Dental implantology is the field of dentistry that is concerned with the replacement of missing teeth and their supporting structures with artificial prostheses anchored to the jawbone.

Tooth loss can cause patients various problems, both functionally and psychologically, having a significant impact on their quality of life. When a natural tooth is lost, many patients find that it impacts their self-esteem, making smiling, laughing, and eating in public more challenging. Particularly when multiple teeth are missing, eating can become so difficult that it effects nutrition in some cases. Further to this, tooth loss causes the bone to deteriorate over time, limiting options for restorative treatment down the line. Dental implantology addresses these problems with an effective, long-term solution for missing teeth.

Dental implants can be used to replace one or more missing teeth. The implant-retained prosthesis might be a crown, bridge, or full arch replacement, depending on the extent of tooth loss. Every patient is different, so it is important to have a good knowledge of dental implantology options to ensure that the right solutions are provided for each individual situation. This is true even if you do not provide all treatment options yourself, as it is important to discuss all solutions with patients to ensure informed consent.

A simple single unit implant retained crown has 4 components:

• Crown

• Abutment

• Screw

• Fixture

History of Dental Implantology

Humans have been replacing missing teeth for centuries, making dental implantology, despite its status as a modern and rapidly evolving field, far from a new concept. Evidence suggests that the earliest examples of dental implants date back to the Mayans, who used tooth-shaped fragments of shells to replace missing lower incisors as early as 600 AD.

While dental implants might seem like a marvel of modern technology, they actually have a long and winding history. As long as there have been people, there have been those unhappy about losing their teeth. To understand the dental implants, we use today in the 21st century, it's essential to explore their historical roots.

The Ancient History of Dental Implants

It might be surprising, but humans have been attempting to improve their smiles for thousands of years. Researchers have uncovered some remarkable findings about ancient dental practices:

• 2500 BC: Ancient Egyptians tried to stabilise loose teeth with gold wire or by implanting seashells into the jaw.

• 2000 BC: In China, pegs carved from bamboo were used as replacement teeth.

• 1000 BC: Copper pegs were hammered into the jawbone of an Egyptian king, though it is unclear if this was done during his lifetime or after his death.

• 500 BC: The Etruscans used gold bands to secure their teeth, while the Phoenicians utilised gold wires for stabilisation.

• 100 BC: People in various cultures replaced missing teeth with teeth from animals or slaves.

• 300 AD: The Phoenicians crafted fixed bridges using teeth carved from ivory and gold wire.

• 600 AD: The Mayans used seashells as tooth replacements, a practice first discovered in a 1931 archaeological dig.

• 800 AD: Stone implants became popular in Mayan and Honduran cultures.

Developments in Dental Implants

One of the early modern types of dental implants was the endosteal blade implant, independently developed by two groups led by Roberts in 1967. These implants consisted of thin plates inserted into bone, particularly useful for narrow anatomical structures such as posterior areas with significant bone resorption. However, due to various complications, the use of blade implants has declined in recent years.

Indications For Dental Implants

Dental implant therapy is widely regarded as the gold standard for restoring missing teeth in various clinical scenarios. It is particularly indicated in cases where other restorative options may not provide sufficient stability, function, or aesthetics. Common indications for dental implants include tooth loss due to:

• Traumatic injury

• Advanced dental caries

• Failing root canal treatments or post restorations

• Failing prosthetic restorations (e.g., bridges or dentures)

• Congenitally missing teeth

• Root resorption

Benefits of Dental Implant Treatment

Dental implants offer numerous advantages over other forms of tooth replacement, making them a preferred choice for many patients and clinicians:

• Restoration of Dental Aesthetics: Implants closely mimic the appearance of natural teeth, providing a seamless aesthetic outcome.

• Improvement of Dental Function: They restore normal speech and chewing function, allowing patients to eat and speak comfortably.

• Maintenance of Tooth Spacing and Alignment: Implants help maintain the natural alignment of the teeth and ensure occlusal stability, preventing shifting of adjacent teeth.

