Dental Implants
Learning Outcomes
On completion of this chapter, the student will be able to achieve the following objectives:
• Pronounce, define, and spell the Key Terms.
• Discuss the indications for and contraindications to dental implants.
• Describe the selection of patients to receive dental implants.
• Identify the types of dental implants.
• Describe the surgical procedures for implantation.
• Describe home care procedures and follow-up visits required after dental implants are received.
Performance Outcome
On completion of this chapter, the student will be able to achieve competency standards in the following skill:
Electronic Resources
Additional information related to content in Chapter 53 can be found on the companion Evolve Web site.
• Interactive Dental Office Patient Case Study: Gregory H. Brooks
• Procedure Sequencing Exercises
• WebLinks
Key Terms
Circumoral (sir-kum-OR-ul) Surrounding the mouth.
Endosteal (en-DOS-tee-ul) Type of implant that is surgically embedded into the bone.
Osseointegration (os-ee-oe-in-te-GRAY-shun) The process of introducing certain metals, such as titanium, into living bone and forming a biocompatible bond with living bone.
Subperiosteal (sub-per-ee-OS-tee-ul) Type of implant that includes a metal frame, which is surgically placed under the periosteum.
Titanium (tye-TAY-nee-um) Type of metal used for implants.
Transosteal (tranz-OS-tee-ul) Type of implant in which the metal framework is surgically inserted through the inferior border of the mandible. This type of implant is used only on the mandible.
When natural teeth are lost, it is challenging to duplicate their function and appearance with a removable partial or denture. Dental implants provide a natural-looking and functional replacement for missing teeth that incorporates principles from fixed and removable prosthodontics with the use of bone-anchored implants. Artificial teeth are attached to metal implants that are permanently secured in the jaw. These implants hold the artificial teeth in place as firmly as the root system holds natural teeth.
Dental implants are used to attach artificial teeth to anchors (similar to posts) that have been surgically embedded into the bone (Fig. 53-1). The implantation process involves several steps and can take anywhere from 3 to 9 months to complete. Depending on the type of implant, the steps will vary. Most dental implant procedures are performed in the dental office, but some may be performed in a hospital, depending on the patient’s general health and the type of implant.
The placement of dental implants involves both surgery and placement of the prosthesis. Several specialists, including the oral and maxillofacial surgeon, periodontist, prosthodontist, and implantologist (general dentist with specialized training), may perform the procedure. The experienced dental laboratory technician is also involved in this field of dentistry.
The type of specialist who performs the procedure is less important than the ability, experience, and education of the clinician involved. The clinician must have in-depth knowledge of both surgical and prosthodontic aspects of implants. A coordinated effort among specialists and general practitioners is necessary to obtain optimal results when implants are being considered.
Indications for Implants
Dental implants are now considered as the standard of care. For example, the lower full denture yields a very low rate of patient satisfaction, and implant dentistry has a very good chance of solving the problems associated with a mandibular denture.
A dental implant can have a success rate greater than 90 percent. Effective home care and regular dental visits are essential for the long-term success of dental implants; this should be conveyed to the patient during the treatment planning phase. Dental implants can last as long as 20 years and in some cases can last a lifetime. Indications for dental implants include the following:
• To replace one or more teeth as single units without affecting adjoining teeth
• To support a bridge and eliminate the need for a removable partial denture
• To provide support for a denture, making it more secure and comfortable
• To prevent bone loss and gum recession that often accompany bridgework and dentures
• To enhance the patient’s confidence in smiling and speaking
• To improve the patient’s overall psychological health
• To improve the esthetic appearance of the patient’s teeth and mouth
Contraindications to Implants
As with any dental procedure, dental implants involve some risk. Because each patient is unique, any surgical success cannot be 100 percent guaranteed. The patient must be properly screened, and some patients may not be good candidates for implants. The following contraindications should be considered when implant options are discussed:
• The financial investment is greater than that for a conventional bridge or denture.
• Treatment can take several months or longer to complete.
• As with any surgical procedure, implants convey a risk of infection and other complications.
• An implant may loosen, requiring replacement.
• Emotionally, the implant procedure may be challenging for some patients.
Patients with certain medical complications are not good candidates for dental implants. Medical conditions that may contraindicate implants include diseases of the cardiovascular, respiratory, and gastrointestinal systems; a seriously compromised immune system; and other chronic conditions that impede healing.
The Dental Implant Patient
A comprehensive evaluation is essential in the determination of whether the patient will benefit from dental implants. The ideal candidate to receive an implant should be in good to stable health and have adequate alveolar bone and should be willing to commit to attentive oral hygiene and regular dental visits.
During treatment planning, the dentist and the patient should discuss the patient’s needs, desires, and financial commitment. After these issues and existing problems have been evaluated, the treatment is decided upon, and the prosthesis that satisfies these goals is started. Specific treatment options are available for the partially and completely edentulous patient, with the prosthesis being fixed or removable depending on existing oral conditions.
Psychological Evaluation
The psychological evaluation takes place at the initial visit. The dentist assesses the patient’s attitude, ability to cooperate during complex procedures, and overall outlook on dental treatment. The dentist also determines whether the patient has realistic expectations about dental implants and the end results.
Dental Examination
During the examination, the dentist evaluates the condition of the teeth and soft tissues, areas of attached and unattached tissue, and the height and width of the edentul/>
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