Stephen Forrest D.D.S

Dental implant
Dental implant
	A titanium dental implant with a crown attached used for a single tooth replacement
ICD-9-CM	23.5-23.6
MeSH	D003757
	[edit on Wikidata]

Implantology (from Latin in meaning 'into' and planta 'cutting,'^[1] and -logy from the Greek λόγος lógos 'word,' 'study,') is the term for the placement of dental implants by a dentist, specialist dentist in oral surgery, or oral and maxillofacial surgeons. With a license to practice, every dentist obtains permission to practice the full range of dentistry and thus also to place dental implants. The 'focus area in implantology' established in 2001 by the European Association of Dental Implantologists (BDIZ EDI) before the Federal Constitutional Court^[2] is not an additional designation according to the training regulations and is not granted under public law.

A dental implant (also known as an endosseous implant or fixture) is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biological process called osseointegration, in which materials such as titanium or zirconia form an intimate bond to the bone.^[3] The implant fixture is first placed so that it is likely to osseointegrate, then a dental prosthetic is added. A variable amount of healing time is required for osseointegration before either the dental prosthetic (a tooth, bridge, or denture) is attached to the implant or an abutment is placed which will hold a dental prosthetic or crown.

Success or failure of implants depends primarily on the thickness and health of the bone and gingival tissues that surround the implant,^[4] but also on the health of the person receiving the treatment and drugs which affect the chances of osseointegration.^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12] The amount of stress that will be put on the implant and fixture during normal function is also evaluated. Planning the position and number of implants is key to the long-term health of the prosthetic since biomechanical forces created during chewing can be significant. The position of implants is determined by the position and angle of adjacent teeth, by lab simulations or by using computed tomography with CAD/CAM simulations^[13]^[14]^[15]^[16] and surgical guides called stents. The prerequisites for long-term success of osseointegrated dental implants are healthy bone and gingiva. Since both can atrophy after tooth extraction, pre-prosthetic procedures such as sinus lifts or gingival grafts are sometimes required to recreate ideal bone and gingiva.

The final prosthetic can be either fixed, where a person cannot remove the denture or teeth from their mouth, or removable, where they can remove the prosthetic. In each case an abutment is attached to the implant fixture. Where the prosthetic is fixed, the crown, bridge or denture is fixed to the abutment either with lag screws or with dental cement. Where the prosthetic is removable, a corresponding adapter is placed in the prosthetic so that the two pieces can be secured together.

The risks and complications related to implant therapy divide into those that occur during surgery (such as excessive bleeding or nerve injury, inadequate primary stability), those that occur in the first six months (such as infection and failure to osseointegrate) and those that occur long-term (such as peri-implantitis and mechanical failures). In the presence of healthy tissues, a well-integrated implant with appropriate biomechanical loads can have 5-year plus survival rates from 93 to 98 percent^[17]^[18]^[19] and 10-to-15-year lifespans for the prosthetic teeth.^[20] Long-term studies show a 16- to 20-year success (implants surviving without complications or revisions) between 52% and 76%, with complications occurring up to 48% of the time.^[21]^[22]

Medical uses

Common uses of dental implants

Mouth with many implant supported teeth where it is difficult to distinguish the real teeth from the prosthetic teeth.

Individual teeth were replaced with implants where it is difficult to distinguish the real teeth from the prosthetic teeth.

Movement in a lower denture can be decreased by implants with ball and socket retention.

A bridge of teeth can be supported by two or more implants.

The primary use of dental implants is to support dental prosthetics (i.e. false teeth). Modern dental implants work through a biologic process where bone fuses tightly to the surface of specific materials such as titanium and some ceramics. The integration of implant and bone can support physical loads for decades without failure.^[23]^{: 103–107}

The US has seen an increasing use of dental implants, with usage increasing from 0.7% of patients missing at least one tooth (1999–2000), to 5.7% (2015–2016), and was projected to potentially reach 26% in 2026.^[24] Implants are used to replace missing individual teeth (single tooth restorations), multiple teeth, or to restore edentulous (toothless) dental arches (implant retained fixed bridge, implant-supported overdenture).^[25] While use of dental implants in the US has increased, other treatments to tooth loss exist.

