Over the past few years, dental implants have become the best solution for the replacement of missing teeth. The number of patients receiving implants has also grown exponentially. In general, patients are more educated on how to practice good oral hygiene. As a result of this, patients also have better oral health. Tooth loss is still unfortunately a prevalent issue which impacts many adults. Patients are also living longer and want to maintain a good quality of life as they age.
The increased life expectancy has resulted in a greater need for tooth-replacement solutions among the older populations which is drastically growing. A few million patients in the United States are estimated to have one or more dental implants, a figure which is continuing to grow daily. There is increased awareness regarding the incredible success of implants.
With the growing popularity and interest in implants, there have also been significant improvements to the technology, techniques, and materials used for the procedure. In addition, 3D printing and CADCAM technology is expected to make significant changes for implants in the near future. When evaluating different types of implant systems, there are numerous factors for patients to consider. To meet the needs of diverse patients of all ages, the dental implant procedure has significantly changed over time. Even minor changes have been found to extend the life expectancy of the implant.
Ove one hundred companies manufacture various components used in implants. Just a few major dental implant companies are respected and recognized globally. The companies which are top implant producers include Straumann, Zimmer Biomet, Nobel BioCare, MIS, BioHorizon, and Dentsply.
While there are numerous companies which offer discounted generic implant components, patients should be sure to do their research. Cheaper is certainly not always better. Patients should be especially cognizant of things which will be used in their body. There is fortunately improved awareness and education regarding implants and implant manufacturers. In some cases, patients have a preference regarding the manufacturer of implant components prior to the consultation. It is also critical for dental professionals to be well-educated regarding their options for implant manufacturers.
Another important element is for the dental laboratory to be educated and familiar with the implant manufacturers. Lab technicians receive specific training and use certain tools for the implant components. Practices who use implant components from top manufacturing companies are at an advantage. Patients should feel confident in the quality of their implant components which are being used for their restoration.
The leading implant companies invest heavily in implant research and development. When choosing products from these companies, providers can feel confident that they are providing patients with the highest quality components. When the implant is surgically placed in the jawbone, there is a biological response which is triggered. This results in an exchange of information between the cells and biomaterials or implant components. The name of this process is osseointegration which results in the implant fusing to the jawbone during the natural healing process.
The number of implant systems available can be overwhelming. Implants are an investment and patients want to make the right choice. Patients and providers should be diligent in reviewing the potential manufacturers. This gives them a better understanding of the products which are offered and different levels of quality. Dental implant companies commonly want to be a one-stop shop for the production of all implant components. When a practice accepts more complex cases, they may not be able to use a single system to accommodate their patients. Providers often need to consider at least two brands in order to meet their patient’s needs. Working with a smaller number of manufacturers also gives the provider a better understanding of the various systems. In addition, the provider is able to establish a better relationship with the manufacturer.
Once the implant system is selected, the patient will then need to decide between screw-retained implants and cement-retained abutments. Patients can also choose between custom abutments and stock abutments. Custom abutments are typically preferred as they produce more natural looking results.
Titanium implants are typically preferred, but other materials such as zirconia are becoming more popular. Various types of crowns can be used with a custom abutment restoration.
Titanium Implants
Most dental implants are made from titanium. This material is considered to be biocompatible and easily integrates with the bone. Bone grows on the surface of the titanium implant, which permanently secures it into place. Titanium implants have a success rate of 95% or higher. Pure titanium was considered to be too soft, so implant companies developed an alloy that resolves this issue. While there aren’t reports of allergic reactions to titanium, patients may be allergic to other types of metals used in the alloy. Patients should be sure to discuss any known or suspected allergies with their provider.
Zirconium Implants
Some implant companies developed metal-free implants which use zirconium. This material is technically considered to be a ceramic; however, it contains trace amounts of hafnium and yttrium metals. Zirconia is very strong and also contains the necessary osseointegration properties.
Certain factors should also be considered when deciding between screw-retained or cement-retained implant crowns. Some of these factors include retrievability, maintaining the peri-implant tissues, ease of use, suitability for angled implants, and the overall treatment cost.
Retrievability
It may be necessary for the provider to temporarily remove an implant crown. There are certain cements which are designed to make this process easier. Dental professionals may also opt to use a temporary cement for securing an implant crown into place. This can offer certain benefits but creates challenges as the crown is less retentive. Screw-retained implant crowns are much more predictable when the crown needs to be retrieved. When more abutments are needed, this is especially important. Multi-unit restorations which are permanently cemented in place are far more challenging to remove and offer predictable results.
Maintenance of Peri-Implant Tissues
Crowns which are cemented into place can create a risk of excess cement extruding into the sulcus. When the cement is not removed completely, It can result in damage to the peri-implant tissues. Subgingival cement surrounding an implant can result in peri-implant mucositis or peri-implantitis, which can cause the failure of the implant. There are techniques which can be used to properly remove the subgingival cement when placing an implant crown. It is still possible for the dentist to overlook some of the material. Screw-retained crowns eliminate this risk, also allowing for easy cleaning and maintenance.
Usability
A screw-retained implant crown can be more complicated to place compared to a cement-retained crown. When fitting multiple unit restorations, this can be exaggerated. Cement-retained restorations that contain multiple abutments are quite similar to the placement of routine bridges. The placement of a screw-retained restoration requires additional steps which ensure proper fit.
Angled Implants
For aesthetic reasons, it is not possible to place screw holes in the incisal or facial contours of an implant crown. In cases where the implant angle is imperfect, the dental professional must use an angled, screw-retained abutment. This will increase the cost of the procedure. In this case, the dental professional may opt to use a cement-retained crown with a custom or stock angled abutment.
Stock and Custom Abutments
Another choice with implant systems is between a stock implant abutment and a custom implant abutment. In order to ensure the optimal solution for patients, providers must be properly educated.
Stock abutments come in standard, pre-set sizes. This type of abutment can be used for implants at the bone or tissue level. Implant component manufacturers have strategically designed the stock abutments to be user-friendly and effective. Stock abutments are typically less expensive and commonly used in cement-retained restorations. There are also angled and straight abutments available. Stock abutments are ideally used for tissue level implants that are not located in the front of the mouth where they are more visible.
One limitation of stock abutments is that they come in standardized sizes, meaning the tissue must conform to the abutment. When placing an implant within the esthetic zone, these types of abutments are less desirable. It is more challenging for the manufacturer to create the correct emergence profile, provide critical tissue support, or achieve the desired results with the restoration. Stock abutments do not allow for control of the final margin placement of the crown. This is determined by the depth of the implant and height of the abutment. In order to achieve the desired profile and correct fit with this type of abutment, the dentist spends added time with alterations and adjustments.
Both bone and tissue level implants can accommodate a custom abutment. These types of abutments are waxed or milled into the specified shape as needed to align with the tissue. Custom abutments can be made from titanium or zirconia materials. In addition, they can be fabricated using a zirconia with a titanium base. During the placement of a custom abutment, dentists will use delivery jigs. This helps to achieve the desired outcome. The results are also more accurate and precise when using custom abutments. Custom abutments are more expensive but can achieve more predictable esthetic results and far better tissue management. Custom abutments are suitable for both cemented and screw-retained crowns. In many cases, custom abutments are also more efficient compared to stock abutments. This is the result of fewer clinical resources and lower lab fees.
Dental implants are an exceptional tooth-replacement treatment available for patients. Patients should work with their provider to determine which type of implant system will best meet their individual needs.