Interventions For The Replacing Missing Teeth

Question: Discuss about the Interventions for the replacing missing teeth. Answer: Introduction: An end osseous implant is also known as a dental implant or fixture, it is a surgical component which provides support to the dental prosthesis by linking it to the jaw bone. It also can act as the orthodontic anchor in certain cases. The process that is used in case of instillation of modern dental implant devices is the process of osseointegration. Other two techniques that are abundantly used in case of the endosseous implanting are extracoronal technique which wires the implant with the adjacent teeth. The other technique utilizes intracoronal techniques like inlay splinting and parallel or nonparallel pin splinting (1). It has to be mentioned that loss of teeth is a very common problem which is facilitated by the lack of bone support that eventually leads to an unfavourable crown to root ratio. The endosseous implant is an abundantly utilized technique used in such cases. Although loss of teeth can occur to adults as well, the most prevalence has been reported in the elderly population. Hence the most plausible target market in this case is the elderly population, preferably the age group of 70 and above. Design Of An Endosseous Implant: Endosseous implants are the most common dental implant designs that are found and utilized. It has a more or less complex design when compared to the other types og dental implants. This type of implants is generally positioned inside or within the jaw bone to gain the optimal support from the bone by the process of osseointegration. The shape of the implants can vary however; the shape generally conforms to the natural root (2). However, the screw resembling design of the implants is also commonly utilized. The material that is used in case of the dental implants are generally the titanium or titanium alloy. Along with that, the surface of the implants are often coated in order o create a textured surface so that osseointegration can be enhanced. There are primarily three basic components of the endosseous implants, the fixture, which is primarily the implant component that enlarges the bone. The second component is the transmucossal abutment, which provides the connection between the fixture and prosthesis. And the third and the final part of the dental implant is the prosthesis. The material for this type of implant is mainly of two types metal and ceramic and the choice depends on the need of the patients or the implant components used. However, metallic implants are more abundantly used in clinical setting and the metals generally used are titanium and gold. The reason behind the abundant selection of the metallic implant materials is due to the higher degree of biocompatibility, higher strength, and higher resistance to corrosion (3). Selection Of Treatment And Implant Planning: There are various trajectories due to which the process of teeth loss is facilitated, it can be age related decay, cavity, periodontal diseases and even excessive smoking. While the most abundantly opted treatment pathways in these cases are the implant placement procedure, the dental implants used may vary between different origins of teeth loss for the patient. In case of the periodontal diseases or gum diseases the most commonly utilized dental implants are the endosseous implants made up of titanium (4) In case of smoking and resultant teeth loss in the patients often endosseous implants are used although the failure rates in this case higher. Hence cautionary aftercare including cessation of smoking for at least a month after surgery is recommended to such patients to ensure success of the surgery (5). Implant Procedure: The implant placement procedure is completed in various stages; the first stage is the surgery in which the implant is first placed into the bone structure. The implant component is surgically placed in the maxilla or mandible of the patient. In the second stage the implant is left alone for a period of 4-6 months so facilitate the process of osseointegration. In the third stage is the second surgery where the healing cap is placed to facilitate proper healing of the soft tissues. The next stage is the placement of the abutment; it can be either a fixed or removable denture. This abutment is joined with the implant fixture and is penetrated into the mucosa of the patient. The abutment remains attached to the implant with abutment screws. As the prosthetic is also attached to the implant structure the formation of the root tooth analogue is complete and is followed by immediate loading (6). Implant Restoration And Aftercare: There are various implant placement procedure failures and hence there are various the process of implant restoration and aftercare is very important aspect. The most risk that the pat8ients are in after an implant placement surgery is the risk of infection, bleeding, and displacement. There are a few aftercare principles that can help the patient avoid the risks mentioned, first and foremost maintaining a strict infection control and oral hygiene is mandatory for the patients after a successful implant placement surgery. Along with that, right after the placement of the implant the patients must fluid based diet for 5 to 7 days after which the patients will have to commence on a soft food based diet plan. There is generally no need for removing the stitches manually as the self dissolving stitches are generally used in the plant surgeries nowadays. However, along with the dental implants, there are provisional restorations placed to facilitate the faster recovery and healing fusing process. It is very important or the patient to regularly clean the provisional restorations as well (7). Latest Technology Development: There are various new technologies that are used in order to ensure and facilitate the success of implant surgeries. This new technologies include 3D printing and different nanotechnological processes. By the virtue of the 3D printing and graphics oriented imaging by the ICAT machine, the dental surgeons can now successfully integrate the combined model-guided surgery with immediate placement of a nanostructured implant. This model guided surgical procedure also uses acupuncture technique to replace the need for anesthetizing the patient before surgery, which a great breakthrough in case of dental implant placement surgeries. In order to facilitate success of the implant placement, the additional medical process of surface coating and functional coatings are also used to enhance the biocompatibility. On the other hand another technological breakthroughs in this case are the mini or micro implants, that are being used in case of the dentures. These require lesser healing time and inflict lesser pain on the patients as well, making it a cutting edge technology that does not require additional healing time or restoration. It enables the patient to start wearing the replacement teeth right after the surgery (8). References: Simonis P, Dufour T, Tenenbaum H. Long?term implant survival and success: a 10–16?year follow?up of non?submerged dental implants. Clinical oral implants research. 2010 Jul 1;21(7):772-7. Esposito M, Grusovin MG, Maghaireh H, Worthington HV. Interventions for replacing missing teeth: different times for loading dental implants. The Cochrane Library. 2013 Jan 1. Annibali S, Cristalli MP, Dell’Aquila D, Bignozzi I, La Monaca G, Pilloni A. Short dental implants: a systematic review. Journal of dental research. 2012 Jan;91(1):25-32. Vervaeke S, Collaert B, Vandeweghe S, Cosyn J, Deschepper E, De Bruyn H. The effect of smoking on survival and bone loss of implants with a fluoride?modified surface: a 2?year retrospective analysis of 1106 implants placed in daily practice. Clinical oral implants research. 2012 Jun 1;23(6):758-66. Lemons JE, Misch-Dietsh F, McCracken MS. Biomaterials for dental implants. InDental Implant Prosthetics 2014 Jul 2. Elsevier Inc.. D’haese J, Van De Velde T, Komiyama AI, Hultin M, De Bruyn H. Accuracy and complications using computer?designed stereolithographic surgical guides for oral rehabilitation by means of dental implants: a review of the literature. Clinical implant dentistry and related research. 2012 Jun 1;14(3):321-35. Citarella R, Armentani E, Caputo F, Lepore M. Stress analysis of an endosseus dental implant by BEM and FEM. The Open Mechanical Engineering Journal. 2012 Nov 8;6(1). Tettamanti S, Millen C, Gavric J, Buser D, Belser UC, Brägger U, Wittneben JG. Esthetic Evaluation of Implant Crowns and Peri?Implant Soft Tissue in the Anterior Maxilla: Comparison and Reproducibility of Three Different Indices. Clinical implant dentistry and related research. 2016 Jun 1;18(3):517-

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