Dental Implant Types and Dental Implant Complications

Dental Implants has a a lot of different types and there are different treatments. On this article you will se kinds of dental implant types and possible complications of dental implant.

The dental implant (also known as an endosseous implant) is a medical device of a surgical type used to functionally and aesthetically rehabilitate the congenital loss or lack of one or more teeth, allowing the support of a prosthetic substitute through direct bone support thanks to a biological process known as osseointegration; it can be inserted into both the jaw and the jaw.

The implant element is inserted immediately, so that osseointegration occurs more easily, while only afterwards the visible dental prosthesis is added; a variable amount of time is therefore necessary to achieve correct osseointegration. [1] The most commonly used type is formed by one or more sections, usually of a cylindrical and conical truncated shape, and is often provided in its endosseous part of coils or other accessory retention elements. It can be used to support single prosthetic crowns and bridges, up to complete arches. The most frequently used material is titanium in its pure form, as it allows a better osseointegration, going to form an intimate bond with the bone. Simplified models with reduced dimensions (so called mini implants or miniscrews) are also used to provide stability to mobile prosthetics and orthodontics to provide temporary anchorage points needed for dental movements.

The success or failure of the implants depends both on the state of health of the person receiving it, on any medications taken and that have a possible impact with osseointegration and the condition of the tissues of the mouth. The mechanical stress to which the plant would have to meet during its life must be carefully evaluated. The correct planning of the position and the number of implants is fundamental for the long-term preservation of the prosthesis, since the biomechanical forces acting during chewing can be significant. The position of the implants is determined by the position and the angle of the adjacent teeth, by laboratory simulations or by the use of computerized tomography (often using CBCT equipment) with CAD / CAM simulations and surgical guides.

The prerequisites for the long-term success of osseointegrated dental implants are healthy bone and gingiva. Since both can atrophy after a dental extraction procedure, sometimes it is necessary to resort to gingival grafts or maxillary sinus augmentation in order to recreate ideal conditions of bone and gingiva. The final prosthesis can be fixed or removable; in any case, a stump is connected to the implant element. When the prosthesis is fixed it is fixed to the abutment or with a captive screw or with dental cement, while when it is instead removable a corresponding adapter is inserted into the prosthesis so that the two pieces can be fixed together.

The risks and complications related to implant therapy are divided between those that occur during surgery (such as excessive bleeding or nerve injury), those that occur in the first six months (such as infection and failure to osseointegration). ) and those that occur in the long term (such as peri-implantitis and mechanical ruptures). In the presence of healthy tissues, a well-integrated implant with appropriate biomechanical loads can have a long-term success rate of between 93% and 98% for fixation and a duration of ten to fifteen years for prosthetic teeth. Dental implant prices in Turkey are very low than other countries.

Titanium Dental Implants

 

Titanium Dental Implants
Titanium Dental Implants

After many decades of different, today sometimes naïve, pre-war implant forms, rotationally symmetric implants (usually screw implants) have become established. In these implants, the implant body is circular in cross-section, so that the implant cavity, the cavity which is to receive the implant, can be prepared with rotating instruments, for example a cannon drill, into the jawbone. The screw implants differ mainly in their conicity and in the type of thread.

This surgical procedure puts less strain on the patient than previous implantation techniques and very rarely results in wound healing complications. In addition, screw implants have the advantage that they immediately “fix” themselves in the bone through their thread (primary stability). This shortens the healing time, because only a few bones have to “regrow”. In some of the implants, the cylindrical basic forms tapers apicalward, towards the end, so that a cone shape is created overall.

In contrast to orthopedics, which mainly uses titanium alloys, dental implants are manufactured from pure titanium. Titanium has high biocompatibility, which does not trigger allergic or foreign body reactions. Titanium, in contrast to other materials, enters into a direct molecular connection with the bone. Here, the rough, morphological surface design with a micro-pore depth of on average 5 to 100 μm plays a key role. At the beginning, this was achieved by spraying (“additive process”) titanium powder under argon and high temperature (titanium plasma spray “TPS”).  This process is relatively expensive, and since about 2000, many manufacturers have resorted to the cheaper acid etching process (or combinations thereof, called “SLA”) through a mixture of hydrochloric acid and sulfuric acid (“subtractive processes”). ) which is equivalent or even superior to the additive method.

The property of titanium to form a protective oxide layer on the surface with oxygen is the reason for its particularly good compatibility. Both methods have a high success rate (over 95% for a five-year stay). Implants must be certified by health authorities as safe medical devices (CE or FDA approved). According to the Medical Devices Act (MPG), there are exceptions for individual implants that are made for a single patient on the basis of a prescription by the dentist.

