Different Dental Implant Systems
Dental implants continue to increase in popularity as an excellent way for restoring missing or damaged teeth. In general, our oral health has significantly improved over time as a population. However, patients continue to experience tooth loss for a variety of different reasons. As life expectancy continues to increase and people are able to maintain a good quality of life as they age, the loss of teeth can be a significant burden. It is important to maintain good oral health for numerous reasons. Good oral health helps patients to maintain their smile, their ability to consume various foods without restrictions and maintain necessary function for daily activities such as eating and talking.
Permanent solutions for replacing missing teeth are becoming more popular as the population continues to age. This is becoming especially prevalent as the baby boomer generation begins to enter retirement-age. In the United States along, an estimated 3 million people have dental implants. A number which is growing by approximately 500,000 people annually. As patients and dentist become more aware of implants and their impressive success rates of nearly 95%, the demand grows.
With the growing demand, the technology used for dental implants also continues to improve and advance. Based on these modern enhancements, the implant market is expected to see a significant transformation in the near future.
Implant Systems
Dental implants come in a variety of different shapes, sizes, and methods. Options which have significantly developed and grown over time. The top dental implant manufacturers are continuously working to improve their implants and offer the patient the best product with the most successful outcome.
More than 100 companies create various implant components around the world, however, the top implant companies include BioHorizon, Dentsply, MIS, Nobel BioCare, Straumann, and Zimmer Biomet.
There are numerous companies which manufacture generic implant components at a cheaper rate, however, these products can cause ongoing issues and challenges. Thankfully, patients are more informed regarding the technology and products used for dental implants. In addition, patients opt for products which are created from a reputable manufacturer.
Top dental laboratories are also familiar with implant manufacturers who are well-respected in the industry. The laboratory technicians are often provided with specialized training and tools required to create these specific components.
Top implant manufacturers also make significant investments towards the research and development of their products. As a result, patients receive high quality component along with the necessary support if any issues arise. After the implant device is placed, there is a biological response which occurs and results in an exchange of information between the cells and biomaterials.
This natural process determines if the implant is accepted or rejected in addition to determining the number of cells to populate on the surface of the implant. Based on research, these osteoblastic cells are able to adhere more efficiently to rough surfaces. Well-respected dental implant companies focus on this fact to promote the improvement of osseointegration.
The biomechanical qualities of dental implants manufactured by these companies are clinically researched and transparent in sharing the results. Unfortunately, the biomechanical qualities of generic implants are not well-researched or transparent as it relates to the product’s lifespan.
It can be a daunting and time-intensive task for patients to determine which implant systems to invest in. In most cases, implants are a relatively routine procedure and the selection of the particular implant system is not vital. In more complication scenarios, however, the selection of the implant system can be critical.
The manufacturer’s website can be a helpful place to start when reviewing and selecting an implant system. The website can often provide a thorough overview of the available products. Most dental implant companies work diligently to be a one-stop resource. In some cases, however, it can be difficult for a single implant system to meet the unique needs of each patient. It is common for a dental office to select a few manufacturers to work with. This give the dentist the ability to be familiar and well versed in the dental implant systems offered.
Implant Types
Once the implant system is chosen, there are a few other decisions which will need to be made. For example, the dentist is able to use screw-retained implants or cement-retained abutments. Custom abutments or stock abutments can also be used. Custom abutments are usually preferred as they offer more natural-looking results. However, the patient should work with their dentist to make the right choice for their specific case.
Most dentists prefer using titanium implant posts, however, zirconia has gained popularity in recent years. There are also numerous types of different crowns which can be placed once the abutment is attached.
Cemented Abutments and Screw-Retained Implants
There are numerous factors which should be evaluated when determining whether to use a screw-retained implant crown or cement-retained implant crown. Some of the most important factors may include the retrievability, the status of the peri-implant tissues, ease of use, the use of the crown with angled implants, and the overall cost.
Implant crowns sometimes need to be removed temporarily. Some types of cements are specially created for implant restorations and can easily be retrieved. Dentists may also opt to use a temporary cement which can secure the implant crown into place. This works well, however, it cause the crown to be less retentive. In comparison, screw-retained implant crowns are far more predictable when the crown must be retrieved. Crown retrieval is often necessary when additional abutments are required. A multi-unit restoration, which includes the use of a cement abutment, is typically far more challenging to remove.
Peri-Implant Tissue Maintenance
When cement is used to secure the crown of an implant into place, there is a risk of excess cement being forced into the sulcus. This has the potential of damaging the peri-implant tissues, unless the cement is removed entirely. When subgingival cement is present around the implant, it can increase the risk of peri-implant mucositis and peri-implantitis. There are techniques which can be used to remove subgingival cement. However, there is a risk that not all of the cement will be completely removed. Screw-retained crown do not have this risk and can be easily removed for maintenance and cleaning when necessary.
Usability
The placement of a screw-retained implant crown is far more challenging than using a cement-retained crown. When a multiple unit restoration is being fit, this is increasingly challenging. When a cement-retained restoration is used for multiple abutments, the procedure to fit the restoration is similar to placing a routine bridge. The placement of a screw-retained restoration requires additional steps to ensure a proper fit. It is important that the restoration does not place any stress on the implant.
Angled Implants
For visual purposes, screw holes should be placed in the incisal or facial contours of an implant crown. In the event the angle of the implant is slightly off, an angled, screw-retained abutment be used. This will result in additional cost. In this case, it is safer to use a cement-retained crown with either a custom abutment or a stock angled abutment.
Stock and Custom Abutments
Another decision which needs to be made with an implant procedure, is to use either a stock implant abutment or custom implant abutment. Understanding the features with both types of abutments aids in determining which solution will best meet the patient’s needs.
Stock abutments are available in standardized sizes which are predetermined. The can be safely used for predetermined at the bone or tissue level. Stock abutments are designed to be easy to use and easily obtain impressions. Stock abutments are often used alongside a cement retained restoration. They are also the less expensive option. Both angled and straight abutments are available. This type of abutment is ideal for tissue level implants.
One of the primary challenges with a stock abutment is the standardized sizes which are available. In many cases, the tissue will conform to the shape of the abutment. This type of abutment is not ideal for use in the front of the moth where the restoration is visible. This is due to the challenge in creating the correct emergence profile, providing critical tissue support, and achieving optimal results. Another consideration with stock abutments is that it is impossible to control the final margin placement of the crown. The determination of this is made by the abutment’s height and the implant’s depth. In order for the dentist to achieve the desired fit and emergence profile, they may need to spend additional time making the necessary adjustments.
Custom abutments can be used for bone or tissue level implants. They are waxed or milled into the specific shape required as it relates to the crest of the tissue. Custom abutments can be created from titanium or zirconia. They can also be fabricated from zirconia with a titanium base. With the placement of a custom abutment, delivery jigs are used to ensure a smooth and accurate restoration. While a custom abutment is more expensive, it also provides the patient with more predictable results and superior tissue management. Custom abutments can be used with either screw-retained or cemented crowns. Custom abutments often require less time for fitting and placement compared to a stock abutment. As a result, they are often the more cost-effective solution in the long run. This is because there are fewer lab fees for modifying stock abutments. Fewer clinical resources are also required to obtain the proper fit.