Dental Implants India – Centre for Advanced Immediate Loading Basal Implants

FAQs


Frequently Asked Questions

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[toggle_item title=”1. What is a dental implant?”]

Dental implants are artificial (mostly Titanium based) teeth replacements providing facilities to fix teeth into the jaw bone giving a cosmetic and functional results close to that of natural teeth. It is not a transplant, which is taken from another person. . Most are made of titanium, which is a metal that is bio-compatible with human tissues. Titanium implants have been used for decades, without any known ill effects. They can be used in both the lower jaw (mandible) or the upper jaw (maxilla). There are several categories / designs of dental implants, which will be selected by the doctor depending on your specific needs and general dental condition. You would require x-rays and / or CT scans to evaluate the amount of bone remaining, models of your mouth to assess the area where implants need to be placed and a thorough examination to decide which type of implant can help you the most.

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[toggle_item title=”2. What are the advantages of dental implants?”]

Dental implants can be used in a variety of ways. In some instances they offer better solutions than conventional dental restorations. Implants are the only solution if removable or complete dentures are to be avoided. Here are some of the ways dental implants can be used:

* Dental implants can replace a single missing tooth. In this case, using an implant would avoid drilling the adjacent teeth needed to support a permanently cemented bridge. This is often desirable when the abutment teeth do not have any fillings.  A single dental implant reduces the need for extra crowns and future dental work.

* Dental implants can replace a removable partial denture. Removable bridges are not always as firm and kind to the tissues as we would like. When they’re not, they tend to move around a bit, sometimes wiggling or loosening the teeth they rest on, which are called abutments. In time, abutment teeth can become loose and sometimes need to be removed. When this happens, a new, larger removable denture is needed. Removable dentures collect a lot of plaque, and make cleaning around some teeth quite difficult. And there’s always the chance that decay will form at the spot where tooth meets the gums in the remaining teeth. With implants, these problems tend to be avoided or, at least, minimized.

* Dental implants can replace a full upper or lower denture. Most people have enough bone remaining to have implants placed in their jaws. In the off-chance that there’s not enough bone, new techniques exist to regenerate the amount needed to successfully have implants.

* Dental implants can provide more retention for full or partial dentures. Instead of placing five, six, or more implants, two-four implants can be inserted for increased stability. When this happens, the final prosthesis will be more stable, giving a greater sense of security. Also, the prosthesis is often smaller than the one being replaced.

* Dental implants avoid removable bridges. Often, the loss of a critical tooth eliminates a fixed bridge as an option. Either there are not enough teeth to support a fixed bridge, or the span will be too long, or a critical abutment has been removed. Regardless of the cause, a fixed (cemented) bridge cannot be employed to replace the missing teeth, so a removable bridge is suggested. Is a removable bridge the only option to replace missing teeth when there are not enough suitable abutments? This is the time to consider dental implants.

* Dental implants can be used in complex cases in order to avoid a denture while the patient still has some teeth left. These patients usually have existing bridges, and they are certainly not strangers to the dental chair. What usually happens is that a root canal has failed, or a key abutment tooth has cracked, or their periodontal condition has worsened. Any of these conditions could force a dentist to suggest that unless dental implants are placed in strategic areas, complete (removable) dentures will be needed. For most people, this step is too horrific to contemplate, let alone experience. But with the success of dental implants, complete (removable) dentures can be avoided with proper planning.

* Dental implants are also being used these days to help fix eye and year prosthesis. The implants placed inside the bony sockets housing the artificial eye  or ear help in retaining the prostheses in position.[/toggle_item]

[toggle_item title=”3. Is there discomfort involved?”]

