DENTAL IMPLANTS

INTRODUCTION
Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food.

 Tooth is consist of mainly two parts, Enamel and Dentin. Enamel is the hardest and most highly mineralized substance of the body. It is normally visible and must be supported by underlying dentin. 96% of enamel consists of mineral, with water and organic material comprising the rest.

 The normal color of enamel varies from light yellow to grayish white. Dentin is the substance between enamel or cementum and the pulp chamber. The porous, yellow-hued material is made up of 70% inorganic materials, 20% organic materials, and 10% water by weight.

DENTAL IMPLANTS.
Virtually all dental implants placed today are root-form endosseous implants. They appear similar to an actual tooth root (and thus possess a "root-form") and are placed within the bone (endo- being the Greek prefix for "in" and osseous referring to "bone"). Most implants were either blade endosseous implants, in that the shape of the metal piece placed within the bone resembled a flat blade, or a framework was constructed to lie upon and was attached with screws to the exposed bone of the jaws.

 Dental implants can be used to support a number of dental prostheses, including crowns, implant-supported bridges or dentures. They can also be used as anchorage for orthodontic tooth movement.

MATERIAL USED IN DENTAL IMPLANTS.

Now a days Titanium alloys are used for dental implants but zirconia and stainless steel is also been used for the dental implants.

TITANIUM ALLOYS
A typical implant consists of a titanium screw (resembling a tooth root) with a roughened or smooth surface. The majority of dental implants are made out of commercially pure titanium, which is available in 4 grades depending upon the amount of carbon and iron contained. More recently grade 5 titanium has increased in use. Grade 5 titanium, Titanium 6AL-4V, (signifying the Titanium alloy containing 6% Aluminium and 4% Vanadium alloy) is used. Ti- 6Al-4V alloy offers better tensile strength and fracture resistance.

 Today most implants are still made out of commercially pure titanium (grades 1 to 4) but some implant systems are fabricated out of the Ti-6Al-4V alloy. Implant surfaces may be modified by plasma spraying, anodizing, etching, or sandblasting to increase the surface area.

 The implant, which is made of titanium, is placed in the upper or lower jawbone. Crown, usually made of porcelain fused to a metal alloy (PFM). The crown is attached either to the abutment or directly to the implant. It can be screwed or cemented onto the abutment.

ZIRCONIA
Recent state-of-the-art dental care only allowed for implants made of pure titanium; but scientific dentistry has found a way to circumvent the potential harmful titanium and is now proud to have rendered the application of zirconium-based implants possible. Advantages of zirconia over titanium is 1) No allergic reactions to be expected. 2) Extraordinary tensile strength and no danger of corrosion. 3) Highly enduring with regard to stress and strain. 4) Resistant against any kinds of acid.

 Zirconium is a very poor chemical and electric conductor and does therefore easily withstand changes in temperature. Zirconia implants are said to provide an improved patient service with a quicker and more patient-oriented implant therapy. The high corrosion resistance of the material means that there is virtually no danger of corrosion with Zirconia implants.

 One of the main risks associated with Zirconium based implants is radioactivity. Zirconium at any time can contain a certain number of radioactive isotopes. This can lead to an increased chance of various Oral cancers.

GOLD TEETH
Dentists have used gold for filling cavities for crowns, and for other purposes. Gold is malleable, nearly immune to corrosion, and hard enough to form a biting surface that can be used for years. Gold had been used before silver was available and continued to be used for specialized purposes. In certain regions of the world, especially in Eastern Europe, the former Soviet countries, Central Asia and the Caucasus, gold teeth are worn as a status symbol, a symbol of wealth. Originally the most expensive historical dental prosthetic, these are sometimes now installed in place of healthy teeth or as crowns over filed-down healthy teeth.

SURGICAL PROCEDURE
Before surgery, careful and detailed planning is required to identify vital structures such as the inferior alveolar nerve or the sinus, as well as the shape and dimensions of the bone to properly orient the implants for the most predictable outcome. Two-dimensional radiographs are often taken prior to the surgery. Sometimes, a CT scan will also be obtained. Specialized 3D CAD/CAM computer programs may be used to plan the case.

BASIC PROCESS
The placement of an implant requires a preparation into the bone using either hand osteotomes or precision drills with highly regulated speed. After a variable amount of time to allow the bone to grow on to the surface of the implant . A crown or crowns can be placed on the implant. The amount of time required to place an implant will vary depending on the experience of the Dentist, the quality and quantity of the bone and the difficulty of the individual situation.

DETAIL PROCESS
At edentulous (without teeth) jaw sites, a pilot hole is bored into the recipient bone, taking care to avoid the vital structures. Drilling into jawbone usually occurs in several separate steps. The pilot hole is expanded by using progressively wider drills (typically between three and seven successive drilling steps, depending on implant width and length). A cooling saline or water spray keeps the temperature of the bone to below 47 degrees Celsius (approximately 117 degrees Fahrenheit). Typically in most implant systems, the drilled hole is about 1mm deeper than the implant being placed, due to the shape of the drill tip.

HEALING TIME
In general, Dentists allow 26 months for healing but preliminary studies show that early loading of implant may not increase early or long term complications. If the implant is loaded too soon, it is possible that the implant may move which results in failure. For conventional implants, the subsequent time to heal, possibly graft, and eventually place a new implant may take up to eighteen months.

DENTAL BRIDGE
A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth by joining permanently to adjacent teeth or dental implants. Types of bridges may vary, depending upon how they are fabricated and the way they anchor to the adjacent teeth. A bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth. The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone.

SUCCESS RATE
Dental implant success is related to operator skill, quality and quantity of the bone available at the site, and the patient's oral hygiene. The consensus is that implants carry a success rate of around 95%. One of the most important factors that determine implant success is the achievement and maintenance of implant stability. Other contributing factors to the success of dental implant placement, as with most surgical procedures, include the patient's overall general health and compliance with post-surgical care.

FAILURE
Risk of failure is increased in smokers. For this reason implants are frequently placed only after a patient has stopped smoking as the treatment is very expensive. More rarely, an implant may fail because of poor positioning at the time of surgery.