Dental implants: Our experience and expertise

Abisheik Johnson Babu

Oral and Maxillofacial Surgeon, Kauvery Hospital, Trichy

Background

Anterior teeth are usually replaced soon due to aesthetic reasons. Posterior teeth are more often neglected. When an upper or lower first molar is missing, the opposite molar gets supra erupted, adjacent teeth get mesially and distally tilted, causing chewing difficulty on the same side. When this is neglected, the individual starts using the opposite side only for chewing which causes damage and decay of the opposite side teeth

Importance of tooth Replacement

Replacement Options

Removable Partial Denture – RPD: It is a removable option. The claps are given in metal, which damages the adjacent teeth. Food entrapment happens between the denture and teeth which needs meticulous cleaning and maintenance. The palatal acrylic plate prevents from tasting the food.

Fixed Partial Denture – FPD: fixed option. Definitely a better option than RPD, but need to sacrifice the adjacent teeth to replace one tooth. Over a period, spaces develop between the lower surface of the FPD and the gums causing food entrapment

Complete Dentures – CD: Fully edentulous patients. Good total teeth replacement option. Removable option. Needs meticulous cleaning after every meal. Bone loss occurs over a period of time, causing ill-fitting dentures. Need replacement once the denture becomes lose. Lower denture is always ill fitting and lose due to presence tongue and saliva.

Dental Implants

It was a more versatile fixed option. Replaces only the missing teeth with no additional attachments. No bone loss in due course of time as bone grows around the implant due to osseointegration. Implants work as the roots of the tooth holding the crown in position and bearing the masticatory forces while chewing.

RPD

FPD

Complete Denture

Dental Implants

Scenarios in Dental Implants

Partially Edentulous Areas
Aesthetic Zones
Implant Over denture
All on 4 & All on 6 Fixed Hybrid Denture
Patient Specific Implant – PSI
Zygoma Implant

Partially Edentulous Spaces

The extraction of root stumps are performed and implants placed immediately. Implants are placed in a tilted manner so as to anchor a larger surface area and provide more support. Axial implants are placed on the other side. Screw retained porcelain fused to metal restoration was given after 4 months.

Aesthetic Zone

The patient c/o upper and lower anterior crowding. He was found to have anterior cross bite, wanted a quicker solution, and was not willing for Orthodontic alignment of teeth for want of time.

Upper and lower anterior teeth 11,21,22,32,31,41,42 were extracted and immediate implants were placed. Immediate temporization was also done. Final prosthesis was done after 6 months of osseointegration. The final prosthesis corrected the anterior crossbite and the malocclusion and also was saved time

Implant Over-denture

It is semi fixed option with two anterior implants. Stabilizes the ill-fitting lower denture. A bar is connected between the two implants over which the lower denture rests preventing it from micro movements during speech and swallowing. Like a regular denture, needs to be removed at night and cleaned meticulously after every meal.

Treatment concepts based on Zones of Maxilla Bedrossian et al, IJOMI 2010; 1213 – 1221

Presence of Bone	Surgical Approach
Zone I, II, III	Traditional – Axial All on Six
Zone I, II	All on Four
Zone I	Axial + 2 Zygomatic Implants
Insufficient Bone	4 Zygomatic Implants

All on 4 technique – Dr Paulo Malo

All on 6, All on 4 – 4 or 6 implants are placed per arch depending upon the bone availability. The implants are splinted together to make a metal based bar. The teeth are fabricated on the bar and the bar is screwed to the implants. This kind of full mouth rehabilitation is fixed and more comfortable to the patient. Avoids the palatal plate enabling the patient to taste food. Needs an yearly check up and review to monitor the maintenance of the denture.

Complete Denture Wearer for the past 3 years

Case presentation: Patient Specific Implant – PSI

A 42 years old female patient with a chief complaints of multiple loose teeth, Proclined upper and lower front teeth with chewing difficulty. Mobile fixed partial denture

Procedure – PSI

Patient Specific Implant: Multiple mobile teeth and poor bone in maxilla making even an All on 4 difficult. 3D scan of the maxilla mandible is done. 3D stereolithographic model of the maxilla is taken. Patient specific implant is designed in the 3D model and fabricated in titanium. Patient is taken under GA and PSI is plated and screwed in the maxilla. All on 4 was performed in the mandible. A fixed hybrid denture was fabricated and delivered.

The Zygoma Technique

A chronic periodontitis in both the arches. Total extraction was done and all on 4 with 2 Zygoma implants was done in maxilla, All on 6 was done in mandible. Healing period of 3 months. Final prosthesis given with hybrid denture.

Branemark

Remote implant anchorage for the rehabilitation of maxillary defects – J Prosthet Dent 2001 ; 86, 377 – 381
97% success 5 – 10 years follow up 164 implants

Malavez et al

Clinical outcome of 103 consecutive Zygoma implants – Clin Oral Implant Research v. 15, 18 -22, 2004
100% success 6 – 48 months follow up 103 implants.

Zygoma Implant

A 30 years old female patient with chief complaints of multiple loose teeth and ill-fitting fixed bridge, Inability to chew food Unable to attend social gatherings and Halitosis

Jig Trial

Jaw Relation

Wax Trial

Before After

Future Mission

Digital Dentistry Era: digital scanning which we started for crowns and implants work.

Statistics

Single Implants	Implant Bridges	Implant Over Denture	Full Arch Implants	PSI and Zygoma
106	73	62	147	09

Failures

Single Implants	Implant Bridges	Implant Over Denture	Full Arch Implants	PSI and Zygoma
06	02	04	04	Nil

Success Rate – 96

Single Implants	Implant Bridges	Implant Over Denture	Full Arch Implants	PSI and Zygoma
94.33	97.26	93.54	97.27	100

Conclusion

We conclude, by saying that seeing all the options for teeth replacement, dental implants have found to be the best and more versatile. Hence, we use dental implants in all kinds of situations and have a good success rate.

Acknowledgment

Dencity – Our Team

Dr V Iyappan Shankar
Dr M Raj Mohan
Dr S Thayumanavan
Dr D Abishiek Johnson Babu
Dr R Pandiyan
Dr Arif Salman
Dr Abby Abraham.

Dr. Abisheik Johnson Babu
Oral and Maxillofacial Surgeon

Dental implants: Our experience and expertise

Dental implants: Our experience and expertise

Abisheik Johnson Babu

Journals