Dental implants are also used in orthodontics to provide anchorage (orthodontic mini implants). Orthodontic treatment^[26] might be required prior to placing a dental implant. An evolving field is the use of implants to retain obturators (removable prostheses used to fill a communication between the oral and maxillary or nasal cavities).^[25] Facial prosthetics, used to correct facial deformities (e.g. from cancer treatment or injuries), can use connections to implants placed in the facial bones.^[27] Depending on the situation the implant may be used to retain either a fixed or removable prosthetic that replaces part of the face.^[28]^[29]

Single tooth implant restoration

Single tooth restorations are individual freestanding units not connected to other teeth or implants, used to replace missing individual teeth.^[25] For individual tooth replacement, an implant abutment is first secured to the implant with an abutment screw. A crown (the dental prosthesis) is then connected to the abutment with dental cement, a small screw, or fused with the abutment as one piece during fabrication.^[30]^{: 211–232} Dental implants, in the same way, can also be used to retain a multiple tooth dental prosthesis either in the form of a fixed bridge or removable dentures.

There is limited evidence that implant-supported single crowns perform better than tooth-supported fixed partial dentures (FPDs) on a long-term basis. However, taking into account the favorable cost-benefit ratio and the high implant survival rate, dental implant therapy is the first-line strategy for single-tooth replacement. Implants preserve the integrity of the teeth adjacent to the edentulous area, and it has been shown that dental implant therapy is less costly and more efficient over time than tooth-supported FPDs for the replacement of one missing tooth. The major disadvantage of dental implant surgery is the need for a surgical procedure.^[31]

Implant retained fixed bridge or implant supported bridge

An implant supported bridge (or fixed denture) is a group of teeth secured to dental implants so the prosthetic cannot be removed by the user. They are similar to conventional bridges, except that the prosthesis is supported and retained by one or more implants instead of natural teeth. Bridges typically connect to more than one implant and may also connect to teeth as anchor points. Typically the number of teeth will outnumber the anchor points with the teeth that are directly over the implants referred to as abutments and those between abutments referred to as pontics. Implant supported bridges attach to implant abutments in the same way as a single tooth implant replacement. A fixed bridge may replace as few as two teeth (also known as a fixed partial denture) and may extend to replace an entire arch of teeth (also known as a fixed full denture). In both cases, the prosthesis is said to be fixed because it cannot be removed by the denture wearer.^[30]

Implant-supported overdenture

A removable implant-supported denture (also an implant-supported overdenture^[32]^: 31) is a removable prosthesis which replaces teeth, using implants to improve support, retention and stability. They are most commonly complete dentures (as opposed to partial), used to restore edentulous dental arches.^[25] The dental prosthesis can be disconnected from the implant abutments with finger pressure by the wearer. To enable this, the abutment is shaped as a small connector (a button, ball, bar or magnet) which can be connected to analogous adapters in the underside of the dental prosthesis.

Orthodontic mini-implants (TAD)

Dental implants are used in orthodontic patients to replace missing teeth or as a temporary anchorage device (TAD) to facilitate orthodontic movement by providing an additional anchorage point.^[31]^[33] For teeth to move, a force must be applied to them in the direction of the desired movement. The force stimulates cells in the periodontal ligament to cause bone remodeling, removing bone in the direction of travel of the tooth and adding it to the space created. In order to generate a force on a tooth, an anchor point (something that will not move) is needed. Since implants do not have a periodontal ligament, and bone remodelling will not be stimulated when tension is applied, they are ideal anchor points in orthodontics. Typically, implants designed for orthodontic movement are small and do not fully osseointegrate, allowing easy removal following treatment.^[34] They are indicated when needing to shorten treatment time, or as an alternative to extra-oral anchorage. Mini-implants are frequently placed between the roots of teeth, but may also be sited in the roof of the mouth. They are then connected to a fixed brace to help move the teeth.

