Dental Implant Surgery
Description
Many people find that dental implants are more comfortable, efficient and secure than are dentures or bridgework.
Dental implants aren't the same thing as artificial replacement teeth. Dental implants are actually the threaded metal cylinders that serve as the roots of missing teeth. The implant, sometimes called a post or cylinder, is surgically implanted in the jawbone beneath the gum tissue. An abutment, or extension, is attached on top of the metal cylinder. Finally, a realistic-looking artificial tooth (crown) is attached to the abutment, creating a three-piece device that completes your smile. You may have one tooth replaced with dental implant surgery or many.
Most healthy adults with missing teeth are candidates for dental implants. Your dentist, oral and maxillofacial surgeon or periodontist can help you decide if dental implants are a good option for you.
In general, dental implants may be right for you if you:
- Have one or more missing teeth
- Have a jawbone that's reached full growth
- Have adequate bone to secure the implants, or are able to have a bone grafting procedure
- Have healthy oral tissues
- Don't have health conditions that will impair bone healing
- Are unable or unwilling to wear dentures
- Want to improve your speech
- Are willing to commit several months to the process
Implants are made from different materials with substantial reserach resources being directed towards investigation of new hybrid materials of which the most recent is Zirconium Dental Implants.
Dental implants made of bio ceramics - zirconium
With the development of the an zirconium implant system, in 2005, the brand Ziterion broke new grounds in dental implantology. For the first time a dental implant system, considering the requirements of ceramics was developed in the view of bio capability.
Besides the advantages of metal free implants , the system offers variability, simplicity and lucidity.
The special zit thread design HSD (high stability design) with its micro-roughened surface assures a high primary and secondary stability for all zit Implants.
Arguments in favour of the application of zirconium Implants
- Simple, quick and patient-oriented implant therapy
- Time and cost saving
- Standard therapy with titanium implants
- High end aesthetic therapy with ceramic implants
- Perfect, well suited and lucid product range
Here are some standard answers to a number of questions that people have in relation to the use of zirconium.
Is Zirconium radioactive?
“Radioactive burden resulting from zirconia implants” (Article in German)
Fischer-Brandies E, Pratzel H, Wendt T.
Klinik und Poliklinik fur Kieferchirurgie der Universitat Munchen.
Due to its mechanical properties zirconia is an interesting implantation material. However, it may contain a certain amount of radioactive isotopes. The measurement of alpha-emission reveals varying amounts of radiation. As a result, a declaration of radioactivity should be required for zirconia implants and only zirconia with low emission levels should be used for implantation purposes.
PMID: 1817864 (PubMed)
“Zirconia Ceramics as Biomaterials – Radioactivity Issues”
Background
Zirconium compounds are refined from naturally occurring ores, notably zircon, and usually contain trace amounts of other elements depending upon the source of the original ore.
In particular, zirconia typically contains trace amounts of radionuclide of the actinide series such as 226Ra and 228Th.
As a consequence there have been some concerns about the use of zirconium ceramics as implant materials.
The Radioactivity of Zirconium Biomaterials
However, the radioactivity of zirconia is negligible.
For example, the radiation emitted by a 3 mol% Y2O3-ZrO2 powder was the same order of magnitude as alumina powder, both of which were several orders of magnitude less than that typically measured for water, milk, vegetables and meat (in Europe).
The radioactivity of Y-TZP zirconia femoral heads were shown to be similar to that of alumina and cobalt-chrome alloy femoral heads accepted for human implantation.
The radiation dose of each material was well below European radiation limits specified for general external exposure of the human body and also for local internal exposure of organs and tissue, and was no more than the ambient radiation of the surroundings.
The Radioactivity of Commercially Available Zirconia Powders Similarly, the radiation levels of several commercially-available zirconia powders (Nilcra Ceramics, Melbourne, Australia) measured by the Australian Radiation Laboratory were found to be minimal and well below acceptable limits.
The Radiation Health Committee of the National Health and Medical Research Council of Australia consider that magnesia partially stabilised zirconia femoral heads made from these powders would pose very little hazard to surrounding tissue.
Radiation Absorption
In a dense ceramic, almost all the radiation will be absorbed within the bulk of the material. Any external radiation could come only from radionuclides at the surface in the case of a-emission, or from radionuclides in the first few millimetres in the case of b-emission.
Furthermore, in the case of artificial hip joints, any radiation from the femoral head will be absorbed mostly by the ultra high molecular weight polyethylene acetabular cup or the metal femoral stem.
