Multiple Dental Implants

Implant Supported Bridge is an optimum solution for multiple missing teeth. Implant supported dental bridge stays secure and strong. It is comfortable, natural and look like natural dentition.

Dental Implant supported bridge have the following advantages:

  • It looks, feels and performs similar to natural teeth.
  • Sound adjacent teeth are not compromised to support a bridge.
  • Preserves sorrounding bone.
  • Dental bridge attached securely to dental implants.
  • It prevents resorption of bone.
  • Recurrent wear around abutment is eliminated.
  • Seld esteem of the patient is improved.

Dental Implants will maintain surrounding bone and soft tissue, as well as replace missing teeth.

Dental Implant Maintenance

Poor oral hygiene is related to marginal bone loss. Proper hygiene is critical so the patient should understand the importance of plaque control. Dental implant maintenance is tedious and requires effort. The dentist should help evaluate devices which best suit the patient’s needs.

An implant brush is the most important tool for plaque control. A soft bristle brush type is effective for cleaning the abutment and prosthesis. It is used at the gingiva-abutment junction. Appropriate size of dental implant brush should be chosen to fit into the space between fully anchored denture and gingiva. The size should be comfortable for the patient.

Two filament dental implant brush with extra narrow brush head and flexible head

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Dental Implant Procedure Appointment Sequence

Appointment sequence for dental implant procedure

1. Examination and diagnosis.
2. Treatment planning.
3. First surgery, fixture installation.
4. Suture removal one week post surgery.
5. Soft denture reline insertion two weeks post surgery.
6. Relining procedures once a week for first month, then once every two to three weeks. Healing period is three to four months for mandible and four to six month for maxilla.
7. Second surgery, abutment connection.
8. Suture removal one week post-surgery.
9. Prosthesis insertion two weeks post surgery. Oral hygiene final instructions.
10. Regular recall appointments, one, three, six and twelve month time intervals. Remove and clean a free standing fixed partial denture once a year.

Hobo S, Ichida E, Garcia L T: Osseointegration and Occlusal Rehabilitation, Quintessence Publishing Co., Ltd. 1989

Artificial Gingiva in Dental Implants

These are functional and esthetic problems that can be solved by prosthetic gingival reconstruction in Dental Implants:
1. Narrow and longer prosthetic teeth.
2. Inverted smile line.
3. Misalignment of the tooth axes.
4. Unsupported lip profile.

Individual papilla loss and situations of horizontal and vertical tissue dificiencies of the anterior region are some of surgical limitations of augmentation that can be solved by prosthetic gingiva.

Wax-up of Implant Supported Prosthesis with Artificial Gingiva

Post-operative Intructions for Dental Implant Patients

A list of post-surgery instructions should be given to dental implant patients. It is important to describe all post surgery home care instructions for the patients to follow.

It is important to follow the directions during the first 2 weeks after the operation to insure adequate healing.

1. Do not rinse your mouth vigorously during the first 24 hours after the operation.
2. Use ice packs over the surgical area for 20 minutes at a time, during the first 2 days after the operation.
3. If nose bleeding starts, do not blow your nose vigorously.
4. Maintain a liquid diet for the first 5 days after the operation. Do not smoke or consume alcoholic beverages during the first week.
5. Two weeks after the operation, begin a soft diet and restrict smoking and alcoholic consumption.
6. Use an elevates head rest or an extra pillow for the first 2 nights after the operation.
7. If bleeding begins in the surgical area, apply gentle pressure to the area by biting on a roll of gauze for 1 hour. If bleeding does not stop, please contact Dr. _______.
8. Rinse your mouth thoroughly with a salt water rinse or prescribed mouth rinse after every meal.
9. Do not use prosthesis until it has been relined.
10. Follow the directions carefully for any prescribed medications.
11. If you have any questions or any problems related to the healing of your operation, please contact Dr. _______.

Dental Implant Surgery Indications

Indications for Dental Implant Treatment

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 partial denture (bridge) treatment.
4. Patient who refuses using removable type dental prosthesis.

Hobo S, Ichida E, Garcia L T: Osseointegration and Occlusal Rehabilitation, Quintessence Publishing Co., Ltd. 1989

Divisions of Available Bone for Dental Implants

There are four divisions of available bone based on width, height, length, angulation and crown height in the edentulous site.

1. Division A edentulous ridge offer abundant bone in all dimensions.
2. Division B bone may provide adequate width for narrower, small diameter root form endosteal implants.
3. Division C edentulous ridge exhibits moderate resorption and presents more limiting factors for predictable endosteal implants.
4. Division D edentulous ridge basal bone loss and severe atrophy, resulting in dehiscent mandibular canals or a completely flat maxilla.

Misch CE: Dental Implant Prosthetics, Mosby Inc 2005

Mini Dental Implants

Mini Dental Implants (Small Diameter Implants)

Mini Dental Implants, also known as Small Diameter Implants are commonly used to improve the retention of Lower Complete Denture. It was designed as temporary, but nowadays it can provide long term service inside the patient’s mouth. It can provide long-term full denture stabilization, partial denture stabilization, long term fixation of single crown and dental bridges. SDI (Small Diameter Implants) are also used in other fields of Dentistry, especially in Orthodontics.

Irradiation of Bone with Dental Implants

Radiation therapy is defined as the therapeutic use of ionizing radiation. The 2 principal types of ionizing radiation are electromagnetic irradiation and particle irradiation. In irradiation of implants in bone, it is recommended the removal of all abutments and superstructures and closure of skin and mucosa over the implants prior to radiation. [1] Radiation therapy can begin when healing is complete.

Irradiation of dental implants in bone results in backscatter. The tissues on the radiation source side of the implants receive a higher dose than the other tissues in the field. The dose in increased by about 15% at 1 mm from the dental implant. [2]

1. Granstrom G, Tjellstrom A, ALbrektsson T: Postimplantation irradiation for head and neck cancer treatment. Int J Oral Maxillofacial Implants 1993;8(4):495-500.
2. Wall JA, Burkee EA: Gamma dose distribution at and near the the interface of different materials. IEEE Trans Nucl Sci 1970; 17:305.