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Implantology is the branch of dentistry that deals with the permanent implantation of artificial teeth in the jaw. ... During the dental implant surgery itself, the oral surgeon makes a cut to open the gum and expose the bone. Holes are drilled into the bone where the dental implant metal post will be placed
Dental implants fuse with bone to create a strong and durable foundation for replacement of an individual tooth or an implant-supported bridge or denture containing multiple teeth. The cylindrical and/or tapered post is typically made of titanium, and serves as a substitute for the tooth root.
Dental implants are available in a variety of sizes and heights, including standard and narrow (mini). The most commonly used type of implant is the endosteal implant, which is a small screw-, cylinder- or plate-shaped implant placed in the mandible. Subperiosteal implants are placed under the gingiva on or above the mandible, in patients with shallow mandibles or for those who prefer not to undergo rebuilding procedures.
Implant restorations feel, fit, look, and function like natural teeth, without negatively impacting eating, smiling or speaking. Implants maintain the natural shape of the face and smile, remain carries-free, help to prevent adjacent teeth from shifting over time and are the only restoration option that stimulates bone growth and prevents bone loss.
Are narrow implants a reliable solution?
Can narrow implants be used in the posterior maxillary and mandibular regions to replace premolars and molars? Can they eliminate the need for grafting in certain circumstances?
Narrow implants (from 3.5 mm in diameter and less) have been designed for treatment of the anterior maxillary and mandibular regions mainly for the replacement of lower incisors, but not for the replacement of premolars and molars. Concerning these teeth, wider implants are indicated.1
At the beginning of the 1990s, due to their mechanical properties, 5 mm diameter implants were considered the ideal implants for the replacement of premolars. A study published in the late 1990s disproved this belief, reporting higher failure rates (18%) for 5 mm diameter implants compared to 3.75 mm and 4 mm wide implants, which yielded 5% and 3% failure rates respectively.2 Similarly, other authors observed a higher survival rate using 3.75 mm diameter implants rather than adopting wider diameter ones.3
Moreover, long-term results show more marginal bone loss around wide-diameter implants than around 3.75 mm or 4 mm diameter implants.4
Then, one should ask the following question: do we need more bone and less titanium, or less bone and more titanium?
Some authors concluded that narrow implants (2.75 mm to 3.25 mm diameter) could be successfully used as a minimally invasive alternative to horizontal bone augmentation in posterior mandibles for up to one year of function.5
The logical evidences in such cases would be more bone to promote osseointegration.
In 1998, I started to place narrow implants not only in the anterior areas, but also in posterior maxillary and mandibular regions in order to replace premolars and molars. I began to treat partially edentulous patients with a high success rate.
Following this concept, I extended the indications to fully edentulous patients, having in mind:
• simplification of the surgical procedures
• reduced grafting procedures
• reduced morbidity and first complications
• reduced postsurgical problems
I immediately found an increasing number of cases to be treated in this way. From 1998 to 2008, I placed 824 narrow implants, with a success rate of 98.5%. From 2009 to 2016, I placed 4,266 narrow implants, multiplying the number of narrow implants by nearly six.
During these years, in my clinical experience, I found:
• a high success rate
• a very stable marginal bone level
• one implant fracture
In the presence of narrow ridges, the use of narrow implants may avoid grafting procedures in certain circumstances. Narrow implants can be used in the posterior maxilla with or without sinus elevation, in the posterior mandibula in the presence of horizontal bone loss, and in areas with thin ridges.
Placement of a narrow implant in the anterior maxillary region. This is the primary indication for a narrow implant.
Placement of narrow implants. In a full-arch restoration in the presence of alveolae and thin ridges, narrow implants allow the placement of more biomaterial in the alveolae for ridge preservation. Bone grafting will be avoided in the presence of the ridges.
Postsurgical x-ray. Eight narrow implants placed with immediate loading and a temporary bridge in place.
