A relatively new concept in the replacement of missing teeth, is the introduction of dental implants. These structures are basically designed on the model of screws used by orthopedic surgeons for joining broken bones. Stated very simply, a dental implant is a small titanium screw that serves as the replacement for the root portion of a missing natural tooth. It is available in various sizes (both width and height) for different clinical situations. Dental Implants may be used to replace one or more missing teeth. In case of completely edentulous patients, implants may be used to fix the dentures to the underlying bone. Alternately, implants may be used to provide fixed tooth to edentulous patients without the use of dentures. Needless to say, an implant offers several advantages over conventional treatment options.  

What are the Benefits of Implants?

	Implant supported teeth are more comfortable than conventional dentures because there is no slipping or movement, because the implants are fixed they feel and function like natural teeth. This eliminates some of the key worries of denture wearers and improves self-confidence.
	Dental implants are an alternative to conventional bridgework. They eliminate the need to prepare healthy teeth and do not place additional loads on the teeth supporting the bridge.
	When teeth are missing the surrounding bone shrinks. Implants stimulate the bone to be maintained which helps keep shape and structure of the jaw stable.

With today's advancements in dental implant techniques, materials and technologies, almost anyone with missing teeth can now have dental implant treatments done. Conventional implants techniques have had good long-standing success rates.

Also due to new developments in implant technologies and techniques, immediate implants and immediate loaded implants are now possible that can dramatically shorten treatment.
 

	At initial consultation, all possible alternatives are considered and the feasibility of implant treatment is assessed.
	Should you wish to proceed with implant treatment, a full and detailed assessment is done which involve the taking of impressions, x-rays and in some cases CT scans. This completes the diagnostic planning and treatment details including sequence of treatment, costs and possible complications are discussed with the patient.

Implant Placement - This is generally a simple procedure that is performed under sterile conditions in a dental surgery using local anesthesia. If required, bone saved from the drilling procedure and some artificial bone may be used augment the contour of the ridge and gum around the implant.

Healing Process - Osseointegration

	The implant is left to integrate with the jaw bone for a period of 2 to 6 months
	The sutures are typically removed seven to fourteen days after surgery
	The patients own denture or in some cases a simple adhesive bridge can be worn during the healing phase.

The Restorative Phase –

	When the gum tissue is ready, a special abutment or metal bar/ball is attached to the implant
	If crowns or bridges are opted, an abutment is placed and this provides the support for the new crown or bridge.
	If overdentures are opted, the metal bar/ball is placed and is the the clip used to securely retain the set of new overdentures
	After impressions are taken, the crown/bridge or overdenture is made and fixed in place.

Maintenance –

	Patients are demonstrated brushing and flossing around the implant
	Patient is scheduled on recall program to monitor the health of gums, implant integrity and bone levels and to perform professional prophylaxis if required

In cases where bone condition and density are favourable, dental implants can now be embedded after tooth extraction. Such techniques being referred to as immediate implants, one-day implants, single day implants or same day implants. This means that the patient have new tooth roots upon leaving the office.
 

Immediate Loaded Implants ( Teeth-in-an-Hour)

In addition, for certain cases, permanent or temporary prosthetics may be placed immediately during the same treatment visit when the dental implants are surgical placed. This is known as immediate loaded implants. This forms the basis of "Tooth in an Hour" concept that is widely being used by dentists the world over. The immediate loading of dental implants shortens the treatment time and makes it possible to give the patient an esthetic appearance during the whole treatment period.

Benefits of Immediate Loaded Implants

 

	Good esthetic results
	Shorter treatment time with minimized pain
	Immediately functioning teeth

However, immediate loaded implants does not apply to all cases and is largely dependent on the individual's bone quality and condition.

There are certain conditions that preclude the procedure of immediate loading. The decision to immediately load the implant is largely dependent on a large extent on the clinical judgment of the operating surgeon. However, certain rules must be kept in mind:

 

	The patient should be healthy and compliant with good oral hygiene.
	Good bone quality and quantity is a prime requirement for immediate implants to be successful
	The site selected for immediate loading should be free from any infection. Infact even the neighboring teeth should be free from radiologic/clinical signs of infection.
	Even in good bone quality and quantity cases, if the drilling technique removes a lot of bone so that primary implant stability is not attained, immediate loading should not be attempted.
	Stable relationships between opposing teeth.

Implants supported Fixed Bridge
 

	The best remedy in situations where there are no posterior teeth or where there are no healthy natural teeth available for fixed bridge support
	Patient can chew better because the bridges are tightly secured.
	Gives better strength and stability than dentures
	Renewed confidence and improved quality of life as well
	Save adjacent teeth. Prevents bone loss and exisiting teeth from drifting into surrounding space of the missing teeth
	Requires less maintainence than implant supported overdentures.

There is a choice in the type of teeth (crowns) that can be placed- metal, metal ceramic or all ceramic.

Installing Implants with Fixed Bridge

FAQ's regarding implants:

Who is a good candidate for dental implants?

Anyone in reasonable health who wants to replace missing teeth; those who are dissatisfied with their current denture; those people who would like to eat better and with more comfort, smile more frequently and feel more secure when they talk and laugh. Age should not be a deterrent. If the treatment is properly planned, the surgery accomplished following accepted rules of practice, the prosthesis fabricated correctly and properly maintained by the patient, success rates are in excess of 98%. In the majority of situations, only one or two implants are required. Patients that have had implants placed eat better, eat foods that they have been denied before, are more comfortable when they eat, and don’t have to use adhesives to retain their dentures. They can talk and laugh without feeling self-conscious and without fear of their dentures slipping out. All these improvements make people with dentures feel better about themselves increasing their self-confidence while improving their social and business lives.

