Latest Procedures in Implant Dentistry
Immediate extraction and implant placement
Immediate implantation has provided implant dentistry the opportunity to achieve better and faster functional and esthetic results. Several studies have been done which state that immediate implant placement in a fresh extraction socket is not an absolute contraindication and they may be successfully placed as long as primary stability is achieved. The rationale behind implant placement in fresh extraction socket is the preservation of soft tissue esthetics, reduced treatment time and reduced cost for the patient. However, the localized bone defects surrounding implants placed immediately into fresh extraction sites present a challenge to the surgeon. Success was reduced when implants were placed in morphologically compromised jaw bone sites. Besides, immediate implant placement must be avoided in extraction sites with a previous history of periodontal disease.
Image-guided implantology
The placement of dental implants requires meticulous planning and careful surgical procedures. A radiographic prescription is often needed to provide a more complete visualization of the current clinical situation and to guide in further clinical steps. A revolutionary development in field of imaging now allows a real-time navigational implant surgery, wherein the implant surgery is guided by an on-screen computer guidance thereby allowing easy intra-operative adjustments. However, a major drawback is an expensive machine and long hours of calibration may be needed. Another option available is the use of stereolithographic surgical splints which help to place implants at the predetermined sites. This greatly enhances the speed of implant placement and reduces the chair side time. However, any error in the planning or fabrication of the splint cannot be corrected by the surgeon unless he abandons the use of the splint.
All-on-4
All-on-4 is an alternative approach to place a full arch (top or bottom set) of fixed, replacement teeth. Four dental implants are used to stabilize the replacement teeth. The All-on-4 concept involves placing implants in available bone, thereby avoiding the need for bone grafting. Special abutments allow a temporary set of replacement teeth to be placed the same day and used with a modified diet while gum tissues heal and the implants integrate with natural bone. After about six months, the final bridge is then placed and the patient is able to resume a normal diet.
The all-on-four approach involves multiple appointments, typically including one or two consultation and planning visits, one to place the dental implants and temporary teeth, check-ups during the six month healing period, and another appointment to place the final bridge.
Sinus Lift
A sinus lift is surgery that adds bone to your upper jaw in the area of your molars and premolars. It’s sometimes called a sinus augmentation. The bone is added between your jaw and the maxillary sinuses, which are on either side of your nose. To make room for the bone, the sinus membrane has to be moved upward, or “lifted.” A sinus lift usually is done by a specialist.
Your surgeon will cut the gum tissue where your back teeth used to be. The tissue is raised, exposing the bone. A small, oval window is opened in the bone. The membrane lining the sinus on the other side of the window separates your sinus from your jaw. This membrane is gently pushed up and away from your jaw.
Granules of bone-graft material are then packed into the space where the sinus was. The amount of bone used will vary, but usually several millimeters of bone is added above the jaw.
Once the bone is in place, the tissue is closed with stitches. Your implants will be placed four to nine months later. This allows time for the grafted material to mesh with your bone. The amount of time depends on the amount of bone needed.
Narrow Implants
The possibility of placing implants can sometimes be limited due to physical conditions, e.g. where the horizontal space is limited by adjacent teeth and roots, or in situations with a narrow alveolar ridge. By using a narrow implant the need for bone augmentation or orthodontic tooth movement can be avoided. In situations with limited horizontal space a narrow diameter implant may be the only option to replace a missing tooth.