Innovations in Dental Implants

Dental implants were the brave new world of dentistry twenty years ago.  Now they're everyday dentistry, used routinely to replace teeth.   As implants become more common, they have also gotten better.   They're now easier to place, less likely to fail, faster to integrate with bone, and use new materials that are more compatible with the human body.   Here are some of the latest innovations in both materials and uses of implants.

Technology of imaging:

The Cone Beam CT Scan gives a 3D image of the mouth, making placement of implants more precise.  "Let's say a patient comes in for an implant in the back of the lower jaw," explains Peter Moy DDS, maxillofacial surgeon and Nobel Biocare Endowed Chair in Surgical Implant Dentistry at the UCLA School of Dentistry.  "The main concern is figuring out how much bone covers the nerve.  The nerve is in a circular canal but on a flat film you can't see the actual distance from bone to nerve.  A 3D x-ray is like a hologram.  It allows the dentist to see that perhaps you have less bone than he thought you had."

CAD/ CAM (computer-aided design/computer-aided manufacturing) Imaging determines the optimal shape of the tooth that will go on the implant.   Instead of looking for bone, putting in implants and then putting a crown on the implant, the dentist uses special software to image the crown and couples it with the 3D CAT scan.  This allows him to determine the best bone site, and see if it fits the crown. "Top down planning rather than the other way around gives the patient the best result," asserts Dr. Moy.

New implant designs:

Surfaces that enhance integration with bone. Implants haven't changed since 1982 when they were first introduced.   They're still screw shaped, but the surface characteristics have changed.  In the past, implant surfaces were smooth.  Bone would bond to the smooth titanium, but more weakly than with new, roughened titanium.   Titanium implants used to be roughened by spraying material on them, but the spray was a weak spot. Today there's no spraying—implants are all titanium.  Studies have shown that roughened titanium implants require a shorter healing period.  Recently, a new highly porous titanium biomaterial has been developed which promises even better and faster osteointegration.

Mini implants came about because some patients don't have sufficient bone volume for conventional implants.   An important caveat is that, unlike regular implants, they haven't been proven effective in long term studies.   "They do work, but if they're overloaded they will fail," Dr. Moy says.  "I'll put them in for the transition period to support a temporary bridge while the patient's regular implants are healing, but if a patient doesn't have enough bone, I prefer a bone graft and a standard implant"    In some cases they might be effective, however.   A study at the University of California at San Francisco reported a high success rate for mini implants used to retain lower dentures.

Biological materials:

If a patient doesn't have sufficient bone to place an implant, the dentist has to do a bone graft. Until now, surgeons had to use the patient's own bone or cadaver bone, both of which have significant disadvantages.  Using the patient's bone means risking damage to the site where it's removed.  Cadaver bone brings in the "ick" factor plus, since it's not living bone, it doesn't work as well.  "Eventually dentists won't have to use patients own bone or tissue for implants at all," explains Dr. Moy.  "We now have synthetic materials plus recombinant gene therapy if an implant needs to go where there isn't enough gum or bone. Researchers are finding materials from the animal world such as coral that will act as scaffolding for patients' own bone growth. They're also experimenting with recombinant therapy—taking the DNA from living human cells and transferring them to animals in order to grow cells that stimulate or attract bone forming cells in humans."

Implants as the treatment of choice:

When a tooth starts to give you trouble there are various treatments you can choose: either a root canal with or without a crown, a bridge, partial denture or extraction.   Or you can get the tooth removed and replaced with an implant. The mantra of dentistry since the root canals and crowns were invented has been "save the tooth."   But now that implants are available there's a lot of controversy in the dental profession about when to stop trying to save a tooth and when to take it out and just put in an implant.  "The implant is the ideal course of treatment," in Dr. Moy's opinion.  "Implant treatment has moved up the scale as a viable treatment option.  In the long run if you compare the cost and survivability of  a root canal and crown,  compared to an implant, the implant wins every time."

CONNECT THE DOTS

Are you wondering about the advantages of dental implants, or what kinds of implants are available?   If you have dentures, how can implants help you?  Also, check out these related healthymagination posts: "Orthodontics for Adults," "Reattaching Knocked-Out Teeth with Adult Stem Cells," and "Turning Adult Stem Cells Into Wisdom Teeth."

Erica Manfred 13 Dec, 2011

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Source: http://www.healthymagination.com/blog/innovations-in-dental-implants/
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