Generally dental implant procedures are done under local anesthesia… the same anesthetic technique used for extractions and minor surgical work in the mouth and jaws. Complex dental implant procedures may be carried out under general anesthesia. Sedation techniques can also be employed in patients who are too apprehensive. Just as with any surgery, there can be some discomfort; however, anesthetic and patient sedation are used to eliminate any discomfort at the time of the procedure. Approximately 95 percent of patients report discomfort of 0-2 on a scale of 0-10 the day after the implants are placed. The doctor will prescribe medications to ease any discomfort that may occur. Special care will be taken to stay in contact with you after the surgery to be sure that you remain comfortable.[/toggle_item]

[toggle_item title=”4. How much rest is needed after implant procedures? How long could one expect to miss work?”]

Generally, we recommend the day of and the following day after surgery, that no strenuous exercise be done. You can expect to be slightly swollen. The amount of time off required is an individual decision.
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[toggle_item title=”5. What will happen without treatment?”]

When you lose your teeth, you gradually lose the bone that supported them. As this bone disappears, problems with other teeth nearby and a lack of support for dentures, partials and bridges increase. These could include pain, mobility, lack of retention for prosthetics, sharp, painful ridges, mobile gum tissue and sore spots. The tongue enlarges to accommodate spaces of missing teeth. With tooth loss, a five-fold decrease in function occurs and the diet shifts to softer foods. Also, when bone is lost, numbness to the lower lip or even the possibility of fracture of the jaw rises. Since the bone is deteriorating, it will spread and deteriorate around healthy teeth and ultimately cause the loss of those teeth. I think everyone’s heard of the “domino effect”. Here’s a very easy way to explain what happens. Picture a brick wall; take a brick right out of the middle of the wall. What happens? Eventually, the brick above starts to fall in from lack of support, the bricks to the side start shifting toward each other and those eventually fall out; then the process starts all over for those bricks nearest them. It’s a similar process in the mouth. In addition, this progresssion will affect the ability to provide the same treatment in the later stages of bone loss than if treatment had been started earlier in the process. It’s much better to replace a tooth BEFORE all of the side effects kick in. By waiting, you risk the possibility of not being able to provide the same, simple type of treatment that would have been possible earlier.
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[toggle_item title=”6. Who is a candidate for implants?”]

Anyone who is missing one or more (even all) of their teeth may be a candidate for implants. If one or a few of the teeth are missing, implants in conjunction with a crown or bridge can replace those teeth and function as normal teeth without losing more bone and being subject to decay. If all or most of your teeth are missing, then implants may be placed to anchor a loose denture. Sometimes, if there is already some bone loss, bone can be added and regenerated or a technique called bone expansion can be used to create a more ideal site for the implant(s). More detailed information and images are available from the treatment menu. Ultimately, a consultation with a dentist who is knowledgable on these procedures can help determine your individual needs.
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[toggle_item title=”7. How costly are dental implants?”]

Costs of dental implants vary based on their design of the implants chosen for a particular patient.
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[toggle_item title=”8. What are the different types of dental implants available and how is  a particular implant design chosen for a particular treatment?”]

Various designs of implants are available and may be broadly classified as crestal & basal/lateral implants. The jawbone parameters at the proposed implant site such as bone width, length, height, quality and proximity to adjacent anatomical landmarks such as the maxillary sinus, the inferior dental nerve, muscle attachments in the area will dictate the implant design chosen for a particular area. Clinical examination, Xrays and CT imaging help assess the bone in the proposed area for implant placement. The general medical status of the patient will also determine the dental implant choice to a certain extent. For instance, diabetic patients and smokers will benefit more from basal implant designs.

There is yet another important classification of dental implants based on the number of components in dental implants:

Three Piece implants – The conventional implants are all three piece – with the implant, the abutment and the fixing screw forming the three components of the implants. They are mostly used as delayed loading implants

Two Piece implants – has the dental implant and the abutment separate. Both are cold-welded into place using morse-taper technology without the use of a screw to connect the two. They are mostly used as delayed loading implants.

Single Piece implants – both the implant and abutment are fused into a single piece. These implants are mostly used as immediate loading implants.

