The main concern with complete dentures (CD) is poor retention. Resilient linings, denture creams, and other retention aids may alleviate the problem temporarily but rarely “remedy” retention or stability issues. One approach to addressing such concerns during the 1970s and, subsequently, was the subperiosteal implant which comprised a metallic framework that closely fit and sat directly on the bone.

Subperiosteal Implants

The subperiosteal implant is designed as a metal implant framework that rests directly on the bone, subjacent to the periosteum, providing attachment posts. The posts extend across the gingival tissue for prosthesis anchorage. Hence, masticatory and other stresses were transmitted directly to the supporting bone rather than to the oral mucosa as with conventional CDs.

Fabricating a subperiosteal implant consumes a lot of time and focus.

  • The mandibular mucosa had to be reflected and an impression made of the exposed bone.
  • A wax pattern was then designed on the gypsum cast and used as the pattern for a chrome-cobalt cast framework.
  • In a subsequent procedure, the mucosa was reflected again, and the framework was placed on the exposed bone before the mucosa was restored in position and healing was allowed to start.
  • After healing, a CD could be fabricated and seated on the abutments projecting through the mucosa.

The three principal varieties of subperiosteal implants are full mandibular, full maxilla,ary, and unilateral or single‐unit implants. The latter was smaller than full arch implants and had only one protruding abutment.

The subperiosteal implant is a lengthy procedure and usually has complications. The implant causes discomfort to patients. Subperiosteal implants required close collaboration between the prosthodontist, surgeon, and dental technician with great surgical skills to guarantee optimal clinical outcomes. But if the carefully selected patient has good overlying soft tissue and no residual alveolar bone, the procedure could have a reasonably high short-term success chance.

Endodontic Implants

Endodontic pin implant, also called “endodontic stabilizer” is the most and longest established implant for years. The implant functions as a rigid anchor of a mobile tooth to the bone. Some of the consequences of a mobile tooth are gum tissue and alveolar bone recession, unbalanced occlusion, unfavorable crown-to-root ratio, and bruxism.

The basis of this approach was that a pin was inserted through the root canal into the underlying bone such that it was anchored in bone but with the upper end projecting into the mouth and upon which, a crown or RPD was fabricated. Typically, the lower end of the pin did not penetrate the cortical plate of the mandible or the antral or nasal floors of the maxilla.

Indications for endodontic implants included treatment of root fractures, external or internal root resorption, and when better support and stability were required for FPD or RPD abutments.


Endosseous Implants

Endosseous implants, also called intra-osseous and endosteal implants have been in clinical use since the 1960s. Regardless of implant design, endosseous implants are used in edentulous areas with sufficient healthy bone to accommodate the implant. The four main categories of endosseous implants are pins, spirals, blades, and screws.

In 1947, the Formiggini screw implant was the first successful endosseous implant. Later, the Cherchève spiral‐post implant in the 1960s to 1970.

Cherchève implant consisted of a double hollow spiral mounted on a square post. After the bone was surgically drilled to create a cavity, the implant was set below the alveolar ridge with the shank or post extending into the oral cavity, at which point, the final prosthesis was constructed.

The surgically drilled bone of early implants created a gap or space between the abutment post and the host’s hard and soft tissues, and this could sometimes present consequences.

In the late 1960s, the spiral implant developed modifications mostly consisted of self‐tapping screw implants, often with a vent or port for retention. While a lot of these screw implants were successful, there are still many failed implantation of these screws as the consequence of tissue irritation, frank infection, and epithelial down growth that intercept adequate retention and on occasion complete uprooting of the implant. Usually, poor bony attachment to these implants had given rise to stability issues.

A tripodal pin implant is another endosseous implant that existed at the same time as the screw-type. Thin tantalum pins fit into the bone at around 120° angulations and the exposed ends of the pins were bonded together using acrylic resin.