The radiation risk of zirconia ceramics is negligible and certainly no more than that of alumina.
Primary author: Dr. Owen Standard. Source: Abstracted from Ph.D Thesis “Application of Transformation-Toughened Zirconia Ceramics as Bioceramics”, University of New South Wales, Australia, 1995.
Dental Implant - Pitt-Easy
Pitt Easy is one of the most reliable and tested Implant systems on the market. Dentists have been using them for over 15 years and they are reliable and well tested.
The prime advantage of Pitt Easy Dental Implants is their cost. They are well suited to less complicated cases.
A possible disadvantage compared to some of the new systems (such as Camlog) is that only have a 5 year guarantee.
- Camlog Dental Implant
- Zimmer Dental Implants
- Rapid Implementation Dental Implant - Straumann SLActive
The Straumann SL Active System is the newest implant system available and combines the outstanding technological precision of their German manufacturer with a number of key innovations that reduce treatment time and the risks of infection.
Although they are about 10% more expensive than Camlog, they allow us to offer a complete treatment from implant to crown of only 3 months. In some cases it is possible to achieve the crown fitting within 1 month.
Straumann SLActive is the newest technology tooth implant. With more than 20 years of clinical research that have resulted in over 3000 scientific publications, this implant is the most extensively documented, clinically validated and practice-proven implant system. The Straumann system is reliable, simple and versatile. Reliable because it works with reduced healing time, designed for optimal tissue response and has maximum stability. Simple because it is simple to use by the oral surgeon and versatile because it has successful outcomes with any indications, many surgical possibilities and prosthetic options.
Most of the implant surfaces are made rough with a titanium plasma spray (TPS) so to help osseointegration. Straumann had created a new technology in 1997 with which they had cut healing time by half. This surface was called SLA (sandblasted and acid etched) and resulted much greater than its anchestors. These surfaces were already very popular by the time Straumann had created a newest surface in 2005, the first hydrophilic surface (SLActive), which cut healing times by half again. Hydrophilic means that the surface attracts watery liquids to it which means that body fluids are attracted to the surface of the implant body and so accelerate growth and also reduce the possibility of infections.
With SLActive Straumann had sett new standards in implant dentistry. SLActive provides 60% more bone after two weeks, cutting the healing time from 6-8 weeks to 3-4 weeks. Higher treatment predicability and reduced risks.
Most implant failures occur in the critical early period between week 2 and 4. This is the pivotal 'dip' (stability gap), presents in the period between primary and secondary stability in the bone formation process. The innovation of SLActive is the 'Activation of full healing potential' which means the full and immediate activation of the human body's natural healing potential. The SLActive surface (chemicall active, hydrophilic) promotes the initial healing reaction, allowing for direct cell interaction at the initial stage of the osseointegration process. Bone formation is immediately initiated resulting an earlier secondary stability and reducing the critical dip.
Accelerated Dental Implant Treatment (Nobel Biocare Teeth in an Hour)
Summary: neat marketing slogan for something that takes rather longer than an hour, but use of CT scan enables a computer model of the patients mouth to be developed and totally accurate insertion to take place
There has been a lot of discussion in the press about the Teeth in an hour techniques and some resistance from dental implantologists wedding to the notion and traditional time frames of osseointegration (the process whereby the bones grows around the implant).
This process uses the information from a CAT scan to enable Nobel biocare to create a computer model of the treatment process and a physical guide which the implantologist uses to insert implants in a very accurate way to exploit strong and thick bone etc. This means that the implants can be loaded straight away with crowns and the normal wait of three months is avoided.
However, this is relatively new and seems to be applicable to patients with certain types of mouths and bone structures. Usually younger patients.
It takes more than an hour as you have to have the CT scan several weeks before surgery. It is also very expensive at the moment.
Types of Dental Implants
Different dental implants surgeons work with different types of implants sourced from different manufacturers. We have listed information about the different types used by our partners to help you understand more about treatments and different treatment costs.
Zirconium Dental Implants
The Zit Implant System consists of ceramic material zirconium, which is most suitable for highest aesthetic demands.
The abutment part was designed identically for all implants. Thus, the application of impression caps and laboratory analogues is made possible for standardized prosthetics on trans-gingival and sub-gingival zit Implants. The zit instrument kit, with ceramic drills, is restricted to the essentials, setting new standards with regard to design, user-orientation, as well as to cost efficiency and utility.
