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Rationale for dental implants /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit ,or call

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  • 1. INDIAN DENTAL ACADEMY Leader in continuing dental education Rationale for dental implants
  • 2. Introduction One of the most significant advances in restorative dentistry is the replacement of lost natural teeth by an implant. Two decades ago a majority of dentists were skeptical about implants and rejected them. Today's situation is reversed. Tomorrow implants will be the workhorse of restorative dental practice. Today’s journal club is from the British Dental Journal, vol:2000; no.12, june24, 2006. This article is the first amongst the 16 articles which we propose to discuss in the on coming journal clubs, so as to have a brief & clear overview of dental implants.
  • 3. Rationale means “reason” or “underlying principle”. This article ‘Rationale for dental implants’ authored by S.Jivraj & W. Chee, form the University of Southern California, School of dentistry, emphasizes the various factors to prove the superiority of dental implants over conventional treatments to replace lost natural teeth.
  • 4. 1. 2. 3. 4. Implant dentistry has enjoyed great progressive development in the recent years. The areas of development can be listed as: Development of new implant systems Improved diagnostic procedures Novel surgical techniques Introduction of state of art CAD-CAM technology (to improve prosthodontic precision of fit & allow restoration of implants in nonideal positions) Osseointegration is a well predicted phenomenon with the present day implants. Successful osseointegration is not a sole representative of success of an implant.
  • 5.      The implant is deemed a success when the definitive restoration restores the patient – Tatum The normal contour The normal function Esthetics Speech Health Clinical success has been obtained with the use of implant therapy in edentulous & partially edentulous patients. The implant therapy has greater advantages over conventional, fixed or removable treatment options. But many clinicians still choose to prepare the teeth for an FPD than to go for implant therapy.
  • 6. Tooth structure has to be significantly reduced with FPD’s to obtain esthetics. Such reduction can predispose to endodontic and periodontal problems. The factors which contribute to the need of implant supported restorations are divided into four groups. 1. 2. 3. 4. Preservation of tooth structure Preservation of bone Provision of additional support Resistance to disease
  • 7. Preservation of tooth structure Before implant therapy, FPD’s were considered as the common mode of treatment. But failures of FPD’s are supported by long term studies. Studies conducted by Walton TR, has shown 87% of success of FPD at 10 years & 69% at 15 years. Failures were also due to nonvital anterior abutments, pier abutments and pulp capped teeth. Studies compiled by Goodacre from 19811997 on clinical complications of osseointegrated implants related complications due to:
  • 8. Type of prosthesis  Length of the implant  Bone quality  Arch  Time When compared to other prosthetic designs implant single crowns had the lowest failure rate at 2.7%. The present article concentrates on the complications related to single tooth implants omitting the other factors. Most of the failures of implant supported restorations occurred during the first year & implant loss was significantly lower in the second & the third year. 
  • 9. The restoration that has passed the first year of service is likely to survive a considerable length of time. Studies conducted by Zarb, Hass & Henry on single unit implant restorations have demonstrated 96.5% success rate over a period of 11 years. There are no reports regarding the loss of adjacent teeth when single tooth implant restorations have been undertaken, but this is not the case with the FPD.
  • 10. Preservation of bone o o o o There exists a close relationship between the tooth & the bone. A change occurs in the bone if its function is altered, & to maintain that, bone requires stimulation. Pietrokvoski, stated that after tooth loss, lack of stimulation occurs which causes, A decrease in bone trabeculae Decreased bone density Loss of width Loss of height
  • 11. After a 25 year study it was found that a four fold greater loss was seen in the maxilla than in the mandible. Bone loss was seen antero-posterioly in the maxilla & downwards and laterally in the mandible. This usually results in a class III skeletal relationship. Due to this, the maxillary molars are more facially placed & the mandibular molars are more lingually positioned. The literature concludes that if the teeth are lost the bone is not stimulated which results in bone loss. Usually a partial or complete denture cannot maintain the bone & may also increase the bone loss if it is ill – fitting. These patients must be informed about this during extraction.
  • 12.
  • 13. Continued bone loss decrease retention & stability. Soft tissue changes like loss of facial support & VD can affect the overall esthetics. After a severe bone loss, if the patient desires implant therapy, surgical procedures like iliac crest grafting must be performed. Placement of dental implants stimulates & preserves bone, thereby maintaining the function & esthetics.
  • 14.
  • 15. Provision of additional support Dental implants provide additional support by improving the masticatory performance. Normally a patient who grinds or clenches exerts up to 1000psi of force. In an edentulous patient the force is reduced to about 50psi. Carr & Laney stated that if a patient is edentulous for a longer time they generate less force. This state can also affect the overall health of the patient.
  • 16. When compared with complete denture prostheses implant supported fixed prostheses results in increased bite force similar to that of a fixed restoration. RPD’s do not provide posterior support, due to resiliency and like effect, whereas dental implants provide. One more advantage of implant supported restoration is “retrievability”. It is advantageous when reservicing, replacement or salvaging of an implant is considered. It is considered as a safety factor during:  loosening of the retaining screw  # of porcelain  # of an abutment and  Modification of the prostheses through loss of an implant.
  • 17. Implant restorations can be:  Screw retained  Cement retained  Combination of both Screw retained prostheses are easily retrieved and it is the authors preference whenever possible.
  • 18. Resistance to disease Patients who are susceptible to disease should be carefully evaluated before the treatment plan. Elderly patients are on many drugs which can alter the salivary flow leading to root surface caries. In such patients decision must be made on long term basis whether to preserve the teeth or use dental implants.
  • 19. Waerhaug, Wilding & Shugars studied the various periodontal changes in a partial denture wearer & concluded that patients wearing RPD have:      Greater mobility of the abutment teeth Greater plaque accumulation Increased bleeding on probing More incidence of caries Accelerated bone loss in the edentulous regions Dental implants are resistant to disease as they are not susceptible to dental caries & also preserve the adjacent teeth.
  • 20.
  • 21. With the traditional treatment options available, decision has to be made as to when extraction & implant placement can be done which can alter the treatment planning process. There are two schools of thought, of which one implies on a traditional treatment, whereas the other advocates extraction of a compromised tooth & replacing it with an implant in patients who are prone to caries.
  • 22. Summary Completely edentulous & partially edentulous conditions are treated with complete dentures & removable partial dentures respectively. The decreased masticatory efficiency of these prostheses when compared with that of a natural dentition is well documented. Furthermore these prostheses also causes progressive resorption of bone. The implant supported prostheses offers predictable solutions than the conventional prostheses. “These patients can enjoy a better quality of life”.
  • 23. In a nut shell…..  Dental implants are a more conservative long term option than long span bridges  Placement of dental implants serves to preserve bone  Dental implants can provide long term posterior support than RPD’s  Dental implants are resistant to disease
  • 24. Next article The next article in this series will focus on treatment planning of implants in the posterior quadrants.
  • 25.