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Dental implants becoming a routine procedure in todays dentistry!

Renova dental implant

In many cases an extraction of decayed, rotten or broken tooth and the dental implant placement occurs in the same visit and leads to excellent integration and prognosis.  (The things is, that the bone socket naturally fills with bone after the tooth is removed, and having the implant already there, just speeds up the process and eliminates unnecessary surgery.) A lot of times, when patient comes as an emergency and tooth has to be extracted, we  would do the emergency extraction with immediate placement of implant (love doing that and so do the patients).

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Little bit of history   The birth of modern dental implant technology is attributed to a Swedish scientist  Brånemark, who  discovered in 1951 that titanium can irreversibly integrate with the living bone tissue, forming a strong bond between two. His discovery met a lot of doubts and scrutiny among the scientific community. He has continiusly worked on his research and in 1982 has presented his findings at the Toronto conference on Osseointegration in Clinical Dentistry.
Even though  Brånemark is considered the father of todays implantology in dentistry, the first use of dental implants has been tracked as far as 1300 years ago to 600 AD in ancient Mayans. There quite few archaeological discoveries pointing to placing
Ivory and the bones of animals in attempt to replace missing teeth.
  • In eighteen century they started to attempt to replace extracted teeth with teeth of human donors. Even though there are some mentions of success, the most attemts have failed due to the immune reaction to foreign material.
  •  In the ninetenth century the use of gold, and later platinum and other metal was attemted to be placed  into sockets of freshly extracted teeth in an attempt to create suitable replacements. Again, even though there a few descriptions of success the long-term success rates were extremely poor.
  • 1937  Dr. Alvin Strock at Harvard University successfully places vitallium implant and conducting his implants studies for 15 years till he dies. His experiments showed great results and high tolerance in implants placed immediately in the extraction site.
  • In the middle of 20th century the use of subperiosteal, endosteal balde, and root form implants took the new spin. The root form implant or endoosteal implant is the implant of choice in today dental implantology.

Dental Implants Overview  Dental implants are rapidly becoming a routine procedure in today’s dentistry. In many clinical situations, implant is the number one choice of restoration for missing tooth. The most commonly used implants are the endosseous implants. There are also other kinds of implants  in dentistry, but they are used rarely today.  I will focus here on procedures and use of endosseous dental implants.Implants in dentistry is a very fast developing field. That is why there are many different manufacturers producing endosseous implants. The will differ in shape and form; their available sizes can slightly differ. The most accepted material for dental implants is either high grade Titanium (Commercial Pure) or Titanium alloy. The titanium alloy implants tend to be stronger than the CP titanium implants. The bone integration shows no difference to the two different types of titanium.

Endosseous Implants  If you look at the implant from the side, it resembles a screw. The endosseous dental implant is substitute for the root of the tooth, that is why they often called rootform implant. The body of the implant is the part which goes inside the bone, it's outer surface may have different coatings stimulating bone growth, or it may just have smooth or roughened surface. The hex of the implant is a top side, where the future restoration goes. Remember, that implant itself is a substitute for the root and is used to support the restoration which goes on top of it. ( for more see below)

External and Internal Hex Implants

The top part of the dental implant is called Hex. It has a locking mechanism, which may be inside the body of the implant- internal hex implants, or stick as a platform above the body of the implant-external hex implants. Also, if you look at the implant from the top you will see the threaded ‘canal’ in the middle of the hex going down the body of the implant. The future restoration will be seated on the hex and screw tightened to the implant. It is doctor's preference which type of implants to use. I prefer internal hex implants for these reasons: they give a better retention for the future restoration, and they can be placed slightly deeper allowing for more cosmetic restorations.

Dental implants come in various thicknesses and length.  Your anatomy and bone levels dictate the size of the implant that can be placed.  The longer, thicker implants usually last the longest.

 It is each doctor’s preferences to decide which type of implant to use. However, their basic principle is the same. Endosseous implants or Root-formed implants are the anchors, which are placed inside the bone of the jaw and substitute the root part of the tooth. You must remember that implant is just a support for future restoration. Endosseous implants can be used:·       To support single crown for one missing tooth,

·       Two or more implants can be used as a support for fixed bridge restoration and one of best alternatives in restoring missing teeth

·       Implants can be used as a retainer of removable dentures

How and why implants work?  

After dental implant is placed inside the bone, it usually takes about 2 to 6 month for the implant “to heal”. Actually, we are waiting for the implant to bond with the surrounding tissue – a process known as osseointegration. Osseointegration was a term coined by a Swedish Professor Per-Ingvar Brånemark in 1952 when he discovered the ability of living tissue to integrate with titanium. Osseointegration has been described as a direct structural and functional connection between living bone and the surface of a load carrying implant. During his original research, Prof. Brånemark found a way of using pure titanium as an anchoring unit and support for a variety of prosthetic reconstructions. The long-term predictability and success of Dental implants is based on the fact that an active bond between bone and implant is created at the molecular level. The fixture is not only accepted but also incorporated within the bone. 

Indications and Contraindications  Generally, any edentulous (toothless) area, having enough bone support can be an indication for restoring missing tooth with implant. A decision has to be made whether it is a good idea based on the patient’s requirements and expectations, and on case-by-case bases. The doctor will consider many things before advising you on one or another treatment options. Even though there is practically no absolute contraindications for placement of implants, there are few factors that can put it in a high risk situation.
 The risk factors are
·       Endocrine disorders, such as uncontrolled Diabetes Mellitus, Pituitary and Adrenal insufficiency and Hypothyroidism can cause considerable healing problems.
·       Uncontrolled granulomatous diseases, such as Tuberculosis and Sarcoidosis may also lead to a poor healing response to surgical procedures.
·       Patients with cardiovascular diseases, taking blood thinning drugs and patients with uncontrolled hematological disorders such as Generalized Anemia, Hemophilia (Factor VIII deficiency), Factor IX, X and XII deficiencies and any other acquired coagulation disorders are contraindicated to surgical procedures due to poor hemorrhage control. (In most cases medicine can be stopped for a few days with permission of your medical doctor)
·       Patients with bone diseases, such as Histiocytosis X,  Paget's Disease and Fibrous Dysplasia may not be good candidates for implants, because there is a higher chance for the implant to fail due to poor osseointegration
·       Cigarette smoking
·       Patients receiving radio and chemotherapy should not do implants within 6 month period of therapy 

Bicon implants

The mostly used implants are not coated implants. Some dentists like to use coated implants in particular situations. The factors contributing to selection of the implant is a particular site, presence of inflammtion, general health of the patient.

External hex implants
Internal hex implants

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Integration of live tissue with the implant

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