Category Archives: Two Stage

Rationale for Dental Implants

Missing a tooth or teeth for most people can be a problem as normal contour, function, comfort, esthetics, and speech are compromised. With continued advancement in the dental field, challenging clinical situations is now a reality with a predictable success rate.

The most natural option to replace a lost tooth is to use an implant. Dental implant is a replacement tooth that is recognized as the standard of care for tooth replacement. There are numerous advantages of this treatment modality over any other prosthetic restoration such as FPD (fixed partial denture aka “bridge”) and RPD (removable partial denture).

When a tooth is lost, it’s best to consider implant replacement as early as possible to prevent bone loss. Without the natural tooth to stimulate the jaw, one starts to experience bone loss underneath it. The bone that used to support the natural tooth will begin to shrink, just like the “use it or lose it” phenomenon. Imagine a 200 lbs. body builder who completely halted his training after some years, do you think he will still look the same? Of course not! Same as the unstimulated bone, the bone volume decreases as time goes by, causing the face to look prematurely aged. By placing dental implants, not only it provides preservation of facial bone but also it provides foundation for replacement teeth that will look and function like natural teeth. Hence, many people are rediscovering the joy and comfort of having to eat and speak well once again!

Facial appearance with healthy teeth and bones. -

Facial appearance with healthy teeth and bones. –

Appearance after tooth and bone loss. -

Appearance after tooth and bone loss. –

Candidates for Dental Implants

Dental Implants can be placed in most adults who are in good to moderate health. They are not typically placed in adolescents until they have reached their full expected physical maturity. If you feel implant dentistry is the treatment of your choice, we suggest you go through an implant consultation in order to review your medical & dental history and diagnostic aids (such as radiographs, computed tomographic scans, models) and verify periodontal stability by means of clinical and radiographic assessment. The trained dentist can determine the best treatment plan for you. Do not hesitate to ask your doctor to explain the benefits and risks to see if tooth replacement with implants is best fit for you.

If you have been told that you don’t have enough bone to hold the implant, grafting and augmentation procedures are done to regenerate and improve the lost bone and gums to safely place an implant.

Natural tooth vs. dental implants. -

Natural tooth vs. dental implants. –

Today’s Dental Implants

The modern dental implant is a titanium screw and abutment that is anchored into the jawbone where it serves as a post for custom-made tooth crown. Dental Implants are available in several different designs, addressed according to your specific needs. A single tooth, several teeth or entire arch can be replaced by dental implant.

Dental History

Dental history is an important part in implant treatment. This includes information gathered during mouth examination.

1. Evaluate soft tissue condition.
2. Evaluate remaining teeth condition.
3. Evaluate edentulous areas.
4. Evaluate present occlusion.
5. Evaluate for temporomandibular disorders.
6. Evaluate for parafunctional habits.

Evaluate soft tissue condition for health of periodontium and pathology, location of alveolar and attached mucosa. -

Evaluate soft tissue condition for health of periodontium and pathology, location of alveolar and attached mucosa. –

Dental Implant Contraindications

Dental implant treatment is the ideal treatment option available for any patient. However, there are contraindications to dental implants.

Absolute contraindication are as follows:
1. High dose irradiated patients.
2. Patient with psychiatric problems.
3. Hematologic systemic disorders.

Dental Implant Closure, third dental implant is still visible (mesial to 14)

Dental Implant Closure, third dental implant is still visible (mesial to 14)

Relative contraindications are as follows:
1. Pathology of hard or soft tissues.
2. Recent extraction sites.
3. Patient with drug, alcohol or chewing tobacco abuse.
4. Low dose irradiated patients.
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Dental Implant Indications

Dental implant treatment is the ideal treatment option available for any patient, regardless of sex or age. Indications for dental implant treatment are as follows:
1. edentulous patient
2. partially edentulous patient with history of difficulty in wearing removable partial dentures.
3. patient with missing dentition requiring long span fixed bridge.
4. patient who refuses using removable type prosthesis.

Fully implant supported Fixed Bridge -

Fully implant supported Fixed Bridge –

Other indications are:
1. any edentulous area or severe change in complete denture bearing tissues.
2. poor oral muscular coordination.
3. low tissue tolerance.
4. parafunctional habits that compromise prosthesis stability. Continue reading

Study Casts

In implant dentistry, study casts, a facebow transfer and occlusal registration are essential for treatment planning. The study casts are important for studying the remaining teeth and residual bone and for analyzing the maxillomandibular relationship. The mounted casts can be helpful to the surgeon for implant fixture placement. Angle Class II and Class III situations are more easily evaluated from a centric relation record on the articulator. The directions for mandibular fixture placement can be estimated. In the Angle Class II or III situation, the fixture is situation, the fixture is angled toward the maxillary teeth or risidual ridge. This helps prevent prosthetic problem when fabricating the denture for proper esthetics and function.

A diagnostic wax up can also be done on the study casts or their duplicate. Proposed fixture installation sites can be checked on the study casts for proper alignment, direction, location and relation to the remaining teeth. Diagnostic wax up helps to determine the esthetic placement of teeth and potential functional speech disturbances.

Load Transfer in Dental Implant-Retained Overdentures

In overdentures retained by Locator attachments, the distribution of dental implants had a significant effect on the force measured on the palate of the oral analogue. The measured load was not significantly lower than the eight dental implant design, when the distance between the four dental implants was sixteen or more millimeters, suggesting that the palate of a four dental implant-retained overdenture with a distance of sixteen millimeter or more, does not contribute significantly to the load transfer to underlying hard palate in the in vitro analogue evaluated.

Dental Implant-Retained Maxillary Overdenture

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Dental Implants in Overdentures

Overdenture prosthetic treatment is an alternative to a fully bone supported and retained dentures. It provides an effective, if not superior method of treatment. Overdentures can be advantageous, both functionally and esthetically for patients with post surgical or congenital defects. If defects exist, esthetics can be improved by increasing or decreasing the amount of denture base material.

Overdenture prosthetic treatment

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Fully Implant Supported Denture

The use of dental implants in edentulous patients was first developed by Dr. Per Ingvar Branemark and the type of restorative treatment studied and used was the fully bone anchored denture. After implant placement, healing and subsequent denture insertion, the bone reaches a steady state. This is a balance between forces transmitted through the dentures and implants and bone remodelling capabilities.

Implant Supported Fixed Bridges. Photo credit: Dr. Stephen Almonte

Treatment planning is the most important factor for successful results and is an integral part of good communication between the periodontist and the prosthodontist.
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Tilite Prosthesis in Dental Implantology

Black gums and Allergic Inflammation of gums

This really is frequently triggered by low quality alloy. Lesser quality alloys frequently contain non-refined metallic elements which yield toxic substances throughout formulation. These non-refined metallic elements contain lead, cadmium, iron, mercury along with other undesirable elements.

Porcelain fused to tilite metal fixed partial denture.

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Dental Implant Surgery: Two Stages

The success of a Dental Implant treatment depends on adherence to Dental Implant Surgery principles, the Prosthodontic aspect of the treatment, and proper Dental Implant Maintenance.

There are two types of Dental Implant Surgery according to number of stages; the single stage and the two stage dental implant surgery. The type of surgery may increase or decrease the dental implants cost.
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