All instruments and laboratory components suitable for the trans-gingival system can also be applied with the sub-gingival system. Only one insertion instrument is required for all implants. Due to the unique and lucid product range, logistic expenditure as well as the costs for dental implant treatments with zirconium Implants in surgery are reduced considerably.
Dental implants made of bio ceramics - zirconium
With the development of the an zirconium implant system, in 2005, the brand Ziterion broke new grounds in dental implantology. For the first time a dental implant system, considering the requirements of ceramics was developed in the view of bio capability.
Arguments in favour of the application of zirconium Implants
Your financial situation also might be a factor in determining whether dental implants are a good option. Dental implants are expensive and often aren't covered by insurance.
Questions about Zirconium Dental Implants
Medical Facts
Typical Dental Implant Treatment PlanA dental implant treatment plan is drawn by the dentist in consultation with you and defines both the number of implants that will be placed as well as the number of crowns to cover them. It also proposes the schedule of visits and any other work that may be required such as sinus lifts or extra bone thickening.
It is necessarily the case that you will have the same number of crowns as implants as it is often better to cover a large gap with a "bridge" rather than a number of separate crowns. By using crowns it is possible to reduce the number of implants placed without effecting the reliability or robustness of the bridge.
Some patients have very thin bone which requires that new bone is grown before implants can be placed. This will effect the treatment plan.
It is not possible to guarantee a treatment plan before the dentist has actually seen the patient even if the dentist has reviewed an XRay before the patient's arrival.
How to prepare for dental implant surgery?
Because dental implants require one or more surgical procedures, you must have a thorough evaluation in preparation for the process.
To start, you have a comprehensive dental exam. This may include taking dental X-rays and making models of your mouth. In addition, be sure to talk to your doctor about any medical conditions you have and any medications you take, including prescriptions, over-the-counter medications or supplements.
If you have certain heart conditions or vascular or orthopaedic implants, your doctor may prescribe antibiotics before surgery to help prevent infection.A treatment plan is tailored to your particular situation. This plan takes into account such factors as how many teeth must be replaced and the condition of your jawbone. This planning process may involve a variety of dental specialists, including:
- An oral and maxillofacial surgeon, a doctor who specializes in the diagnosis and treatment of injuries, diseases and other problems of the mouth, jaw and face.
- A periodontist, a dentist who specializes in the diagnosis and treatment of the structures that support the teeth.
- A prosthodontist, a dentist who specializes in making and fitting artificial replacements for missing or defective teeth.
How is dental implant surgery done?
Placement of dental implants and artificial teeth involves surgical procedures usually done in several stages. The entire process takes three to nine months, or sometimes even longer. That may sound daunting, but a lot of that time is spent on healing and waiting for the growth of new bone in your jaw.
What can you expect during dental implant surgery?
Specifically how dental implant surgery is performed depends on the type of implant used and the condition of your jawbone. In general, the dental implant cylinder is first implanted in your jawbone, and then you must sit through a period of healing for several months. After that, the abutment is placed, followed by a shorter healing period. Finally, you get your new artificial tooth, sometimes also called an implant prosthesis or crown. Some people may require bone grafting before the initial dental implant surgery, which lengthens the whole process.
When bone grafting is required?
If your jawbone isn't thick enough or is too soft, you may need bone grafting before you can proceed with dental implant surgery. That's because the powerful chewing action of your mouth exerts great pressure on your bone, and if it can't support the implant, the surgery to replace your teeth would likely be a failure. A bone graft can create a much more solid base for the implant.
With bone grafting, a piece of bone is removed from another part of your body, such as your hip, and transplanted to your jawbone. The transplanted bone will grow, but it may take six to nine months to grow enough new bone to support a dental implant. In some cases, you may need only minor bone grafting that can be done at the same time as the implant surgery. The condition of your jawbone determines how you can proceed.
Placing the dental implant
Whether you have a bone graft or not, the dental implant must be surgically placed in your jawbone. This surgery is usually done on an outpatient basis, in either a dental office or a hospital. You don't need to stay in a hospital overnight.
You get some form of anesthesia for pain control during surgery. Anesthesia options include local anesthesia, sedation or general anesthesia. Talk to your dental specialist about which option is best for you. Your dental care team gives you specific instructions about eating and drinking before surgery, depending on what type of anesthesia you have. For instance, if you're having general anesthesia, plan to have someone take you home after surgery and expect to rest for the remainder of the day.
During the surgery, your gum is cut open to expose the bone. Holes are then drilled into the bone where the dental implant cylinder will be placed. Since the cylinder will serve as the tooth root, it's implanted deep into the bone. Once the dental implant is securely in place, your gums are stitched closed over the cylinder. The cylinder sits below the surface of your gum, so it's not visible when you open your mouth.
