. Patient radiograph and study models will be analyzed to select appropriate length & width of the implant to be placed.

Local anesthesia is administered to patients. An incision is place on the alveolar ridge of the jaw bone where implant is planned to be placed, gums are reflected to expose the bone. Bone is drilled in a slow speed with gradually wider drills till the appropriate length and width of bone prepared in relation to the implant size selected. Implant is placed in the prepared bone and closed with cover screw. The incision is closed by gums completely (covering the implant along with cover screw).

Recovery after Implant Placement surgery

Patient don’t feel any pain during the procedure there might be slight discomfort. swelling for 3 to 4 days will be present after the surgery. Antibiotics, Painkiller and anti-inflammatory drugs will be prescribed. Patients will recover completely within a week.

Abutment placement

Conventionally Implant is left undisturbed the for 3 months to Osseointegrate with bone. During second surgery incision is made on the implant placed region. Stability of implant is examined. If the implant has Osseo integrated successfully then the cover screw is removed and abutment is screwed into implant. Then incision is sutured.

Prosthesis placement

For crown and bridge the doctor will take an impression of abutment with adjacent tooth Structure and gums. The impression will be send to lab for fabrication of dental crown. Crown is then cemented to abutments.  Another type of prosthesis is custom made abutments and dental crown are fabricated as a single piece and screwed to implants.

For implant supported dentures, denture is fabricated earlier itself. Impression of implants is taken. Dental lab fabricates custom made abutments (metal shaped ball or bars) to hold the denture in place. still it is a removable denture, but implants give good retention for denture.

Note: There is one more method of dental implant placement where the dental implant is placed on the same day after removing the tooth and abutment, crown is placed. The surgical steps are the same the difference being it is being done in a single day.

Maintenance of the Dental Implant

Good oral hygiene is essential for longevity of implants. Patient should give utmost care to keep the implant clean. Periodical dental visits, regular flossing, correct brushing technique, use of chlorhexidine mouthwash is advised.

Prognosis- how long will the implant last?

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.

Dental implants require the same care as real teeth, including brushing, flossing, rinsing with an antibacterial mouthwash, and regular dental check-ups.

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