• Fixed, Comfortable, and Convenient Solution: Unlike removable dentures, implants provide a fixed solution that does not need to be removed, improving comfort and convenience.

• Preservation of Bone Structure: Dental implants stimulate the underlying bone, preventing bone resorption and disuse atrophy that commonly occur following tooth loss (Esposito et al., 2010).

Tailored Treatment for Each Patient

Each patient presents with unique clinical needs and considerations; therefore, dental implant treatment must be personalised to achieve the best functional and aesthetic outcomes. High-quality dental implants provide a reliable and effective solution, enabling patients to regain their oral function and confidence.

Optimising predictability

Treatment predictability is crucial for the success of dental implant placement and restoration. To achieve predictable outcomes, several key factors must be carefully considered:

• Accurate Assessment and Diagnosis: Thorough evaluation during the diagnostic phase helps identify factors that could affect treatment and lead to complications. Accurate assessment ensures that potential issues are addressed early on.

• Choice of Implant System: The selection of the implant system significantly impacts treatment outcomes. Clinicians should consider the biocompatibility, design, and surface characteristics of the implant to ensure optimal integration and function.

• Surgical Technique: The choice of surgical technique plays a vital role in implant success. Clinicians must have a comprehensive understanding of various surgical approaches and choose the most suitable technique for each individual patient.

• Restoration Considerations: The design of the prosthesis, abutment selection, and loading conditions are critical for the long-term success of the restoration. Proper planning and execution in these areas are essential for achieving desired results.

• Post-Placement Maintenance: Ongoing maintenance of the implant is crucial for its long-term success. Educating patients on proper care and ensuring that the implant site remains clean and accessible will help minimise the risk of peri-implant diseases.

By addressing these factors, clinicians can enhance the predictability of dental implant treatments and improve long-term outcomes.

https://www.adi.org.uk/resources/what_is_dental_implantology_-_inidications_for_dental_implants

Dental implants are a long-term solution for replacing missing teeth, offering stability and a natural appearance. Below are answers to the most common questions regarding the procedure and recovery.

General Questions

What exactly is a dental implant? A dental implant is a small titanium post that acts as a substitute for the root of a tooth. It is surgically placed into the jawbone, where it fuses with the bone over time (a process called osseointegration). Once stable, a custom-made crown is attached to the top to look and function like a natural tooth.

Am I a good candidate for implants? Most adults in good general health are candidates. The primary requirements are:

• Healthy Gums: Free of periodontal disease.

• Adequate Bone Density: There must be enough bone in the jaw to support the post.

• Commitment to Hygiene: Implants require the same brushing and flossing as natural teeth.

The Procedure & Recovery

Does the procedure hurt? The surgery is typically performed under local anesthesia, so you should not feel pain during the appointment. Most patients report that the discomfort afterward is similar to or less than a tooth extraction and can be managed with over-the-counter pain relief.

How long does the whole process take? The timeline varies by patient. After the implant is placed, it typically needs 3 to 12 months to heal and bond with the bone. Once healed, the final crown is placed. If bone grafting is needed beforehand, the process may take longer. 

Patients with certain medical conditions—such as diabetes, a history of cancer treatment, high cholesterol, or other systemic health factors—may experience longer healing times and require closer monitoring throughout the process. 

What is the "success rate" of implants? Dental implants have a very high success rate, generally reported at 95% to 98%. Success depends largely on where in the jaw the implants are placed, how well the patient maintains their oral hygiene, and systemic health factors.

Sedation Options »

Your clinician may recommend sedation to ensure a comfortable and stress-free experience. Sedation allows you to remain relaxed throughout treatment and often produces little to no memory (amnesia) of the procedure. 

Aftercare & Longevity

How long do dental implants last? With proper care, dental implants are designed to be a permanent solution. While the crown on top may need replacement due to normal wear and tear after 10–15 years, the titanium post itself can last a lifetime.

How do I care for my implants? Treat them like natural teeth:

• Brush twice a day.

