Good news for people suffering from this problem: there is not only one but multiple permanent solutions to decide upon. Among the most important and useful options are
dental implants. While dentists provide the possibility of dental implant placement, they can replace both the root and the crown of the tooth by offering functional, natural-looking, and long-lasting replacements.
The benefits of dental implants are numerous; however, patients must understand that this dental surgery is much more intrusive compared to simple extractions. Thus, although the various advantages of dental implants make them an attractive dental option, individuals need to familiarize themselves with the process to improve their chances for a successful outcome.
The dental implantation procedure is typically done in three main phases:
- Consultation, where personalized treatment planning is carried out.
- Implant Placement, which involves inserting the new tooth root.
- Fitting New Teeth, utilizing the implanted roots for support.
These phases can take several weeks or, more commonly, months to complete. Comprehensive oral care at home, combined with professional assistance from the dentist’s office, significantly increases the chances of a smooth and successful dental implant process. Patients should understand the implications of each stage of the treatment and explore the best ways to maintain a strong, long-lasting smile.
Definition and Types of Dental Implants
The dental implants are actually objects made of titanium or zirconium, which can have various shapes, thicknesses, and lengths. The implant can be compared forcefully to a screw with a narrow tip. This offers us benefits. If it is a screw that expands or breaks the base in the case of implanting in the bone, the hole is bigger only at the base of the osteotomy. Another type of implant that has recently become known is the zygomatic implants. These have much more length since they are implanted in the body of the zygomatic bone. For that reason, they are placed in very serious cases of maxillary atrophy. A bridge or prosthesis is placed on top of the implants. The one that is installed here is provisional. That is, it fulfills its function, is held, bitten, chewed, but it is placed for a while as the gums move in response to the early stages of bone healing. After several months, the specialist disassembles it and places the implants. Only then is the definitive prosthesis placed.
Only a person who studies implantology can place dental implants; they are usually some kind of dentist, sometimes maxillofacial experts, or dental surgeons who have expanded their training in an expert way. The implants have a small groove so that when biting and applying the strength of the bite, they provide stability and support for the teeth. The bite force, and therefore the ability to chew and eat, returns in a natural way. Apart from aesthetics and being able to bite in a confirmed way, it also offers us another benefit. The bone is resorbed by the body only if it is needed. The body invests the least energy to maintain those spaces that are barely used, since the form of life does not form and it disappears. It is a bit like the atrophy of the muscle of a sedentary person who has an arm or a leg stuck. The muscles begin to atrophy and lose strength. The same happens in the mouth with the alveolar bone and the maxillary sinuses. When an implant is placed, a new root is also placed. The bones interpret this fact as a signal of stability. Hence, in those areas with implants, the bone is maintained longer, or that is what happens in a great many cases.
The Dental Implant Procedure
Dental implants are permanent titanium screws set into the jawbone and restored with additional dental components. A single dental implant is usually restored with a crown that looks, feels, and functions like a real tooth. Placing dental implants is a minor surgical procedure completed by an oral surgeon. Given the biological variations starting from tooth to gum, bone, and blood supply, every single dental implant offered to the patient is an absolutely unique custom-made product. The most intelligent of our teeth would not allow such a surgical invasion. While the thinnest grafts needed in implantology measure 1 mm in thickness, the tiniest drill has a diameter of 2 – 2.2 mm. With the applied technologies available, the optimal approach to dental implantology is to keep within the available safe limits to avoid any unnecessary risk, force, or waste.
Before the implants are placed, a thorough visual, radiographic, and clinical examination is necessary to assess the amount, volume, and quality of bone available in the proposed implant site. If there is little or no bone in the proposed area for the dental implant, devices or special graft materials may be required. If a single naturally shaped incision is made and it is closed tight after the minimal bone preparation necessary is performed, then faster healing should occur without damaging the blood supply. This greatly reduces the rate of implant loss due to lack of bone formation, morbidity, and costs. In the vast majority of cases, the classic titanium screw implant can be placed with unique masculinity and minimal invasiveness, affordably for the patient, allowing him or her to proceed immediately to the immediate or early function during the three-day visiting phase, after which long-lasting crowns, dentures, or bridges are attached.
