Dental implants are a great way for patients to replace a missing tooth! This safe and popular choice can also replace multiple missing teeth with an implant-supported partial or full denture. Patients who are healthy enough to endure implant placement surgery and can deal with the extensive healing time, up to six months, need to make sure they are aware of the limitations they will need to adhere to during that time. Dental implants have a success rate between 95% and 97% and are a stable, natural-looking way to restore your smile!
Before you begin treatment, you will need to have an implant consultation, at which point your Dentist will evaluate the area to be treated and speak with you about your lifestyle and habits before they determine what type of implant system will be appropriate for you. Most Dentists have a specific system that they prefer to work with but will use the system that will be best for your individual case.
Top Implant Systems
Even though there are many companies that make dental implants, the following are the six most respected and well-known that produce widely used implant systems:
* Nobel BioCare
* BioHorizon
* Dentsply
* Straumann
* Zimmer Biomet
* MIS
Throughout the world, over 100 manufacturing companies produce implant parts, but selecting a system fabricated by one of those six top companies can be beneficial down the road. Dentists and dental labs the world over are more likely to be familiar with the more popular implant systems and are therefore able to provide emergency service to patients that may be unable to get to their personal Dentist, such as during travel. A generic implant system from a lesser known company may come at a lower price point but if you break part of your implant or develop a problem that requires immediate attention, a Dentist and their preferred lab will be much more likely to have the necessary tools to treat you if your implant was fabricated by a more commonly used company.
If you are considering a dental implant restoration, speak with your Dentist to learn what types of systems they use in their practice before you begin researching on your own. The six companies listed above make high-quality implant systems with the necessary biomechanical properties which are thoroughly researched to give patients the best possible chance of success with their implant treatment. Osseointegration is the process of the implant fusing with the jaw bone and is crucial for an implant to succeed. A high-quality implant has a rough finish on the surface that allows for osteoblastic cells to adhere to and create the necessary fusion.
Types of Implants
There are two types of implants available, titanium and zirconia. Your Dentist will review your options and help you determine which type will be best for your individual needs and lifestyle. Zirconia implants are becoming increasingly popular, especially for use in patients with metal allergies.
Titanium Implants
Titanium implants have been in use since the 1960s and have excellent biocompatibility with a success rate between 95%-97%. Biocompatibility is crucial for implants, allowing them to properly integrate with the jawbone. Titanium implants have a rough finish which allows for osteoblastic cells to adhere to the surface of the implant to create the necessary fusion between the implant and jawbone for a stable foundation for the implant restoration.
Titanium implants are able to support all implant restorations including implant-supported dentures.
Zirconia Implants
Zirconia implants have been in use for only about 12 years, so they do not have the recorded long-term success rate of titanium implants but they are a great option for patients with metal sensitivities. Zirconia implants do contain trace amounts of hafnium and yttruim which are incorporated to improve its biocompatibility properties so they are able to integrate with your jawbone similarly to titanium and are still very strong even though they are composed mostly of ceramic material.
Zirconia implants are fabricated as a single piece and are more challenging to place, so bone density is a major factor when your Dentist is determining what type of implant is appropriate for you. Since zirconia implants do not contain metal, there is never a risk of dark metal showing through at the gumline. This rarely happens with titanium implants unless the patient develops gum disease and gum recession. It should also be noted that any restoration on a zirconia implant must be cemented in place, it cannot be screw retained.
Implant Abutments
The implant abutment is a piece of the system that acts as the bridge between the implant and the implant restoration. The restoration is the visible part of the implant, the fake tooth, and can be a crown, bridge, or partial or full denture. The restoration can either be screwed onto the implant or cemented in place and your Dentist will determine which type is best for your individual case. The abutment your Dentist uses may be a stock abutment or a custom abutment.
Cementable vs Screw-Retained Implant Abutments
When determining what type of restoration to place, factors your doctor will take into consideration include ease-of-use, retrievability, peri-implant issues, and whether or not it is suitable for angled implants.
Ease of use
A cement-retained implant restoration is generally easier to work with than screw-retained. A cement-retained restoration is placed much the same as a crown or bridge, being permanently cemented onto a prepared tooth. A screw-retained restoration requires additional steps to ensure a proper fit and tension before the restoration is screwed into place.
Retrievability
Retrievability describes the ease of removal in the event that an implant restoration needs to be replaced due to fracture or other damage; certain cements can make removing the old restoration more difficult than others. A screw-retained restoration is more predictable and easier to remove than cement-retained. There are cements available that make it easier for your Dentist to remove the restoration or they may choose to use a temporary cement, none of which are as secure as a screw.
Maintaining peri-implant tissue
When cement is used to place a dental restoration, there is always a risk that excess cement can extrude into the gum pocket around the tooth and cause damage to the gum tissue surrounding the implant. If excess cement is not completely removed, it can pose an increased risk of irritation, swelling, and discomfort at the implant site. Your Dentist will take an x-ray after placing your restoration which will show any cement that has seeped into the gum pocket to ensure no excess cement is left behind. Using a screw retained restoration avoids that risk altogether.
Use with angled implants
One drawback of a screw retained restoration is that they are not ideal for front teeth. A screw retained implant restoration requires an access hole which is drilled through the prosthetic tooth. After the restoration is placed, the hole is filled with composite material to hide the hole and protect the screw. This is not easily done on front teeth because the surface area is smaller, so Dentists often choose to use a cement retained implant restoration.
Stock Abutments vs Custom Abutments
A stock abutment can typically be used on implant cases but sometimes, a case may require a custom abutment. Your Dentist will decide which type will best suit your individual needs.
Custom abutments
A custom abutment can be used for either cementable or screw retained implant restorations and can be made from titanium or zirconia. Custom abutments are more expensive but allow for better tissue management and have a more predictable outcome. A dental lab will fabricate a custom abutment at the same time they fabricate your restoration, using a model of your teeth provided by your Dentist made from impressions they take of your whole mouth.
Stock abutments
Stock abutments have the benefit of being easily replaced by any Dentist in the event that you have an emergency and are unable to see your Dentist. If you are out of town and break your restoration and the abutment, a different Dentist would be able to replace a stock abutment more readily than they could a custom abutment. Stock abutments are much more user-friendly and can be placed using either cement or a screw.
The gum tissue around the abutment will conform to the shape of the abutment. Stock abutments are a standard size and may not be suitable for your gum tissue in which case your Dentist would choose to use a custom abutment. It is important that the margins of your implant restoration make good contact with neighboring teeth so you may need some adjustments to be sure you can floss properly but also that the contacts are tight enough to prevent food from constantly getting trapped in any space.
Implant Crowns
Porcelain and ceramic are the most popular material choice for their aesthetics and durability. There are a number of materials available to fabricate implant crowns though most patients prefer ceramic or porcelain since it is the most natural-looking and can be tinted to match remaining natural teeth.
Implant crowns can also be fabricated from gold or other base metals, porcelain fused to metal (PFM), e-max, or zirconia. Crowns made from metals and PFM crowns are much stronger and more durable than crowns fabricated using only porcelain and ceramic. The drawback to a PFM crown is the risk of metal eventually showing through the outer porcelain layer as they age.