Year : 2018 | Volume
: 15 | Issue : 3 | Page : 127--131
Recent trends in implant dentistry: A mini-review
Shatakshi Sharma, Deepa Dhruvakumar
Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
Department of Periodontology, Subharti Dental College and Hospital, Delhi-Haridwar By-Pass Road, Meerut 250005, Uttar Pradesh
The issue of osseointegration serving as the endpoint of implant therapy is no longer relevant. The long-term health and stability of the implant, prosthesis, and peri-implant tissues are the most desirable outcomes for implant therapy however recent advances have been developed to support the fabrication of a fixed provisional prosthesis that provides implant patients with improved esthetics and function during the osseointegration period. However with the advent of new technologies and materials the success and failures of these materials still remains in question and have to be evaluated. This paper presents an overview of the recent trends in implant dentistry.
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Sharma S, Dhruvakumar D. Recent trends in implant dentistry: A mini-review.Tanta Dent J 2018;15:127-131
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Sharma S, Dhruvakumar D. Recent trends in implant dentistry: A mini-review. Tanta Dent J [serial online] 2018 [cited 2018 Dec 12 ];15:127-131
Available from: http://www.tmj.eg.net/text.asp?2018/15/3/127/243074
Dental implants have greatly evolved over the past 20 years. The idea of permanently being able to replace teeth has been a desire of civilizations since the days of the Egyptians. Luckily, our modern-day methods of dental implantation are much more successful and painless than attempts from 3000 years ago copper peg was used to replace the lost tooth structure . In the mid-1960s, Dr Per-Ingvar Brånemark in Sweden discovered that bone could grow in proximity with the titanium without being rejected and called this phenomenon as 'osseointegration,' hence the term osseointegration had been coined . This discovery paved the way for all future dental implant work henceforth. Osseointegration, by definition, is living (newly formed) bone in contact with an implant. Stability of osseointegrated implants may depend on: the percentage of bone-to-implant contact; how the new bone deposited on the implant surface is attached to the surrounding bone; and the bone density (quality) of the surrounding bone. However, the percentage of bone-to-implant contact can be used to estimate differences in the speed of bone apposition onto the implant surface between materials and/or surface modifications . Another further breakthrough in the evolution of dental implants emerged with the advent of computed tomography (CT) which were considered appropriate for patients who are being considered for multiple implants .
Advances in implant materials
Current research and observations evoked a change of paradigm during the past decade: instead of focusing mainly on topographical features, surface roughness, the new paradigm includes now the role of wetting properties for the interfacial biological responses and considers interrelating effects of topography and wetting, that is, microroughness and nanoroughness induced wetting phenomena. Latest findings also identified synergistic effects of nanostructured surfaces and hydrophilicity on the biological response . Various materials used are (a) ceramics, (b) carbon and polymers, (c) hydroxyapatite (HA), (d) bone morphogenetic proteins, and (e) plasma spraying.
Ceramics implant material
High-strength ceramics used for implants are very inert in the body and exhibit minimal ion release. Aluminum oxide is regarded by many as the standard inert material as the remodeling of bony tissue adjacent to its surface is not altered by the presence of ions released or by immune reactions. The ionic ceramic surface is in a high oxidation state, thermodynamically stable and hydrophilic minimal ion release has been noted for aluminum oxide or zirconium oxide under normal conditions. Coatings may also include biologic coatings such as proteoglycans, bone morphogenetic proteins, and growth factors .
Zirconia is a ceramic material used in implantology because of biocompatibility (bioinert), superior esthetics (because its color is similar to the teeth), and mechanical properties, which are better than alumina.
They have high resistance to corrosion, flexion, and fracture when contact with bone and soft tissue it is similar to that observed in titanium implants. It can be used to produce an entire implant or as a coating .
Carbon and polymeric implant surfaces
It has been shown to exhibit an inert and biocompatible surface when exposed to blood or tissue. The carbon structure used for dental implants is known as turbostratic and is a modified graphite structure. Polymeric surfaces are not commonly seen for dental implants. Designed to act as a shock absorber, but this polymeric element requires periodic replacement due to wear.
Properties of HA composites is highly dependent on the particle size and morphology of the HA filler. HA of sufficient fineness should be developed. RF induction suspension plasma spraying with a wet suspension of HA .
Advances in implant materials, forms, shape, and surface topography
Advances in implant materials, forms, shape, and surface topography: (a) mini-implants, (b) transitional implants, and (c) one-piece implants.
