Since man’s earliest attempts at replacing missing teeth, a wide variety of materials were placed into the gums and sockets of extracted teeth, including seashells, bone, other people’s teeth in the vain hope of getting something to integrate with the jawbone.
In the 1960s, a very clever man called Branemark, discovered the holy grail for dentists when he realised that pure titanium placed into bone would activate the bone healing process and lock the two together.
Shortly afterwards the long process of developing a predictable way to use this phenomenon to support replacement teeth began.
Early attempts were a little on the crude side, and the prognosis was far from predictable, but over the last forty years researchers have developed better designs and surface treatments to give a very reliable and versatile management tool for missing teeth.
There are many manufacturers of implants, and generally they are fairly similar with a threaded screw milled to very high tolerances and with internal fixing points to hold and support various structures within the mouth.
I personally trained on three different systems under Prof. Cemal Ucer, who has trained hundreds of implantologists over the years. For me there was no choice as to which system I would go on to use in my everyday practice, as Straumann uses a very versatile placement system which allows me to direct the implant very precisely to avoid neighbouring structures unlike some other systems which “ self – tap “ and are therefore susceptible to being driven off track by local variations in bone density.
There are essentially three treatment options when using implants:
This is the primary indication, where an implant is placed where a single tooth has been lost. Traditional dental solutions included a removable denture (not very nice to have to wear) or a bridge which often involved the need to cut down the neighbouring tooth or teeth to support the false tooth.
Nowadays, a titanium implant is a simple, freestanding unit which supports a single crown, avoiding either of the above unpleasant outcomes.
The long-term prognosis is excellent, and this has become the benchmark treatment for single spaces.
Where several neighbouring teeth have been lost, a very useful technique is to place an implant at either end of the space. Preferably these are placed parallel to each other, allowing the implants to support a screw-retained bridge.
This can be extended to a full arch supported by a minimum of six implants. There are several variations on this theme, including a whole arch on four implants, but many implantologists question the predictability of so much force being applied to so few implants.
Where many teeth have been lost, fixed bridgework is sometimes not indicated and a removable denture supported and retained by several implants can provide a better solution.
This can be as simple as using two implants in the lower arch to carry locators. These are similar to press studs, and are a very simple way of stabilising a lower denture in particular.
Whatever the proposed indication, there are several things to consider.
The main concern is to ensure that the implants will last as long as possible. Well-placed implants loaded correctly should last for many years. There are Straumann implants still in function after thirty years, although obviously this would be foolish to promise as so many uncontrolled variables exist beyond our control once the patient has left the surgery.
There are certain well-researched factors which can have a negative impact on implants and may preclude their use, but should certainly be part of the treatment planning conversation.
This is harmful to the bloodflow and general health of the gums around implants. This can lead to gum disease and untreated can lead to bone-loss around the implant (peri-implantitis).
In certain circumstances, this can be identified and remediated but this can often lead to premature loss of the implant. Once lost, it is often possible to place a bone-graft, allow bone to grow into the graft, then return to place a new implant nine months later.
Patients who smoke, especially if this is more than ten per day, should think carefully about whether or not the sometimes significant investment in time and money would be sensible if they are undermining the long-term prognosis.
This very common condition has been shown to adversely affect the way our white blood cells move through tissues to fight infection. Many studies have shown diabetes, especially when unstable, to significantly reduce success in implants
Well-controlled diabetes appears to have a relatively low impact on outcomes, but again this should be taken into consideration when planning.
Poor plaque control
This is the easiest thing to control, as regular care with a dental hygienist and plenty of professional nagging from the team can help implant patients to keep their plaque control at the highest levels possible, minimising the risk of early loss.
The presence of infection anywhere in the mouth but especially around neighbouring teeth can lead to implants failing to osseointegrate, so we always take a series of x-rays to check all is well before commencing with implant placement. It is also crucial that any gum disease present is thoroughly dealt with before implant treatment begins.
Enough of the serious stuff!
Implants are an excellent way to close spaces left by dental disease and trauma, and have become an integral part of modern dentistry, making the wearing of unstable, loose dentures unnecessary and avoiding the need to damage healthy teeth to provide fixed bridgework.
Well cared for, they can last and provide useful function for many years and, unlike teeth, they very rarely break, can’t decay and don’t have those inconvenient nerves that can make life such fun when teeth go wrong.