A Swedish orthopedic surgeon named Per-Ingvar Brandmark patented dental implants, as we know them today, in 1952. Today, they are known to be the standard of treatment in dentistry for prosthetic removal of broken teeth. A dental implant is a surgical fixture that is inserted onto the jawbone over a course of a few months and helps the bone to connect. The dental implant serves as a bridge for a missing tooth’s root. This “artificial tooth root” in turn helps to carry a substitute tooth or bridge. The nearest thing to mimicking a real tooth is making a dental implant fused to the jawbone, so it sits on its own without damaging the nearby teeth and has tremendous durability. The fusion process is called “osseointegration.” between the dental implant and the jawbone. Many dental implants are made of titanium, which helps them to blend with the bone without being recognized in our bodies as a foreign entity. Technology and research have evolved over time to significantly increase the results of the placing of dental implants. The dental implant success rate today is equivalent to 98 percent.
Why is there a need for a dental implant?
For the removal of a single tooth, multiple teeth, or all teeth, dental implants may be used. In dentistry, the purpose of removing teeth is to regain function as well as esthetics. Usually, there are three options when it comes to teeth replacement:
- removable dental appliance (complete denture or partial denture).
- fixed dental bridge (cemented).
- dental implant.
Dentures are the most affordable solution to replacement teeth, but because of the inconvenience of a removable appliance in the mouth, they are the least attractive. In addition, dentures can alter one’s taste and sensory perception of food. Dental bridgework was the most traditional restorative choice prior to the comparatively recent change to dental implant therapy. The primary downside of bridgework is the reliance on established natural teeth for assistance. Implants are protected only by bone and do not impact the normal teeth around them. It depends on several variables to decide on which choice to select. These variables are primarily for dental implants, including
- Place of the tooth or teeth missing
- The quantity and consistency of the jawbone in which to position the dental implant
- The patient’s welfare
- Preference for patients.
The dental surgeon investigates the area to be used for a dental implant and makes a professional evaluation as to whether the patient is a suitable choice for a dental implant. There are great benefits of using a dental implant to replace the teeth with the other alternatives. Dental implants are traditional in that missing teeth may be inserted without changing or modifying the adjacent teeth. Furthermore, since dental implants are incorporated into the bone structure, they are very durable and can have the look and sound of one’s own natural teeth.
Dental implants types
Two male dentist in uniform perform dental implantation operation on a patient at dentistry office
There have traditionally been two distinct types of dental implants:
- Endosteal refers to an implant that is “in the bone, and subperiosteal.
- subperiosteal refers to an implant that lies on the surface of the jawbone under the gum tissue. Subperiosteal implants are no longer in use today due to their poor long-term performance relative to endosteal dental implants.
While the main role of dental implants is to cover teeth, there are places where implants can help with other dental procedures. Because of their durability, dental implants may be used to support a removable denture to have a more stable and supportive fit. In addition, for orthodontic procedures, dental mini-implants can serve as temporary anchorage devices (TADs) to help shift teeth to the desired location. These mini-implants are tiny and temporarily attached to the bone when helping to anchor the movement of the teeth. Subsequently, they are removed after their function has been served.
For patients who have lost all their teeth due to deterioration or gum disease in the upper and/or lower arcs, a very safe and supportive prosthesis using a limited number of implants is available. One such example is the All-On-4 technique, named after the implant manufacturer Nobel Biocare.
This procedure derives its name from the notion that four implants should be used to cover all the teeth in a single arch (upper or lower). The implants are carefully located in places of strong bone strength and a thin denture prosthesis is screwed into place.
The All-On-4 technique offers a replacement of teeth that is stable (not removable) and looks like natural teeth relative to the older conventional (removable) full denture process.
During the consultation and preparation process, the dental surgeon will physically inspect the location in the mouth where the dental implant is being considered, as well as the dental imaging tests (X-rays, panoramic films, and/or CT scans). At this time, the condition and quantity of the jawbone is measured to decide if more bone is required at the site. When it has been determined if a dental implant will be positioned at the correct spot, the patient can return to the dental implant for surgery (s). During all surgery visits, the patient is usually given local anesthetic to numb the surgical region as well as any other sedatives required for relaxation and anxiety.