Mini-dental implant (MDI) is in fact a trade name for the most widely used small diameter implant, the 3M ESPE MDI, the dental industry has adopted the term to describe this class of implants. Some small diameter implants are used as anchors in orthodontic cases and are called temporary anchorage devices. One example of a temporary anchorage device is the Unitek Temporary Anchorage Device System. These vary from the more common MDIs in that they are removed after they are no longer needed and orthodontic treatment is completed . It is important to note that the pull out strength of an implant has been shown to be based on its length rather than its diameter . Multiple tip, thread, body, and head designs are available in the category as well. The majority tip designs are sharp or slightly blunted to provide the self-tapping ability of the implant to the medullary bone. Some blunted designs taut a compression of the bone as an advantage.
Thread designs vary from thin to thick and thread spacing is also variable. The design variations allow for use of the implants in the different densities of bone (D1, very dense; D2 and D3, soft) found throughout the mouth. Fixed crowns or bridges can be cemented directly to the square or cubic head of the mini. Subsequently, a sphere was milled into the square portion of the head allowing for a more elegant restorative solution. This 'o-ball' design became a popular solution to secure loose dentures.
Procedure. These are available in lengths of 6, 8, 10, 13, 15, and 18 mm and are inserted directly through the overlying gingiva and into the bone beneath, there is no need to surgically cut and raise the overlying flap. A single minimally invasive surgery is needed for insertion of MDI. Immediate loading can be done due to their self-tapping design.
Their diameter ranges from 1.8 to 2.8 mm and length ranges from 7 to 14 mm. Transitional implant are fabricated with pure titanium in a single body with treated surface. There primary function is to absorb masticatory stress during the healing phase, ensuring stress free maturation of bone around the submerged implants and allowing them to heal uneventfully.
Contraindication. (a) Depth of supporting bone is less than 10 mm with an insufficient cortical bone to provide implant stabilization. (b) Patients with excessive bruxism. (c) When placement of sufficient number of transitional implants is not possible. (d) Should be used with caution: transitional implants should be placed 1.5–2.5 mm from definitive implants to avoid interference on osseointegration .
Abutment and implant body in one piece and not separate; they are commercially available in 3 mm diameter and 12, 15, and 18 mm length. They have unique properties such as: (a) maximum strength – minimum profile. It is one-piece, titanium alloy construction provides maximum strength, while its 3.0 mm diameter allows placement in areas of limited tooth-to-tooth spacing. The one piece 3.0 has been shown more strength when loaded to failure than other implants less than 4 mm in diameter. (b) Minimal surgery – maximum esthetics. Because one-piece implants are placed using a single-stage protocol, the soft tissue experiences less trauma than typical two-stage protocols.
Indications. The long-term treatment of missing maxillary laterals and mandibular incisors, for treatment of spaces that cannot be handled with larger two-piece implants also used for over dentures .
Advances in diagnostic imaging
Diagnostic imaging techniques are an essential tool in developing and implementing a cohesive and comprehensive treatment plan. The exceptional imaging modalities that exist today are employed to ascertain vital information concerning both preoperative and postoperative phases. These imaging techniques can be grouped as either analog or digital and two-dimensional or three-dimensional. The current trend in implant imaging is cone beam computed tomography (CBCT), which implements revolutionary three-dimensional images with axial, coronal, and sagittal views and a stream of useful data while delivering substantially less amounts of radiation to the patient . Advanced imaging techniques includes: (a) zonography, (b) CBCT, (c) microtomography, (d) multi-slice helical CT, (e) Dentascan, and (f) interactive CT (ICT).
A modification of the panoramic radiographic machine for making cross-sectional images of the jaws. The tomographic layer is ~5 mm. For an appreciation of the spatial relationship between the critical structures and the implant site.
Limitations. Tomographic layers relatively thick, adjacent structures blurring, and superimposition, not useful for determining the differences in bone density or for identifying disease at an implant site.
Tomography is the generic name formed by the Greek words 'tomo' (slice) and 'graphy' (picture). Enables visualization of a section of patient's anatomy by blurring other regions above and below the site of interest. For dental implant patients, high-quality complex motion tomography is required .
CT is a digital and mathematical imaging technique that creates tomographic sections. With latest CT scanners, images with sectional thickness of 0.25 mm can be obtained. This can be useful for determining the implant site in terms of bone density, and location of adjacent anatomic structures .
Recent advances in computed tomography
CBCT. Use of CBCT is becoming increasingly popular and widespread among clinicians globally. This is moderately because of a new understanding of anatomic landmarks and structures, such as neurovascular canals and bundles, being at risk during implant placement. Although CBCT is currently growing rapidly in popularity for imaging in the field of implant dentistry, and might even be considered as a primary imaging modality in selected cases, upcoming breakthroughs in research will probably bring new technologies that will again change the way in which we visualize hard and soft tissues for preoperative and postoperative evaluation of dental implants .
