In dentistry today, our options to replace teeth with implants have expanded greatly since the first implants, as we know them today, were placed 47 years ago. This type of implant, which is referred to as an endosteal implant, was intended to replace a single tooth, which is the most popular use of implants today. There are multiple types of implant crowns (restorations we place on implants), depending on the situation. Initially, on back teeth, all metal restorations are made of gold due to the strength and biocompatibility of gold. Unfortunately, they were not an esthetic option, so porcelain was fused over metal, which was an improvement esthetically but typically left a grey line around the gum line. Although appearance was better, it was still not acceptable for some patients. With advancement of porcelain materials, we now have metal free porcelain restorations, which mimic teeth and are our most life-like options.
Restorations attach to the implants in the bone using different styles of abutments, which extend to the implant above the gum line. Initially, all implant abutments were custom made in a laboratory and screwed into the implant and the final restoration was either cemented on or screwed into place. These custom abutments work well but add cost and time to the patient.
In cosmetic cases, we are able to use a tooth colored material such as zirconium along with an all porcelain crown to give us a case that is cosmetically excellent and blends in so that you are unable to tell that the implant restoration you are looking at is not the patient’s own tooth or teeth. Currently, we use direct abutments, which we place in the implant at the time it is uncovered after healing. Using direct abutments, we can fabricate the porcelain crown at the time of that appointment using CAD CAM technology, reducing the time our patients are missing teeth. In a case of multiple missing teeth, we can place several implants and place implant bridges to replace all of the teeth that are missing.
The greatest area of expansion in dental implants is for those patients that wear dentures. There are numerous ways we can use implants to improve the quality of life for our denture wearing patients. The single largest complaint that denture wearers express is the lack of stability in their dentures. With dental implants, we are able to secure existing dentures using just two implants. We place what we call ball abutments on the end of the implants and a receiver inside of the denture – I like to compare it with a ball hitch and trailer that goes over the ball hitch. Although the patient still takes the implant dentures in and out like a traditional denture, they stay in place while the patient chews and talks.
The latest advancement in replacing removable dentures are “All In Four Dentures” and “Teeth In A Day.” The “All In Four Dentures” are a modified denture that is fixed in the mouth on four implants. The great thing about these is that we can greatly reduce the size of the denture because the denture is made on a titanium bar to give it strength. Some of the biggest complaints about dentures are that there is so much material that it affects how food tastes and the denture moves while eating. Because the denture is reinforced and attached to the bone via implants, it does not move while eating and it feels less bulky.
The “Teeth In A Day” advancement is a reality in many cases by using a cone beam radiographic unit and implant planning software. Using information gathered with these tools, we can virtually plan implant placement and then create a computer model of a denture to be placed on these implants. We can then prefabricate the denture and place it at the time of surgery. These procedures take a great deal of skill, technology and cooperation, but “Teeth In A Day” are a reality. FBN
If you have any questions, feel free to contact me at bryan@flagstaffdental.com. By Bryan J Shanahan DDS.
