Patients who are missing a tooth or have to have a tooth extracted have a great restoration option with dental implants. Implants have a success rate between 95% and 97% and are a stable, natural-looking way to restore your smile! Not only can implants be used to replace a single tooth, they can replace multiple teeth in one area or even in conjunction with an implant-supported denture. It is important to understand the implant process before beginning treatment and those who are overall healthy have the best success with dental implants.
When all is said and done, the process can take up to six months during which the patient will need to stick to a modified diet, avoiding very hard or crunchy foods as well as those that require a lot of chewing.
Before you begin treatment, you will need to have a consultation so your dentist can evaluate the area to be treated and speak with you about your lifestyle and habits before they are able to determine what type of implant system will be best for you. Most dentists have a preferred system that they work with but will use whichever is best for your individual case.
What are the most common implant systems?
There are many companies that make dental implants but the following produce the most well-known and widely used implant systems:
- Nobel BioCare
- BioHorizon
- Dentsply
- Straumann
- Zimmer Biomet
- MIS
There are over 100 manufacturing companies that produce implant parts throughout the world but opting for a system fabricated by one of those six top companies can be beneficial in the long run. Dentists and dental labs across the world are more likely to be familiar with those more popular implant systems and therefore are more likely to be able to provide emergency service to patients that may be unable to get to their personal dentist, such as during travel.
With a generic implant system from a lesser known company, you may pay a lower price but if you break part of your implant or develop a problem that requires immediate attention and are unable to see your regular dentist, a different dentist and their preferred lab will be much more likely to have the necessary tools if your implant was fabricated by a more commonly used company.
What types of implants are used?
There are two types of implants available: titanium and zirconia. Your dentist will review your options and help you determine which type will be best for your individual needs and lifestyle. Zirconia implants are becoming increasingly popular, especially for use in patients with metal allergies and holistic dentists.
Biocompatibility is crucial for implants to integrate with the jaw bone through osseointegration, the process of the implant fusing with the jaw bone. A high-quality implant has a rough finish on the surface for osteoblastic cells to adhere to and create the necessary fusion for a successful implant.
Titanium Implants
Titanium implants have been in use since the 1960s and have excellent biocompatibility with a success rate between 95%-97%. They are designed to make a stable foundation for the implant restoration. They are fabricated as a separate piece and require an abutment and implant restoration (fake tooth part) which is either screwed or cemented onto the implant. Titanium implants are able to support all implant restorations including implant-supported dentures.
Zirconia Implants
Zirconia implants have been used in the United States for over a decade, longer in Europe, but they do not yet have the recorded long-term success rate of titanium implants. Even so, they are a great option for patients with metal sensitivities. Zirconia implants do contain trace amounts of hafnium and yttruim, transition metals, which are incorporated to improve its biocompatibility properties, allowing them to integrate with your jaw bone similarly to titanium.
Unlike titanium, zirconia implants are fabricated with the abutment as one unit and are more challenging to place, so bone density will play a big role when your dentist is determining what type of implant is appropriate for you.
Since zirconia implants do not contain metal, there is never a risk of dark metal showing through at the gumline. This rarely happens with titanium implants unless the patient develops gum disease and experiences gum recession. It should also be noted that any restoration on a zirconia implant must be cemented in place, it cannot be screw retained.
Implant Abutments
The implant abutment, either custom or stock, is a part of the implant system that acts as the connecting bridge between the implant and the implant restoration. The restoration can be a crown, bridge, or a full denture. The restoration can either be screwed onto the implant or cemented in place. Your dentist will decide which retainment method is best for your case.
Cementable vs Screw-Retained Implant Abutments
There are a few factors your doctor will take into consideration when they are deciding on a cemented or screwed on restoration. Some of these factors include ease-of-use, retrievability, peri-implant issues, and whether or not it is suitable for angled implants.
Ease of Use
A cement-retained implant restoration is generally easier to work with than screw-retained. A cemented restoration is placed much the same as a crown or bridge which is permanently cemented onto a prepared tooth. When the restoration is screw-retained, additional steps are necessary to ensure proper fit and tension before the restoration is screwed down.
Retrievability
This term describes the ease of removal in the event that the restoration needs to be replaced due to damage. Certain cements can be more difficult than others but a screw-retained restoration is more predictable and easier to remove. There are cements available that make it easier for your dentist to remove the restoration or they may choose to use a temporary cement but these options are not as secure as a screw.
Peri-Implant Issues
Peri-implantitis is the term for an infection at the implant site. When cement is used, excess cement can extrude into the surrounding gum pocket and cause damage to the gum tissue surrounding the implant. If excess cement is not completely removed, it can pose an increased risk of irritation, swelling, and discomfort at the implant site.
In an effort to prevent such issues, your dentist will take an x-ray after placing your restoration which will show any cement that has seeped into the gum pocket. Using a screw retained restoration avoids that risk and minimizes the chance of peri-implantitis.
Additional Considerations
One drawback of a screw-retained restoration is that they are not ideal for front teeth. An access hole is drilled through the prosthetic tooth for the screw to reach the threads of the implant. After the restoration is placed, the hole is filled with composite material to hide the hole and protect the screw. This is not easily done on front teeth because the surface area is smaller, so dentists often choose to use a cement retained implant restoration on anterior teeth.
Stock Abutments vs Custom Abutments
Custom abutments
An abutment can be fabricated for use with either a cementable or screw-retained implant restoration and can be made from titanium or zirconia. Custom abutments do have a higher cost but they allow for better tissue management and have a more predictable outcome as opposed to a stock abutment.
Stock abutments
A stock abutment is less costly and has the benefit of being easily replaced by any dentist in the event that you have an emergency and are unable to see your regular dentist. Another dentist would be able to replace a stock abutment more readily than they could a custom abutment. Stock abutments are much more user-friendly and can be placed using either cement or a screw.
The gum tissue around the abutment will eventually conform to the shape of the abutment. Since stock abutments are a standard size, they may not be suitable for your gum tissue in which case your dentist would opt for a custom abutment. It is important that the margins of your implant restoration make good contact with neighboring teeth, allowing you to floss properly while being tight enough to prevent food from constantly getting trapped in any space between teeth.
Implant Restorations
Since implants can be used for so many different restoration types, they are the most versatile while being incredibly durable and natural-looking. Regardless of the type of restoration, porcelain and ceramic are the most popular material choice for their aesthetics and durability.
There are a number of materials available to fabricate implant restorations though most patients prefer ceramic or porcelain since it is the most natural-looking and can be tinted to match the patient’s natural teeth. Some implant restorations can be fabricated from gold or other base metals, porcelain fused to metal (PFM), or e-max. Crowns made from metals and PFM crowns are much stronger and more durable than crowns fabricated using only porcelain and ceramic. The drawback to a PFM crown is the risk of metal eventually showing through the outer porcelain layer as the restoration ages.
If you are considering dental implants to replace one or more missing teeth, speak with your dentist to learn what types of systems they use in their practice before researching on your own. Doing a little research can help you learn what questions to ask about treatment and what to expect during treatment. Implants are the most popular restoration option for a reason. Speak with your dentist to see if you are a candidate!