Pre-Surgical Evaluation and Planning
Preoperative evaluation and planning are critical to ensure the safety and predictability of dental implant surgery. Multiple patient- and site-specific considerations affect the ultimate success of the implant to heal and osseointegrate. Patient-related factors include biologic and anatomic variables such as age, sex, systemic condition, history of osteoporosis medication use or radiation therapy, coagulative alterations, and smoking. Site- and surgical-related factors include soft and bone tissue evaluation, timing of force application, and bone repair potential. Prosthetic-restorative related factors consist of the implant-abutment connection type, threaded fixture target depth, and the emergence profile.
To plan the implants that will carry out the planned restoration, three-dimensional information of potential surgical sites should be employed, as it is very important to know about the anatomic situation; otherwise, you could have very serious consequences such as vascular or nerve injuries. As diagnostic tools, clinicians have available panoramic radiography, anterior and posterior rules, lateral cephalogram, computed tomography, images, digital wax-ups, and diagnostic imaging software to visually integrate the 3D diagnostic context directly in the dentist’s office.
Surgical Placement of Implants
Before the surgical placement of the dental implants, a panoramic X-ray or 3D tomography is necessary to determine the bone height, bone width, and anatomical structures such as the mandibular nerve, nasal cavity, or maxillary sinuses, which are crucial for a secure surgery that implies no risk to the patient. The procedure involves providing appropriate anesthetic, suitable incisions, and dissection, as well as the use of different drills and preparation systems, having already studied the surgical guide that the prosthodontist used to guide the placement of the implant. When the dental implants are placed in the shortened maxilla, a sinus graft is usually necessary. This is a surgical procedure used to replace or enhance structures around the patient’s teeth, among which is the maxillary sinus, using bone from the patient’s body. This procedure is performed to increase bone support or bone height so that there is a better prognosis for implants placed in an area with an insufficient quantity of bone in the posterior region of the upper jaw. The internal augmentation is used to simulate the floor of the maxillary sinus and to facilitate a secure treatment in case of perforation using an osteotome.
Osseointegration Process
Osseointegration is a direct structural and functional connection between ordered living bone and the surface of a load-carrying implant. An osseointegrated implant is defined as a component that is directly anchored to bone, providing support for an artificial tooth that also mimics natural tooth function. Numerous factors have been demonstrated to affect the quality of osseointegration. This process occurs after brief bone contact with the implant surface, followed immediately by the healing of alveolar bone.
The concept of osseointegration originated in Sweden as a parallel discovery in both experimental and clinical orthopedic studies. The aim of developing the dental implant technique was to design a fixture with the goal of establishing long-term load-bearing bone-muscle function, specifically incorporating a period of “no loading” during a necessary four to six-month healing period.
Osseointegration Factors:
The primary factors influencing osseointegration between the surrounding bone tissue and the implant include:
- Architectural factors
- Surface characteristics
- Macroscopic factors
- Microscopic factors
- Mechanical factors
Osseointegration, therefore, refers to the direct structural and functional bond between ordered, living bone and the surface of an implant carrying a load. An osseointegrated implant is considered a component directly anchored to bone, providing support for an artificial tooth that functions similarly to a natural one.
The process occurs immediately following brief contact between the implant surface and the bone, allowing for rapid healing of the alveolar bone. The discovery of osseointegration was made independently in Sweden through both experimental and clinical orthopedic research. This development aimed to establish a long-term anatomical, load-bearing bone-muscular function, with the crucial inclusion of a “no loading” period lasting four to six months to ensure proper healing.