This type of implant could be used as a bridge abutment or to support the single‐unit prosthesis. The tripodal pin has its usefulness but it does not possess long‐term retention, usually not self‐supporting and the pins were easily displaced.

Between 1968 to 1971, Linkow designed and took part in modifying the blade or blade vent implant. Blade vent implant was a major development in endosseous implants and was originally designed for use in areas with knife‐edge alveolar ridges, and situations where screw‐type implants are contraindicated. The blade implant can be applied in almost all maxillary and mandibular edentulous areas, on the condition that there is sufficient residual alveolar process.

Several concerns were linked with blade vent implants, especially the difficulty in achieving an ideal gingival relationship to the crown when it is used to support a single crown. Another issue is the thin ridges in a manner that any bony destruction could result in implant loss. Fewer problems were found with blades used to support a denture base although stability was a problem with unilateral mandibular free‐end saddles.


The modern “screw” implant derives from the pioneering work of Stefano Tramonte in Italy and Per‐Ingvar Brånemark in Sweden, both of whom advocated the use of titanium for dental implants. The excellent physical properties and outstanding biocompatibility of titanium were the driving force for this application. In particular, Brånemark described the clinically observed close apposition and adherence of bone with titanium, which he termed osseointegration. Since then, a wide variety of “screw” or tooth root‐shaped endosseous implants have come into clinical use, and they have achieved remarkable clinical success such that they are now considered important components of the restorative dentistry armamentarium. However, the clinical success of dental implants requires good clinical technique, accurate placement, and careful patient selection with good bone quality.

The efficacy and rate of osseointegration of bone and implant have been enhanced by techniques such as designing the implant with a screw profile, providing a micro‐texture to the implant surface as well as coating the surface with hydroxyapatite (HA). More recently, a novel approach to dental implantology has been to coat the implant surface with a nanometer‐thick layer of protein containing a bisphosphonate drug. Animal studies indicate that the bone surrounding the implant becomes denser and stronger, ensuring a more durable implant‐tissue interface.


Dental implants have existed from the very early 1900s until the present time. Numerous successes and failures of implantation occurred, but as modifications and innovations continue to develop together with the skills and knowledge of the dental professionals, the success rate of implantations rises. The modern dental implant has become one of the best alternatives for replacing missing teeth and as a support to a crown, bridges, and other prostheses.



Dental Implant is a surgical procedure to replace a missing tooth root and fused with the bone providing a fixed or permanent foundation or support for crown, bridge(s), or dentures. The back of the lower jaw has the highest success rate of dental implantation and osseointegration because it is denser than the posterior (back) section of the upper jaw.

The pre‐operative protocol covers a review of the patient’s medical history and recording of the vital signs such as pulse rate. The patients will pre‐rinse with chlorhexidine solution to reduce the bacterial load. Subsequently, the patient should be anesthetized, typically with maxillary infiltration of both the buccal and palatal, and/or a mandibular block.

Steps in surgical procedure for a simple implant

  1. Create access
  2. Perform osteotomy
  3. Place the implant
  4. Site closure

Access to the Bone

There are two approaches to creating access, namely flap reflection or a surgical punch (flapless).

  • Flap reflection

The flap reflection allows the surgical site to be visible, easy to access, and accurate positioning for implant placement. But the reflected tissue must be sutured back in place after implant insertion.

  • Surgical punch

A surgical punch is a simpler process for an experienced dentist to gain access to the cortical bone surface. But, it necessitates accurate location of the cut hole on a first‐time basis. The tissue punch removes keratinized gingiva.


