Dental Implant Systems
Dental implants are a popular treatment for addressing a missing tooth or multiple teeth. What many people do not realize, however, is that there are many different types of dental implant systems available to address a range of needs. The first step to determine which dental implant system(s) may be a good solution for your needs is to schedule a consultation with your periodontist. During this consultation, they will perform a thorough examination of your overall oral and physical health, which will include diagnostic exams to determine the health and density of your jawbone.
Due to advancements in dental technologies and surgical techniques, there are now a variety of dental implant systems that can be implemented to meet a variety of unique patient needs and treatment goals and to improve patient outcomes. Thanks to subtle changes in factors such as implant length, width, shape, and surface texture, the process of placing dental implants has never been safer or provided such natural looking, durable results.
There are several different types of dental implant systems available to meet a range of needs. These systems range with regards to the type of technology used to place the implants, surgical procedural steps, and the materials used for the implants. To learn more about these different systems and which one may be right for you, please refer to the following.
Cement-Retained Vs. Screw-Retained Implants
One example of two distinct dental implant systems is cement retained versus screw-retained dental implants. Factors to keep in mind when deciding between cement-retained versus screw-retained implants include:
- Retrievability: While it is unlikely that the dental implant and/or implant crown will fail, there are times when temporarily removing the implant crown will be necessary. While there are some dental cements that allow for greater retrievability of a crown should this be necessary, they also provide inferior support. Screw-retained implants, on the other hand, are far easier to retrieve, especially if multiple abutments are necessary.
- Procedural Risks: Use of dental cement carries the risk, though small, of excess cement reaching the sulcus, which can damage the implant tissues and increase one’s risk of developing peri-implantitis, a condition that, if left untreated, can result in implant failure. While there are effective techniques for removing this cement, screw-retained crowns completely eliminate this possibility and can be easily removed for cleaning and maintenance.
- Difficulty of placement: Compared to using dental cement, a screw-retained implant crown is much more difficult to insert, especially if multiple restorations are being fit, and will require several additional steps to ensure the fit is correct and that no stress is placed on the implant.
- Cost: The cost of screw retained is typically higher than cement-retained implants.
Stock Abutments Vs. Custom Abutments
Another important example of different dental implant systems and their associated benefits and drawbacks is stock abutments versus custom abutments. For patients whose primary concern is that the aesthetic appearance of their dental implant look as natural as possible, a custom abutment is generally recommended.
Stock abutments are designed by dental implant companies to be standard sized, usable for most tissue and bone level implants, and easy to take impressions. Stock abutments are generally a more cost-effective option and are used for cement retained restorations. While stock abutments can provide excellent results at an affordable price, they are not ideal for use in the aesthetic zone, due to the fact that the tissue conforms to the shape of the abutment. Additionally, the height of the abutment and depth of the implant determines the margin placement of the crown, resulting in the need for additional alterations in order to achieve the correct emergence profile and fit.
Though typically a more expensive treatment option, custom abutments provide superior tissue management and more consistent aesthetically desired results. Custom abutments can be made from zirconia or titanium, be milled or waxed to fit the desired shape, and can be used for tissue level and bone level implants. Custom abutments work equally well with cemented crowns and screw retained crowns. While custom abutments are often the more expensive option, there are instances when they are actually more cost affordable, due to the money that is saved on clinical resources used during the fitting process along with associated lab fees necessary to modifying stock abutments.
Titanium Vs. Zirconia
Titanium implants have historically been the preferred material type; however, zirconia has recently increased in popularity. One of the biggest reasons titanium has been the industry standard for dental implants is due to the materials biocompatibility in naturally fusing with the bone. Titanium is also a popular treatment option given its success rate of over 95%. Although pure titanium used to be the industry standard, over time an alloy was developed that offered improved strength while still maintaining the biocompatible properties that made titanium such an effective implant solution. While this alloy is an effective solution for most patients, there are approximately 5% of patients who will have a sensitivity or allergic reaction to one of the metals used in this alloy and/or concerns at the thought of having a metal placed in their body.
Given the possibility of an allergic reaction, sensitivity, or concern over the use of this alloy, zirconium implants (which are metal-free) have recently grown in popularity. Like titanium, zirconia is also able to naturally osseointegrate and provides a strong and durable solution.
One of the big uncertainties about zirconia is its long-term durability. Where titanium has a proven track record spanning decades of use in implant success, that data is not available for
zirconia implants yet.
Another important difference between these two type of implants is their design. Titanium implants offer greater flexibility in surgical placement and treatment planning, can be used to support overdentures and fixed restorations, and can be fabricated as one or two pieces. Zirconium implants, on the other hand, are one single piece and must be cemented in place. Zirconium implants also require greater care when being placed, as there is much less room for error.
While more difficult to place and limited in procedural flexibility, there are several benefits to using zirconia dental implants, such as the fact that the material will not corrode. Additionally, there is no risk of metal showing through the gum line, which, though rare, can occur with titanium implants, especially among patients who have thin gums. While titanium implants continue to be the industry standard, given their history of providing stable, effective results, for patients who have metal allergies and/or are concerned about the aesthetic appearance of their implant, zirconia implants can be a viable treatment alternative.
Benefits and Drawbacks of Model-less Restorations
Dental impressions have historically been one of the most essential components to achieving a restoration that looks and feels natural and has strong durability. While a good impression can result in a life-changing restoration free of complications, an impression that is not designed correctly can result in a restoration that causes oral health issues to develop and a restoration to feel unnatural and function improperly.
Thanks to advancements in digital technology over the last few years, many of the issues attributed to poor dental impressions have been eliminated due to the use of intraoral scanners. These systems make it possible to fabricate precise restorations by collecting digital data by scanning the full mouth. These digital impressions can then be sent to a lab, after which they are used to create resin or polyurethane models which are then used to fabricate the restoration. Another option is for these digital impressions to be inputted into a CAD/CAM program, which then creates designs for the restoration.
The benefits and drawbacks of these type of approaches include the following:
- Cost: From the perspective of a clinic, the cost of investing in digital scanning technology is a considerable one, which means the clinic will have to recuperate this cost either through increasing the cost of treatment or by saving money in the cost of lab bills, supplies, and impression materials. While the patient may incur additional costs through the use of these digital scanners, knowing that these scans will be used to inform their treatment plan and increase the precision of their restoration should make the added costs seem like money well spent.
- Accuracy: According to studies, model-less restorations have as high if not a higher degree of accuracy compared to conventional impressions. Additionally, crowns are found to have a better fit.
- Procedural experience: Many patients prefer the digital restoration process, especially patients who have a small mouth and/or strong gag reflex, as the scanning process is less invasive and can be stopped at any moment.
- Time: One of the biggest benefits to model-less impressions is that they significantly reduce the time required to complete the dental implant process. Because the files are sent digitally, the time spent waiting for the impressions to be sent directly to the laboratory is eliminated. Additionally, the heightened accuracy of the impression ensures that there is less procedural time required and fewer remakes necessary to ensure the fit of the implant is correct. Finally, the quality of the preparation can be monitored digitally and a new impression can be taken immediately should any issues be identified, compared to conventional impressions, which would require an entire new impression be made, extending the dental implant process even longer.