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DENTAL IMPLANTS

A relatively new concept in the replacement of missing teeth, is Dental Implantsthe 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.

 

Immediate implant placement in extraction socket

Immediate PlacementImmediate Placement
Extraction SocketExtraction Socket
 

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

 

bulletGood esthetic results
bulletShorter treatment time with minimized pain
bulletImmediately 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:

 

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The patient should be healthy and compliant with good oral hygiene.
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Good bone quality and quantity is a prime requirement for immediate implants to be successful
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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.
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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.
bulletStable relationships between opposing teeth.

Implants supported Fixed Bridge
 

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

1. Before the procedure

2. Implant Placement: First, the implants are installed. With conventional procedure, implants are left about 2-6 months to integrate with the jawbone before the next step is taken. If immediate loaded implants can be done, a temporary bridge may be placed at the same time.

3.Attaching the bridge to the implants

4. End result : The new bridge will handle all the pressure that your strong, natural back teeth did. You will have a stable and secure solution that allows you to eat what you want.

 
Implants supported Overdentures
bulletDenture stablized with implants.So renewed confidence and improved quality of life as well
bulletPossible to use existing dentures
bulletRemovable
bulletSimple and relatively Inexpensive

Installing Full Arch Implants with Overdentures

The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.
 
Installing Full Arch Implants with Overdentures
 

1. Before the procedure

The dentist determines what needs to be done and prepares both himself and the patient for the coming treatment procedure.

2. Implant Placement

The first step is installing dental implants to replace the lost tooth roots. In this case, two implants are used. Four implants may be placed in cases for added overdenture retention. Temporary dentures may be worn that enable you to eat and function like normal while waiting for the permanent overdenture to be installed.

3.Attaching the bridge to the implants

A ball or bar is then attached on top of the implants and the overdentures installed over. The ball or bar acts as a clip that enables the overdentures to snap securely in place.

4. End result

The removable overdentures are securely clipped on top of the implant with the ball/bar giving the strength and stability that allows you to better than with conventional dentures

 
Nobel  Active Implants 

14NobelActive is a unique implant system, with an innovative body design and prosthetic connection, that expands experienced surgical and restorative clinicians options in soft to medium bone.
With its unique tip and thread design, the implant slices through bone unlike conventional self-tapping implants that scrape the bone away as they tap. By progressively condensing and repositioning bone as it is inserted, Nobel Active™ can be “actively” placed at different angles for exceptional initial stability and optimal restorative orientation.

Nobel Active offers high initial stability, a gradual bone condensing property, and adjustable implant orientation for optimal prosthetic connection angulation. These indication-based protocols support all surgical modalities:

• one- and two-stage,
• flapless and flapped,
• immediate and delayed loading.

Unique Design

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The thread design enables clinicians to adjust implant orientation if necessary for better esthetic results.
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The coronal design that allows for maximum alveolar bone volume around the implant collar.
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It enables narrow ridge expansion and is designed to attain high stability even in compromised bone situations.
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NobelActive comes with TiUnite, a highly crystalline and phosphate-enriched titanium oxide surface, documented to enhance osseointegration, thereby increasing the predictability of implant treatment, both in the short and long term.
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Grooves were also added to NobelActive. Testing has demonstrated that surface bone forms faster within the grooves, compared to implants without grooves.
 
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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.