Small-diameter implants (mini-implants)

The introduction of small-diameter implants has provided dentists the means of providing edentulous and partially edentulous patients with immediate functioning transitional prostheses while definitive restorations are being fabricated. Many clinical studies have been done on the success of long-term usage of these implants. Based on the findings of many studies, mini dental implants exhibit excellent survival rates in the short to medium term (3–5 years). They appear to be a reasonable alternative treatment modality to retain mandibular complete overdentures from the available evidence.^[35]^[36]

Composition

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Specialties	Endodontics Oral and maxillofacial pathology Oral and maxillofacial radiology Oral and maxillofacial surgery Orthodontics and dentofacial orthopedics Pediatric dentistry Periodontics Prosthodontics Public health Cosmetic dentistry Dental implantology Geriatric dentistry Restorative dentistry Forensic odontology Dental traumatology Holistic dentistry
Surgery	Dental extraction Tooth filling Root canal therapy Root end surgery Scaling and root planing Teeth cleaning Dental bonding Tooth polishing Tooth bleaching Socket preservation Dental implant root analogue Laser-assisted new attachment procedure
Instruments	Akers' clasp Articulator Barbed broach Braces Curing light Custom-made medical device Dental dam Dental engine Dental key Denture cleaner Drill Electronic apex locator Elevator Coupland's elevators Endodontic files and reamers Explorer Floss Gag Implant Laser carbon-dioxide Er:YAG Nd:YAG Lentulo spiral Loupe Mandibular advancement splint Mouth mirror Mouth prop Mouthguard Multi-unit abutment Oral care swab Oral irrigator Periodontal curette Periodontal probe Periodontal scaler Suction Syntette Tongue cleaner Toothbrush electric toothbrush Playbrush Sonicare ultrasonic toothbrush Torque wrench Vibration appliance Wilkerson dental chair
Organisations	Digital Dentistry Society American Association of Orthodontists British Dental Association British Dental Health Foundation British Orthodontic Society Canadian Association of Orthodontists Dental Technologists Association General Dental Council Indian Dental Association National Health Service
By country	Canada Philippines Israel United Kingdom United States
See also	Index of oral health and dental articles Outline of dentistry and oral health Dental fear Dental instruments Dental material History of dental treatments Ancient Rome Infant oral mutilation Mouth assessment Oral hygiene

Authority control databases
International	GND
National	Czech Republic 2 Israel
Other	Yale LUX

Tooth
A chimpanzee displaying his teeth
Details
Identifiers
Latin	dens
Greek	ὀδούς (odoús)
MeSH	D014070
FMA	12516
Anatomical terminology [edit on Wikidata]

Authority control databases
International	GND
National	United States France BnF data Japan Czech Republic Israel
Other	Yale LUX

Stephen Forrest D.D.S

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Overbite

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Des Moines Cosmetic Dentistry Center

Cosmetic Dentist in Des Moines

Stephen Forrest D.D.S

Citations and other links

Improvement

Replacement

Material

Tartar

Sensitivity

About Dental implant

Medical uses

Single tooth implant restoration

Implant retained fixed bridge or implant supported bridge

Implant-supported overdenture

Orthodontic mini-implants (TAD)

Small-diameter implants (mini-implants)

Composition

Technique

Planning

General considerations

Biomechanical considerations

Bisphosphonate drugs

Main surgical procedures

Placing the implant

Timing of implants after extraction of teeth

One versus two-stage surgery

Additional procedures to augment deficient bone in implant site

Hard tissue (bone) reconstruction

Soft tissue (gingiva) reconstruction

The orthodontic implant site-switching technique

Recovery

Healing time

Single teeth, bridges and fixed dentures

Prosthetic procedures for removable dentures

Maintenance

Risks and complications

During surgery

First six months

Primary implant stability

Immediate post-operative risks

Failure to integrate

Long term

Single crown implants (5-year)

Fixed complete dentures

Removable dentures (overdentures)

History

See also

References

Further reading

About Tooth

Etymology

Origin

Mammals

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Canines

Cetaceans

Primates

Horse

Proboscideans

Rabbit

Rodents

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Fish

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Fossilization and taphonomy

See also

References

Sources

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