When narrow implants were placed in both posterior jaws and the values for marginal bone resorption at one, five, and 10 years were measured, they were within the accepted standard success criteria for dental implants. Regarding the implant failures, the majority occurred in the first six months of function, following the pattern for standard-diameter implants.6
A recent systematic review reports average survival rates of mini-implants (1.8 mm to 2.9 mm diameter) and narrow implants (3 mm to 3.5 mm diameter) as 98% and 98% respectively, while the average success rates were 93% and 96% respectively. The average peri-implant bone loss after 12, 24, and 36 months was 0.89 mm, 1.18 mm, and 1.02 mm for mini-implants and 0.18 mm, 0.12 mm, and -0.32 mm for narrow implants. Both mini-implants and narrow implants showed adequate clinical behavior as overdenture retainers and clinical outcomes similar to standard implants. The narrow implants also showed a higher survival rate for the studies with higher follow-up time, and they present a better long-term predictability than the mini-implants when conventional loading is applied.4
Another review concludes that survival rates reported for narrow implants are analogous to those reported for standard-width implants. These survival rates did not appear to differ between studies that used flapless and flap-reflection techniques. The failure rate appeared to be higher in shorter than in longer ones in the studies in which the length of the failed implants was reported. Narrow implants could be considered for use with fixed restorations and mandibular overdentures, since their success rate appears to be comparable to that of regular-diameter implants.7
Some authors state that using small-diameter implants is a treatment option as predictable as using standard-diameter implants. They summarize their findings as follows:8
• The medium-term prognosis of narrow implants is comparable to that of standard-diameter implants followed up in the present study. Therefore, the high reliability of small-diameter implants is confirmed.
• Standard- and narrow-implant prognoses were influenced by peri-implant bone infection more than biomechanical factors, such as implant overloading.
• Peri-implant bone resorption was not significantly influenced by different implant diameters (3.3 mm and 4.1 mm).
• Bone quality seems to be an important prognosis factor both for standard- and small-diameter implants; spongy bone (type 4) may increase implant failures.
• Survival of standard and narrow implants does not seem to be affected by implant location.
Narrow implants can be used in almost every area, except the posterior maxilla/mandibula with a limited bone height. The use of narrow implants is a safe and reliable technique with no problems in relation to function and esthetics. From perio implanta dvisory
Dental implant complications: “My dental implant fell out!”
Dr. Scott Froum says if you get a call from a patient saying their “dental implant fell out,” it’s important to clarify exactly which component fell out so you can proceed with treatment. Here’s how.
Although many studies have shown that dental implants have a greater than 90% survival rate over a 10-year period, complications can occur, and dental implant components can fail.1 An emergency phone call from a patient at the office or a message left with the office’s answering service stating that “the patient’s dental implant fell out” can be quite dramatic and anxiety-inducing. The problem is many implant patients do not quite know the exact implant components and often label any part of the implant-abutment complex as the “dental implant.” This clinical tip addresses how a dentist can make a quick clarification on which part actually fell out.
Failing dental implants: Ascertaining the etiology behind a sudden increase
Probability of dental implant component failure
Explain the different parts of the dental implant to the patient before and after treatment (figure 1).
Figure 1: There are many components to the dental implant including a cover screw, healing abutment, abutment, crown, abutment screw, and finally the implant fixture screw itself. Any of these can fall out of the mouth.
The implant fixture or screw portion is what the dentist will assume fell out after an emergency patient phone call, even though the literature shows that the probability of exfoliation is around 2%–12% over a five-year period.2 A higher probability exists that the cover screw or healing abutment exfoliated—if the implant is not submerged—as opposed to the implant fixture. In addition, the probability of the abutment or abutment-crown complex unseating and exfoliating has been estimated to be 20%–59% over a 15-year period in function.3
Identify which part of the implant fell out
One way to help the dental patient correctly identify the implant part failure is to ask them to take a picture of the piece that fell out of their mouth and either text it to the office or request a teledental consultation. Many times, a healing cap or cover screw can fall out and be confused with a dental implant screw. Explain to the patient that replacing the cover screw or healing abutment back onto the implant is often an easy procedure involving simple removal of tissue.
If the dental abutment or crown has fallen off, the implant dentist must first evaluate the implant part to see if there is any damage to the material. The dental implant fixture that remains in the bone must also be evaluated to determine whether there is any damage to the platform and/or internal chamber. Then, an attempt should be made to identify the etiology of why the part fell out. Once again, placing the implant abutment or implant crown back into the mouth is usually not a difficult procedure if all other implant parts are intact.
More clinical tips:
5 causes of tooth pain after root canal therapy
Implant malposition: A simple clinical technique for prevention
The dental implant fixture exfoliated
On rare occasions, the dental implant fixture can fall out (figure 2).
