Job 115 Top Implants 1 – Different Dental Implant Systems

Job 115 Top Implants 1 – Different Dental Implant Systems
Dental implant treatments have increased in popularity exponentially over the last few years. Despite people having better dental health than ever, tooth loss is still prevalent. And with people living longer and remaining active beyond their sixties and seventies, having the ability to smile confidently and eat their favorite foods are expected components of a long and prosperous retirement.
Given the aging population that includes baby boomers, demand for long-term tooth loss solutions is expected to continue growing. Data from the American Academy of Implant Dentistry indicates that 3 million patients in the United States have dental implants and the figure is expected to grow by 500,000 per year. It is forecasted that by 2022, the dental implant markets in Europe and the United States will be an estimated $4.2 billion. Dental implant demand is growing in part because of public awareness of the procedure but also because it has a success rate of 95% or better which is amongst the highest in dentistry.
As demand has increased, technological advancements, new techniques, and better materials have been developed to increase the reliability and predictability of implant treatments. 3D printing and CADCAM technology will revolutionize the market in the coming years.
Many different factors must be considered by clinicians when choosing which implant system and techniques will be most valuable for their patients. This article will examine some of the more popular implant systems in use as well as evaluate the pros and cons of various implant types.

Most Popular Dental Implant Systems Used by Dentists
The shape and size of dental implants have evolved to adhere to current surgical techniques and improve treatment. On an ongoing basis, the leading dental implant manufacturers continue to research subtle changes to the shape, texture, length, and width of implants in order to determine the effect and improve success rates.
While there are more than 100 companies producing dental implant components, only a select group are well known and well regarded worldwide. Amongst these companies are:
* Nobel BioCare
* Straumann
* Zimmer Biomet
* MIS
* Dentsply
* BioHorizon
Is Choosing One of the Most Popular Systems Important?
Patients may be lured by the cheaper components offered by generic implant companies, but this can prove to be flawed. For starters, patient education regarding dental implant technology is increasing meaning they are more likely to demand their dentist use components from a well-regarded manufacturer for their dental implant procedure. Having a documented track-record of the implant components, can help patients make educated decisions about their implant system and choice of dentist.
Additionally, any respectable dental laboratory will have familiarity with the top manufacturers and their technicians will have the specific tools and training required to use the components. And as the world moves closer to a global economy where people frequently relocate to different countries, knowing that replacement components from the top implant manufacturers can be obtained anywhere provides peace of mind.
The leading implant manufacturers have heavily invested in research and development. By selecting products from these companies, patients are assured to receive components of the highest quality and durability.
Abundant research has ben performed regarding the surface characteristics of dental implants. When first placed, the body promotes a biological response to the implant where information is exchanged between cells and the biomaterials. Whether the dental implant is accepted or rejected will determine the number of cells that populate the implant surface. Studies have shown that osteoblastic cells adhere quicker to roughened surfaces which is a quality top implant manufacturers focus on to promote superior osseointegration.
Top dental implant manufacturers perform clinical research on the biomechanical qualities of their components and publish their results for public review. In contrast, generic dental implants have unknown biomechanical qualities regardless of how closely they replicate a name-brand implant.

Deciding on an Implant System
It can be a time-consuming and bewildering process to determine which implant system to choose. Choice of implant system may be less important in routine cases, but should the case be more complex, like situations where the patient has low bone density, choice of implant system is more relevant.

Types of Implants
Depending on the implant system used, a decision will be made whether to use screw-retained or cement-retained abutments and if custom abutments will be needed rather than stock abutments. Aesthetic results are generally better with custom abutments but can vary on a case-by-case basis. Titanium implants have been used by dentists for years but zirconia is becoming increasingly popular. And finally, different crown types will be chosen from for use with a custom abutment.

Screw-Retained Implants vs. Cementable Abutments
Choosing between screw-retained implant crowns or cement-retained implant crowns will come down to the following considerations:
* Retrievability: In certain cases it is necessary to remove an implant crown temporarily. Implant-specific cements are available on the market that are designed to make it easier to retrieve an implant crown. While this may be a good solution, it means the crown will be less retentive. In situations where the crown needs removal, screw-retained implants are much more predictable especially if a greater number of abutments are necessary. It will be much more difficult to remove a multi-unit restoration if it is cemented in place.
* Peri-Implant Tissue Maintenance: When cement is used, there is a risk of excess cement extruding into the sulcus. Unless the cement is completely removed, damage to the peri-implant tissues can occur. While good techniques exist for removing excess cement, screw-retained crowns avoid the risk altogether and can be easily removed for cleaning and maintenance.
* Ease of Use: Screw-retained implant crowns tend to be more challenging to insert than cement-retained versions especially for multiple unit restorations. Several extra steps are required when placing screw-retained restorations to ensure proper and function where a cement-retained restoration is similar to placing a bridge.
* Suitability with Angled Implants: Because of aesthetic limitations, it may not be possible to place screw holes in the facial or incisal contours of the implant crown. Should implant angle be slightly off, an angled, screw-retained abutment will be required which increases cost of treatment. In these situations, relying on a cement-retained crown with either a custom or stock angled abutment is easier.

Stock vs. Custom Abutments
Available in standard sizes, stock abutments can be used for tissue and bone level implants. Stock abutments are designed to be user-friendly, are frequently used with cement-retained restorations, and are cost effective. Stock abutments are ideal for tissue level implants outside the esthetic zone.
One drawback to stock abutments it that because of their standard size, the patient’s tissue will conform to the abutment’s shape. Because of this, stock abutments are not an ideal choice in cases within the esthetic zone as it is more difficult to correct the emergence profile needed to provide tissue support and optimize results. Stock abutments are further limited in their inability to control the crown’s final margin placement.
Also suitable for either tissue or bone level implants, custom abutments may be milled or waxed into the precise shape relative to the tissue. Custom abutments are made from zirconia, titanium, or a combination of the two. Although more expensive than stock abutments, custom abutments offer superior tissue management and better esthetic predictability. Suitable for cemented or screw-retained crowns, custom abutments may be more efficient from a clinician’s perspective as they require less modifications and clinical resources for fitting.

Titanium vs Zirconia Implants
Titanium has been the industry standard for dental implants since the 1960s and have a success rate of 95% or better. The material is biocompatible and integrates extremely well with bone. When first used in implants, the pure titanium used in the components was discovered to be too soft. As such, manufacturers developed alloys with superior strength that still retained the excellent biocompatibility.
While there are no documented cases of allergic reactions to titanium, a small segment of the population may be sensitive or allergic to other metals found in the alloy. Roughly 5% of the population have sensitivities to nickel or may just find the idea of metal in their body to be abhorrent.
In response to concerns regarding allergies and sensitivity to titanium alloys, some manufacturers have researched and created metal-free implants out of zirconium. Although considered a ceramic, zirconium contains trace amounts of two metals: yttrium and hafnium. These metals help give zirconia its strength and like titanium, zirconia osseointegrates in a similar way.
The long-term success of titanium is unquestioned as implants will function well for decades of use. While it is possible zirconia will offer similar long-term success, the newness of the material makes evaluating long-term results impossible. Because they are created as one or two-piece systems, titanium implants are more versatile, offer dentists greater flexibility in treatment, and can be used to support fixed restorations in addition to overdentures.
Because they are fabricated in one piece, zirconium implants have to be cemented into place. Great care must be taken when placing zirconium implants and bone volume is especially important with so little room for error. Zironia is advantageous in that the material is not thermally conductive, will not corrode, and the material’s color ensures maximum aesthetic results.