The first step of oral surgery also includes the extraction of teeth. Sometimes, an existing missing tooth is still present at the dental implant site. The tooth would need to be removed in order to allow for the insertion of a dental implant. More frequently than not, an “alveolar bone graft” (cadaver or plastic bone) is inserted to achieve a stable bone foundation for the implant. This place will be healed for two to six months. For a site that has no tooth and no bone loss, a different bone graft is expected to be put on top of the current jawbone (“onlay bone graft”). This process is more complex and typically involves about six or more months of recovery.
In certain cases, where enough bone is present, the affected tooth may be replaced, followed by an implant insertion operation on the same appointment. This operation is called the insertion of a “immediate implant”
In cases where the implant is to be positioned in the maxilla (upper jaw) in the back or posterior area, the amount of bone accessible can often be reduced by the involvement of the maxillary sinus (air-filled space found in the bones of the face). “Sinus augmentation” or “sinus lift” is done to increase the sinus floor and graft more bone into the sinus. This would make more bones available to support a dental implant.
When the bone is solid enough, the site is ready for the implant. At the insertion of the implant, the dental implant (titanium post) is inserted in the bone with a special drill and equipment. The “healing cap” is placed on the implant, the gum is stitched up, and the healing process begins. During this recovery process, a temporary denture can be used to replace damaged teeth for esthetic purposes. Healing time depends very much on the consistency of the bone present. Healing time is usually between two and six months. During this time, the implant is fused with the bone. It is necessary to prevent putting any force or tension on the dental implant when it heals.
Follow-up visits to monitor the surgery site are normally made to ensure that there is no infection and healing is completed.
After the necessary healing time, the dental implant will be checked to assess if the surrounding bone has been properly extracted. Once this has been confirmed, the prosthetic part is attached with a screw to the dental implant. This part is called a “abutment.” It is used to hold a permanent tooth or a “crown.” The dentist may provide the image (mold) of this abutment in the mouth and the crown implant is custom-made to match. The crown of the implant is either cemented or fixed to the foundation with a pin.
potential risks, complications, and problems with a dental implant
There are always some risks and potential complications to the patient or to the success of a dental implant with any surgery. Careful planning is important to ensure that the patient is healthy enough to perform oral surgery and heal properly. Like any oral surgery, bleeding disorders, infections, allergies, existing medical conditions, and medications need to be carefully reviewed prior to treatment. Fortunately, the success rate is quite high and usually fails when the infection occurs unlikely, implant fractures, dental overloads, surrounding area damage (nerves, blood vessels, teeth), poor dental implant positions or inadequate bone quantity or quality. Again, careful planning with a qualified surgeon can help to avoid these problems. In many cases, a further attempt may be made to replace a failed dental implant after the required healing time has taken place.
Is dental implant surgery painful?
Dental implant operation is usually carried out under local anesthesia, so no pain should be felt during the operation.
Once the local anesthetic has been worn out, each individual case will vary in post-operative discomfort.
In general, however, most people will feel uncomfortable afterwards like a dental extraction.
Immediately after treatment, a cold ice pack is placed on the skin to help reduce swelling.
This pain can generally be treated using pain drugs like ibuprofen (Advil) and acetaminophen in general (Tylenol).
More invasive intervention may require more prescription pain medication and more time to recover.
Apart from pain relief, antibiotic and oral rinse medications may be needed for the next couple of weeks to facilitate healing of the region.
follow-up care after getting dental implant
Dental implants have the risk of contracting a syndrome called peri-implantitis, which is equivalent to periodontal (gum) disease of natural teeth. The inflammation of the gum and bone around the implant is referred to.
The inflammation of the tissue around the implant or bacterial infection is often attributed to excessive biting forces.
If periimplantitis is left untreated, it may lead to the implant failure.
Routine care at home and follow-up in the dental clinic is necessary in order to prevent this disease after having a dental implant.
Strong oral hygiene on an implant at home ensures that food waste and plaque are burnt regularly and flushed away.
In the dental office, the underlying soft and hard tissues are inspected and special techniques are used to extract the tougher calcified layers around the dental implant.
If required, the bite is calibrated to ensure that the implant does not support strong biting powers.