Tuesday 1 January 2013

Dental Implantology- What to know before going for it? What ware the Companies Manufacturing Implants? Is my Case Suitable for Implants? What is the Success Rate of Implants? How will Implant Treatment change the way I look, talk and my personality?

Dental Implants- A Patients Guide

Dental Implants, as the name suggests is a Small Metal Implant placed inside your Bone to act as artificial root for your artificial tooth.

Our human tooth is a great piece of engineering. It bears all the chewing forces, which is around 100kgs. That is when we chew we exert a pressure equal to 100kg between our teeth. Tooth is made of four layers, the Outermost is Enamel, second to Enamel is Dentin and the innermost is soft part called as Pulp. There is a sub-structure Cementum that comprises root part of tooth.

Enamel the Outermost White part of tooth that we see is the Hardest structure in our body. It has 90% Calcium whereas the stiffest bone has around 60% Calcium. So by this we can imagine how hard our tooth is from outside. Enamel has no life.

Dentine is 63% Calcium, yellow in colour and second most hard structure in our body. Actually often people complain of yellowness of their teeth, it is not due to staining but due to exposure of Dentine caused by very hard brush and wrong brushing technique. Dentine is partly live and partly dead. 

Pulp is soft part and living part of tooth. We experience pain and hot&cold sensitivity because of this living part. When we do RCT (Root Canal Treatment) we actually remove this living part. 

Root of our tooth has all these three components and a fourth component that is Cementum. Cementum is similar to bone and may be at places even softer than bone. Cementum is also Yellow in colour and when our gums recedes downwards causing exposure of cementum. Cementum when exposed also causes hot and cold sensitivity.

Coming back to our core topic of discussion, i.e. Implants, implant mimics our natural tooth. It has a Root part and a Crown part. Theoretically implant is only the Root Component whereas the Crown Portion is called as Abutment.

Picture 1
Picture 2
 Picture 1 shows Implant whereas Picture 2 ( sorry for blurr image) shows the Implant loaded with Abutment and Tooth. 

FAQ's
1. How to know whether i am a fit candidate for Implant Treatment or not?
Ans. Any person desiring of getting Implant should be:
1. Medically fit.
2. No signs of Diabetes, and if present should have sufficient history of it being under control.
3. No signs of Hypertension and if present then the Blood Pressure readings before surgery should be below: 150/95 mm Hg
4. No recent history of any Cardiac problem and/or surgery.
5. No recent history of any Thyroid problem.
6. No recent history of any Blood disease like Thalassemia, Leukemia, etc.
7. No recent history of any Infectious disease.

2. How to decide how many implants do i need?
Ans. Rule is simple:
1. Each Molar should be replaced with  One Implant each.
2. Rest all other teeth can be restored using simple rule that the total number of implants supporting the teeth should have equal or more surface area than the teeth being supported on them.

3. Full Mouth Fixed Prosthesis requires how many Implants?
Ans. Greater the number better it is. But 6 Implants for Upper Prosthesis and 5 Implants for Lower Prosthesis.

4. What are the various Companies manufacturing Implants and which one is the Best?
Ans. There are several companies. 
Dentsply Ankylos
Noble Biocare
Leader Italia
MIS
BOI
etc.

It will be unfair to call any company as best, because all are awesome systems. 
Noble Biocare are oldest people manufacturing Implants and have a very great Brand Value. 
Whereas Dentsply Friadent Ankylos is leading implant system and relatively the most advanced one as well. The specially tapered design of Ankylos makes it the most preferred and sturdy implant. Ankylos stands out as an implant system.
Leader Italia is relatively newer system but equally good. This is a very economical system and you will find most dental surgeons in colleges doing this as this is relatively easier to learn and practice.
MIS is a second system which is equivalent to Leader Italia, a bit costlier than Leader though.
BOI is revolutionary system, and the best. But it has certain limitations and being a very radical implant, it is not common. Very few doctors are doing BOI.

5. What is the cost of Implant?
Ans. Normally Each Implant costs varies with the company. Ankylos Costs Rs.25,000 ($500) to 35,000 ($700) each. Leader costs Rs.14000 ($280) whereas MIS around Rs.20000($400) each. Noble Biocare is costliest with costs around $750+. 

6. What tests should be done for Implant surgery?
Ans. CT, BT, Hb, TLC, DLC, BP and Sugar. and any other case specific test.

7. What is most common problem with Implants?
Ans. Loosening of Implant is most common problem associated with Implant system. Every person having an implant at least once has encountered this problem. Recently two companies have introduced Implants with Morse Taper Design which drastically reduces the chances of loosening.
Dentsply Implant and Leader Implus Implants have unique Morse effect, which prevents loosening of the Implant at any point during its life.
So, what is Morse Effect?



The screw with self-locking
tapered head
The screw with self-locking
tapered head is different from the
traditional screw because of the
tapered design of one of its part.
Moreover, the abutment has a
seat with the same tapering in the
hole for the connection screw. The
taper of the cones is 5° 






Inserting with pressure an element with a tapered external surface in a corresponding female element that has a hole with an identical tapered design, the friction between the two tapered surfaces, combined with the push created by the insertion force that presses them together, locks the male cone in the female one. This locking remains and keeps itself efficient also when the insertion force applied ceases. This is the "Morse" effect.
The locking force, which is proportional to the insertion force, prevents the male cone from being extracted from the female one, whether trying to rotate it or by applying an axial push.
A suitable tapering of the cones guarantees such "locking" that will become a safe and natural engaging system for the screw that connects the abutment to the implant.


Keep Reading this Section for More.

Dr. Aman Singh
MClinDent Endodontics
B.D.S. 
On Panel: Lead Medical, New York, USA
                  Share Care, Chicago, USA
                  Lambdon School Dental Project, New Zealand
Member of Netherland Dental Association
Member of Kenyan Dental Association
Member of Indian Dental Association
Reach me at: www.odontos.in
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