Conventional implant design

Single Piece Implants

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[toggle_item title=”9. What will be the time duration required for dental implant treatment? What is the difference between immediate loading dental implants and conventional dental implants?”]

The duration of treatment will be based on multiple factors. The bone availability for implant placement, the dental implant design chosen and the general medical status of the patient are the primary factors. The process of fixing of the artificial teeth (prostheses) on the implants placed is called “loading” of the implant.  Broadly, based on treatment duration, implants are classified into delayed loading and immediate loading.

Delayed loading – all conventional dental implants (the three piece and the two piece varieties) are mostly delayed loading. The implants are placed via surgery procedures in the jaw bone and sutured. They are left undisturbed in order to osseointegrate (this means that the bone is allowed to integrate with the implant so that there is a firm and healthy attachment of the implant inside bone). After three to six months, the implant is re-exposed and then, the abutment (the attachment fixed onto the implant on which the artificial tooth crown is fixed) is placed. The crown is then fixed onto the abutment. Rarely three/two piece implants may also be taken up for immediate loading, however, based on certain important bone quality parameters.

Immediate loading the latest implant designs such as the single piece crestal implants and the single piece basal / lateral implants are all immediate loading dental implant designs.  The dental implants are loaded immediately… within two to three days such that the patient is able to start chewing from the second or third day of the dental implant procedure.

However, with immediate loading basal implants, it should be borne in mind that implants placed immediately after extractions / open surgical procedures,  are generally provided interim prostheses after 3 days. This very often needs to be replaced with permanent prostheses after 6 months to 1 year. This is because the bone and gums around the surgery sites tend to change contours during the healing phase leaving gaps between the prostheses and the tissues. Food particles can get trapped in these gaps causing discomfort for patients in addition to causing bad breath. This kind of trapping can rarely cause inflammation / infection of the superficial gums too.  However, the integrity of the basal implants are not affected in any way as they have smooth long shafts and the stability of these implants is based on the strong retention provided by the basal cortical bone in which they are firmly anchored.

Moreover, the deranged bite patterns (which is generally seen in such patients who have a few teeth in the mouth along with removable partial dentures) will have to be established with the help of the temporary prostheses provided over the implants. Once healing is completed, the final prostheses can be fabricated based on the new tissue contours and the newly established stable bite patterns. Moreover, the vertical dimensions (VD) of  patients can also be altered to achieve optimal results from both the cosmetic as well as functional viewpoints.

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[toggle_item title=”10. What sort of information is needed by the Dental Implantologist to make a preliminary assessment concerning of patients needing dental implants?”]

A proper assessment is vital before planning and estimation of costs is done with respect to dental implant treatment procedures.

The following are necessary to make a proper assessment. You may forward these details by email to Dr@TheSmileCentre.in .

1. A digital OPG Xray (Panoramic Dental Xray) image – gives a clear idea of the present condition of  the upper and lower jaws along with the teeth
2. A short note on the general medical status of the implant patient. Blood sugar and Blood pressure are to be assessed before the patient is taken up for implant surgery. A thorough medical history along with details of relevant medicines the patient has had previously or is on at present is also essential.
3. A physician’s clearance may be needed for patients with relevant medical history or who are on medications for medical conditions
4. Photographs of the patient’s face with lips in rest position & smiling – frontal and side views
5. Photographs of the smile of the patient – in all its fullness
6. Photographs of dental problem areas – eg. the area of missing teeth where the patient intends to have implants placed.

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[toggle_item title=”11. How many implants are needed to situations where the patient has no teeth at all or if he or she needs to undergo extractions of all the teeth and get fixed replacements?”]

For full mouth rehabilitation using implants, generally a complete set of artificial (ceramic / PFM /  zirconia / acrylic) teeth are fixed on the implants. Generally in case of full mouth rehabilitation, we restore up to the second molars. The third molars are not necessary for chewing and often create problems while chewing and therefore are not replaced. This means the patient gets 14 teeth in each jaw. We give a temporary acrylic bridge towards the end of the day of implantation. This is removed by the third day and the fixed artificial teeth are cemented within 3 days of implantation.