For the most part, composite dental implants have become established because they can best be adapted to the given conditions by virtue of their ability to combine the root and crown proportion, and because the two-step procedure ensures that the osseointegration of the implant is not impaired by premature loading. Multi-part implants consist of the implant body anchored in the bone, more rarely a separate neck portion lying in the area of ​​the oral mucosa and the head part, the abutment, which accommodates the superstructure. The two or three parts are usually bolted together. The superstructures (crowns, bridge or denture anchors) attached to them are screwed, cemented or glued. [4]

In the case of one-piece dental implants, the dental implant head protrudes out of the mucous membrane, so that premature loading during the healing phase is often unavoidable.

Hollow cylinder implants 

The hollow cylinder implants (also referred to as basket implants) developed in the 1980s were supposed to increase the integrating surface, but they did not work because the in-cylinder bone had caused complications due to a lack of adequate blood flow. In a modified form as a short implant with a wide diameter and with new surgical technique, they are currently experiencing a renaissance.

Leaf implants 

In addition to these cylindrical implants with or without screw thread, there are also flat, leaf-shaped implants (extension implants), which are sunk along the bone course of the jaw in an approximately 1 mm wide in there prepared slot 4 to 14 mm in length and grow there. These implants also have drill holes through which the bone can also grow horizontally.

Narrow-stem implants 

Drilling template for 2 implants

A drilling template ensures the precise and safe insertion of dental implants.
Small oral implants, also known as mini-implants, have a diameter of 1.8 to 3.1 mm. They are individually suitable only for small gaps in the teeth and are subject to indications z. B. in the posterior region. Due to the faster dimensional fatigue under chewing load, they are usually constructed in one piece. An improved bionic design and high-quality titanium alloys or titanium alloys lead to a renewed increased use z. B. in the field of prosthodontics. After diagnostic evaluation, they are used for minimally invasive and single-stage surgical procedures. The technique, which is still not without controversy, is usually supplied prosthetically with primary blocking (ridge) or secondary blocking with various anchor systems. The target group for such procedures are patients who, after detailed medical history, can not be admitted from a anatomical, psychological or financial perspective to a more complex conventional implant treatment. Undisputed is the therapeutic value of Schmalkieferimplantaten z. B. for temporary use in orthodontics, for intraoral fixation of surgical guides or as auxiliary implants for circumferential provisional implant restorations.

Two screw implants and two BASAL implants for supplying a one-sided shortened row of teeth in the upper jaw.

Flat lattice-shaped leaf / extension implant with 2 piers to protect the lower jaw nerves; with a fixed bridge as a superstructure

Disk Implants

Disk implants belong to the group of BASAL implants. They have the shape of a skeletonized cylinder and are inserted laterally into the jaw. The hold takes place in the hard and well-perfused outer wall of the bone. Disk implants may be charged immediately. Because of their special shape, they should ensure stable healing even at low bone height or advanced jaw removal.

Subperiosteal Implants 
The subperiosteal implants are as large as possible under the mucosa directly to the bone. They were used primarily for high-grade bone loss when the jawbone was too shallow or too narrow for cylinder or extension implants. The mere superposition of the shallow subperiosteal implant under the periosteum often led to extensive inflammation with z. T. considerable extensive Knocheneinschmelzungen, because an effective infection protection by a bacteria-proof completion at the point of passage of the head part naturally lacks.

Although there are great successes with subperiosteal implants in the USA (more than 95% after a five-year stay with unilateral mandibular implants), [7] their scientific development in Germany has not been further advanced. The reason lies essentially in the fact that the findings of bone biology with regard to the reliable regeneration of bone tissue open up possibilities to use cylinder implants by means of suitable surgical jaw erection procedures even in cases of scarce bone supply. There is no manufacturer of subperiosteal framework implants in Germany.

Ceramic implants

The pure ceramic implants used in the past were characterized by excellent ingrowth. However, fractures very often occurred because the ceramic is brittle (higher elastic modulus) and undergoes aging processes. Bone, as a biological tissue, allows more or less pronounced bends that do not involve ceramics. Therefore, one has largely left this group of materials.

Zirconium (IV) oxide 

Because of cosmetic problems associated with gum and bone regression, zirconia (ZrO2) (also referred to as zirconia or the common name zirconia, also colloquially referred to as “zirconia”) is used as the implant material. Zirconium (IV) oxide should be distinguished by a titanium compatibility comparable to the tissue. There are still no scientific studies on the amount of removal torque, a size that provides information about the degree of osseointegration of the implant body. However, recent experience reports show extensive bone-dissolving inflammation and a loss rate of over 50% in the 2-year period. These numbers are completely unacceptable compared to the use of titanium implants and have been a reason for the end of the so-called Tübingen or Munich implants years ago. These were also made of ceramic and had a failure rate of over 30%, because of the titanium crystal inherent mechanism of reversible ionic

Cytokines
More recent approaches coat the implant surface with proteins that stimulate and promote bone formation on the implant. Whether these attempts ultimately prevail and whether they accelerate the osseointegration must be awaited. The unexplained overall effect of these special proteins (cytokines) on other areas of the biology of the organism is a clear question mark behind these experiments, because there are first indications of fatal liver damage. The cytokines used here, especially BMP 2, by no means only have a special bone-promoting effect, but act elsewhere as triggers of controlled cell death (apoptosis). Their effect is exacerbated by the influence of blood clotting inhibition by heparin (20-fold). [8]

Ultimately, however, there is hardly anything to improve in the now established success rate of consistently over 95% of the most common implant types without artificial mineral or protein deposition. The causes of the remaining 3-4% loss can not be scientifically attributed to the surface design or the shape of the implant.