Figure 2: Example of an exfoliated dental implant, which is the entire dental implant/abutment crown complex
There are a variety of reasons as to why this happens, including:
Acute bacterial infection
Lack of osseointegration
Typical treatment postexfoliation and prior to dental office visitation can consist of prescribing an antibiotic rinse and systemic antibiotics. The patient should be seen as soon as possible to evaluate the area and determine if grafting is necessary to prevent tissue collapse. A clinical exam and radiographs should be taken, and an occlusal analysis should be performed. In addition, a review of the patient’s medical, dental, and social history should take place in case anything was omitted or discovered since the first preoperative implant exam that could have led to dental implant failure.
Smart dental implants
More than 3 million people in America have dental implants, used to replace a tooth lost to decay, gum disease, or injury. Implants represent a leap of progress over dentures or bridges, fitting much more securely and designed to last 20 years or more.
But often implants fall short of that expectation, instead needing replacement in five to 10 years due to local inflammation or gum disease, necessitating a repeat of a costly and invasive procedure for patients.
"We wanted to address this issue, and so we came up with an innovative new implant," says Geelsu Hwang, an assistant professor in the University of Pennsylvania School of Dental Medicine, who has a background in engineering that he brings to his research on oral health issues.
The novel implant would implement two key technologies, Hwang says. One is a nanoparticle-infused material that resists bacterial colonization. And the second is an embedded light source to conduct phototherapy, powered by the natural motions of the mouth, such as chewing or toothbrushing. In a paper in the journal ACS Applied Materials & Interfaces and a 2020 paper in the journal Advanced Healthcare Materials, Hwang and colleagues lay out their platform, which could one day be integrated not only into dental implants but other technologies, such as joint replacements, as well.
"Phototherapy can address a diverse set of health issues," says Hwang. "But once a biomaterial is implanted, it's not practical to replace or recharge a battery. We are using a piezoelectric material, which can generate electrical power from natural oral motions to supply a light that can conduct phototherapy, and we find that it can successfully protect gingival tissue from bacterial challenge."
In the paper, the material the researchers explored was barium titanate (BTO), which has piezoelectric properties that are leveraged in applications such as capacitators and transistors, but has not yet been explored as a foundation for anti-infectious implantable biomaterials. To test its potential as the foundation for a dental implant, the team first used discs embedded with nanoparticles of BTO and exposed them to Streptococcus mutans, a primary component of the bacterial biofilm responsible for tooth decay commonly known as dental plaque. They found that the discs resisted biofilm formation in a dose-dependent manner. Discs with higher concentrations of BTO were better at preventing biofilms from binding.
While earlier studies had suggested that BTO might kill bacteria outright using reactive oxygen species generated by light-catalyzed or electric polarization reactions, Hwang and colleagues did not find this to be the case due to the short-lived efficacy and off-target effects of these approaches. Instead, the material generates enhanced negative surface charge that repels the negatively charged cell walls of bacteria. It's likely that this repulsion effect would be long-lasting, the researchers say.
"We wanted an implant material that could resist bacterial growth for a long time because bacterial challenges are not a one-time threat," Hwang says.
The power-generating property of the material was sustained and in tests over time the material did not leach. It also demonstrated a level of mechanical strength comparable to other materials used in dental applications.
Finally, the material did not harm normal gingival tissue in the researchers' experiments, supporting the idea that this could be used without ill effect in the mouth.
The technology is a finalist in the Science Center's research accelerator program, the QED Proof-of-Concept program. As one of 12 finalists, Hwang and colleagues will receive guidance from experts in commercialization. If the project advances to be one of three finalists, the group has the potential to receive up to $200,000 in funding.
In future work, the team hopes to continue to refine the "smart" dental implant system, testing new material types and perhaps even using assymetric properties on each side of the implant components, one that encourages tissue integration on the side facing the gums and one that resists bacterial formation on the side facing the rest of the mouth.
"We hope to further develop the implant system and eventually see it commercialized so it can be used in the dental field," Hwang says.
Geelsu Hwang is an assistant professor in the Division of Restorative Dentistry and Department of Preventive and Restorative Sciences in the University of Pennsylvania's School of Dental Medicine.
Hwang's coauthors on the paper were Penn Dental Medicine's Atul Dhall and Yu Zhang and Temple University's Sayemul Islam, Moonchul Park, and Albert Kim.
The research was supported by the National Institutes for Dental and Craniofacial Research(Grant DE027970) and the National Science Foundation (Grant 2029077). It was carried out in part at Penn's Singh Center for Nanotechnology, which is supported by the NSF National Nanotechnology Coordinated Infrastructure Program under Grant NNCI-1542153.