Newer Technologies Opening Implant Landscape
CHARLOTTE - New designs and technologies continue to modify implant options, according to a speaker at the ?Updates in Contemporary Dentistry Meeting? held here recently. Dental Learning Advisory Board Member Scott Parker, DDS, reviewed the history of the implant process, reviewed the types of available implants, and discussed final restorative placement.
The key to practicing good dentistry, Parker said, ?is finding what motivates you and offering that to your patients.? Parker noted that implants are quickly becoming the standard of care for missing teeth.
Implants have progressed through various forms, including blade, root, endosseous, and others. Parker said that nearly all implants today are root form implants made from various high grades of titanium, and that studies are under way to produce commercially available zirconium implants in the United States.
Implant surface technology has also changed over the years, encompassing grit blasting and thermal acid etchings. Even the connections for the implants have changed.The purpose of the connector is two-fold: it securely stabilizes the prosthetic component and facilitates easy placement. Unfortunately, these connectors can have small movements due to poorly-fitting connector-implant junctions, which results in cratering of the bone around the implant. This phenomenon is expected and accepted as normal, but has been found in studies to be assocaited with increased inflammation and an increase in infammatory cells. In a European study of more than 11,000 platform-switching implants, the overall failure rate was about 2.3%; these failures were largely the result of a lack of osseointegration and peri-implantitis; three-quarters of these failures were pre-restoration.
Because of the potential for implant failures and cratering, Parker pointed out that a connector without microgaps - and therefore no micromovement - would be ideal. He mentioned the Ankylos implant (DENTSPLY Tulsa Dental), which features a Morse taper, one of the strongest mechanical connections in engineering. He said that because the implant/abutment surface area is high, there is less micromovement, hence no rocking or rotation, basically eliminating the potential for bacteria to accumulate there. The process of platform switching, which uses an abutment that is smaller than the diameter of the implant, reduces the proximal edge microgap and micromovement, thus reducing inflammation or bacterial-induced bone loss.
Many companies, including DENTSPLY, Astra, Bicon, Biohorizons, Keystone, Nobel Biocare, Straumann, and Zimmer, are using the principle of platform switching. Parker encouraged attendees to look at these technologies because positioning of the implant at or below the crest of the bone can increase bone and tissue volume, reducing the need for grafting. The stronger connections associated with platform switching mean ?smaller implants can support larger teeth,? according to Parker.
Parker encouraged a team approach to the implant restoration process, incorporating dentists, surgeons, technicians, and patients. He encouraged attendees to discuss options with patients for addressing missing teeth, and to come to a conclusion on what the dentist and patient want to accomplish with the procedure.
Finally, he urged dentists to consider looking for implants that:
- Are easy to use
- Feature strong connectors
- Are stable periodontally
- Are stable at bone level
- Provide good aesthetic outcomes
- Have proven track records.