As technology changes and we learn more about the body, we have better materials for surgical procedures. There are a range of options for tooth implants, depending on your jaw structure and health requirements.
When first exploring dental implants as an option for you, your dentist/ dental surgeon should conduct a range of tests and imaging procedures. They will examine your teeth and gums to check bone density, which dictates the type of implant that you require. This process may involve CT scans, X-Rays, and other imaging processes such as 3D scans.
Then, the dentist should also ask you questions about your oral hygiene, ability to follow after-care best practices, and general health. For instance, smoking increases the healing time and decreases the likelihood of success. If you are on blood thinners or other medications, you may be required to have a period of time without these drugs before the process can be carried out. There are a wide range of factors that must be taken into account. Once the dentist has sufficient information, they can provide a personalised solution for your health and lifestyle.
There are four main types of dental implants. Zygomatic, subperiosteal, transosteal and endosteal. The type of procedure that’s best for you will depend on how many teeth you require, the condition of your jawbone and your general health.
Zygomatic implants. It’s a complex, highly specialised procedure that is only done when there’s not enough jawbone for other options. To do this, the implant, rather than going into the jaw, is inserted into the cheekbone of the patient.
Subperiosteal implants. These implants are not fixed into the jawbone. Instead, a metal frame is inserted under the gum and the posts are attached to that. The gum encloses around the frame as it heals, and the teeth are affixed to the poles. This method is not used frequently due to various limitations.
Transosteal implants are used only for the lower jaw and are not very common. It’s complicated surgery which requires a metal plate being attached to the jaw, with screws then being inserted through the jawbone. The implants are affixed to the metal plate.
Endosteal is the most common method, where posts, shaped like screws, are surgically implanted into the jaw. After the gum heals, the prosthetic tooth is placed on the post, creating a stable, strong tooth or set of teeth. Generally, there are two sizes of dental implants. Narrow ones, used in the front of the mouth, are between 3.5mm and 4.2mm in diameter. Wide platform implants are used in the back of the mouth and are from 4.5mm to 6mm in diameter.
This article focuses on Endosteal implants as these are the most common option and preferred in terms of outcomes and impact of surgery.
Single implant placements are straight forward. One tooth missing means one ‘root’ post will be inserted, and one tooth.
Multiple teeth implants are when the patient may be missing two or more teeth in one location. The process is the same as for a single implant, except it’s not always 1:1 tooth to implant ratio. If there are four teeth missing, for instance, it’s possible only two implants are required.
Full arch rehabilitations include surgical procedures known in the dental industry as all-on-4 and all-on-6 as well as numerous other variations of these techniques. This is the standard process when someone talks about full-mouth or upper/lower jaw dental implant bridges. This is when all the teeth are removed and a full/ half mouth of teeth are needed. Posts are inserted in all four quadrants of your mouth. Then, prosthetic teeth known as a full arch bridge is screwed on. These teeth can be removed by your dentist for maintenance but require no removal from you.
Full arch rehabilitations with the use of Zygomatic implants is a highly specialised procedure but a good option for patients with substantial bone loss in the posterior or anterior maxilla(upper jaw). Like standard full arch rehabilitations, these are fixed removable teeth, but they are affixed to implants which anchors in the cheek, whilst still connecting to the removable teeth within the normal tooth arch in the mouth.
Mini implants are very narrow implants. These are used where the bone with is extremely narrow or existing tooth roots are too close together to have an ordinary sized implant. They are also sometimes used to stabilise a lower denture. These have a lower success rate than standard dentures.
Implant retained overdentures are a removable option, halfway between a full set of dental implants and dentures. This is when titanium posts are inserted into your gums, the same as with implants. However, instead of teeth prosthesis being permanently installed, a set of teeth clip on and off. These are more stable that traditional dentures, and can be removed for cleaning and sleeping.
There are three main types of implant materials. The option you use will depend on a range of factors, which your surgeon will discuss with you.
Metals, more specifically titanium are the most popular option for all dental implant manufacturers. OSSTEM implants are manufactured from surgical grade 4 titanium, which is the purest form of titanium. They are very strong and non-reactive. This non-reactiveness increases the chance of the jaw accepting the implant. This is called biocompatibility, and it’s very important for the success of the implant.
As well as the metal being biocompatible, the shape and finish of the implant affects healing, how well this osseointegration occurs, and how stable the implant is. There are three main techniques used to increase successful integration:
Ceramics are used due to their ability to integrate with living bone. They join the implant to the host tissue. They are most generally used for the crown of the tooth, as they look realistic as well as being durable and non-reactive.
Polymers are softer and more flexible than other materials, and have much less mechanical strength. However, they are used as a shock-absorbing component that is inserted between the implant and tooth.
Depending on your health and the condition of your jaw, you may be required to undergo extra processes.
Bone graft / bone augmentation: This is when the jaw bone has degraded and needs extra assistance to encourage good osseointegration (the fusion of the implant and your jaw). A good strong fusion is vital for a strong, long-lasting implant. Additives can help to fortify the bone, or implanting bone taken from other parts of your body or synthetic bone alternatives(xeno bone) can help to grow more bone in that part of the jaw.
Sinus lift: If the jawline has seriously degraded, a sinus life may be required. This procedure adds bone below the sinus cavity, allowing more space for the implants to be inserted.
Ridge expansion: If the jaw is not wide enough for dental implants to be fully supported, bone grafts can be made. These are inserted in a small ridge along the top of the jaw.
Ridge splitting: In the event of a narrow ridge not suitable for implant placement the bone can be surgically split and widened to the desired width with the use of surgical saw’s and widening drills making implant placement possible.
Technology has come a long way over the past few years. One hundred years ago, false teeth were the only option, still sometimes made out of human or animal teeth, often clunky and awkward. It was only in the 1950’s that the first dental implants were created. The progression of the process has swiftly progressed, and now we have CAD/ CAM guided surgical systems to assist with surgery ensuring near perfect placement of implants and highly aesthetic restorative solutions.
Implant planning therefore becomes more restoratively driven ensuring implant and crown will be placed in the best position to ensure the most aesthetically pleasing solution. The surgery itself is far more accurate using personalised guides for site preparation and implant insertion. The surgery becomes simplified and minimally invasive. This facilitates faster healing and better overall long term outcomes. OSSTEM have a unique guided surgical solution called OneGuide which combine all of these features and benefits in a simple, straightforward protocol.
Each option has different healing times, a different process and timeline, and varying number of appointments. Discuss with your dentist what your solution looks like. Things like type of sedation, cost and what you can expect will also be discussed. It’s important that all factors must be accounted for, and a personalised solution created for the best chance of success.