Do implants require special maintainence?

No, dental implants require the same care as real teeth, including brushing, flossing, and regular dental check-ups:
 

	Brush after eating and before bedtime around the implant with a soft toothbrush
	Floss at least once to twice a day. Use the proxy brush or floss threader to remove plaque under and around these areas to maintain good oral hygiene. Buildup of food debris and plaque on your teeth and gums can become infected.
	Rinse with fluoride rinse before bed. Swish the fluoride rinse vigorously in your mouth for at least one minute. Do not swallow any of the rinse and do not eat or drink anything for 30 minutes
	See your dentist for regular professional check-ups and cleanings

Which Implant ?

Currently the market is flooded with companies marketing dental implants. Barring few and negligible differences almost all have same design and pattern. Choice for a particular product is purely based on user preference and being friendly to a particular product. Common systems available in the market include Nobel Biocare, Xive, Endopore, Alpha Bio etc

What to do in cases where bone volume does not support implants?

The success of a dental implant primarily depends on its ability to bear chewing forces which in turn is very much dependent upon how much bone is available in the site where the implant is placed. There are lots of things that affect the bone volume like gum diseases, trauma and age and it is not unusual to open up a site in the mouth for implant placement and find out that some of the critical supporting bone is missing. No problem.... Modern dentistry has gifted us new techniques to augment missing bone. We can increase both the height and width of bone by using bone substitutes called as Bone grafts. We can even use grafting techniques to prevent the loss of bone in circumstances where bone would normally be lost like the extraction of a tooth.

Types of Bone Grafts

There are a number of ways in which bone grafting can be done. The bone used for grafting may be collected when preparing an implant site and then reusing the same bone for grafting purposes. Use of such autogenous bone provides the best results.

But due to the limited quantity that can be procured and the requirement of a second surgical site, most often synthetic bone substitutes commercially available are used for the purpose. This bone is specially prepared from cadavers, corals or other sources but it is very effective and very safe.

The Sinus Lift

The human skull has several air filled cavities called "sinuses". They help to make the head lighter and add resonance to voice. However, they sometimes pose a problem in implant placement in the upper jaw specially in molar region by limiting the available bone volume. We cannot place a dental implant into the sinus because we would just be placing it into an air cavity and nothing would hold it into place. In such cases, bone grafts are placed on the floor of the sinus to increase the bone volume. The procedure is called "Sinus Lift". It has a very high success rate and is commonly done to augment bone for implant placement. We can then go back several months later and place our dental implants in solid bone. Sometimes, there is enough bone to place the implants at the same time that you raise the floor of the sinus.

Drawbacks of Bone Grafting Technique:
1. The bone grafting process adds significant time to the procedure.
2. The second problem is the increased cost to the patient.

Is the implant treatment very painful?

The implant treatment might appear very scary but infact it is associated with little or no pain or discomfort during the entire procedure.

Can anyone have implants?

Most patients can have dental implants irrespective of age, providing growth of the jaws has stopped. If you are healthy enough to undergo routine dental extractions then you should be a suitable candidate for implants. In some rare cases a lack or loss of bone may preclude implant treatment. Smoking can increase the number of problems associated with implants.

How long do implants last?

An implant will normally serve its owner for life. Statistics confirm a success rate of nearly 95% for individual implants and even higher for the bridges they support.

Is the treatment painful?

Patients are often surprised at how little discomfort they experience during and after implant procedures. In general the placing of a single implant fixture is no more traumatic than a tooth extraction.

Is it Expensive?

Implant treatment may initially be considered costly. For instance a single implant will cost about twice as much as a single tooth bridge. However, research shows that over a ten year period less that 70% of these bridges will last, necessitating more destructive and expensive treatment. However, 95% of the implants will survive, therefore, in the long term they are both more conservative and cost effective than conventional treatment.

What to do in cases where bone volume does not support implants?

The success of a dental implant primarily depends on it's ability to bear chewing forces which in turn is very much dependent upon how much bone is available in the site where the implant is placed. There are lots of things that affect the bone volume like gum diseases, trauma and age and it is not unusual to open up a site in the mouth for implant placement and find out that some of the critical supporting bone is missing. No problem.... Modern dentistry has gifted us new techniques to augment missing bone. We can increase both the height and width of bone by using bone substitutes called as Bone grafts. We can even use grafting techniques to prevent the loss of bone in circumstances where bone would normally be lost like the extraction of a tooth.

Types of Bone Grafts

There are a number of ways in which bone grafting can be done. The bone used for grafting may be collected when preparing an implant site and then reusing the same bone for grafting purposes. Use of such autogenous bone provides the best results.

But due to the limited quantity that can be procured and the requirement of a second surgical site, most often synthetic bone substitutes commercially available are used for the purpose. This bone is specially prepared from cadavers, corals or other sources but it is very effective and very safe.

The Sinus Lift

The human skull has several air filled cavities called "sinuses". They help to make the head lighter and add resonance to voice. However, they sometimes pose a problem in implant placement in the upper jaw specially in molar region by limiting the available bone volume. We cannot place a dental implant into the sinus because we would just be placing it into an air cavity and nothing would hold it into place. In such cases, bone grafts are placed on the floor of the sinus to increase the bone volume. The procedure is called "Sinus Lift". It has a very high success rate and is commonly done to augment bone for implant placement. We can then go back several months later and place our dental implants in solid bone. Sometimes, there is enough bone to place the implants at the same time that you raise the floor of the sinus.