• Floss daily (using specialized floss or interproximal brushes if recommended).

• Maintain regular professional cleanings and check-ups.

Investment

Are implants better than dentures or bridges? While more of an initial investment, implants offer several advantages:

1. Bone Preservation: They stimulate the jawbone, preventing the bone loss that occurs with missing teeth.

2. No Damage to Neighbors: Unlike bridges, they don't require grinding down adjacent healthy teeth.

3. Stability: They don't slip or click like dentures, allowing you to eat and speak with confidence.

Restoration Options

Implants can support fixed dentures, as well as individual crowns and bridges. These restorations are available in a variety of materials, including acrylic, zirconia, and porcelain. Your clinician will help guide you in selecting the option that best fits your clinical needs and budget. 

Fixed vs Removable

Implant-supported restorations may be either fixed (permanently secured) or removable. Fixed options remain in place and are not removed by the patient, while removable options can be taken out as needed with minimal effort. 

Tissue and Bone Level Implants

Tissue-level implants are designed to sit partially above the gum line, with the implant's polished collar remaining exposed at the tissue level. This design aims to simplify soft tissue management and reduce the risk of bacterial colonisation around the implant. Tissue-level implants are often chosen for posterior regions where aesthetics are less critical but where durability and ease of maintenance are important.

Bone-level implants, on the other hand, are fully submerged within the bone, with the implant's platform placed at the level of the bone crest. This type of implant is preferred in areas where aesthetics are crucial, such as the anterior regions, as it allows for more precise management of soft tissue contours and emergence profiles. Bone-level implants provide flexibility in prosthetic solutions and can promote better integration with the surrounding bone tissue.

What are implants made from

Dental implants are typically made from three main materials:

• Commercially Pure Titanium (Grades 1-4): This is the most common material used for dental implants due to its excellent biocompatibility, strength, and ability to integrate with bone (osseointegration). The different grades (1-4) refer to the varying levels of purity and mechanical properties, with Grade 4 being the strongest.

• Titanium Alloys: These implants are made from alloys that combine commercially pure titanium with small amounts of other metals, such as aluminium and vanadium, to enhance strength and durability while maintaining excellent biocompatibility.

• Ceramics: Ceramic implants, typically made from materials like zirconia, offer an alternative to metal implants. They are known for their high biocompatibility, aesthetic appeal, and resistance to corrosion, making them a popular choice for patients with metal sensitivities or those seeking a metal-free solution.

Parallel or tapered implants

Parallel and tapered implants differ in their shape and design, which affects their insertion, stability, and suitability for different clinical situations. Understanding the differences between these two types of implants, along with their respective benefits and risks, is crucial for selecting the most appropriate option for each patient.

Parallel Implants

Parallel implants, also known as straight or cylindrical implants, have a uniform diameter along their entire length. This design has been widely used in dental implantology and is considered a standard option in many cases.

Benefits:

• Ease of Placement: Parallel implants are generally easier to place and require a less complex drilling sequence. They are especially useful in situations where there is adequate bone width (Albrektsson & Wennerberg, 2004).

• Good Primary Stability in Dense Bone: In dense bone types, parallel implants can provide good primary stability due to their uniform shape and larger surface area (Brunski, 1999).

• Reduced Risk of Bone Compression: The cylindrical design may reduce the risk of bone compression and necrosis, which is particularly beneficial in areas with dense cortical bone (Schenk et al., 1994).

Risks:

• Limited Primary Stability in Soft Bone: In softer bone types, such as the posterior maxilla, parallel implants may offer less primary stability, as their shape does not compress the surrounding bone to the same extent as tapered implants (Bidez & Misch, 1992).

• Higher Risk of Micromovement: The reduced initial stability in softer bone can lead to micromovement during the healing period, potentially compromising osseointegration (Brunski, 1999).

Tapered Implants

Tapered implants have a conical shape, with a narrower apex and a wider coronal portion, resembling the shape of a natural tooth root. This design has been developed to enhance primary stability, especially in areas with compromised bone quality or volume.

