A dental implant is an artificial device often made of titanium in a form of a threaded cylinder or cone. It is designed to replace the root(s) of missing tooth (teeth).
Dental implant is surgically placed in the jaw bone where the natural tooth is missing and will provide support and retention for the artificial tooth or dental prosthesis that is fabricated to replace the missing tooth. This type of dental prosthesis that attached to a dental implant is called “implant supported crown”. This crown can be fixated to the implant by a screw or dental cement.
Dental implants can also be used when multiple or even whole arch of teeth are missing, and in this situation the implants will provide support for a larger dental prosthesis. These prostheses can be categorized as below:
Successful dental implants and the overlying prostheses will transfer chewing load to the jaw bone. This physiologic stimulation prevents resorption of the jaw bone where a tooth (teeth) is (are) missing. The resorption of the jaw bone, in situations of not replacing missing teeth with dental implants, can lead to shrinkage of the gum tissues. This resorption and shrinkage in the front part of the mouth can have cosmetic consequences such as uneven gum margins which may be visible during smiling, and collapse of lips and/or cheeks due to lost support by jaw bone.
Generally, a dental implant is not suitable for or is at high risk of failure in:
If you do not belong to any of the above-mentioned categories, and you have a missing tooth or you are losing a tooth, dental implant supported prosthesis may be the right treatment modality for you. The volume of your jaw bone in the site(s) of missing tooth (teeth) needs to be enough to receive a dental implant. This can be assessed by your prosthodontist through referring you to have a 3D X-ray imaging from your dental arch also known as Cone Beam CT scan.
In situations where the volume of jaw bone is inadequate, surgical bone grafting procedure before or during placement of the implant can be planned for you. These procedures are mainly done under specialist care. The specialists who perform these surgical procedures are either Oral and Maxillofacial Surgeons or Periodontists, with whom your Prosthodontist will communicate and request for specific treatment approach which will suit your prosthodontic need.
The bone required for the grafting procedure can be harvested from other parts of your jaw bone. The bone minerals extracted from animals such as cows and pigs have also been used in jaw bone surgeries and have been proven to successfully integrate with human jaw bone.
In situations that an extensive part of the jaw bone needs to be reconstructed such as after resection of jaw tumors, bone grafts from other parts of the body can be harvested such as from ribs or pelvis. This surgical procedure is performed under General Anesthesia with a General Surgeon and Oral & maxillofacial Surgeon working collaboratively to harvest the bone and graft it to the jaw structure.
Alternative to implant supported prostheses are:
The following are types of tooth supported prosthesis available as alternatives of implant supported ones. In these treatment modalities the teeth that are going to provide support for the prosthesis need to be prepared for this purpose. This preparation involves removing a layer of tooth structure to create space for the retainer portion of the prosthesis that is attached to the prepared tooth. These prostheses include:
The removable alternatives to implant supported prostheses are:
These prostheses gain support and retention from teeth and/or oral tissues and need to be removed from the mouth for performing hygiene measures.
Dental implants are placed in the recipient site via a surgical procedure. This surgery is most often done under local anesthetic but the patient can choose to have it done under sedation or General Anesthesia. The procedure involves raising a gum flap to access the bony site to prepare the site to receive the predetermined size of dental implant. After placement of the dental implant the flap is repositioned and sutured over or around the head of the dental implant depending type of surgery or dental implant that is chosen for the specific clinical scenario.
Similar to any other surgical procedures there are potential complications during or after surgery:
Post-implantation biologic complications:
These complications can be managed by your periodontist by debriding and irrigating the inflamed sites followed by instruction of more efficient oral hygiene measure.
Post-implantation biomechanical complications: similar to any other dental prosthesis, implant supported prosthesis is subjected to wear and tear and requires maintenance. The potential complications that will require prosthodontic attention include:
Most of the biomechanical complications can be managed by your Prosthodontist, by repairing or replacing the damaged part chairside, or sending the defective prosthesis to laboratory for more extensive repair.
