Different Dental Implant Systems
Introduction
As people look to long term solutions for tooth loss, the options for dental implants have started to grow from the multipiece titanium implants introduced in the 1960s. Data shows that 3 million people currently have dental implants and about 500,000 people each year are added to that population. With a success rate of 95%, patients are looking to dental implants more and more. The new technology offered by CADCAM and 3D printing will continue to push the dental implant options even further.
The Most Popular Implant Systems Amongst Dentists
More than 100 companies are involved in the dental implant component market, but only a few major companies are as well-known and well-respected across the world as Straumann, Zimmer Biomet, Nobel BioCare, MIS, BioHorizon and Dentsply. The lesser-known manufacturers may offer less expensive options, but the better-known companies provide specialized tools and training for their specific components. And with a well-established company, you are able to have the peace of mind to have your implant maintained by dentists all over the world.
Types of Implants
After you have talked to the dentist about the type of system they use and the benefits of that particular company’s offerings, it is important determine to discuss the difference between cement-retained abutments and screw-retained implants, custom abutments or stock abutments, titanium implants or zirconia implants, and the different crown options.
Cement-Retained Abutments Versus Screw-Retained Implants
Cement-retained abutments are more popular for people who are using dental implants to replace missing teeth. These types of abutments offer a more aesthetically appealing look along the gum line and have a more natural look. If the prosthetic tooth needs to be replaced or if there is more than one abutment, screw-retained implants offer the dentist the ability to remove the tooth with ease. Screw-retained implants are more difficult to place in the gums and cost more than their cement-retained counter parts. Finally, if the tooth you are replacing is angled, the dentist may recommend a cement-retained abutment based on the limitations of screw-retained implants.
Stock Abutments Versus Custom Abutments
Each dental implant will need to be addressed individually to determine if a stock or custom abutment is best to use. Be sure to review what each option looks like, what you want your final smile to look like and what the dentist realistically believes is achievable in your case. A stock abutment is made in a standard size and comes with a lower price tag than a custom one. When combined with a cement-retained abutment, a stock abutment can keep your costs low. A custom abutment is ideal when your tooth is more visible because the abutment can be shaped to specifically fit the tissue shape in your mouth. These abutments can even be more cost effective when compared to the costs of adjusting stock abutments.
Titanium Implants
The traditional material for implants, titanium is strong and biocompatible which means your jaw bone will grow around the implant. Dentists refer to the process of the titanium implant growing into and with the jaw bone as osseointegration. Once the bone tissue and titanium rod are secured together, the implant is immovable. While these implants are referred to as titanium, they are actually an alloy of titanium to improve the strength of the titanium. The metals used in the alloy can cause an allergic reaction in some people but there is a 95% success rate with this type of implant. Titanium implants are composed of two pieces, allowing the dentist to have more flexibility when placing them.
Zirconium Implants
Zirconium implants or ceramic implants are ideal options for those people with sensitivities to the titanium alloy. Ceramic is the main component but there are trace amounts of metals called hafnium and yttrium to improve the quality of the implant. Like titanium, zirconium implants are able to fuse with the jaw bone to make stable replacement teeth. Because this is a newer material, there is not enough long-term data to determine if these implants last as long as the 20 year average life of the titanium ones. Zirconium implants are composed of one piece and require more precise and time intensive placement. Unlike titanium, these implants do not present the issue of dark metal showing through the gum offering a more natural look.
Types of Crowns for Custom Abutments
The materials used for crowns include: gold (mixture of gold and other metals), ceramic metal mix (PFM crowns), and all ceramic (IPS e.max and zirconia).
- Temporary cement is more than reliable holding the gold and PFM crowns in place. If these crowns are in a place in your mouth where space is tight or closely placed to other crowns, gold and ceramic metal mix crowns are ideal. If the crown will be placed in a spot in your mouth that you use to chew or bite down, the PFM crowns can be reinforced with metal bite stops. The downside to using PFM crowns is that they do not have a truly natural look and it is very noticeable along the gum line.
- IPS e.max crowns are ideal for custom ceramic abutments and dentists can use resin cement to reduce fracturing risks. The resin cement has its own limitations based on how far the abutment is placed below the gums.
- Zirconia crowns are some of the newest to be used so there is no long-term literature on its effect on surrounding teeth’s enamel layers. In order to use layered zirconia crowns instead of full zirconia crowns, you will need to have more space between your teeth when your upper jaw meets your lower jaw while biting down or greater occlusal clearance. If you are looking for the most realistic tooth like crown, a full zirconia crown delivers the best results. But the results are also dependent on the technician who created the crown, its shape as compared to rest of your teeth, the color as compared to your other teeth, and the placement along the gumline in your mouth.
Choosing the material your custom crown is dependent on your expectation of the results, the place of the replacement tooth in your mouth and if it is a cement-retained or screw-retained abutment.
Model or Model-less Restorations
When dentists replace your missing or damaged teeth with crowns, dentists traditionally used a dental impression to create the replacement tooth or restoration. A good impression is dependent on the dentist’s skill and experience and is essential to ensure the restoration fits properly. With digital technology improving the dentist’s ability to capture a good impression, dental labs use information from your whole mouth, not just a small area. The intraoral scanners operate differently from one brand to the next, but the image files sent to dental labs can be used to create polyurethane or resin models or to create computer graphic designs of full contour restorations.
Full Zirconia Implant Retained Prosthesis
For people who are looking to replace all their teeth, not just one or a few, the best type of implant and prosthetic tooth is the most difficult to determine. The dentist needs to determine the health and strength of the jaw bone which is best seen through CT scans. Depending on the jaw bone density and the location of nerve tissue and blood vessels, the dentist can design the number and placement of implants in order to ensure a successful implant. The restorations will need to offer an even bite and full functionality all while offering you the best overall look. In these cases, full arch zirconia implant retained bridges are proving to offer the best quality of life for people who need full dentures.
Treatment Planning
If you are looking to dental implants as an alternative to dentures, the dentist will need to take a cone beam CT scan or CBCT scan. The scan will show the dentist your anatomy allowing for the detection of any bone anomalies and proper planning for surgery. The scan may reveal the need for bone grafting and will offer the dentist a surgical guide for the ideal implant placement. Implant angles, lengths, and widths can be designated from the scan image to customize your treatment plan. The dentist can even use your current denture or prosthesis to help create your new smile.
Be sure to talk to the dentist about the durability of the materials and components of your dental implants. If you have a specific image of the results you want, be sure to share those with the dentist. Based on each selection, the dentist will give you a realistic idea of the results of your implant surgeries. If you are looking to have the comfort of a shorter arch from fewer implants or you are looking to replace the full jaw with a full arch, the dentist can adjust your procedure. Some people require gum tissue grafting or gingival tissue replacement to keep a natural look when you smile. If your smile reveals a gap between your implants and the crowns, then gum tissue will need to be adjusted so you look your best with your new teeth. You are going to have teeth that look natural and feel normal with a full zirconia implant retained denture.