Dental Implant and Its Clinical Application

Introduction:

The history of prostheses is fascinating. From the use of wooden dentures to ivory teeth to modern porcelain teeth prosthetic rehabilitation has taken a long leap. The most modern way of oro-facial prosthetic rehabilitation is dental implants.

What Are Dental Implants?

Dental implants are artificial devices that are used for the replacement of tooth roots. They are used to support the restoration of a missing tooth and they also help to prevent bone loss. The procedure is categorized under prosthetic dentistry or artificial replacement dentistry. It is also used in cosmetic dentistry.

What Are the Indications of Dental Implants?

The main indications for dental implants are:

1. Totally Edentulous Patients- Any patient with one or more missing teeth can receive dental implants.

2. Partially Edentulous Patients- Patients with intermediate gaps, who do not want to grind down their teeth.

3. Prevent bone loss and gum recession.

4. Supporting the partial denture.

5. Improve patient confidence in speaking and smiling.

6. Improve the aesthetic appearance of the teeth.

7. Improve overall oral and physiological health.

8. Various extra-oral implants can retain extraoral prostheses like nasal, orbital, and ocular prostheses. Such cases are helpful in bringing back normal facial profiles in patients suffering from orofacial cancers.

What Are the Reasons for Tooth Loss?

Some of the reasons for tooth loss include:

• Tooth Decay- Tooth decay involves the permanently damaged areas further developed into cavities.

• Periodontitis- This is also known as gum disease and is characterized by infection of the gum, followed by swelling and bleeding gums.

• Calcium Deficiency- If there is a lack of calcium in the body, it is taken up from the bones and teeth which weakens the bones and teeth and increases the risk of developing tooth decay, and further causes tooth loss.

What Are the Contraindications of Dental Implants?

There are specific contraindications in receiving dental implants, with high chances of implant failures. These include:

1. Smoking- There are higher chances of implant failures in smokers compared to nonsmokers due to increased loss of bone and impaired inflammatory process.

2. Bruxism- Excessive grinding of the teeth can also be a contraindication in receiving dental implants. Excessive stress in such cases causes failure of dental implants.

3. Patients with uncontrolled diabetes have poor immunity and impaired inflammatory reactions. This causes implant failure.

4. Patients undergoing chronic steroid therapy.

5. Patients undergoing high-dose radiation therapy.

What Are the Diagnostic Procedures?

To determine whether the patient needs to receive dental implants or not, patients have to consult their dentist. During the appointment, the dentist thoroughly examines the teeth, and gums and checks. The bone density is determined through X-rays or CT scans. This is a way to ensure that the bone structure is correct and proper for placing the implants. Some patients may have insufficient bone density and may receive bone or soft tissue grafts. Sometimes, in this case, dentists also use implants with smaller diameters called mini implants. Options for local anesthesia will also be discussed during the consultation.

What Is the Procedure for Placing Dental Implants?

The process by which the dental implant is fixed or anchored into the jawbone is called osseointegration. It takes six weeks to six months of time for the implant to anchor into the jawbone and for complete healing. There are chances that the implant will fail, if osseointegration does not take place.

The detailed procedure includes:

1. Jaw Preparation for Implantation: Dental implants are mainly composed of a titanium material screw and crown. A pilot hole (a hole with a small diameter) is drilled at edentulous jaw sites. This is done to place the implant in place.

2. Placement: After the pilot hole is drilled, it is then widened for the placement of the implant screw. After it is placed, the surrounding gum tissue is secured over it. A protective cover screw is then placed on top of it. It is left undisturbed for around three months for the osseointegration and healing. After six months, the implant is uncovered. An abutment is placed to hold the crown. After this, the dentist fabricates a final crown.

3. Follow-up: After placing an implant, proper oral hygiene should be maintained to ensure its complete integration with the bone structure. Failure to maintain oral hygiene can result in a failure in treatment. Smoking also has a major contribution to implant failures. There are chances of minor bleeding at the implant site. If the patient feels any discomfort or pain, pain-relieving medications are prescribed by the dentist.

Complete healing takes up to six months. A diet restriction to only taking soft foods should be maintained for a week after the procedure. Follow-up appointments with the dentist should be ensured for proper monitoring.

What Are the Different Types of Dental Implants?

There are different types of implants which are categorized based on the procedure which is used to place them.

This includes:

1. Single-stage Dental Implants- Single-stage procedure includes placing a long implant surgically into the jaw. The placement is in such a manner that it is on the jaw bone, and its top level is within the gum tissue. The implant healing cap will be visible.

2. Two-stage implants- Two-stage procedure involves placing the implant into the jaw bone, surgically, and stitching the gum tissue. After a few months, the prosthetic part is attached to the implant body.

3. Endosteal Implants- Endosteal implants are the most common type of implants used in two-stage implant procedures. It is placed in the jawbone and acts as an alternative to a removable denture. There are different types of endosteal implants available which are: screw types, cylinder types, and bladed types.

4. Subperiosteal Implants- These are the most rarely used implants. It is placed on the jaw bone within the gum tissue.

Implants can also be categorized based on the materials used as metallic implants and nonmetallic implants. Metallic implants are made of titanium, titanium alloy, and plasma-sprayed titanium. Non-metallic implants are made up of ceramic, carbon, alumina, and polymer.

Implants can be categorized based on their sizes which also determines where they can be placed in the mouth. The important criteria in fixture selection would be its platform dimension and its length. The categorization would be like standard platform, wide platform, and narrow body or mini implants.

What Are the Clinical Applications of Dental Implant Systems?

The potential benefits of dental systems are:

1. The placement of dental implants helps in restoring the ability to chew food. The masticatory ability of implant-supported prostheses is far superior to any prostheses.

2. Improves the aesthetic appearance.

3. Helps to protect the surrounding bones and gums.

4. Improves oral health and physiological well-being.

5. One of the main advantages of implant-supported prostheses is it does not require support of the teeth. As a result, teeth structures are not compromised.

What Are the Risks Associated With Dental Implant Systems?

The risks associated with dental implants are minimal. However, there are certain risk factors that are associated with dental implants, which are:

1. Chances of damage to the surrounding teeth during the implant placement.

2. Fracture of the surrounding jawbone during surgery.

3. Sinus perforation- damage to the surrounding tissues and nerve injury during implant surgery may happen.

4. Difficulty in cleaning the gums around the implant prosthetic junction leads to poor oral hygiene.

Conclusion:

Dental implants are the most modern way of replacing missing teeth. Apart from teeth, dental implants can be used for the rehabilitation of oro-facial structures too. Dental implants are helpful in restoring oral functions like chewing, smiling, and speaking. However, proper case selection is necessary for successful dental implant treatment.