TYPES OF DENTAL IMPLANTS
Dental implants are used to replace missing teeth. Teeth can be lost due to many reasons including caries, root canal failure, periodontitis, trauma, or congenital reasons. There are two main Endosteal dental implants; traditional endosteal implants Endosteal dental implants are the most common type of dental implants used. They pierce only one cortical plate of maxilla or mandible and are surgically placed into the maxillary or mandibular bone to replace the root of a missing tooth. They are typically shaped like small screws and are made of titanium. Titanium is an ideal material for dental implants as it is biologically inert (does not trigger foreign body reactions) (Hupp, 2017). Endosteal implants vary in overall shape, length and diameter (Ebenezer, et al., 2021). Dental implants provide an alternative to traditional fixed bridges and removable partial dentures to replace missing teeth. Endosteal implants are typically placed in a dental office with Mini dental implants The main difference between traditional endosteal implants and mini-dental implants is the size. And unlike traditional dental implants, mini-dental implants do not have an abutment placed on them. Instead, they have a ball, socket, and rubber o-ring Subperiosteal dental implants Subperiosteal dental implants represent a far less common type of dental implants. They are attached below the gingival tissue, above the jaw bone, not within the bone like traditional endosteal implants. This is a possible option for patients
types of dental implants; endosteal and subperiosteal (AAID, 2022). Below is a discussion of both types and their indications.
the use of local anesthesia. These types of dental implants can sometimes be placed in a single surgery (immediate loading) or more commonly during a series of two surgical appointments in a dental office. In the placement of two-stage implants, the first surgery consists of surgically placing the implant fixture in the bone, essentially replacing the root of the missing tooth. Following a sufficient period of healing, an abutment is placed, and then a traditional crown can be placed on the dental implant. These types of dental implants can replace one or multiple teeth. They can also be used as abutments for fixed bridgework or full dentures (Ebenezer, et al., 2021).
present which is commonly used to hold overdentures. These dental implants are great options for patients who do not have a sufficient amount of bone present for traditional implants or are looking for a lower cost, less invasive option (Healthline, 2021).
without a sufficient amount of healthy alveolar bone. However, subperiosteal dental implants are not commonly used in the dental field today (AAID, 2022).
IMPLANTS AND ORAL HYGIENE
Proper monitoring and maintenance of the dental implant and its associated restoration through a combination of appropriate professional care and effective patient oral hygiene are essential to ensure their longevity (Bansal et al., 2019). The value of conventional periodontal parameters in determining peri-implant health is not clearly evident in the literature, but these evaluation techniques do not appear to have a detrimental effect. The concern about compromising the integrity of the implant and the contiguous tissues can cause improper monitoring and treatment which can promote the development of peri-implant disease (Hutto and Liberman, 2020). Therefore, it is paramount that the dental implant team understand the similarities and distinctions between the dental implant and the natural tooth. Subsequently, by comparing and contrasting these characteristics of the natural tooth and a dental implant, basic guidelines can be provided for maintaining the long-term health of the dental implant. Direct anchorage of the dental implant body to alveolar bone provides the foundation for a prosthesis and transmits occlusal forces to the alveolar bone. This is the definition of osseointegration which includes clinical and radiographic evidence of successful osseointegration of the implant to the alveolar bone (Pirc and Dragan, 2017). With the increased acceptance of dental implants as a viable treatment option for the restoration of a partially or fully edentulous mouth, the tasks of maintaining the implant and associated prosthesis and educating patients about dental hygiene have fallen to the dental team. In recent years, the focus of implant dentistry has changed from obtaining osseointegration, which is now highly predictable, to the long-term maintenance of the health of the peri- implant’s hard and soft tissues. This can be achieved through appropriate professional care, patient education and cooperation, and effective home care (Kandasamy, et al., 2018). Patients must accept the responsibility of being cotherapists in maintenance therapy, and thus, the dental team essentially must screen the potential implant patient to ensure that this is an achievable goal. Typically, diagnosis and treatment planning based on a risk- benefit analysis are performed after thorough medical, dental,
head-and-neck, psychological, and radiographic examinations and a temporomandibular joint health evaluation (Hutto and Liberman, 2020). There is convincing evidence that bacterial plaque not only leads to gingivitis and periodontitis (Shankar, et al., 2016) but also can induce the development of peri-implantitis (Caton et al., 2018). 0 Thus, personal oral hygiene must begin at the time of implant placement and should be modified as required using various adjunctive aids to effectively clean the altered morphology of the peri-implant region before, during, and after implant placement. For instance, the routine use of interproximal brushes should be encouraged because it can provide additional access for routing hygiene and may effectively clean the peri-implant sulcus and studies have indicated the superiority of the use interproximal brushes compared to use of traditional floss (Hatfield, 2021; Van Velzen, et al., 2016). In addition to mechanical plaque control, daily rinses using 0.1% chlorhexidine gluconate and the use of a dentifrice with 0.3% triclosan are effective adjuncts for implant home care (Stewart, et al. 2018). Clinical inspection for signs of inflammation (i.e., bleeding on probing, exudate, mobility, probable pockets) and a radiographic evaluation of the peri-implant bony housing are common methods for evaluating the long-term status of endosseous dental implants. For instance, successful and stable endosseous dental implants exhibit no mobility. When there is clinically perceptible mobility, the dental professional should examine the abutment retaining screw and/or prosthetic abutment collar interface for looseness or breakage subsequent to radiographic evaluation of the implant and its surrounding bony housing. The presence of saliva bubbling at the gingival margin when pressure is applied to the implant-retained restoration in a buccal-lingual direction can indicate a loose internal screw while movement and no bubbling or pain can indicate detachment of the external screw or the breakdown of the cement (Hutto and Liberman, 2020).
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