Benefits of Dental Implants
Prosthetic dental implants are widely recognized for restoring oral function, occlusal stability, and preserving bone level. However, these are not their only benefits. Implants also have several advantages over other restorations, such as dental bridges, partial denture prostheses, and full dentures. Additional benefits of dental implants include helping to maintain bone and securing soft tissues, convenience and cleaning, comfort and confidence, and improved aesthetics. Prosthetic dental implants are very effective and include aspects such as improving chewing function, masticatory stability, enhanced phonetics, minimal or no extra prosthetic devices, not requiring support from adjacent teeth, and even self-supporting affected by simple restorations, especially for partial or full dentures. Patients often receive implants without being aware of the restrictions caused by other more traditional methods of support or use. Community surveys have reported that patients are generally satisfied with their dental implants, accept their restoration, and enjoy an improved quality of life due to their ability to eat and smile. In addition, implant placement is associated with greater patient satisfaction than conventional prosthetic therapy. In most cases, a single implant dose is sufficient for restoration, although the frequency may vary depending on the location of the implant. Dental implants are long-lasting restoratives and last longer than other types of dentures.
Improved Aesthetics and Functionality
Dental implants designed to replace missing teeth are synthetic structures that are placed in the area of the tooth, usually made of titanium or zirconium metal. Dental implants are placed in the jawbone where they provide a functional and aesthetic solution. Dental implants are used today to overcome dental deficiencies, the main problem area being the loss of teeth. Starting from the day the tooth and root structure are lost, sometimes long hours are spent with missing teeth, and regular problems can be encountered. With dental implants, patients can return to their normal lives after a certain period of time. Another advantage is that they have no adverse effects on the teeth in the mouth; they are only applied to the area where the implant is lost, so they do not contact any teeth in the mouth.
Loss of teeth poses many problems, including aesthetic dissatisfaction of individuals as well as serious insufficiencies in communication, chewing habits, bone, and facial structure. The shorter the time a person remains with missing teeth, the more serious the situation becomes. Those who first lose their front teeth feel the problem more acutely. Tooth loss is not confined to aesthetic concerns alone. The majority of patients complaining about tooth loss suffer from unhealthy nutrition, as well as decreased social communication quality. Dental implants are fast and effective solutions for patient satisfaction and functionality, and they are approached favorably by certain groups. The most important feature of dental implants is that they are very similar to natural teeth and therefore have a natural appearance.
After successful implant applications, there may be a psychological improvement, smiling faces, and talking comfort, allowing users to gain confidence. If needed, they can chew better by using their healthy teeth. They serve a very important and beneficial purpose for patients. Dental implants are almost invincible materials. Users regain their normal life in a short time and live their days as if they were not using the implant. They are structured with the aim of creating a benefit for the person and are very successful in this regard. After dental implants, the benefits and gains that anyone receives are very important. With dental implants, people are saved from many problems that they cannot overcome with dentures and bridges alone. Chewing can cause pain, swelling, or even bleeding in the gums.
Implants allow people to escape these problems. In addition, the fact that these teeth are not alive does not mean that they will never decay. Dental implants improve your life by addressing these problems. Furthermore, long-term application should be avoided. Care for them is important, regular, and there are a few points that need to be addressed for permanence. Dental implants, bridges, or other solutions are designed with modern technology and are easy to use. They have almost no difference from normal teeth, and users can understand their weaknesses. They can be designed in accordance with the person’s mouth. A smooth appearance and structure are their most important features. Yet it is clear that they are not observable at all. They do not require any extra care; they have no maintenance. This makes them very attractive to many people and allows them to live freely. The implant reflects the image of your smile in a brighter way and does not interfere with any other teeth. All of these strengths make dental implants the most logical stepping stone to replace missing teeth.
Preservation of Bone Density
Bone stimulates the jawbone, sending signals that are essential for maintaining optimal bone density. Without teeth, the jawbone is no longer stimulated and begins to lose its density. The jaw may also resorb inward, causing a hollowed-out look. This has consequences for the patient as they lose the bone they had that was able to support the soft tissue. For patients replacing a full arch of teeth, the jawbone requires a large area to support the bone graft needed for the process. The border of the graft features a window, which allows mobilization of the osteogenic layer. The graft is then installed, enabling fast attachment to the bone and the necessary stability. With preservation of the alveolar ridge width and height, implants can be placed in their intended position, supported by existing bone volume. These are important for both short-term success with initial implant stability and long-term success with restored function and aesthetics. Over time, these favorable conditions can be lost, which may trigger the need for augmentation. The patient who waits for rehabilitation through the osseointegration of the implant will have the implants installed when the density of the recipient cavity is low, which is negative for the prognosis of the case. That can alter the position and quantity of the necessary future bone grafts.