Performing the Osteotomy

Three basic steps are important in performing the osteotomy (surgical cutting or removal of bone) regardless of the mode of access:

  • Center the osteotomy
  • Establish the length of the osteotomy
  • Establish the width of the osteotomy

Osteotomy procedure

  1. Establish the center of your final restoration
  2. Purchase point made with a high‐speed surgical bur
  3. Center B‐L, M‐D
  4. Establish the length (implant depth)
  5. Length is established with a locator drill (sharp‐tipped drill)
  6. Use radiographs to check angles
  7. The most common implant body length is 10mm.
  8. Establish the width
  9. Width is based on the width of bone and on the tooth to be restored
  • Anterior 3.2–4.7mm width
  • Premolar 3.7–4.7mm width
  • Molar 4.7–7mm width

Surgical Procedure

Step 1

  • An initial bone incision is made with a locator drill to a depth of 6–8mm.
  • After taking a radiograph and carrying out an analysis to check the accurate positioning of the hole using a locating indicator, the locator drill is then used to drill to the full length (depth) required for the implant, typically 10mm.

Step 2

  • The initial osteotomy in soft bone is progressively widened using osteotomy drills of increasing diameter.
  • Coarser thread and heavier-duty drills are used for dense bone.
  • Toto maintains a clean (saliva‐free) work siworksiteevent burning and possible bone necrosis, the osteotomy site is continuously irrigated with sterile saline solution. Ideally, the osteotomy should be isolated from saliva to prevent contamination.

Step 3

  • Remove the implant body from its packaging and insert it into the prepared site using the provided carrier.
  • After initial placement, torque the implant/ carrier in place with the torque driver.
  • Remove the carrier and, after reviewing the positioning and placement, fine-tune positioning: the implant platform should be flush with the bone level or 0.5–1mm below the bone level.
  • Note: The torque wrench should be set to 50Ncm. If the implant cannot be inserted to the required depth (10mm and at the bone level or 0.5–1mm below the bone level), back the implant out and use the corresponding dense bone drill to widen the osteotomy. It is important to not over‐torque the implant to place.

Step 4

  • Insert the healing abutment or cover screw with driver to 15Ncm and suture the reflected flap tissue in place.
  • Note that it is important to maintain the buccal keratinized tissue accomplished at the initial flap design

When suturing the flap, some dentists recommend the use of Cytoplast Polytetrafluoroethylene (PTFE) suture material, since this material is found easy to handle and passes through tissue easily without snagging or tearing.

Time‐Line for a Simple Implant

  1. Surgery
  2. Two‐week follow‐up with radiographs and, if necessary, suture removal.
  3. Impressions. These are taken at six to eight weeks post‐surgery.
  4. Delivery of the crown at 10–12weeks post‐surgery

Postoperative Protocol

  • Eating or other potential trauma to the operative site should be avoided: adjacent teeth may be brushed but not the surgical site for at least 48hours.
  • Antibiotic may be prescribed, typically Amoxicillin 500mg, TID, for five to seven days provided the patient is not allergic
  • Chlorhexidine rinse BID for 10days.
  • Warm salt water rinses after meals.
  • Pain medications: recommend or prescribe as determined by the patient medical history. Typically, ibuprofen 600–800mg is sufficient for most healed site implant placement procedures.
  • Schedule a two‐week follow‐up appointment


The most basic surgical requirement for implant placement is having adequate bone volume and quality. The rule of 6’s illustrates that a patient should have a minimum of 6mm of bone in all dimensions as well as 6mm of interocclusal space. Consult your dentist if you are suitable to have dental implantation.



Dental implants can significantly improve the quality of life and the health of a person who needs them.

Below are some of the advantages and disadvantages of dental implants.

