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Dental implants; Sinus floor augmentation; Immediate dental implant loading; Osseo integration; Computer-aided design

Introduction

Periodontitis is the most frequent reason for tooth loss; but additional reasons include dental caries; trauma; birth defects; and hereditary conditions [1]. In the past 30 years; there has been an upsurge in the use of dental implants to replace missing teeth [2]. Prior to dental implants; dentures and bridges were utilised; but because of the procedure’s high success rate; predictability; and relative lack of problems; dental implants have become a very popular alternative [1- 3].

There have been several researches published and on-going about dental implants. The present state of dental implant research is summarised in each section of this study (implant surface; immediate loading versus conventional loading; short implant; sinus lifting; and custom implant using three-dimensional printing) [4].

A dental surgeon places artificial components called dental implants into a patient’s jawbone. If one or more teeth have been lost; a person may require an implant.

What exactly are dental implants?

(Figure 1) A dental implant is a structure that acts as a tooth replacement. The surgeon places an implant into the jawbone using tools that resemble screws; the implant serves as the anchor for a crown; which is a type of artificial tooth [5].

Figure 1: Dental Implants.

The dental implant and the prosthetic tooth are joined by a component known as an abutment.

The crown is designed specifically for the individual to fit their mouth and complement their tooth colour. Crowns have a natural appearance; feel; and performance [6].

Compared to detachable artificial teeth known as dentures; implants have a number of benefits. Implants:

• Are more comfortable and natural-looking;

• Have a higher success rate;

• enhance chewing ability;

• Lower the risk of cavities forming in teeth nearby;

• Better preserve the bone at the site of the lost tooth;

• Lessen the sensitivity of teeth nearby;

• Don’t need to be taken out and cleaned every night.

Dental implants; however; are not appropriate for everyone. Before having implant surgery; a person’s bones must be in good shape since the implanting devices need to form a bond with the jawbone [7].

Types

Endosteal and sub periosteal dental implants are the two types available.

The most typical kind of implants is Endosteal. Each one can accommodate one or more false teeth and is implanted into the jawbone by a surgeon [8].

A sub periosteal implant is attached to the jawbone by a surgeon.

For patients with low jawbone height; dental surgeons recommend this method.

Stability

Around 3 million Americans have dental implants; and this number rises by roughly 500000 per year; according to the American Academy of Implant Dentistry [9].

When a trained and experienced surgeon or dentist completes the procedure; dental implant surgery is safe. Additionally; it is the only method of dental restoration that promotes the growth and preservation of the jawbone.

Threats

There are some persons who cannot receive dental implants. Dental surgeons should avoid performing procedures on patients who have:

• Acute illness

• Metabolic disorder that is uncontrollable

• Infection or sickness of the bones or soft tissues

A person can get the operation if these problems are fixed. Dentists may decline to treat patients who have any of the following conditions:

• Heavy cigarette smoking;

• Para functional behaviours like clenching or grinding teeth;

• Behavioural or mental health issues;

• HIV;

• Diabetes;

• Osteoporosis;

• AIDS are just a few examples.

There is an increased risk of the implant failing in those who have any of the aforementioned conditions and undergo dental implant surgery [10]. Due to an increased risk of implant issues; dental surgeons may also elect to avoid performing procedures on patients receiving the following treatments:

• Radiation therapy for the head or neck;

• Chemotherapy;

• Bisphosphonate medication treatment for bone loss illnesses;

Risks associated with implant surgery

Complication during or after this treatment could occur in patients [11]. The issues may include:

• A surgical incision opening following surgery;

• Implant movement;

• Implant exposure above the gum line;

• Nerve injury causing altered sensation in the surgical area;

• An implant infection

In order to enhance the condition of the bone and gums; remove or replace the implant; or both; those who experience movement or exposure of the implant may need to undergo further treatments [12].

Some warning signs and symptoms indicating an implant placement was failed include:

• Fast; progressive bone loss;

• Excessive implant mobility;

• Discharge of pus or other fluids from the location;

• Pain when tapping the implant

Methods

Each patient’s experience with dental implant surgery is likely to be unique [12]. The following variables could have an impact on this:

• The quantity and quality of bone at the implant site;

• The number of teeth that need to be replaced;

• The position of the implants inside the jaw;

• The underlying oral and general health of the patient.

These variables may warrant the need for extra procedures. These may consist of:

Sinus augmentation/ Sinus lifting

Intensification or elevation of the sinuses: Due to the location of the sinuses; implant placement in the upper jawbone is typically challenging. A sinus augmentation technique; in which the sinuses’ floors are raised to encourage the growth of additional bone; may be required by the surgeon in order to ensure the success of the implantation [13].