It uses a cone beam and reconstructs the image in any direction using special software. It gives all the information of a CT but, at one-eighth the radiation dose and at a lower cost. The software is used to display and visualize the anatomy in a way that is clinically meaningful. The manufacturers of CBCT scanners offer software that is capable of multiplanar reformations. Conventional CT scans take pictures of slices of the body (like slices of bread). These slices are a few millimeters apart. The newer spiral (also named helical) CT scan takes continuous pictures of the body in a rapid spiral motion, so that there are no gaps in the pictures collected .
Modification of CT, it is especially useful in acquiring serial sections of bone implant interface. Micro-CT is nondestructive, fast, and allows a fully three-dimensional characterization of the bone structure around the implant. Because of its high resolution, individual trabeculae can be visualized. The accuracy of micro-CT was qualitatively evaluated by comparing histological. Even very close to the interface, the titanium implant does not seem to produce significant artifacts. The technique provided high-resolution consecutive cross-sectional radiographic images of the specimens with a slice-to-slice distance of 4.4 to 11.0 μm.
Multi-slice helical computed tomography
The rapid volumetric data acquisition. The speed was further increased by multi-slice CT, and offers higher accuracy of images as compared to CT .
Dentascan imaging provides programmed reformation, organization and display of the imaging study. The radiologist simply indicates the curvature of the mandibular or maxillary arch. The computer is programmed to generate referenced cross-sectional and tangential/panoramic images of the alveolus along with three-dimensional images of the arch. The cross-sectional and panoramic images are spaced 1 mm apart and enable accurate preprosthetic treatment planning.
Limitations. Images may not be of a true size and require compensation for magnification.
Determination of bone quality requires the use of the imaging computer or workstation. Hard copy dentascan images only include a limited range of the diagnostic gray scale of the study. Tilt of the patients head during the examination is critical.
Interactive computed tomography
This technique enables transfer of the imaging study to the clinician as a computer file. The clinician's computer becomes a diagnostic radiologic workstation with tools. An important element of ICT is that the clinician and radiologist can perform 'electronic surgery' (ES). With an appropriately designed diagnostic template, ES can be performed to develop the patient's treatment plan electronically in three dimensional. ES and ICT enable the development of three-dimensional treatment plans. Transfer of the plan to the patient at the time of surgery can be accomplished by.
It can also be accomplished by the production of the computer generated, three-dimensional stereotactic surgical templates from the digital ICT and ES data .
Limitations. Refinement and exact orientation of the implant positions are difficult and cumbersome. Executing the plan may be difficult for the surgical team .
CAD/CAM in implant dentistry
Uses. Used in designing of prosthesis, used in milling/fabrication of prosthesis (framework), for milling of abutments.
Advantages. Superior fit, less degree of rotational freedom so more accurate implant abutment connection.
Advances in implant dentistry
All on four, rescue implant concept, teeth in an hour concept.
All on four
The all on four for edentulous jaws has been developed to make the best use of available bone and to allow for immediate function using only four implants in edentulous jaws, the solution takes advantage of the benefits of tilting the posterior implants to provide a secure and optimal prosthetic support for a prosthetic bridge (even with minimum bone volume), that can be fabricated and functioning within just a few hours after surgery.
The zygomatic implant is an alternative to bone grafting in extremely resorbed maxilla where fixed prosthesis can be provided with four zygomatic implants with either a conventional two-stage procedure or a one-stage surgical procedure or flapless guided surgery. Although bone augmenting measures such as onlay grafts and sinus grafts are popular and well-documented, the four zygomatic implants procedure results in less morbidity, shorter delays between anatomical reconstruction and functional rehabilitation and can provide immediate or early loading with immediate function .
Teeth in an hour concept
Teeth in an hour allows the opportunity to provide patients fixed, well-functioning, and esthetic prostheses on implants in less than an hour. With flapless technique, with greatly reduced healing time, no temporaries and no significant pain or swelling. It allows replacing missing teeth with permanent dental implants – easily, quickly, and comfortably.
Dental implants are now the state of art for dental restorative therapy. Research and development in the field of implantology are constantly focusing on implant redesign to continue to try and improve implant success. New technologies, based on the three-dimensional evaluation of patients for dental implants have opened new avenues to clinicians for accurate and predictable diagnosis, planning, and treatment in a multidisciplinary patient based approach. The clinicians have to thoroughly check for select material and choose particular technique accordingly.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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