Advantages of Dental Implants

  • Dental implants look and feel like natural teeth and replace missing or newly extracted ugly teeth.
  • Dental implants are designed to fuse with the bone.
  • Slip-free. Dental implants are bone-supported dentures making them slip-free and fit perfectly. Thus, do not cause awkward speaking tones or discomfort when talking. A patient can laugh with no worry if the implant will fall.
  • Sliding dentures can be uncomfortable during mastication. Dental implants function like your natural teeth, comfy and painless.
  • Dental implants eliminate the discomfort of removable dentures.
  • Dental Implants can replace the natural teeth and comfortably perform mastication just the same.
  • Self-esteem. Dental implants are a replacement for your missing teeth. A new set of teeth can boost confidence especially when socially interacting.
  • Oral health. Individual implants replace missing teeth, filling the gap created by tooth loss. Preventing food debris from getting stuck and dental problems from developing.
  • Implants are very durable and will last many years. With good care, many implants last a lifetime.
  • Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing dentures, as well as the need for messy adhesives to keep them in place.
  • Helps keep the jawbone from shrinking due to bone loss
  • Preserves the health of the surrounding bone and gums. Dental implants don’t require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your teeth are left intact, improving long-term oral health.
  • Helps keep the adjacent (nearby) teeth stable. When a gap is left by a missing tooth, the surrounding teeth tend to shift because that tooth is no longer helping to keep everything in line.
  • Improves quality of life

Disadvantages of Dental Implants

  • Damage to surrounding natural teeth during implant placement
  • Injury to the surrounding tissues during surgery, such as sinus perforation
  • Injury during surgery (for example, fracture of the surrounding jawbone)
  • Inadequate function, such as feeling like the teeth do not bite together normally
  • A sensation that the tooth is loose or twisting in place resulting from an abutment screw loosening
  • Implant body failure (looseness of the implant body)
    • due to systemic infection, which may be more likely in patients with uncontrolled diabetes
    • due to local infection in bone and gums supporting the implant body
    • due to delayed healing, which may be more likely in patients who smoke
  • Difficulty cleaning the gums around the implant, resulting in poor oral hygiene
  • Untreated periodontal disease
  • Post-surgical numbness due to nerve impingement or damage
  • Always notify health care providers and imaging technicians that you have dental implants before any magnetic resonance imaging (MRI) or x-ray procedures. Dental implants can distort or interfere with these images. FDA is not aware of any adverse events reported for MRI or x-ray procedures with dental implants.

In some cases, the disadvantages of dental implants outweigh the advantages, especially if you have medical concerns that make surgery difficult. You may decide against getting dental implants for the following reasons:

  • Dental implants may require supplemental procedures. Before the actual dental implant process, procedures like oral surgery and bone grafting may be recommended first depending on the clinical situation of the patient. If your teeth have been missing for a long time you may undergo bone grafting. These procedures are an additional expense of getting dental implants and lengthening the dental implant process.
  • Dental implants are expensive. A dental implant procedure is more expensive than tissue-supporting dentures. The whole expense of dental implants is rarely covered by health insurance.
  • Dental implants require surgery. Getting dental implants is a more invasive process than getting a bridge or denture since it requires oral surgery. We may conclude that the risks of dental implant surgery exceed the possible benefits if you have health issues that put you at a higher risk for complications or infection.
  • Dental implants have a longer, 4 to 8 months, treatment time.
  • Regular maintenance is required.


It is important to present the pros and cons to the patient. Sometimes disadvantages may outweigh the advantages if you have other health issues. To understand better, it is recommended to consult your dentist directly for more in-depth information.



When one suffered tooth loss, the patient and the dentist are facing two questions. The first question is: should I replace the missing tooth? The second is: what is the best way to replace it?

Options for Tooth Replacement

Several restorative options for the treatment of missing teeth are recognized as accepted dental therapy, depending on the particular circumstances the patient presents. These include:

  • Tissue-supported removable partial dentures
  • Tooth-supported bridges
  • Implant-supported teeth

Likewise, there are two basic options for replacing teeth in a completely edentulous arch:

  • Tissue-supported removable complete dentures
  • Implant-supported over-dentures

What is Dental Implant?

A Dental Implant is a bone-supported prosthesis, which is usually a replacement for the root of a tooth. The implant is placed where the root of the missing tooth used to be. The replacement root is then used to attach a replacement tooth. Like the other options, dental implants are used to replace missing teeth and restore masticatory function to an individual’s dentition.

Types of Dental Implants

The major types of dental Implants are osseointegrated and fibro integrated implants (such as the subperiosteal implant and the blade implant). The most widely accepted and successful implant today is the osseointegrated implant.