At this point, however, you still have a gap where your tooth is missing. Usually, a type of partial, temporary denture can be placed to look more aesthetically pleasing. This denture is removable for cleaning and to sleep.
Waiting for bone growth
Once the metal dental implant cylinder is placed in your jawbone, osseointegration begins. During this process, the jawbone grows into and unites with the surface of the dental implant. This process usually takes three to six months. This is an important step because it helps provide a very solid base for your new artificial tooth — just as roots do for your natural teeth.
Placing the abutment
Once osseointegration is complete, you need additional surgery to place the abutment, to which the crown will eventually be attached. To place the abutment, your gum is reopened to expose the dental implant. The abutment is attached to the dental implant. This minor surgery is typically done with local anesthesia in an outpatient setting. Once the abutment is placed, the gum tissue is then closed around, but not over, the abutment.
In rare cases, the abutment is attached to the dental implant cylinder at the same time that the cylinder is implanted. That means you won't need an extra surgical step. However, because the abutment juts past the gumline, it's visible when you open your mouth — and it may be that way for six months or so. Some people don't like that appearance and prefer to have the abutment placed in a separate procedure.
Choosing your new artificial teeth After the abutment is placed, your gums must heal for one or two weeks before the artificial tooth can be attached. Once your gums have healed, you have more impressions made of your mouth and remaining teeth. These impressions are used to make the crown — your realistic-looking artificial tooth, or prosthesis. The crown can't be placed earlier in the process because your jawbone isn't yet strong enough to support use of the new tooth.
You and your dental specialist can choose from two main types of artificial teeth. They are:
A removable implant prosthesis. This type is similar to a conventional removable denture. It contains artificial white teeth surrounded by pink plastic gum. It's mounted on a metal frame that's attached to the implant abutment, and it snaps securely into place. It can be easily removed for repair or daily cleaning. It's often a good choice when several teeth in the lower jaw are replaced, largely because it's more affordable than multiple individual dental implants and yet more secure than a traditional denture.
- A fixed implant prosthesis. In this type, an artificial tooth is permanently screwed or cemented onto an individual implant abutment. You can't remove the tooth for cleaning or during sleep. If affordability isn't a concern, you can opt to replace several missing teeth this way. Each crown is attached to its own dental implant.
What happens after dental implant surgery?
Whether you have dental implant surgery in one stage or multiple stages, you may experience some of the typical discomforts associated with any type of dental surgery. These may include:
- Swelling of your gums and face
- Bruising of your skin and gums
- Pain at the implant site
- Minor bleeding
Very rarely, stiffness of your jaw muscles may occur, or an inability to fully open your mouth. When these do occur, they're usually a result of passing a surgical needle through jaw muscle.
If swelling, discomfort or any other problem gets worse in the days after surgery, contact your implant surgeon who may prescribe pain medication or antibiotics.
After each stage of surgery, you may need to eat soft foods for 5 to 7 days. Typically, stitches/sutures that dissolve on their own are used. If your stitches aren't self-dissolving, your doctor removes them after about 10 days.
Making your dental implant surgery a success
Most dental implants are successful long term. You can help your dental implants — and remaining natural teeth — last longer if you:
- Practise exceptional oral hygiene. Just as with your natural teeth, implants, artificial teeth and gum tissue must be kept clean. Specially designed brushes, such as an interdental brush that slides between teeth, can help clean the nooks and crannies around teeth, gums and metal abutments.
- See your dentist regularly. Schedule dental checkups every 6 months to 1 year to ensure the health and proper functioning of your implants.
- Avoid damaging habits. Don't chew hard items, such as ice and hard candy, which can break your crowns — or your natural teeth. Avoid tooth-staining tobacco and caffeine products.
- Schedule treatment if you commonly grind your teeth.
When dental implant surgery doesn't work
In some cases, dental implants don't succeed. The most common reason is when the bone fails to fuse sufficiently (ossify) to the metal implant cylinder. In this case, the implant is removed, the bone is cleaned up, and potentially you can elect to try the procedure again in a month or two.
Another cause of dental implant failure occurs when the implant may become loose. If this happens, the implant can be removed and replaced with a new one.
What are the risks and downsides of dental implant surgery?
Like any surgery, dental implant surgery poses some health risks. Problems are rare, though, and when they do occur they're usually minor and easily treated.
Risks include: