Dental implants are considered to be effective, long-lasting, and permanent in many patients, but is it always the ideal tooth replacement alternative? And if it is, are you a suitable candidate for an implant prosthesis? Let us explore this further as we consider the factors and complications associated with implant success.
Any dental restoration that replaces your missing tooth always comes with the patient's expectation that it should be long-lasting, at least for a few years to come. A dental implant certainly fulfills this criterion by naturally integrating with your jaw bone soon after it is placed. A dental implant is an orthodontic anchor and a surgical component that interfaces with the jaw or the skull permanently to support the superficial structure that resembles the tooth crown and bridge prosthesis.
A dental implant has several advantages that range from:
Improved appearance - It gives almost a pale but precise imitation of the natural tooth once the implant crown is also fit.
Improved speech - In poor-fitted removable and fixed dentures, the words spoken often are mumbled or slurred. In contrast, this possibility does not usually exist in an implant.
Comfort during eating and talking and chewing hard foods - It is otherwise not comfortable if you simply use conventional dentures.
Improved oral health.
90-95% of the implants have shown to have a good success rate over the past decade. It takes a certain amount of time that usually varies from 3 months to 6 months to bind the implant into the jaw by a process called "Osseointegration" (fusing with the bone).
Patients who opt for either fixed bridging or artificial dentures are often unsatisfied with the aesthetic outcome or the frequent fracture or displacement associated with ill-fitting crowns and removable prosthesis like dentures. So an implant is superior to bridges and dentures in terms of both aesthetics and efficiency.
Still, not all the patients who have a missing tooth are ideal cases to get an implant prosthesis because the successful outcomes and in the long run the survival rates of the osseointegrated implant depend on various factors:
1) Age of the patient.
2) Length and diameter of the implant.
3) Bone quality of the patient.
4) Region of implant placement.
Implant failures are common in elderly individuals past 60 years of age who are at high risk for these mentioned conditions or are victims of hypertension, diabetes, kidney, liver, or respiratory diseases. More often, in elderly patients, bone quality plays a role crucial for implant success and not the age itself. Hence a predisposition to general systemic diseases that lower the oxygen saturation and immunity can result in low bone density or bone diseases that result in implant failures.
Children and young adults below 18 years of age are also not suitable candidates because a fully developed jaw bone is an essential prerequisite to the implant stabilization in the jawbones. In children, in order not to interfere with the growth of jaw bones, the installation of an implant should generally be postponed even if the child may miss a permanent tooth in the arch due to reasons of trauma or missing permanent tooth bud that is less often reported and observed by parents or guardians but maybe a possible anomaly.
Also, in puberty, due to the increased nature of growth spurts in both males and females, the stabilization of implants is not ideally or potentially possible. Some young adults reach skeletal maturity of their facial bone contour only after 21 years of age. Hence the ideal age for implantation is from 21 years to 60 years though adults who have undergone implant placement past 65-70 years with good bone density also have reported moderate success.
2) Length and Diameter of the Implant:
Implant failures are common in shorter and wider diameter implants. Longer and less wide implants are usually preferred in maximum cases. Again, it depends upon the bone density and the position of vital nerves for your implantologist to judge exactly whether a shorter or a longer diameter implant is required. As for the implant width, it depends on the minimum space needed to have around an implant after it is placed. 1 to 1.5 mm of bone spacing around the implant is mandatory for long-term survival.
3) Bone Quality of the Patient:
Pre-operatively, the assessment of bone in the patient is always ideal to find out the long-lasting success of the integrated implant. Cone Beam Computed Tomography (3D X-ray for the teeth and jaw bone) is a requisite prior to implant surgery. If the patient's bone density is not ideal in relation to the tooth that is being replaced, for example, mandibular or lower molars and lower incisors or canines require high-density bone for proper integration. In order to enhance the bone quality when the situation is not ideal, bone grafts are a good adjunct to develop and improve the vascularity of the bone before proceeding towards an implant surgery.
4) Region of the Implant Placement:
This is a highly sensitive and tactile source known to your implantologist before they ideally place it in the site that requires replacement by the prosthesis. Operator skills and bone density both are pivotal even after deciding the region where the implant is to be placed, which is decided through CBCT scanning and OPG (Orthopantomogram) and 2D X-ray imaging prior to implant surgery to identify the risks, correct path of placement, and to avoid surgical errors by the operator.
