Different Dental Implant Systems
As people experience tooth loss, they can turn to dental implants to restore their smiles. The American Association of Implant Dentistry has determined about 500,000 people annually are getting dental implants. As different people look to dental implants for a long-term solution to tooth replacement, the variety of dental implant systems offer the unique solutions for the assortment of patients’ needs.
Dental implants have a 95% success rate which only contributes to the popularity of the procedure. Well over 100 companies produce implants, implant components and implant systems, but the benefits of choosing one of the more popular companies include the years of documented evidence and the ability to maintain or replace components anywhere in the world. Only a few major companies are as well-known and well-respected as Straumann, Zimmer Biomet, Nobel BioCare, MIS, BioHorizon and Dentsply. They provide dental offices with specialized tools and training for their specific components for dentists.
Once you and the dentist have decided a dental implant is the best treatment plan to replace your missing teeth, there are additional decisions to make to ensure that you are getting the best implant for your mouth.
Cement-Retained Abutments or Screw-Retained Implants
First, you will need to decide between cement-retained abutments or screw-retained implants. The dentist will review your individual case and look specifically at the potential for removing your implant crown. A screw-retained implant will remove in a predictable way whereas a cement-retained abutment may damage the crown if the dentist attempts to remove the crown. If you have an implant that is supporting more than one crown, the cement-retained abutment will be even less predictable if the dentist needs to remove the crown. If you have a more sensitive gums, the cement-retained abutments may allow for more inflammation of your gums at the site of the cement. If the inflammation persists long enough, then your mouth may reject your implant. Depending on where your implant is located, the dentist may not be able to use a screw-retained implant.
Custom or Stock Abutments
Next, the dentist will help you choose from custom abutments or stock abutments. Stock abutments come in standard sizes and are usually used for cement-retained abutments. These are ideal when the placement of the crown on the implant is not in a highly visible area because the crown may not be able to sit perfectly on the gumline. On the other hand, custom abutments can be waxed, milled, or adjusted into the perfect shape to match the natural teeth on either side. As you may expect, custom abutments are often more expensive, but the results are more predictable and can be more efficient for the dentist to use. In some cases, stock abutments can be modified in a dental lab, increasing their cost but not necessarily improving their look and fit.
Titanium or Zirconia Implants
Afterward, the dentist will help you choose between titanium implants and zirconia implants. Titanium implants are the most common and allow for the implant to fuse to the jaw bone. Pure titanium is not typically used because it can be too soft to support the implant long term, so a titanium alloy is used for biocompatibility and strength. Some people are sensitive or even allergic to the additional metals in the alloy so zirconium implants are the ideal solution. Zirconium implants are good options for people who want to avoid implanting metal in their bodies; the predominantly ceramic based material performs like titanium in strength and its ability to fuse with the jawbone.
Types of Crowns for Custom Abutments
The crown, or false tooth, can be made from a variety of materials depending on the where the tooth is located in your mouth and the look you are trying to achieve. Most people choose between gold, ceramic, and ceramic metal mix. The gold crowns are actually made of a mixture of gold and other metals. All ceramic crowns are referred to as IPS e.max and zirconia. Ceramic metal mix crowns are referred to as PFM. Depending on the material of the crown, the dentist will choose the best way to attach the crown to the implant.
Gold and PFM crowns are held in place best with temporary cement. If you are replacing a missing tooth in tight space in your mouth or near other crowns, then the dentist may recommend using gold or PFM. If the crown is placed in your mouth where you tend to bite down hard or chew heavily, then the PFM crown will need metal bite stops to add strength. Unfortunately, both gold PFM crowns are not ideal for natural looking teeth and PFM crowns are noticeably different along the gum line.
When you have talked to the dentist about a custom ceramic abutments, IPS e.max crowns can be held in place with resin cement. This technique helps reduce the risk of fracturing, however, resin cement is limited in how far it can be placed below the gums before it causes problems for the implant over time. Zirconia crowns are the newest technology but they are without long term research. The effects of zirconia crowns on the surrounding teeth’s enamel is not known. Dentists can use full zirconia for the crown or they can layer the zirconia over other material but the layered crown will need more space between the upper and lower jaw when you bite down. The most natural looking crown is the full zirconia crown, but the results vary from technician to technician. The person creating your crown will use the shape, size and color of your surrounding teeth to ensure the crown seamlessly fits in your smile. The dentist will also look to the crown to fit along your gumline with your natural teeth on either side.
Depending on the look you are trying to achieve, the location of your missing tooth in your mouth and whether the implant is cement-retained or screw-retained, the dentist can recommend an appropriate material for your custom crown.
Model or Model-less Restorations
In order to replace your missing teeth with a crown that fits in its place and functions like the tooth it replaced, the dentist will use a dental impression traditionally. If the dentist is working to achieve a good impression, then the dentist will need to have the training, practice, and experience to ensure good results for your dental implant. As digital technology has improved, dentists have been able to use the improvements to provide the dental lab with complete data from your whole mouth. Each intraoral scanner operates differently depending on the brand, but the results are image files for dental labs to generate models or restorations. The labs will use polyurethane or resin for the models or they will create computer graphic designs of full restorations.
Full Zirconia Implant Retained Prosthesis
If you are looking to replace all your teeth and not just one or two, there are a number of considerations to keep in mind before deciding on the best type of implant and prosthetic tooth. First, the dentist will need to review the results of your CT scan to determine the health and strength of your jawbone. After the dentist confirms the location of your nervous tissue and blood vessels, the dentist can start to decide the ideal placement and number of implants for your mouth. When the implants are placed properly, you will have secured bridges or dentures that offer an even bite with full functionality.
When you start to talk to the dentist about using dental implants instead of dentures to replace your missing teeth, the dentist will first perform a cone beam CT scan or CBCT scan. With the results of the scan, the dentist will be able to see the specifics your mouth to start planning a successful treatment plan. Some people may need bone grafts, tissue grafts, or both to provide a strong base for the implants. Your unique jaw will have its own ideal angles, lengths and widths of implants for the best results. If you already have dentures or a bridge you would like to keep, the dentist may be able to make adjustments to that prosthesis or use the prosthesis as a base for your improved smile.
When you are discussing the process of dental implants with the dentist, you will have to determine what the ideal combination of materials and components will give you the results you are hoping to achieve. Be sure to talk to the dentist about the different combinations and the realistic results of that combination. Your procedure can be adjusted based on whether you have a short arch or full arch, partial denture or full jaw, or if you have too much space between your implants and your crowns. The dentist can move the implant placements, offer gum tissue grafting, and other small adjustments to give you a natural look and feel with your new smile. If you are trying to achieve a specific look based on your original natural teeth or a specific smile, be sure to bring photos to the dentist to help get you close to your vision.