Potential Complications and Risks
Aggressive, immediate loading treatments are being developed and presented through the use of protocols that minimize the risk for the most common problems. Depending on whether mandibular or maxillary implants are used, approximately 0.5% or 1.6% of the patients will experience serious complications in the 24 months following surgery. In the mandible, 1% of the screws used to anchor the dental prosthesis can be damaged by implanting the screws either in the painted cells of the implant heads or into the bones. Different pathologies of the maxillary sinuses can arise, although these are rare. A higher expenditure is the management of these cases. It has to be admitted that the costs and the compatibility of implantation techniques with a patient’s social life have not been well explained due to the lack of extensive, methodologically sound, and well-performed randomized controlled trials or cohort studies. Antithrombotic treatment, associated with an increased risk of adjunct-site hemorrhage during dental implant procedures, is a risk for individuals, particularly those taking oral antiplatelet agents.
Infection and Rejection
Infection of dental implants can be attributed to the native microflora of the host, the host’s weakened immune response, and improper surgical techniques or an unfamiliar implant by the surgeon, leading to the direct lodging of bacteria, other pathological entities, and the microgrooves. Such undesirable events are more likely to occur during surgery because oxygen delivery to the implant decreases and acidic conditions increase, reducing the richness of saliva and its inherent bacterial inhibitory substances. This is especially the case in closed surgeries. Microorganisms possess a coordinated mechanism for binding to and settling on titanium compounds that help with their diffusion, modifying them so these microorganisms can persist on the surface of any soft tissue intermediary implant. Clinical symptoms for peri-implantitis are the same as those of periodontitis and are therefore not necessary for diagnostics. Bleeding, marked pocket depth, or suppuration may be indicative of an infection, with specific inducers associated with dental implants, such as those triggered by certain sudden impacts, placement upon a dry area, drilling compact bone, and vibrations or unplanned movements that increase the chances that stabilization would not adhere to body cavities, preventing overheating. These can be circumvented by operators introducing step and other modern drilling techniques. Other sites of bacteria reseeding include oxygen insertion and release of neutrophils, tissue remodeling, and the toppling over of old implants, forcing bacteria into other areas of the body.
Nerve Damage
In at least 1% of the dental implant cases, the patient suffers a nerve injury. As these injuries affect the mental nerve, a branch of the trigeminal nerve, they can also have serious consequences. These branches are responsible for feeling and providing sensation in the chin, lower lip, lower gum, and teeth attached to them. Following implant surgery, some patients may experience soreness in the area of the implant. In extreme cases, if the implant touches the mental nerve, permanent nerve damage can occur, which results in the patient experiencing numbness. Although this is usually temporary, the condition can be permanent in severe cases. The implant may subsequently need to be removed. Osteotomy size and the drilling sequence are less important, as an increased distance from the nerve has not been shown to minimize damage. The method of device insertion, the direction, or other drilling control features may reduce the risk. Misjudgments in planning and preparation can lead to a nerve injury.
Nerve damage can occur when the surgeon is too aggressive with implant placement, if the implants are placed in the wrong position, when the implants are just too long, or when the implant is placed in an unfavorable underlying anatomic structure. Minimizing nerve injury should help the outcome of the dental implant or any dental surgery. Despite a well-prepared treatment plan and painstakingly conducted operation, accidents can happen. If the surgeon has informed the patient of the potential risks and handled the situation in the correct manner, the patient will not be able to return claims for any negative outcome of the dental process. The chapter explores the main implant complications from nerve and sinus problems. The particular problems, if not handled in the correct manner, relate to medico-legal aspects when patients choose to sue or make a claim for their injury due to nerve damage. The dentist does have certain legal requirements, including the need for written consent and making sure the patient is aware of the associated risks, and they have to be ready to explain what has been done.