Benefits:

• Enhanced Primary Stability in Soft Bone: The conical shape of tapered implants helps compress the surrounding bone during placement, providing greater primary stability in softer or low-density bone (Misch, 2015).

• Better for Immediate Placement and Loading: Tapered implants are well-suited for immediate placement after extraction and for immediate loading protocols due to their enhanced primary stability (Esposito et al., 2014).

• Improved Fit in Narrow Bone Ridges: The tapered design allows for easier placement in narrow bone ridges or in cases where there is limited space between adjacent teeth or implants (Albrektsson & Wennerberg, 2004).

Risks:

• Potential for Bone Compression and Necrosis: The compressive nature of tapered implants can increase the risk of bone compression, potentially leading to necrosis, especially in dense bone (Schenk et al., 1994).

• Technique Sensitivity: Placement of tapered implants may require more precise surgical technique and planning to ensure optimal positioning and stability (Misch, 2015).

• Higher Risk of Overheating During Placement: The increased friction and compression associated with placing tapered implants can lead to overheating, which may negatively affect osseointegration (Kim et al., 2011).

Thread design

Thread and pitch designs in dental implants play a crucial role in how forces are distributed to the surrounding bone during and after the placement of the implant. Different thread shapes and pitches are designed to optimise the transfer of forces, promote osseointegration, and ensure the long-term stability of the implant.

Thread and pitch designs play a vital role in optimising force distribution and ensuring the stability of dental implants. Square or buttress threads are generally preferred for their ability to maximise compressive forces, while V-shape and reverse buttress threads offer a balance of different forces. Tapered implants create more compressive forces, promoting better osseointegration, whereas parallel implants may generate more shear forces, which could be less favourable for bone formation and long-term success.

Types of Forces from Various Threads:

• Compressive Forces: These forces compress the surrounding bone and are considered the most favourable for bone formation and remodelling. Compressive forces help enhance bone density around the implant and improve the long-term success of the implant (Misch, 2008).

• Tensile Forces: These forces pull the bone apart and are less favourable than compressive forces. While some tensile force is inevitable, excessive tensile forces can increase the risk of bone resorption and implant failure (Misch, 2008).

• Shear Forces: Shear forces slide one part of the bone against another and are the least favourable for bone formation. These forces can lead to micro-movements at the bone-implant interface, which can impair osseointegration and increase the risk of implant failure (Misch, 2008).

Thread Designs and Force Distribution

Tapered Implants:

Tapered implants have a conical shape, which creates more compressive forces on the surrounding bone during insertion. The tapered design promotes a tighter fit in the bone, providing higher primary stability, particularly in soft bone.

Due to their shape, tapered implants generate more compressive forces, which are beneficial for promoting bone formation and maintaining implant stability (Misch, 2008).

Parallel Implants:

Parallel implants, also known as cylindrical implants, have a uniform diameter along their length, which may create more shear forces, particularly in dense bone.

The parallel design tends to produce more shear forces, which are the least favourable for bone formation. These shear forces can be detrimental to osseointegration, especially in low-density bone (Lemons, 1993).

Thread Shape and Force Distribution

Square/Buttress Threads:

These threads have a flat top and a wide, squared base, similar to a square or buttress shape.

Square and buttress threads primarily create compressive forces, which are most favourable for bone stability and growth. This design helps to minimise shear forces and distribute load evenly, reducing stress on the bone-implant interface (Misch, 2008).

V-Shape and Reverse Buttress Threads:

These threads have a triangular or V-shape, and the reverse buttress threads have an angled base that points toward the apex of the implant.

V-shape and reverse buttress threads produce a mixture of all three types of forces—compressive, tensile, and shear. While they offer versatility in various bone types, the combination of forces may not be as favourable for bone preservation and osseointegration as the square or buttress threads (Misch, 2008).

https://www.adi.org.uk/resources/resources_guide