Indication distribution of dental implants

Bridge on implants
In partially edentulous patients (> 90%), implants are the most common indication, with single tooth gaps exceeding 50% being the most common indication for implant treatment. Augmentation techniques were also used in about 40% of cases, in the form of membrane technique or sinus floor elevation. The frequent use of the two augmentation techniques results in 53% more implants being inserted in the maxilla than in the mandible. [9]

A Swiss study by the University of Bern shows the following distribution:

Single tooth gaps 51.6%
Free end situations 23.5%
Switching gaps 16.9%
Toothless jaw 8%
Consensus Conference Implantology [edit | Edit]
The Consensus Conference Implantology, a cooperation of two professional associations (Federal Association of Implantology Dentists, BDIZ, Professional Association of German Oral Surgeons, BDO), two scientific societies (German Society of Implantology, DGI, German Society of Dental Implantology, DGZI) and a federation, both professional association as well as scientific society is (German Society of Oral and Maxillofacial Surgery, DGMKG), has defined the indication classes for implants, (as of 7 October 2014). [10]

The optimal therapy for tooth loss is the replacement of each individual tooth with an implant. As a rule, the 8th tooth of a quadrant can not be replaced, and the need for replacement of the 7th tooth can be individually assessed critically. Since this optimum for various reasons (especially anatomical, economic) can not always be achieved, the following standard supplies are set up.

Indication classes 
The standard care provides the following indication classes:

Class I: single tooth replacement
Class II: Reduced residual dentition
Class II a: Free end situation
Class III: Toothless jaw

Definition of standard supplies

Class I a:
If up to four teeth of the OK front are missing, the adjacent teeth are clinically intact: 1 implant per missing tooth.
If up to four teeth of the front are missing, the adjacent teeth are clinically intact: 2 implants should replace the missing teeth.
page dentures

Class I b:
If teeth in the posterior teeth are missing from the closed row of teeth, each missing tooth that is not in need of treatment should be replaced by an implant.
Class II:
Reduced residual dentition Principle: When planning the implantation of the reduced residual dentition, the dentition of the opposing jaw must be taken into account in the planning. In addition, the rules of conventional prosthetics apply

Free-end

Class II a:
Teeth 7 and 8 are missing: no indication for implantation
Teeth 6-8 are missing: 1-2 implants
Teeth 5-8 are missing: 2-3 implants
Teeth 4-8 are missing: 3 implants
Toothless jaw

Class III:
For anchoring a fixed denture: 8 implants in the edentulous maxilla, 6 implants in the edentulous mandible.
For anchoring a removable denture: 6 implants in the maxilla, 4 implants in the lower jaw.
The definitive number of implants always depends on the particular situation and position of the natural teeth, so that the final decision is the responsibility of the practitioner in consultation with his patient.

With the help of computed tomography (CT) or digital volume tomography (DVT), the position of the implant can be determined before the procedure. Planning takes place three-dimensionally on the computer and is based on an individual

Possible complications of Dental Implants

In the foreground of the complications are all factors that favor infection in the implantation area. Dental implants are at risk of peri-implantitis, an inflammation of the bone tissue around the dental implant. The cause is either due to surgery errors or inadequate oral hygiene of the patient. The peri-implantitis leads to a bone loss, which ultimately causes the failure of the implant. Dental implantation is considered a failure if the implant is mobile or has a peri-implant tissue loss greater than 1 mm in the first year. Peri-implantitis can be treated by prophylactic measures together with antibiotic therapy. Peri-implantitis can be detected on an X-ray.

In assembled implants, there are gaps and cavities between the actual implant and the abutment, into which germs can penetrate out of the oral cavity. Later, these germs return to the adjacent tissue and can cause peri-implantitis. As a prophylaxis, these implant spaces should be sealed.

Diabetics must be well-adjusted to reduce the risk of inflammation on the teeth to a manageable level.

In patients undergoing chemotherapy, not only are the immune defenses limited, but also the tissue’s ability to regenerate during the post-implantation healing phase. Therefore, in these patients, the end of the chemotherapy is awaited and implanted only a few months later.

Bedridden patients may possibly be provided with implants if the procedure is performed inpatient.

Treatable periodontitis is not an exclusion criterion.

The risk of failure is increased in smokers. Failure may also occur if the implant has not been properly positioned.

Check wikipedia for more dental implant information.

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