Strengths of Dental Implant

  • Dental implants are strong, durable, and natural in appearance.
  • Dental Implants offer a long-term solution to tooth loss.
  • Dental Implants are usually not susceptible to caries attack
  • Dental implants are less dependent than tooth- or tissue-supported prostheses (partial and complete dentures) on the remaining natural teeth.
  • Dental implants may be used in conjunction with other restorative procedures for maximum effectiveness. For example, a single implant can serve to support a crown replacing a single missing tooth.
  • Implants also can be used to support a dental bridge for the replacement of multiple missing teeth
  • Can be used with dentures to increase stability and reduce gum tissue irritation.
  • Another strategy for implant placement within narrow spaces is the incorporation of the mini-implant. Mini-implants may be used for small teeth and incisors.


  • Failure in the osseointegration process. For example, if the implant is placed in a poor position, osseointegration may not take place.
  • Dental implants may break or become infected (like natural teeth) and crowns may become loose.
  • Can trigger peri-implantitis around dental implants due to poor oral hygiene. This disease is tantamount to the development of periodontitis (severe gum disease) around a natural tooth.

Factors that patient-dentist have to consider during consultation

The decision that the patient and the dentist will make together depends on several factors that are particular to individual patient circumstances. Among these are:

  • The general health of the patient and any contraindications for the surgical implant procedure
  • The configuration of the remaining teeth in the arch as well as the opposing arch
  • The number of tooth spaces that need replacement by the dental prosthesis
  • The preferences of the patient and his/her willingness to undergo a more invasive surgical procedure required by the dental implant option
  • The relative cost of the implant option compared to the alternative; this choice, of course, could be that the patient decides not to replace the missing teeth with any dental prosthesis

Modern dental implants are virtually indistinguishable from natural teeth. They are typically placed in a single sitting but require a period of osseointegration. The integration with the bone of the jaws takes from 3 to 6 months to anchor and heal. After that period a dentist places a permanent restoration for the missing crown of the tooth on the implant

Reasons patients seek dental implant therapy:

  • Function
  • Esthetics
  • Comfort
  • Confidence
  • Facial appearance

Who is suitable to get Dental Implants?

Generally, an individual who is in good health to undergo oral surgery can be a candidate for a dental implant. Preferably a patient with healthy gums who has sufficient bone to hold the implant, dedicated to maintaining good oral hygiene and regular dental visits. But a candidate for a dental implant doesn’t necessarily mean one will undergo the procedure. A dental implant is an expensive procedure and one must have a budget to afford the costs.


Dental implants are among the most successful procedures in dentistry. A Dental Implant lasts long and is durable. If you are considering implants, visit your dental office for more direct information.



Tooth loss is a general healthcare case. A dental implant is one of the tooth replacement alternatives and is not fit for everyone. Hence, when considering tooth replacement, the conventional options of tooth replacement with dentures and bridges should not be overlooked. The diagnosis phase of the planning will aid in determining the causes of the tooth loss and whether dental implants would be an appropriate choice. The main reasons for tooth loss are:

Periodontal disease

Periodontal disease remains one of the most common causes of tooth loss. Patients with missing teeth due to periodontal disease are not poor candidates for dental implant treatment; nevertheless, it is paramount that existing periodontal disease has been treated and stabilized before any consideration of tooth replacement with dental implants. The prognosis of the remaining teeth should also be assessed and incident planning for future loss if the teeth are to be retained. Patients who have lost their teeth due to periodontal infection will usually present with soft and hard tissue loss with complicated treatment conditions and careful treatment planning is crucial to ensure success. Patients who have had the periodontal disease treated and are highly driven have exhibited to have successful implant treatment results, although when compared to non-periodontally susceptible patients, the success rates are slightly lower. These patients will need strict and routine follow-up and supervision care on fulfillment of the implant treatment as they stay at a higher risk of peri-implant disease.


