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Dental implants. What kinds of dental implant systems exist?
The history of dental implants is quite long. But we will talk about modern systems. Everything started 45 years ago, when Swedish orthopedic traumatologist Per-Ingvar Branemark noticed dense healing of bone tissue around metal screw elements he used to fix limb fractures. For that reason, it was sometimes extremely difficult to extract such constructions. He called this phenomenon osseointegration. Upon studying the biological processes leading to this result, Per-Ingvar Branemark suggested restoring missing tooth roots with similar metal elements, which later became known as dental implants.
What types of dental implants exist? Conventionally, all dental implants can be classified into one-stage or two-stage. The difference is that a crown is cemented into one-step implants directly, while two-step implant systems have a connecting element-abutment between the implant and the crown.
Screw implants. First of all, 98% of implants used in dentistry are screw implants. They have a root-like or cylindrical shape and can be either one or two-stage, where an abutment and implant are connected by a screw. Such implants are placed in the jaw by screwing them in.
Plateau-system implants. Plateau-type implants are two-stage, consisting of horizontal plates connected to form a kind of cylinder. The connection between the implant and the abutment is tapered, without using a screw. Such implants are placed by the method of indentation.
Custom implants. This is when an impression is made of the exposed bone, and a metal structure is made to cover the bone, which is then sutured. These are subperiosteal implants.
Zygomatic implants. These implants are not placed in the jawbone, but are attached to the inside of the zygomatic bone. When a person does not have suitable conditions for dental implants, this implant type is used.
Dental implants are most commonly made of medical titanium or zirconium dioxide.
A dental implant consists of the implant itself, an abutment, and a dental crown.
The implant body (simply put, a screw or artificial root) is placed into the bone. After the bone has healed, the abutment is placed in the implant. This is a supragingival part, on which the dental crown is then installed. There is a working part in the mouth, and there is a working part in the bone; so, the connection of the abutment to the implant can be:
- hexagonal
- octahedron
- Morse taper
- combined hexagon-taper
- Mickey Mouse connection (first used in Nobel implants)
In one-stage implant systems, the abutment and implant are one inseparable structure. At the same time, the probability of failure of such implants is quite high. Global statistics show a 63% success rate with their use. This is due to the traumatic effect of these implants and immediate jawbone loading.
What is important to know about the connection of an implant to an abutment? The tighter the connection is and the less micromobility it has, the longer the implant will last.
When a screw implant is placed, the surgeon makes a cavity for it and then screws the implant in. The hole for the implant is always made smaller so that we can screw in (tighten) the implant. What happens to the bone? The bone is compressed by the implant screwed into it and then necrotizes (dies), and the healing process begins only after a few days.
When we place a plateau-type implant, there is no bone compression because the cavity is the same size as the implant. And the implant is tightly inserted rather than screwed in – this implant minimizes trauma to the bone, and the healing process begins immediately.
An implant fails to integrate when there is no healthy bone around the implant, and it is mobile. You cannot put a crown on the implant, and it must be removed. Sometimes, the implant will fall out on its own. The process of implant rejection can be painful or asymptomatic.
Among the causes of implant failure are insufficient diagnosis in the planning of surgery, the patient’s bone structure, chronic bone and blood diseases (hepatitis, insulin-dependent diabetes, leukemia, osteoporosis, and others), and the quality of the implant being placed.
In our practice, we use plateau-type implants more often. This is because the experience of placing these implants shows a good and long-lasting clinical result.
Firstly, the installation of such implants is minimally traumatic, bone healing is fast, complications are rare, and the recovery period does not last more than three days on average.
Secondly, the implant design and the screwless tapered connection of the implant and the abutment do not put pressure on the bone around the implant; so, it is not destroyed.
It is proven that any screw connection of implant-abutment produces micromobility, which destroys the jawbone at the implant neck and causes peri-implantitis.
Third, short (less than 6 mm) plateau-type implants can withstand four times the load of a screw implant of any length due to their design.
Fourthly, the use of short implants eliminates the need for additional bone grafting surgeries (sinus-lift, bone splitting, augmentation), which reduces treatment time dramatically, decreases the risk of complications (sinusitis, osteomyelitis, bone graft rejection) after such surgeries, and significantly lowers the treatment cost.
It is easier to place a screw implant. In contrast, a short plateau-type implant requires a great deal of precision — pinpoint precision in the truest sense. Not all doctors want to learn how to do this. It is also worth noting that if a screw implant is placed incorrectly, it can be unscrewed and immediately replaced with a larger implant, but this cannot be done in the case of a short implant. When placing a short implant, the doctor has no room for mistakes.
Once, there was the “gentle implants” slogan applied to Bicon short implants. It sounds a little weird. One would think, how can surgery be gentle? But what the people who created this slogan wanted to say is that this implant is the least traumatic when placed. Smaller trauma results in faster rehabilitation.
Physiologically, healing occurs in 20 to 30 days. The rest of the time is taken up by remodeling (improving the quality of the healed bone). Therefore, it is believed in dentistry that quality healing should take from two months to six months.
This is a very delicate question, and it is difficult to give an objective and comprehensive answer to it. We evaluate implants by the production practices of their manufacturers. Production standards determine how accurately manufacturers make them, what tolerances and inaccuracies are allowed in production, and whether the implant oxidizes after some time after placement.
When choosing an implant, we pay close attention to how quickly and painlessly it “takes root” in the patient and how long it will last.
Igor Osadchiy
Surgeon
MD, physician with the highest skill accreditation level, member of EACMS (European Association of Cranio-Maxillofacial Surgeons), member of the Association of Implantologists of Ukraine. Alma mater: O.O. Bogomolets National Medical University. Year of graduation: 1984. Experience: Work experience: 38 years. For 13 years (1985-1998), taught dental surgery and maxillofacial surgery…
Igor Osadchiy
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