Dental implants have changed how dentistry is performed more than any other advancement in the last 25 years. Dental implants have many applications to enhance oral health for patients throughout the world. Unfortunately, there is a large amount of inaccurate information and, in some cases, completely false information.
Immense amounts of research has been completed and will continue to be conducted to further enhance how dental implants are used. Implants have one of the highest success rates of any procedure done in dentistry and all health care. Research puts the success rates of dental implants at 94 percent, which is quite astounding. Traditionally, dental implants are fabricated from titanium, which is a highly biocompatible metal. In fact, it is so accepting that bone actually grows onto the surface of the implant, making the implant part of the jaw bone. The first titanium dental implant was placed in Sweden in 1965 and at latest report was still functioning for the patient. I was lucky enough to be invited to and attended the World Implant Congress in Grothenberg, Sweden last year where the first dental implant was placed.
The science that exists and the long history of success show that they are an excellent solution and, when done properly, they have low risk to the patients. The most important part of a successful implant outcome is gathering correct information and diagnosis of existing structure where implants are to be placed. Above all, the most important consideration in dental implant placement is where do we want teeth to be replaced.
Once we know where teeth are to be placed, we have to analyze bone quality and quantity. In addition, we need to understand whether there are any anatomic hurdles to where our implants are to be placed. Hurdles include the nerve in the lower jaw, which runs through most of our mandible on both sides. We must also understand position of sinuses in the maxilla (upper jaw).
In years past, the best source to provide this information was traditional x-rays or panoramic x-rays. The limitation to both of these is that they are two-dimensional, which in some cases will work, but may not help us understand the true three-dimensional position of the anatomic features in our jaws. After all, we are three-dimensional beings, not flat pieces of paper. With new technology, we have the ability to take a Cone Beam Computed Tomography (CBCT) right in our office. Simply put, it is a dental CAT scan we take in 13 seconds and our computer systems will produce a fully interactive three-dimensional view of our patient’s jaw, bones, sinuses, nasal airway and lower airway. The diagnostic quality is so good our ENT was able to use a CBCT scan we took on my son for surgery for a deviated septum. Now, that’s faith in a system.
Having a three-dimensional view of an area where surgery is to be performed only makes the surgeon better, and as the technology advances, it will be considered the standard of care for dental implants in the future. CBCT scans are ready in five minutes, have very low radiation dosage and are very cost effective for our patients. I personally could not imagine doing a surgery without one and insisted my dad get a scan before he had an implant placed.
I personally practice a “tooth down approach” when planning implants. I want to know where the teeth will be placed and then do my best to center the dental implant under the tooth so it mimics real life. This allows for proper cleaning and long- term positive prognosis for the implant and the restoration on top of it.
I have seen cases where the tooth position was not considered, and ultimately the implant was useless because a restoration could not be placed on the implant. If the restoring dentist and surgeon placing the implant is not the same person, then excellent communication between both is needed to achieve the best results for tooth and implant position. I utilize a computer where I can plan teeth position and overlay that on our CT Scan to be assured our bone quantity and quality are acceptable and we have no anatomic hurdles. If position of implant placement is tight, we can then have a surgical template fabricated from our CBCT, which will completely control final implant position of the implant. The template is placed in the mouth and directs the drill position so the implant is placed in the exact place we planned for it in our implant planning program.
Due to the exact controls we use in these surgeries, our surgical time is reduced, which leads to greater patient comfort and better post-operative healing. Most patients on whom we perform implant surgeries are amazed at how easy and pain-free the procedure is, and how fast they heal. Dental implants are an excellent choice for improving oral health and we will talk about the many choices for replacing teeth next month. FBN
By Bryan Shanahan, DDS