Dental caries

This is the second-most-common cause of tooth loss. The overall caries risk needs to be assessed as this will affect the prognosis of the remaining teeth. The need to contingency plan future loss of teeth that have a compromised prognosis concerning the implant treatment is necessary to ensure a positive outcome.

Endodontic failure

Success rates of endodontically treated teeth remain high; however, often teeth that are endodontically treated will fail either due to recurrent infections apically or due to root fracture. If replacement of these teeth with dental implants is planned, it is important to ensure that the infected tissue is fully removed to guarantee that the outcome of implant treatment remains advantageous. Implants placed in sites with a previous history of recurring apical infections may be at a higher risk of failure, and those placed adjacent to endodontically compromised teeth are also at risk, thus planning should factor in the prognosis of the adjacent teeth in these circumstances.

Dentofacial trauma

Traumatic injuries can be varied and localized to the teeth alone or involve the soft tissues, bone, and facial structures. The difficulties related to replacing the missing teeth are based on tooth injury and extensive tooth tissue loss. When the injury is localized to the teeth only, replacement of the teeth with dental implants will offer a more favorable option providing psychological benefits and improved quality of life.

Congenital absence

The prevalence of patients born with missing teeth remains relatively high and can occur independently or as part of a syndrome. Patients with congenitally missing teeth will often have other anomalies with the absence of adequate space, quality of the gingival tissue, and quantity and quality of bone, thereby needing further integrated interventions to create the required shape, form, and space for the teeth to be replaced with dental implants. The treatment expectations of patients with congenitally missing teeth are usually supported by sentiment as part of the treatment process.


Implants used to facilitate other treatment

Dental implants are increasingly being used to provide anchors for orthodontic tooth movement when natural teeth are compromised. The implants can either be in the form of mini tags or conventional implants. If the latter is used then the position of placement should be planned such that the implants are in the required position at the end of the orthodontic treatment and can then be restored.


It is important to truthfully answer the medical and dental history questions asked by a dentist or indicated in the given chart to prevent any misdiagnosis and maltreatment. Filling out false information can lead to undesirable consequences and the cost will mount up as there will be follow-up procedures. If you are considering having a dental implant, just contact and consult with your dentist for specific details on whether you can undergo the procedure.



A dental implant minimizes the loss of sound teeth from adjacent teeth, a remarkable advance in conserving otherwise sound teeth. The dental implant process usually involves a collaborative effort between the restorative and surgical offices, facilitated by a protocol for interdisciplinary treatment planning.

A dentist will do a comprehensive systemic and oral health evaluation of a patient. If there are no oral or other (systemic) health issues that could adversely affect the surgical treatment of the patient, then the dentist will determine why a patient is seeking treatment.

A patient who is seeking a dental implant therapy is based mainly on the following criteria:

  • Function
  • Esthetics
  • Success rate
  • Ability to properly cleanse

Common complaints of patients

  • Loose/ill‐fitting dentures
  • Discomfort
  • Denture‐related halitosis
  • Mobile/missing teeth
  • Unattractive smile/teeth
  • Masticatory pain

Central to the dentist‐patient interaction is a preference for what a dental implant can do for the patient and the dentist. In restorative dentistry, the crown generally meets three important criteria:

  • Long‐term success rate
  • Predictable outcome
  • Low‐stress procedure

Implant dentistry fulfills these three criteria even so with the added benefit that the dentist can control the case from start to finish.

Before devising a treatment plan, the dentist should ensure that the patient is financially feasible. Of course, the costs involved in constructing diagnostic models, wax-ups, CT scans, and surgical guides all mount up, even for the simplest cases. If a dental implant or implants are beyond the financial resources of the patient and financing options are not available, then conventional treatment approaches, although less ideal, must be adopted.