Certain techniques such as “all on 4” and “all on 6” dental implants techniques are being propagated by various implant companies. However, the fact remains that with lesser number of implants, failure rates turn higher as the chewing forces get distributed on the lesser number of implants. Often in these techniques, immediate loading is difficult or nearly impossible. In these techniques, very often the first molars do not get replaced and the replacement occurs only up to the level of the second premolar. Moreoever, there is no functional stimulus in the areas where there are no implants. Functional stimulus (stimulation of bone during chewing) helps in maintaining & even building up bone in areas where the implants are present.

All on 4 & 6

At our center, we generally place minimum of  6 to 8 implants in the lower jaw and 8 to 10 implants in the upper jaw. We use a combination of compression screw implants, basal bicortical screw implants, basal osseointegration (BOI) implants and tubero-pterygoid implants. With these advanced single piece, immediate loading, basal implant techniques, we are easily able to deliver a full set of permanent teeth within 3 days of implantation. The most important factor here is that that all this is done without any kind of bone augmentation / grafting such as “ridge split”, “sinus-lifts”, “GTR techniques” etc. in addition to the benefits of nearly 98% success rate coupled with minimal post implant-surgery difficulties.

Basal implants used for FMR in highly atrophied jaws

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[toggle_item title=”12. What are the possibilities of rejection of dental implants?”]

The body does not reject a dental implant, as it might a soft tissue transplant, such as a lung, heart or kidney. This does not mean that an implant cannot fail, but it would be due to other factors, such as misalignment, improper force on the implant or other conditions or existing diseases of the patient. Dental implants are made of a material, titanium, that is totally bio compatible(compatible with body tissues) and actually integrates with the surrounding bone and becomes part of the body.Titanium is also being used more and more in the medical field to replace body parts.

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[toggle_item title=”13. When do dental implants fail?”]

Dental Implants do not fail… it is the implant bed or the bone into which the implant has been placed that fails. Generally well placed dental implants can fail only because of improper care on the part of the patient as well as an uncontrolled medical status such as as is the case with uncontrolled diabetes mellitus, immuno-compromising diseases etc. Periodic review is essential to avoid dental implant failures. We strongly recommend periodic checkup and oral hygiene measures once in 6 months.

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[toggle_item title=”14. What are the techniques adopted to prevent or reduce the instances of dental implant failures?”]

Meticulous planning prior to implant placement is the most important aspect of successful dental implant procedures. The selection of the right implant design and type suiting the available bone and the modification of bone in the area to suit dental implants play vital roles in success of implants. However, in spite of meticulous selection and implant procedure, there can be implant failures… mainly due to a condition called peri-implantitis. In these situations, we institute laser therapy and bacterial reduction, coupled with open curettage of the area along with bone grafting as and when needed. These generally help in reviving the failing implant. Very rarely, some of the failed implants have to be removed. However, re-insertion of implants of a different dimension and design is possible in most situations like these. In certain patients who are more prone to recurring gum disease, we perform periodic laser bacterial reduction procedures to help reduce the incidence of peri-implantitis, the main cause for failures of dental implants.

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[toggle_item title=”15. What is peri-implantitis?”]

Peri-implantitis is a destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. The array of periodontal pathogens found around failing implants (those affected by peri-implantitis) are very similar to those found in association with various forms of periodontal disease. Therefore, it is seen that persons who are prone to periodontal disease are also prone to peri-implantitis.

However, in our practice, we use varied implant designs which help prevent this condition which is the most important cause for failure of dental implants. The unique designs of offered by the Bicortical Screw (BCS), the KOS-T and the BOI implants, help prevent peri implantitis.

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[toggle_item title=”16. What are the options available in cases of failed implants?”]

