Teeth are important to our health, self-confidence, and appearance. One may lose natural teeth which lowers the confidence and makes him discomfited in conversation. The dental implant is the procedure of replacement of the decayed or missing tooth with an artificial tooth that works in the same manner as natural ones. in past twenty years, implant dentistry has become significant for edentulous patients. Such patients have found implant dentistry, a very valuable remedy for their tooth loss as this procedure restores their esthetic and mastication ability. (1)
What is a Dental Implant? (1)
The dental implant is a procedure in which alloplastic biomaterial is inserted surgically in the jawbone to resolve dental issues and maintain the oral integrity.
Nowadays, biomaterials made of titanium-aluminum-alloy or pure titanium is the material of choice. This implant forms and regulates an oxide layer without any apparent corrosion or breakdown under physiological conditions.
Types of dental implants
- Endosteal implant; the type of implant that involves the surgical insertion of alloplastic biomaterial in the residual bony crest.
- subperiosteal implant; in this type, the implant resides on the top of the jawbone. Because of poor long term results, this type of implant is no longer in practice.
The planning for a dental implant, before starting the surgery, is done by various medical specialists. Maxillofacial and oral surgeon observes problematic conditions of jaw, face, and mouth. Periodontist; a specialized dentist who treats the structures such as bones and gums, that aid the teeth. Prosthodontist; a dentist specialized in designing and fitting artificial teeth.
At first. A comprehensive dental exam is done in which 3D images and dental X-rays are taken. Previous medical conditions of the patient such as heart attack, orthopedic implants, and various others are taken into consideration. In the end, the treatment plan is designed according to the number of teeth to be replaced and the condition of the jawbone.
Local anesthesia or general anesthesia is given to the patient. Following this step, a surgeon access the jawbone using a scalpel and elevator (hand instrument). This process is done either by raising tissue flaps or tiny circular incisions. In the latter technique, the bone is exposed by cutting a small circular portion of gum. The surgeon identifies the exact position to place dental implant. Holes are drilled into the bone. It is essential for the bone not to be overheated during drilling as it will decrease the chances of successful osseointegration. The chosen alloplastic biomaterial post is placed in the holes. This post is implanted deeply into the bone as it will function as a tooth root. Some patients have a soft jawbone that cannot support the implant firmly in the place and becomes the main cause of surgery failure. For such patients, bone grafting is required before implant surgery.
Once the post is placed, the process of osseointegration starts. In this process, the bone grows around the implant post, anchoring it firmly in the place. This process functions in the same manner as the root of natural teeth i.e., the providence of solid base to the new teeth.
After osseointegration, an abutment is placed. The abutment is basically a piece where the crown will attach to the artificial root. Sometimes this abutment is attached to the dental implant while placing the post. But in some cases, this procedure requires extra minor surgery.
In the last step of the procedure, a prosthesis or crown is used to replace a missing tooth. Each prosthesis is specific to its implant. The selected crown is either removable or fixed. The removable type resembles conventional artificial dentures. In the fixed type, an artificial tooth is cemented or screwed completely onto the abutment implant.
Dental implant failure
Many complications are associated with the dental implant which can lead to implant failure. These complications can be biological or mechanical. Based on biological complications, dental failure can be categorized into two halves.
First is an early failure which occurs within 6 months of dental implant. This failure occurs due to unsuccessful osseointegration. About 50% of patients face this failure after dental implants. (2)
Second is a late failure which occurs after the initial 6 months. This failure happened after the progressive bone loss in early failure. That progressive bone loss leads to inflammation or infection known as peri-implantitis. It has been reported that 60% of late failures account for dental implant failure.
Mechanical complications also lead to dental implant failure. It happened due to the disruption in the implant. Mechanical complications include
- Implant fracture
- Abutment screw fracture
- Abutment fracture
Clinical studies have been are done with the follow-up periods of 5 and 10 years. It has been observed that the incident rate of mechanical complications is more than that of the biological one. According to the studies, more than one-half of implants face mechanical complications, among which screw fracture (8.5%) and abutment fracture (5.5%) are common. (3) Eventually, chances of implant failure are 40% in the first five years and 50% in the first 10 years of surgery.
How long dental implant last ?
Studies have shown that dental implants last longer and patients enjoy high survival rates. However, an implant is a medical device and just like other devices, dental implants also do not show 100% durability. Even natural teeth do not last long so one should not expect the dental implant to work any differently. It depends upon the failure rate, patient’s smoking habits, and hygiene practice. According to dentists, implant durability increases if the patient takes care of the implant and maintains periodontal health.
The cost dental implant varies according to the region and the dentist who is going to make it done. In some countries, it costs from $3000 to $4500. It includes surgery, implant crown, and components. Sometimes people choose to select artificial dentures over dental implants. But these dentures need to be replaced every five years. Eventually, costs go beyond the level and take the person finally towards a dental implant. If someone compares single tooth replacement with the conventional 3-unit fixed prosthesis, the former one is more cost-effective. For multiple teeth replacement, initial costs are higher but better improvements in the oral health and patient’s quality of life.