It is also necessary to assemble or collect data for the treatment plan. Typically, this involves the following:

  • Health HX
  • Dental HX
  • Radiographs
  • Cone be-beamed tomography (CBCT) if necessary
  • Models if necessary

A dentist will evaluate the implant site, radiographically and visually. Ideally, the dentist will recommend both normal x-rays and cone-beam computed tomography (CBCT) to be used. If CBCT is not available, then “ridge mapping” is a good alternative. Ridge mapping is the process of bone sounding to create a “map” of the bony structure. The vertical and the horizontal dimensions of the bone are assessed to determine if implant therapy is practical. The basic limitation to implant placement is outlined by “the rule of 6’s.”

Criteria for satisfactory implant placement:

  • 6mm radiographic height
  • 6mm of bone width (determined from CBCT or ridge mapping)
  • 6mm mesial/distal space
  • 6mm inter-occlusal space Implant site accessibility

If these criteria are not met, bone augmentation (bone grafting) can be performed. Bone deficiencies occur for multiple reasons but are primarily due to bone resorption or bone loss over time following an extraction.

Deciding which implant to use is often a matter of personal choice, there is an abundance of implant systems available to the practitioner. The final decision on implant system selection lies with the dentist but will be impacted by the implant site, the operative conditions and the type of restoration to be placed on the implant(s).

Implant selection criteria:

  • Implant design
  • Bone level relative to coronal implant position
  • Internal connection • Long‐term availability of parts
  • Platform switch (horizontal offset)
  • Abutments to allow a multitude of restorative choices

If sufficient bone exists, it must be determined whether the implant can be restored properly. Things to consider include the absence or presence of the opposing teeth as well as their condition. Also, the practitioner must consider the angle at which the implant will be placed. Ideally, the implant should be placed along the long axis of the final restoration. If there is excessive off‐angle loading, bone loss or restorative failure may occur.

Implant Site Evaluation – Healed Bone

Endosseous implants are used in edentulous areas where there is sufficient healthy bone to accommodate the implant without risk of damage to vital structures. Endosseous implants are contraindicated in situations where there has been excessive ridge resorption. Other contra‐indications for endosseous implants include severe malocclusion, bruxism, and parafunctional oral activities such as pipe or pencil chewing. The practitioner may decide to undertake treatment when certain criteria are satisfied.

Implant Site Evaluation – Immediate Site

When evaluating a potential extraction/immediate implant placement site, the dentist must evaluate the following:

  • Absence of any active infection
  • Intact buccal plate
  • The likelihood of an atraumatic tooth extraction
  • The existence of all walls of bone (Buccal, Lingual/Palatal, Mesial, Distal)
  • Sufficient vertical height of bone between the implant site and vital structures
  • Insertion torque – of about 25Ncm

If these criteria are not met, it is best to perform socket preservation and thus delay implant placement. Although placing a single implant in a healed site is perhaps the most straightforward of implant procedures, practitioners can run into problems and situations that need to be addressed appropriately to achieve a successful outcome.


Treatment Agenda

Replacing a missing or extracted single (free-standing) tooth is the most common implant procedure performed. It is the most basic implant procedure in that there is no need for the preparation of abutment teeth for a traditional bridge. Even though this procedure is surgical, it is less invasive in that removal of enamel is an irreversible procedure. Bone and soft tissue can be regenerated through grafting procedures. Generally, the long‐term prognosis is better for a single implant than for a traditional bridge. Further, although the initial cost may be higher for a single implant, the long‐term cost is lower than for a traditional bridge. Also, replacing a single tooth will simplify possible future retention of prostheses such as FPDs, RPDs, and CDs.

Treatment factors for dental implant placement:

  • Need for bone graft (?)
  • Need for guided bone regeneration graft (?)
  • Implant design Need for a custom abutment (?)
  • Crown selection Interim partial denture (?)
  • Implant maintenance

The site criteria for a simple implant:

  • Bone width: ≥6mm
  • Bone height: ≥6mm
  • While the rule of 6 applies to the bone height as an absolute minimum requirement, it is highly recommended to have a 2mm zone of safety when dealing with the inferior alveolar nerve. So, if placing a 6mm implant in the posterior mandible, 8mm of bone height would be needed.
  • Inter‐occlusal space: ≥6mm

If the bone criteria are not satisfied, then grafting or guided bone regeneration (GBR) may be necessary. The next decision is the choice of the implant system.