Re-evaluation of the bone in the area of the failed implant is the most important initial step. After the assessment of the bone parameters, suitable implant designs are chosen which will suit the area. Bone augmentation may be needed in certain situations. Very often BCS and BOI implants offer great designs suiting even the most unfavorable bone conditions. We also employ laser assisted periodontal procedures which help in regeneration of bone in case of failing implants, if identified adequately early.

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[toggle_item title=”17. How long do dental implants last?”]

Two of the commonest questions raised by dental patients are “How long will dental implants last?” and “What is the long-term success rate of dental implants?”.

Regarding the longevity of dental implants, at the present time we cannot answer this question. All we can say at this point is that the first patient who had dental implants placed in 1965 still has his original implants in function today.

The simply answer to the long-term success rate of dental implants are that dental implants can fail, but fortunately very infrequently. Failure rates vary depending on the site in the mouth, whether they are placed into natural or grafted bone and whether the patient smokes. The overall success rates in natural bone is 95%, though this falls to between 85 and 90% in grafted bone. If a patient smokes it has been shown that they are statistically two and a half times more likely to have an implant fail than a non-smoker. Basal implants, with their unique design and smooth machined surface generally tend to be less prone to peri-implantitis, owing to the smooth, machined surfaces they have. Peri-implantitis is detrimental to implants and contributes to their failure. Basal implants are also found to work well in smokers and diabetics.

However, it is always better to take adequate precautions to prevent failure of dental implants, They are to maintain meticulous oral hygiene, and evaluate the dental implant both clinically and radiographically at frequent recall visits with your dentist.

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[toggle_item title=”18. How successful is basal implantology? Why isn’t it being propagated?”]

The fact is that almost 90% of the basal implantology practitioners of today were using conventional implants (they continue to use conventional implants in a limited way) in their implantology practice for several years. I myself have been doing conventional implant procedures for almost 6 years after which I shifted to basal implantology. Now, almost 95% of the implants I place are basal implants… just because of the following reasons:

a) Immediate loading of implants with fixed teeth is truly possible only with the use of basal implants as these are the implants which have been uniquely designed for immediate functional loading. We generally fix teeth within 72 hours of basal implantation at our centre. In situations where bone grafting is necessary, loading of conventional implants with fixed teeth will need a waiting period of minimum 6 months.

b) Basal implants offer excellent designs which help in securing them to bone… even in situations where only limited bone is available, by avoiding complex bone augmentation and sinus lift procedures.

c) The patients tolerate basal implantology procedures very well and the post operative recovery is also quite fast.

d) Total costs with respect to Basal implantology work out to be a lot more economical than conventional implants.

e) The unique single piece designs of basal implants are less prone to interface problems, unlike the  conventional implants which are either two or three piece in design. Moreover, incidence of peri-implantitis, the commonest cause for implant failures,  is also considerably lower with basal implants.

Though there are numerous publications concerning basal implantology, I have have clearly noticed felt that the propagators of conventional implants have always turned a blind eye to basal implants, just because the treatment philosophy with basal implants is completely different from that of conventional implants and at times even contradictory. Moreover, dental implantology training to dentists in most parts of the world is generally performed by conventional implant manufacturers who wish to recover their investments in their respective businesses. Many of the implantology departments and programs in dental colleges are funded by such companies. When they have invested a lot of money into research on bone graft procedures, sinus lifts, implant interface issues etc., it is difficult for them to accept the claim by basal implantologists that such procedures are not needed any more.

However, at the end of the day, dental implant patients will opt for procedures which are faster, advanced in design and without the involvement of tedious and unpredictable procedures. In this era of fast computers, fast planes & trains and super-fast communication services, we cannot remain in the olden era of delayed loading implantology any more.

Now, Basal implantology is increasingly being accepted by implantologists in different parts of the world. The fact that implantologists who have failed in some of their cases with their conventional implants have started prescribing use of basal implants for these patients, points to the reality of affairs.

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[toggle_item title=”19. Who are the doctors involved in your centre in dental implant treatment?”]

