Missing teeth are commonly perceived as a sign of ageing and poor physical condition. Missing teeth have been replaced by prosthetic teeth for thousands of years. Archaeological data has shown that replantation of failed teeth or implantation of artificial teeth has been practised since prehistoric times. Today, worldwide scientific data has shown that replacement teeth supported by dental implants are very successful. The problems with removable dentures, such as looseness, odour, poor esthetics and compromised chewing efficiency are no longer a problem in implant-supported teeth. Patients also report that implanted teeth look, feel and function just like their own teeth.
What are the options?
In the original dental implant treatment protocol, placement of dental implants was a two-step procedure over a period of a few months under an institutional setting. After the initial placement of dental implants in the jawbone, patients had to go without teeth for a period of a few months before their actual implant teeth were made. Denture usage was not encouraged. The old protocol essentially made the patients go through a few months with a ‘naked mouth’ Needless to say, eating functions and social life suffered during this period of time. Generally, however, this remains a viable protocol based on sound biological principles even though it is rarely practiced nowadays.
Rapid Functional Smile Re-creation
Currently, it is widely accepted that simultaneous placement of dental implants and teeth is feasible from a biomechanical point of view. Scientific literature has indicated an approximately 95% success rate using this protocol. Clinical evidence also attests to the predictability of this treatment outcome, and most importantly, patients experience little post-operative discomfort. From the patients’ perspective, those who have gone through this procedure reported minimal post-operative discomfort, which allowed them to go back to their normal daily activities virtually immediately.
Simultaneous placement of dental implants and teeth essentially allows the implant treatment to be completed in one day. This option requires a smaller operating field in implant surgery, which was one of reasons why patients felt no pain when they went through this procedure. This protocol eliminates waiting time and the patients do not need to go around without teeth over a long period of time. This is known as the Teeth in a Day treatment protocol.
Are there any contraindications?
Research from the University of Toronto and UCLA has shown the following:
- Age is not a contraindication. Most of the dental implants have been placed in older populations. No correlation has been found between age and implant failure.
- Cardiovascular disease (e.g. angina, heart stents) – This unique group of patients is usually taking blood-thinning medicines (e.g. Plavix). As long as the blood-thinning medication has been stopped under the direction of the patient’s medical doctor(s), surgical procedures can be carried out safely. There is no difference in implant success rate in this group of patients.
- High blood pressure – As long as the blood pressure is monitored and is under medication control, dental implants are equally successful in this group of individuals when compared with other populations.
- Osteoporosis – Animal studies and retrospective clinical studies have shown that there is no apparent relationship between osteoporosis and implant failure.
- Diabetes – UCLA studies have shown that dental implants are successful for diabetic patients as long as the condition is under control by medicine, dietary control and regular exercise. A quick pretreatment HbA1c test will confirm the status of the patients’ blood sugar control.
- History of cancer treatment – With the exception of individuals who are having a high dose of radiation therapy, implant treatments are predictable in patients with a previous history of surgical and/or medical oncology treatments.
It can be concluded with confidence that contraindications for dental implants are rare as long as the jawbones are of sufficient size and density. In cases where jawbone is lacking, artificial and/or natural bone could be reliably grafted onto the implant site under minor surgery.
Do I need to stay in the hospital for a long time?
This is not needed, however, some individuals may preferred to be treated that way.
What will be the future?
With the advance in dental implant designs, new implant surface technologies, imaging techniques of the jawbones and improvement in surgical techniques, placement of dental implants and placement of teeth in a single step is a viable treatment option.
New implants are being designed to not only bond with the jawbones but to induce and speed up this implant/jawbone bond formation. The biomechanical condition of the jawbones can be verified with CT scans, radiographs and computer-aided-design to determine if the jawbone of the potential implant patient is of adequate size and bone density. As long as the jawbone meets these requirements, immediate placement of implant-supported teeth is a predictable procedure.
What are the key factors to success?
Similar to any surgical discipline, the keys to successful long-term implant treatment are still based on:
- detailed planning,
- meticulous surgery,
- careful execution of biomechanical principles,
- selection of the right equipment, and
- healthy jawbones.
Contributed by Dr Ansgar C Cheng, Dental Specialist in Prosthodontics
Adjunct Associate Professor, Faculty of Dentistry, National University of Singapore