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Dental implants are a revolutionary solution in prosthetic dentistry for replacing missing teeth. They serve as artificial tooth roots and offer a highly successful and widely accepted approach to restoring a complete, functional smile. One of the most successful types of dental implants is the osseointegrated implant, which was discovered through the pioneering work of Swedish Professor Per-Ingvar Brånemark. This type of implant is made of titanium, which can fuse seamlessly with bone tissue when osteoblasts grow on and into the rough surface of the implanted titanium. This creates a strong structural and functional connection between the living bone and the implant. Another implant-related procedure is the implant-supported bridge or implant-supported denture.
If you have one or more missing teeth, there are various options available for replacement, including bridges, partial dentures, or complete dentures. However, dental implants offer a remarkable alternative. They serve to replace missing tooth roots and provide support for artificial replacement teeth. Not only are dental implants comfortable, but they also closely resemble natural teeth in appearance.
A dental implant consists of an artificial root made from titanium metal. It is surgically placed into the jawbone, effectively replacing the root of a natural tooth. A replacement tooth, often referred to as a crown, is attached to the implant. This implant serves as a stable anchor, holding the replacement tooth securely in place.
If you are considering a dental implant, your journey may start with Dr. Andreea Birsila, who may refer you to a dental specialist with advanced training in implantology. Specialists who are skilled in placing implants include periodontists and oral and maxillofacial surgeons, commonly known as oral surgeons. Prosthodontists, on the other hand, are specialists who focus on placing crowns, bridges, and dentures on implants.
Dental implants may be a viable option if you are in good overall health, have healthy gums, and possess enough bone in your jaw to accommodate an implant. In cases where your jawbone has shrunk or didn't develop properly, it may be possible to undergo a bone graft to augment the bone. Bone grafting is a procedure that adds new bone to your existing jawbone. Dr. Andreea Birsila or a dental specialist can evaluate your suitability for this procedure.
A typical dental implant comprises a titanium screw, resembling a tooth root, with a roughened surface. This surface is treated using techniques like plasma spraying, etching, or sandblasting to enhance the implant's ability to integrate with the surrounding bone. The implant is placed into an osteotomy, which is a precisely drilled hole in the jawbone.
The implant surgery is typically conducted on an outpatient basis and can be performed under general anesthesia or local anesthesia. Qualified clinicians, including general dentists, oral surgeons, and periodontists, carry out the surgery. In some cases, general or cosmetic dentists and prosthodontists may also place implants for simpler cases. The treatment plan often involves multiple surgeries over several months, especially when bone augmentation, or bone grafting, is necessary to support the implant placements. On the other hand, some patients can receive both implantation and restoration in a single surgery, a procedure referred to as "immediate function" or "teeth in an hour."
In a conventional implant procedure, an incision is made, and the gum or gingiva is lifted to expose the jawbone. The surgeon drills an osteotomy, places the implant, and then sutures the gum tissue. This procedure typically takes about an hour for a single implant, possibly longer for multiple implants. Following the surgery, patients undergo a period of recovery, regain consciousness, and are then discharged to return home with a companion.
Over the course of several months, the implant(s) gradually heal and integrate with the jawbone in a process known as osseointegration. When the time is right, a restorative or cosmetic dentist or prosthodontist utilizes the implant(s) to anchor crowns or a prosthetic restoration that contains several "teeth." Since these implants are securely integrated with the bone, they offer biomechanical stability and strength, enabling patients to resume normal chewing function immediately.
In cases of immediate function, also known as "teeth in an hour," there is no need to flap the gingiva; instead, a small piece of gingiva directly above the drilling site is removed. The site is drilled, the implant is placed, and a crown is immediately added. Patients are advised to allow ample time for healing and integration before attempting normal chewing.
The timing of dental implant placement after tooth extraction can vary and falls into categories such as immediate post-extraction implant placement, delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction), and late implantation (3 months after tooth extraction). Similarly, dental implant loading can be immediate, early (1 week to 12 weeks), staged (3-6 months), or late (more than 6 months).
Before surgery, particularly for mandibular implants, a neurosensory examination is typically conducted to assess nerve function and establish a baseline. A panoramic X-ray is taken, using a metal ball of known dimensions, to make calibrated measurements from the image. This assists in accurately locating vital structures such as nerves and critical anatomical features like the mental foramen, which is the transit point in the jawbone for the nerve that innervates the lip and chin.
For edentulous (without teeth) jaw sites, a pilot hole is drilled into the recipient bone while taking care to avoid vital structures, particularly the inferior alveolar nerve (IAN) within the mandible. A zone of safety, typically around 2 mm, is standard practice to prevent damage to vital structures like the IAN. When computed tomography (3D X-ray imaging) is employed preoperatively to precisely pinpoint vital structures, the zone of safety can be reduced to 1 mm through computer-aided surgical guides.
Drilling into the jawbone usually occurs in several stages. The pilot hole is gradually enlarged using progressively wider drills, typically between three and seven steps, depending on the implant's width and length. Care is taken to avoid overheating the bone, which could damage the osteoblasts or bone cells. Cooling saline spray is applied to maintain the bone's temperature below 47 degrees Celsius (approximately 117 degrees Fahrenheit). The implant screw is then inserted with precise torque to avoid overloading the surrounding bone, which can lead to osteonecrosis or bone death, potentially causing implant failure. The osteotomy or drilled hole is usually about 1 mm deeper than the implant to accommodate the drill tip's shape. Surgeons must be cautious when drilling near vital structures.
Once the implant is securely torqued into the bone, a cover screw is placed, and the gum tissue is sutured over the site. The area is allowed to heal for several months, enabling osseointegration to occur between the implant's titanium surface and the jawbone.
After several months, the implant is uncovered in a subsequent surgical
