Expanding the horizons of implant dentistry

In my commitment to expanding the horizons of dentistry, I’m using this week to present an overview of dental implants in periodontal therapy.

Over the last 30 years, research has validated the success of osseointegrated implants as a viable alternative to fixed or removable dentures.

Today’s periodontists are extensively trained in surgical procedures to treat and maintain patients with edentulous or partially edentulous arches.

They also play a primary role in treatment planning, maintenance therapy and routinely integrate endosseous implants into periodontal therapy.

Surveys And Studies

Oral health surveys show there are many individuals with compromised dentitions for whom endosseous dental implants may be indicated.

In many cases, implants are an alternative to fixed or removable prosthetic appliances.

The success of implants has been attributed to their firm bone anchorage, referred to as osseointegration, or functional ankylosis.

Initial studies focused on commercially pure titanium implants with a relatively smooth surface created by the machining process.

More research indicated implants made of titanium alloy and/or with relatively rougher surfaces also become integrated with bone.

These include, but are not limited to, implants that are titanium plasma sprayed, acid-etched, grit blasted acid-etched, and hydroxyapatite coated.

The bonding of hydroxyapatite to bone differs from titanium and has been termed biointegration, which denotes a direct biochemical bond of the bone to the surface of an implant at the electron microscopic level and is independent of any mechanical interlocking mechanism.

Implant Systems

Several kinds of dental implant systems are available, organised according to shape and relation to the bony housing. They include subperiosteal, transosteal, and endosseous implants.

The most frequently used implants are endosseous implants, including a range of sizes, shapes, coatings, and prosthetic components.

Implant length and width can be chosen to fit the available bone, and prosthetic components can be selected in a size and angle to accommodate the final restoration.

Appropriate Shape Selection

The selection of implant shape involves the exercise of professional judgement, taking into account such factors as available bone quality and the dimensions of the edentulous ridge.

A threaded implant may provide additional immediate fixation compared to cylindrical implants as a screw-type implant has more surface area for bonding than a parallel walled press-fit implant.

The implant surface further affects the long-term fixation and stabilization of the implant.  A porous coating on an implant can achieve more bone contact per implant length than an implant with a machined titanium surface.

Other surface modifications of implants include a roughened surface (i.e., grit-blasted, or grit-blasted and acid-etched), microgrooved or plasma-sprayed titanium, and plasma-sprayed hydroxyapatite coatings.

As a provider of implant solutions, including cad/cam design, ISUS system and Astra Atlantis system zirconia, I feel an obligation to share knowledge of the implant world.

If you’d like to comment, or discuss implants, feel free to leave a comment here or get in touch with me on social media:

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Image courtesyof: Astra Atlantis

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