Oral- or Dental Implants have opened the door to the 21st century in dentistry and oral rehabilitation. They have increased the treatment possibilities for patients and improved the functional results of their treatment. Patients who had to compromise their esthetic appearance, functionality and nutritional intake due to complete or partial tooth loss can now be restored back to various degrees of normal esthetics and function. Since their commercial introduction, Implant Dentistry has undergone a rapid and progressive development. Many professionals have branched off and specialized in this particular field. Their continuing research efforts reward this field with new concepts and developments almost on a daily basis. Research efforts from many different disciplines such as material science, physics, medicine, biochemistry and others form the foundation for continued improvements in the field of Implant Dentistry as well as the “hardware” being used. What was several years ago considered to be “alternative” or “experimental” treatment in dentistry is often considered “Standard of Care” now.
Rapid advances Implant Dentistry have also made a tremendous impact in the financial world. In the last five years over 100 different implant companies have formed globally to either capture a share of the market or fill the supply for the growing demand. In the United States alone, there has been a steady growth of about twenty-five percent yearly over the past four years, and this figure looks even better for the years to come.
So, what are oral or dental implants actually?
To find an exact and all encompassing definition is difficult because of the different types of implants available. However, one can regard them as a device which is either surgically placed into the jaw bone to replace one or several lost roots of teeth; or as device placed onto the bone, replacing several, if not all roots of lost teeth. The exact definition will depend on the type of implant being used.
Certain terminology associated with Oral Implants needs to be clarified, in order to avoid confusion:
In our context, the IMPLANT is referred to the surgically placed “part” which goes either into- or sits on top of the jawbone. We will also refer to it as the FIXTURE. The actual tooth or teeth that go on top of the Implant (s) are referred to as the PROSTHESIS.
To the left you can see the different components in a typical implant restoration. The top portion labeled Implant is the actual part that is inserted into the bone.The bottom portion is the Prosthesis, which consists of the custom abutment and the crown. The custom abutment is the connecting piece, which attaches the crown to the implant. Implant crowns tend to be more expensive than regular crowns due to the addition of the custom abutment.
This web site will include examples of many different types of implants, however, nowadays, the most common implant used in the dental community is the Rootform Implant.
To the left you can see a typical modern Rootform implant and to the right of the implant is a picture of a natural tooth. One can see how the implant is designed to replace the root of a tooth by the somewhat apparent similarity
The reason they are called Rootform Implants is because they closely resemble the shape of the original root of the lost tooth. These, in various derivations, represent the most commonly used implants today. One of the reasons of their popularity is their constantly improving simplicity in use.
The sequence of events with respect to implant reconstruction with root form implants can be roughly divided into two phases:
The Surgical Phase includes everything that is concerned with getting the implant into or onto the bone and getting it ready for the prosthetic phase.
The Prosthetic Phase includes everything that is necessary to put a tooth or teeth on top of the implant. More detailed descriptions of each of these phases will be given in subsequent pages!
Once the implant is placed into the bone it will need to remain there for a few months unused, in order to allow the bone to grow around it and secure it tightly; this process is known as Osseointegration. (Although, some research is now supporting evidence that under certain circumstances implants can be “used” prosthetically right after placement) Osseointegration is a fairly natural and usually successful process. Sometimes, however, the implant does not integrate (fuse to the bone) for reasons we will still discuss.
The above picture is a histologic section of an integrated implant in bone under low magnification. One can see the implant (black) and bone (red) tightly approximating each other. There is no detectable gap between the black outline of the implant and the contacting (red) bone. This implant can be considered integrated.
Once the implant has successfully integrated, it is ready for the Prosthetic Phase. This usually includes an impression of the implant(s) and the fabrication of a Prosthesis (tooth or teeth), that is then attached in some fashion to the implant(s).
This, of course, is only a short overview of the general procedure. A more detailed description can be found in the page Implant Placement & Restoration.