Dr. Prasanth Pillai, MDS (OMFS), FICD, an Oro-Maxillofacial Surgeon & Implantologist, is the chief of the Dental Implant Centre. His team members include an expert Prosthodontist, Dr. Rupesh P.L., Anesthesiologist, Dr. Narayan Naik and Periodontists, Dr. Siby Chennankara and Dr. Priyanka Pai. Dr. Sreeja Prasanth, Senior Dental Surgeon is the co-ordinator. For more information on the doctors and the team of TheSmileCentre.in, please visit the following link: Our Team

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[toggle_item title=”20. What are the qualifications &  work experience of the dental implant centre team?”]

Our team consists of specialists who have more than 15 years of clinical practice. Dr. Prasanth Pillai & Dr. Sreeja Prasanth, have been in practice since 1994.  We routinely perform Dental Implant procedures in our centre… almost every alternate day. We have an attached Dental Lab to facilitate fast delivery of prosthesis. Since we focus on Immediate Loading Dental Implantology, we generally complete our prosthesis work within 3 days of placement of implants.[/toggle]

[toggle title=”21. I have reached a dental crisis and have received recommendations from 3 dentists here in South Lake Tahoe, CA USA, where I live. There are 4 plans recommended to me, which all include some combination of root canals, crowns, partial dentures, full dentures, bridges and implants I have endured 40 years of extensive dental work already and spent tens of thousands of dollars just the past ten years. I question the advisability of continuing to sink more money and hours of procedures over the next 20 years of my life (I am 69 years old). I seek a more permanent solution, like the permanent teeth in 3 days I have read about and think might work for me. Will you advise full mouth rehabilitation with implants in cases like mine? If so can you give me a brief idea about full mouth rehabilitation with implants?
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Full mouth rehabilitation with immediate loading basal implants is probably one of the best treatment options for patients with multiple deteriorating dental conditions. With these unique implants, the patients are able to secure a third dentition within a short span of time without long waiting periods, bone grafting, sinus lift etc.

Generally we perform full mouth rehab. in patients in a single stage

Stage 1: Extraction of teeth with poor prognosis and immediate replacement with implants + implants facilitating fixation of prosthesis in areas where there are no teeth. Generally we recommend 8 – 10 implants per jaw in situations where the patient is completely edentulous (without teeth).  We generally extract teeth and place immediate loading basal implants in the same sitting. We load these implants within 72 hours… ie the patient gets fixed teeth within 72 hrs. Generally we request full mouth rehab. patients to be available for a period of 3 – 4 weeks so that we are able to complete the adjustments and evaluation after fixation of the interim prosthesis.

Stage 2: After 6 months. This stage is necessary only for patients who have had extractions and implantation and / or  open surgical placement of implants during the first phase. The second prosthesis is necessary as there will be a certain amount of gum and bone healing taking place around the implants and the first stage prosthesis. In such situations, there will be gaps developing between the prostheses and the gums once healing has taken place. This can lead to food impaction and such other problems. Therefore, we give the final prosthesis in the second stage. The final prosthesis is generally done with laser sintered porcelain fused to metal (PFM) crowns or Zirconia or noble metal – ceramic crowns. Sometimes, laser procedures may be employed during the second stage to improve the gum contours around the implants and also eliminate the unhealthy granulation tissues in the implanted sites.

Now, if on clinical examination we feel that patients have healthy teeth which can be retained, we will certainly retain them and that will bring down your costs proportionately.

We have been able to help many patients like you with the help of full mouth rehab. with implant supported prosthesis. Kindly visit our websites:

1. www.TheSmileCentre.in

2. www.GoodbyetoDentures.com

These websites will give you a clear idea of the various treatment options.

You can also visit the testimonials page on www.TheSmileCentre.in to have an idea of the experiences of our patients.

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– Dr. Prasanth Pillai MDS (OMFS), FICD

Oro-Maxillofacial Surgeon & Implantologist