With the advent of dental implants we can now have fixed and highly aesthetic replacement of missing teeth without compromising on adjacent healthy teeth. Implants are a great option not only from an aesthetic point of view but also for the bone and gingival health of patients.
Modern day dental implants were discovered by P Ingvar Branemark in the year 1952, he was a Swedish orthopaedic surgeon. According to Wikipedia A dental implant (also known as an endosseous implant or fixture) is a surgical component that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biologic process called osseointegration, in which materials such as titanium form an intimate bond to bone. The implant fixture is first placed so that it is likely to osseointegrate, then a dental prosthetic is added. A variable amount of healing time is required for osseointegration before either the dental prosthetic (a tooth, bridge or denture) is attached to the implant or an abutment is placed which will hold a dental prosthetic.
Dental implants are considered the golden standard of care for prosthetic replacement of missing teeth. There are certain things which need to be considered before planning an implant replacement like:
- Area or space available for replacement of missing teeth.
- Condition of the bone in edentulous area including structure and hardness.
- Medical condition or health of the patient
- Habits like smoking, tobacco chewing Ect
- Cost of treatment
- Patient preference.
Dental implants have a good success rate if the above factors are taken into consideration. In a healthy patient with adequate bone height and width implants are well accepted. Good and regular oral hygiene habits are of utmost importance. Also certain conditions like uncontrolled high blood pressure and diabetes is another deterring factor.
The steps involved in straightforward placement of dental implants are:
- Formation of a customised treatment plan for individual patient after a thorough clinical and radiographic examination.
- After surgical planning first the extractions are completed following which implant placement is performed. In this the actual implant made of titanium is placed in the bone after local anaesthesia at the surgical site and adequate osteotomy.
- After completion of the surgical step the site is closed and the body is given time to heal which is about 6 to 12 weeks.
- After the completion of the surgical step and adequate healing time, the prosthetic step is initiated in which the implant head is once again exposed.
- Following this the final impression is made and the bite of the patient is recorded for the final prosthetic replacement that is either a crown or a bridge.
Like every surgical or dental procedures implants have certain pros and cons, the advantages are:
- Dental implants are fixed in the bone and not removable.
- Implants have the best aesthetics and appear almost like natural teeth.
- They maintain the integrity of the jaw bone and soft tissues.
- They are very comfortable for the patient for chewing and mastication.
- Regular cleaning and maintenance of the implant and surrounding tissues is very important or else it can result in implant failure due to infection in the gums.
- Implant rejection: In some cases the body does not accept the implant as a foreign body reaction. This results in implant loosening and loss.
- In rare cases if the implant is placed too close or impinging on vital structures or nerves it can lead to pain and partial parasthesia or loss of sensation in the surrounding soft tissues.
- Ridge augmentation or enhancement where there is deficient bone height and width due to bone loss. Various techniques used are bone grafting or enhancement using bone bone graft material.
- Sinus lift : In certain cases when the sinus margin is very close or is low, that is close to the ridge margin, in such cases first the sinus floor needs to be lifted or elevated to create space in the bone to place the implant.
The disadvantages are:
In certain cases implant surgery is not straightforward and requires certain surgical manipulations Like :