Dental implants are manufactured from commercially pure Titanium (containing traces of iron and carbon) or an alloy of Titanium with Aluminum and Vanadium and sometimes Zirconium. These materials has been shown to be biocompatible, corrosion resistant and capable of resisting functional load.
The prosthesis fabricated to be installed on the implant usually consists of a metal framework unto which the tooth coloured material is attached.
The metal framework which is the foundation of the prosthesis, gives the prosthesis the required strength and is the platform to connect to the dental implant which is a metal structure itself. This framework can be constructed from alloys of precious (mainly Gold, Silver and Palladium) or nonprecious metals (predominantly Cobalt, Nickel, Chromium, Titanium) depending on the clinical application.
The tooth coloured material that covers the metal framework is either ceramic (including porcelain) or acrylic materials. These are chemically or mechanically bonded to the framework and contribute to the esthetics of the prosthesis.
Some manufacturers and laboratories offer the prosthesis fabricated mainly from a ceramic material called Zirconia. This can be stained and painted to the colour suits the patient, although esthetic result may not be as predictable as other ceramic or even acrylic materials. Currently there is no long-term clinical research demonstrating that this material is a durable material in oral environment.
The periodontal health or health of tissues surrounding the remaining teeth are extremely important in success of implant surgery and health of the implant following the placement. Periodontal disease needs to be treated and compliance to adequate oral hygiene needs to be confirmed before embarking on implant surgery.
Sometimes implant surgery is done in two stages. The implant is placed in the first stage and is covered by gum flap also termed submerged healing. After allowing integration period of 3-6 months, the top of implant is exposed via a minor surgical approach, and a healing component is attached to it which allows the gum tissues to heal around it and provide access to the implant for the fabrication of the prosthesis.
As mentioned earlier, if there is not adequate bone volume in the area that your Prosthodontist plans to have implant to support the required prosthesis, then bone grafting procedures prior or at the time of implant placement is indicated.
In situations that there are severe worn dentition and inadequate space between the dental arches for replacement of missing teeth, your Prosthodontist will plan a pre-implant treatment that involves restoring the remaining dentition in such a way to gain space between the arches of teeth for which a prosthesis can be fabricated.
In situations that the missing teeth are lost many years before seeking for their replacement, the adjacent or opposing teeth may move towards the missing teeth spaces. This will require orthodontic correction prior to placement of implant in the proper sites to achieve an optimal functional and esthetic outcome.
Following the delivery of implant prosthesis, you need to be under routine check-up regime by your prosthodontist and periodontist or oral surgeon, to ensure that the success criteria are met and maintained in the long-term.
A successful dental implant and the prosthesis attached to it provides a comfortable function and looks esthetically pleasing. The prosthesis should also allow you to pronounce natural phonetics of words when you speak, and should give you adequate lip and cheek support if constructed for number of missing teeth in the front part of the mouth.
There should be no pain when you function with the implant supported prosthesis. The gum tissues around the implants should appear firm and healthy with no bleeding when touched or brushed. In case of fixed prosthesis supported by implants, there should be no mobility associated with the prosthesis, as it is rigidly fixated to the implant(s). The removable prosthesis supported by implants have slight degree of resilience while in the mouth, but stable enough to provide comfortable chewing function. They are detachable from the implants by the retentive elements being disengaged from the corresponding retentive device attached to the head of the implant (retentive abutment).
The cost of dental implant treatment varies widely because there are extensive range of options depending on the design of the prosthesis and the number of components needed for surgical and prosthetic stages.
The surgical fee varies depending on whether grafting is done prior or at the time of implant placement and whether implant surgery is done in single or two-stage protocol, and is also dependent on qualification of the surgical practitioner. Cost of implant and accessory components, and also the grafting material is also a part of the surgical fee. Obviously in multiple implant placement the cost will be multiplied by the number of implants.
The prosthetic cost varies depending on the type of components needed to fabricate the prosthesis and type of materials used, qualification of the practitioner and the lab costs.
