Different Dental Implant Systems
Dental implants are a safe and popular choice for patients who need to replace one or more missing teeth and are healthy enough to endure implant placement surgery. Implants need up to six months of healing time so patients need to be aware of the limitations they will need to adhere to during that time. Dental implants have a success rate between 95% and 97% and are a secure, natural-looking way to restore your smile!
During your implant consultation, your dentist will evaluate the area to be treated and speak with you about your lifestyle and habits before they determine what type of implant system will be appropriate for you. Most dentists have a specific system that they prefer to work with but will use whatever system will be best for your individual case.
Top Implant Systems
The following are the six most respected and well-known companies that produce widely used implant systems:
* Nobel BioCare
* BioHorizon
* Dentsply
* Straumann
* Zimmer Biomet
* MIS
Throughout the world, there are over 100 manufacturing companies that produce implant parts, opting for a system fabricated by one of the top companies can be beneficial down the road. Dentists and dental labs the world over are more likely to be familiar with the more popular implant systems and are therefore able provide emergency service to patients that may be unable to get to their personal dentist. A generic implant system from a lesser known company may come at a lower price point but if you break part of your implant or develop a problem that requires immediate attention, a dentist and their preferred lab will be much more likely to have the necessary tools to treat you if parts from one of the top companies was used.
If you are considering a dental implant restoration, speak with your dentist to learn what types of systems they use in their practice before you begin researching on your own. The six companies listed above make high-quality implant systems with the necessary biomechanical properties which are thoroughly researched to give patients the best possible chance of success with their implant treatment. Osseointegration is the process of the implant fusing with the jaw bone and is crucial for an implant to succeed. A high-quality implant has a rough finish that allows for osteoblastic cells to adhere to and create that necessary fusion.
Types of Implant Abutments
An abutment is a piece of the implant system that acts as the bridge between the implant and the implant restoration. The restoration is the visible part of the implant, the fake tooth, and can be either a crown, bridge, partial or full denture. The restoration can either be screwed or cemented in place, your dentist will determine which type is best for your individual case. The abutment your dentist uses can be a stock abutment or a custom made abutment.
Cementable vs Screw-Retained Implant Abutments
When determining what type of restoration to place, factors your doctor will take into consideration include ease-of-use, retrievability, peri-implant issues, and whether or not it is suitable for angled implants.
Ease of use
Cement-retained implant restorations are generally easier to work with than screw-retained. A cement-retained restoration is placed much the same as a crown or bridge being cemented onto a prepared tooth. A screw-retained restoration requires additional steps to ensure a proper fit and tension before the restoration is screwed down.
Retrievability
In the event that an implant restoration needs to be replaced due to fracture or other damage, certain cements can make removing the old restoration more difficult than others. A screw-retained restoration is more predictable and easier to remove than cement-retained. There are cements available that make it easier for your dentist to remove the restoration or they may choose to use a temporary cement, none of which are not as secure as a screw.
Maintaining peri-implant tissue
When cement is used to place a dental restoration, there is always a risk that excess cement can extrude into the gum pocket around the tooth and cause damage to the gum tissue surrounding the implant. If excess cement is not completely removed, it can pose an increased risk of irritation, swelling, and discomfort at the implant site. Your dentist will take a postoperative x-ray which will show any cement that has seeped into the gum pocket to ensure no excess cement is left behind. Using a screw retained restoration avoids that risk altogether.
Use with angled implants
One drawback with a screw retained restoration is that they are not ideal for front teeth. A screw retained restoration requires an access hole that is drilled through the prosthetic tooth. The hole is filled with composite material, like when you get a filling, to hide the hole and protect the screw. This is not easily done on front teeth so dentists often choose to use a cement retained restoration.
Stock Abutments vs Custom Abutments
Generally, a stock abutment can be used but sometimes a case may require a custom abutment. Your dentist will decide which type will be best for your individual case.
Custom abutments
A custom abutment can be used for either cementable or screw retained implant restorations and can be made from titanium or zirconia. Custom abutments are more expensive but allow for better tissue management and have a more predictable outcome. A dental lab will fabricate a custom abutment at the same time they fabricate your restoration using a model of your teeth provided by your dentist. Your dentist will make the model from impressions they take of your mouth.
Stock abutments
Stock abutments have the benefit of being easily replaced by any dentist in the event that you have an emergency and are unable to see your dentist. If you are out of town and break your restoration and the abutment, a different dentist would be able to replace a stock abutment more readily than they could a custom abutment. Stock abutments are much more user-friendly and can be either cement or screw-retained.
The gum tissue around the abutment will conform to the shape of the abutment so since stock abutments are a standard size and may not be suitable for your gum tissue in which case your dentist would opt for a custom abutment. It is important that the margins of your implant restoration make good contact with neighboring teeth so you may need some adjustments to be sure you can floss properly but also that the contacts are tight enough to prevent a food trap.
Types of Implants
There are two types of implants available to patients and dentists, titanium and zirconia. Your dentist will review your options and together, you will determine which type will best suit your individual needs and lifestyle. Zirconia implants are becoming popular, especially in patients with metal allergies.
Titanium Implants
Titanium implants have been utilized since the 1960s and have optimal biocompatibility and a 95%-97% success rate. Biocompatibility is crucial for implants to be able to integrate with jaw bone structure. Titanium implants have a rough finish which allows for osteoblastic cells to adhere to the surface of the implant and create the necessary fusion between implant and jaw bone for a stable foundation for the implant restoration.
Titanium implants are able to support all implant restorations including implant-supported dentures. If you have a metal sensitivity or other concerns about titanium implants, speak to your doctor about zirconia implants.
Zirconia Implants
Zirconia implants have not been around as long as titanium implants, about 12 years, so they do not have the recorded long-term success rate of titanium implants. Zirconia implants are an excellent option for patients with metal sensitivities though they do contain trace amounts of hafnium and yttruim which are incorporated to improve its biocompatibility properties. Zirconia implants are able to integrate with your bone similarly to titanium and are still very strong even though they are composed mostly of ceramic material.
Zirconia implants are fabricated as a single piece and are more challenging to place so bone density will be a major determining factor when your dentist is deciding what type of implant is appropriate for you. One big benefit to zirconia implants is the fact that there is no metal that can risk showing through the gumline, though this rarely happens with titanium implants unless the patient develops gum disease and gum recession. It should also be noted that any restoration on a zirconia implant must be cemented in place, it cannot be screw retained.
Types of Implant Crowns
There are a number of materials available to fabricate implant crowns though most patients prefer ceramic or porcelain since it is the most natural-looking and can be tinted to match the rest of their teeth! Along with ceramic and porcelain, mplant crowns can be fabricated from gold or other base metals, porcelain fused to metal (PFM),e-max, or zirconia.
Crowns made from gold or metals and PFM crowns are much stronger and more durable than their porcelain and ceramic counterparts. The drawback to a PFM crown is the risk of metal eventually showing through the outer porcelain layer as they age.