Sinus augmentation technique: The term “sinus augmentation;” sometimes known as “sinus lifting;” was first used to refer to a surgical procedure that involved making a bone window in the vestibular wall of the sinus. Next; a gap was made for bone grafting by gently raising the sinus epithelium. In the vicinity of the iliac crest; bone was harvested and then positioned in the ready location [14]. Prior to implantation; the healing process lasted roughly 6 months. It was suggested that bone grafting during sinus augmentation use autogenous bone; allograft; and alloplast material. There was also a demonstration of the one-stage technique; which combines sinus augmentation and implantation in a single procedure as opposed to the two-stage approach; which delayed the implantation for a number of months [15]. Due to its consistent efficacy; the aforementioned technique-also known as sinus lifting with the lateral window—is still frequently employed in contemporary implant dentistry.

One-stage osteotome sinus floor elevation was a less intrusive method. This method used a crestal approach to gain access to the sinus epithelium. With increasing diameter; the osteotomes’ tips elevate the sinus epithelium by pushing a mass of bone above the initial sinus floor to the necessary elevation [16]. After performing sinus enlargement and any necessary bone grafting; the implants were then put in place without needing to be drilled. However; it was asserted that main stability required a minimum of 6-mm alveolar bone height.

Perforation of the sinus epithelium was one of the most frequent side effects of sinus augmentation. This condition could be brought on by sinusitis; severe bleeding; or a slow rate of recovery [17]. In order to prevent complications from sinus augmentation; numerous modified surgical methods and tools were developed. To lessen the possibility of rupturing the sinus membrane; a crystal approach utilising a nontraumatic drill was recommended. Long implants (13 mm and 15 mm) were placed in 265 instances during a retrospective analysis. There were numerous options for bone grafting.

Either a bone replacement or bone from the osteotomy site might be used to replace the missing bone. Implants may be placed by skilled surgeons without the need for grafting; and the tips of the implants could support the sinus membrane. Similar to the crystal approach technique; primary stability is attained if there is at least 3 mm of accessible alveolar bone height [18].

Additionally; using absorbable collagen membranes in perforated sinuses for sinus elevation and implant implantation yielded positive outcomes. In another method; implants were first inserted in the ulna to treat the posterior edentulous maxilla. A sinus region with a 3 to 4 mm protrusion was transplanted with bone blocks containing implants after 6 weeks. After that; the implants were given six weeks to recover [19]. Patients who received particulate bone grafts (an autogenous bone graft from the symphysis; tibia; or iliac crest) served as controls to compare the effectiveness of this therapy technique. In the control group; grafts had been allowed to heal for six months before being implanted. Regarding implant stability; there were no differences between the two groups. At 6 and 12 months; there was a considerable improvement in implant stability in both groups. In extreme cases of bone atrophy; an ulna implant block in conjunction with sinus grafting may be an efficient way to increase the vertical bone height [20].

Ridge transformation

Some people’s jawbone abnormalities hinder the development of enough bone for an implant. A ridge alteration may be required in such circumstances by the surgeon.

In order to see the area of the malformed bone; you must lift the gum. The surgeon will next rebuild the damaged area using bone or a bone substitute. In order to prepare for dental implant surgery; this enhances the jawbone’s quality [21, 22].

Restoration

Following dental implant surgery; a patient must continue to maintain good oral hygiene habits; including regular brushing and flossing. The same maintenance is needed for artificial teeth as for natural teeth.

To check on the implants and make sure the teeth and gums are in good condition; the surgeon or dentist will also arrange follow-up appointments [23]. For thorough cleanings every six months; it’s vital to visit the dentist again.

Expense

The following elements may affect the price of dental implant surgery:

• Whether further treatments are required to prepare the mouth for surgery;

• The quantity and types of implants that are required;

• Where the implants are located within the jaw.

The price of dental implant surgery can be estimated by a dentist or other oral health expert during a preliminary exam [24].

Some dental insurance plans offer greater expense coverage. Bridges are one alternative to dentures that may be less expensive. Bridges; on the other hand; are more difficult to keep clean and frequently need replacement and repair; which raises the overall cost. If dental implants are taken care of properly; they might have longer-term advantages [25, 26].

Discussion

Dental implants serve as bone-anchored fixtures to replace lost teeth. Long-term advantages can be obtained through implants; which have a high success rate.

To prepare their mouth for dental implants; some people require extra operations. These will raise the overall price. Costs may also increase depending on the type and quantity of implants needed. Asking their dentist if dental implant surgery is right for them is advised for anybody considering it.

Conclusion

Recent advancements in implant success rates include sinus lifts; rapid loading; short implants; surface changes; and bespoke implants. The absence of long-term or clinical trials has; however; resulted in restrictions. We require a more predictive analysis and a lengthy clinical trial.

Acknowledgement

None

Conflict of Interest

None

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