Implant system selection.

  • Tapered
  • Bone level
  • Internal connection
  • Platform switch
  • Long‐term availability
  • Wide array of restorative options
  • Stock abutments (straight/ angled)
  • Engaging/nonengaging
  • UCLA abutments
  • Multi‐unit abutments
  • Ti bases
  • Digital scan transfers

Regardless of the implant system selected, the implant site, or the various patient factors, the cautious dentist should always anticipate the worst and prepare for the need for bone grafting regardless of pre‐operative radiographic evidence.

Implant Scenarios

The Single Crown

  • The single implant‐retained crown replaces a missing tooth and can restore an unattractive or patient‐restricted smile, improve masticatory ability and slow down or retard bone loss.
  • The other major advantage of the single dental implant is that it avoids the need for a three‐unit bridge.
  • Another advantage of individually‐restored implants compared to bridges is that implants tend to retard continuing bone loss that often occurs at edentulous

The Edentulous Patient

  • Treating edan entulopatientsent with severely resorbed ridges, flat ridges,s or, in the case of an upper denture, a shallow palatal vault, is a challenge to generadentistsst.
  • Edentulous patients with these conditions have difficulty achieving a stable, retentive denture without resorting to retentive aids such as denture fixatives.

These are some of the  patient complaints and dissatisfactions with complete dentures:

  • Poor denture stability
  • Lack of retention
  • Diminished masticatory forces
  • Pain due to impinging nerve eon severely resorbed mandible
  • Speech impairment
  • Impaired taste and thermal sensitivity with upper dentures oralral malodor

There are two basic choices for the “terminal dentition” or the edentulous patient. The first option is the implant over‐denture. The second option is the fixed implant bridge(s).

Implant Overdenture

  • The implant over‐denture is implant and tissue‐supported prosthesis.
  • Generally, two to four implants are placed per arch to stabilize the denture.
  • Specific abutments are placed on the implants and corresponding attachments are processed into the denture to create a “snapping‐in” of the denture.
  • The patient should remove the appliance to clean daily.
  • The patient is instructed to not sleep with the appliance.
  • Recommended scheduled maintenance includes implant and prosthesis cleaning at 6‐month intervals, replacing denture attachments every six months–to one year, and relining the appliance every two to five years.
  • Abutments may need to be replaced after five years due to wear although wear patterns can be variable due to patient factors.

Fixed Implant Bridge(S)

  • Fixed implant bridges are completely implant‐supported screw‐retained prostheses.
  • Generally, four to six implants are used to support the prosthesis.
  • Materials used include milled bars (chrome–cobalt or titanium) and processed acrylic or milled prosthesis (poly-methyl methacrylate) [PMMA] or zirconia).
  • Increasingly, zirconia is becoming the material of choice for these prostheses due to its strength, durability, and biocompatibility.
  • When zirconia is utilized, the prosthesis is fabricated much like the traditional FPD, potentially allowing for better cleanability.
  • Patients are educated in the use of water flosser devices as well as floss threaders.
  • Regularlyar scheduled maintenance for fixed implant bridges include implant and prosthesis cleaning every six months, and appliance removal every one to two years with possible screw replacement.
  • Regardless of the stabilization/retention method adopted, implant‐supported dentures successfully address, if not eliminate, most if not all the patient issues with CDs.
  • With implant‐retained dentures, such problems as denture slipping, poor stability, impaired masticatory performance, ance and masticatory pain become things of the past for the edentulous patient.


When discussing the treatment plan, communicate with your dentist attentively because the dentist will explain all details and alternatives in concern with your wants and clinical situations.