Apart from these four crucial factors, operator skills and the patient co-operativeness before, during, and after the implant placement are major mandates for implant success.
An implant is usually considered a failure if it is presented with mobility, infection following the removal of the implant itself, or any technically mechanical failure that interferes with the implant integration that renders it unusable. Often even if an implant integrates well with the host bone, the prosthesis or crown portion attached to the implant head is another major factor for a correct stable fit. The tactility and operator sensitivity while fixing the implant crown prosthesis after 3-6 months using either cement-retained restorations or screw-retained restoration is what the patient needs to discuss with their implantologist soon after the implant surgery is complete.
Patients also need to follow certain instructions regarding their oral hygiene and do's and don'ts for the 3-6 month period before fitting the implant crown so that the implant-bone fit is completely stable in the jaw bone.
The complications that may occur due to negligence in preoperative assessment and ignoring the factors are:
Pain or foul-smelling pus.
Swelling or edema.
Marginal bone loss.
Hence to conclude, dental implants are indeed the future of long-term and long-lasting dental restorations. Definitely, they are more often associated with high success rates and free of masticatory troubles. This is because the natural bite force of the tooth is nearly restored by the titanium post of the implant that replaces the natural tooth root and bears the same amount of biting, chewing, or masticatory stress as a natural tooth root does, in fact. In ideally placed implants with pre-surgical review by the dentist and post-surgical implant care, biologic and prosthetic (crown-related) complications are very rare or reported in less frequency.
Hence, a thorough understanding of the implant site and the patient assessment by the operator, combined with his skills, is a major determinant of the long-term success rate of dental implants. Also, talk to your local dentist/Implantologist about your medical and dental history before undergoing the implant procedure.
The lifespan of implants depends on several factors like maintaining oral hygiene, design, bone quality, and the region. However, around 25 years is the average longevity of implants.
Since the procedure for placement of implants is done under local anesthesia, it is not painful. Mild pain may be experienced after surgery but can be managed with painkillers, and it will subside in a couple of days.
When the tooth has significant decay and is advised for extraction, and if the patient can afford and is ready for an invasive and lengthy process, implants are done. On the other hand, if the decay is correctable and the patient does not want to lose his tooth, less invasive and more affordable root canal treatment is done.
Partial dentures, tooth-supported bridges, and resin-bonded bridges are the cheaper alternatives to dental implants.
It is always recommended to place the implant after three to six months of healing after extraction. However, in very few patients with the healthy jawbone, implants are placed on the extraction day.
The number of years after extraction is not a significant factor for deciding implant placement; instead, the bone density determines it. An implant can be placed even after ten years of tooth removal if all other elements are good.
Sedation is generally not needed as local anesthesia is sufficient and does not cause any pain till the implant procedure is fully completed.
If not replaced within a year, missing teeth can cause bone atrophy, which means that the height of the alveolar bone and bone density deteriorates. As a result, placing implants after that may require a bone graft, in addition.
Implants mimic the natural tooth, in which it is placed inside the bone and is allowed to fuse with the surrounding bone. It acts as a root to which the artificial crown is attached.
- Cardiac diseases like myocardial infarction, valvular diseases, cardiomyopathy, angina, etc.
- Cancer and radiotherapy.
- Bone diseases.
- Immunological disorders.
- Tobacco consumption.
- Addiction to drugs and alcohol.
- Older age.
- Reduced bone mineral density.
- Poor oral hygiene.
The best available replacement for missing teeth is dental implants, which are safe, reliable, long-lasting, and esthetically sound.
- Brush twice daily with a soft-bristled toothbrush and floss daily.
- Do not use abrasive toothpaste.
- Brush hard-to-reach areas of the crown with the help of a nylon-coated interdental brush.
- Use a prescribed oral irrigator.
- Avoid damaging habits.
- Regular follow-ups with the dentist.
- Overheating of bone.
- Implant site contamination.
- Radiotherapy during treatment.
- Periapical lesion of the extracted tooth.
- Overloading the implant immediately after placement.
- Poor bone quality.
Last reviewed at:
29 Nov 2022 - 5 min read
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