IMPLANT INFORMATION about Dental Implants

04 basic information about DENTAL/ORAL IMPLANTS INFORMATION by ANATOMY

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What … for? (Indications) Dental implants serve as replacement of teeth, to avoid grinding of teeth for crowns/bridges, to hold bridges, to stabilize dentures, for functional reasons (joint, face muscles), for esthetic reasons and as orthodontic anchor (temporary)				lower molar implant Xray to the above implant illustration
Numbers There are no reliable and comparable data known, but rough estimates. USA: 3 Million people have 8.6Mio implants (AAID 2016). USA: About 300.000 to 400.000 dental implants are placed per year in the USA (carefree). About 1.3 Mio dental implants are placed per year in Germany (DGI 2017, Symposium 2018, Wiesbaden). The global dental implants market is estimated to grow from $7,365.7 Million in 2015 to $10,427.7 Million in 2020 (marketsandmarkets 2016).				snapping attachments to hold a denture and counterpart within the denture
Times Many different techniques take different times. Healing times are shorter with 3D-supported techniques. Faster if no bone augmentation needed. Healing phase after placing takes usually 2-6 month. Under certain preconditions immediate loading (usually reduced use after placing) is possible.				Implant abutment to hold a crown crown fixed
Contraindications		behavioral	Poor oral hygiene, smoking, parafunction, no aftercare possible.
(may be relative, if the preconditions can be changed)
		medical	Diabetes mellitus, infectious diseases, certain systemic/metabolism diseases, low ability for surgery, low bone quality, bone loss (see bone augmentation).

		pharmaceutical	Biphosphonates (Review), chemotherapy, drugs, alcohol, corticosteroids, immune suppression, antidepressants.

Risks		at surgery	Tissue injury, swallowing/inhaling parts, bone fracture, injury of neighbouring teeth or structures/nervs.

		short term	Inflammation, injury of neighbouring teeth or structures. Foreign body reactions, allergic reactions, rejection.

		long term	Implant dislocation, chronic inflammation, chronic pain, reoperation, fracture, implant loss. Superstructure (Crown/Bridge/Denture): loosening, fracture.

Failures	Risks depend from several preconditions like bone volume, bone quality, superstructure and reasons in connection with the above contraindications. There are problems reported with abutments on implants (which may be renewed without surgery), but not with implants themselves.

Materials	Titanium		mostly Grade 4, Grade 5 Titanium
	Ceramic		Zirconium oxide ceramic
	PEEK		Polyetheretherketone
	Dental implants come with many sizes and shapes. Most of them are screws, but blades, discs and individual shapes are possible. The surface of the implant is important (roughness, coating).
Statistics	Survival Analysis of Dental Implants, Andrew Kai-Ming Kwan et al: after 5 years 94.4% http://www.statistics.gov.hk/wsc/CPS014-P5-S.pdf Survival rates range from 91 – 97% since the late 1990ies (Knöfler 2004) Failing rate after 20 years 20.7% (range 2.6-54.3% according to system) (Gomez G, et al. 1996) Failure rate after 10 years with augmentations 26.7% (Schliephake H et al. 1997) The way the superstructure (crowns/bridges/dentures) is made is important in a long run (Knöfler, 2004)

Literature	Problems		Most problems happen in the 1st year. No material related problems. Study warns of rare risk of chronic pain from dental implant surgery (Devine et al. Eur J Oral Implantol 9(2):179-186)

	Science/Future		Most implants are made of titanium. In a longer distance there might come new materials like ceramics and plastics or derivatives. Stem cell treatment seems to be possible.

Criticism	In Dental Implantology has to be discussed at which point a natural tooth may be maintained or not.
Selected patient information	Topics to be discussed while planning: Individual risks, sufficient bone or bone augmentation needed (see chapter on oral bone and soft tissue), 3D-planning necessary, pretreatment necessary, surgical guide necessary, alternative solutions, preparation, aftercare.
Implant Patient Register	No register known. Implants are identifiable. Patients get a documentation (implant-passport), important for longterm care. Identifying an unknown implant? If you don´t find it at Implant-Register®, maybe WHAT IMPLANT IS THAT? or Osseosource helps.
Medical Societies	dealing with dental/oral Implantology are listed here
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