Surgical procedures and other medical treatments are complex and require immense skill on the part of the treating physician. Adequate visualization of the area of the body being treated is critical; without it, the rate of complications is significantly higher. However, many areas of the body are difficult to see, particularly in the oral cavity. Image guidance is a newer technology in the field of dentistry that allows dental health professionals to visualize different areas of the mouth before and during the procedure. In the past, implants were typically done only using x-ray technology, which left more room for error. Image guidance is now the preferred method for placing dental implants. CBCT images are obtained and CAD technology is used to “place” the implants virtually in a highly accurate, computerized surgical guide. Image guidance has eliminated the need for a flap in a large number of implant surgeries, reducing the risk of potential complications.
Image stitching, also called photo stitching, is the process of merging multiple photographs together to create a single high resolution or panoramic image. Image stitching is most often done via computer using specific software designed to sense areas of overlap and combine them. The overlaps need to be as exact as possible and the exposures identical to elicit a final image with no visible seams. Because the illumination in two separate images could differ, even if the images are taken in quick succession, image stitching could result in seams between the images. Depending on the application, these seams may or may not be significant. In the field of dentistry, photo stitching is often used for x-rays and CAD/CAM images. This is because it’s not possible to organically capture an image of the entire mouth in one sitting; instead, multiple images from different angles must be obtained and fused together.
With traditional implant dentistry, the dental implant hardware is given time to heal before the prosthetic is loaded onto the abutment. However, many patients dislike this option because it requires approximately three to twelve months for the final dental restoration to be completed. In cases where the implant will be done in the front of the mouth, the long wait is particularly concerning. Immediate implant placement, is a newer type of procedure that allows dental restorations to be completed much more quickly, greatly reducing a patient’s time-to-teeth. Immediate implant placement may be done when appropriate at the same time the natural tooth is removed. Immediate loading, also called immediate function, is the loading of a temporary dental restoration or crown into the implanted abutment directly after it is placed. In some cases, patients may be able to have a tooth removed and a temporary tooth placed in the same day.
In implant dentistry, there are two types of immediate loading: immediate occlusal loading and immediate non-occlusal loading. Immediate occlusal loading occurs when a dental implant is placed with adequate initial stability and the corresponding dental restoration features full centric occlusion in max intercuspation. This type of loading must be done within 48 hours of the placement of the dental implant hardware. The process of immediate occlusal loading is determined by the design of the dental prosthetic to eliminate the potential for micromotion at the implant site. Immediate non-occlusal loading occurs when a dental implant is placed with adequate initial stability but isn’t in functional occlusion. This type of loading is generally exclusively used for aesthetic-only dental implants or for short-term applications. Often, immediate non-occlusal loading is done to provide patients with a temporary tooth replacement while the dental implant hardware heals, especially when patients prefer not to use a removable prosthesis.
Immediate occlusal loading refers to a clinical protocol for the placement and subsequent application of force on dental implants where there is either a fixed or removable restoration in occlusal contact with the opposing dentition. Immediate occlusal loading takes place during the same clinical visit in which the restoration was performed. Immediate occlusal loading allows the new implant, prosthesis, or restoration to come in contact with the opposing teeth directly following the procedure. Though studies have not shown a significant difference in the success or longevity between immediate occlusal loading and non-occlusal loading, a variety of factors can affect the overall life of the restoration. These factors are largely patient-based and include chewing habits, medical history, oral care and hygiene, clenching of the jaw, and injury. In some cases, component failure can also cause the restoration to fail as can an error on the part of the dental professional.
Immediate placement, or immediate implant placement, is the placement of a dental implant into the extraction socket immediately following the extraction procedure. This employs an opposite method than that of non-immediate or delayed placement where subsequent visits are scheduled for the insertion of the implant. Immediate placement is often preferred by patients since less time is required to achieve the end result, there are fewer surgeries needed, and costs may be lower due to fewer office visits. When performed correctly, immediate implant placement has the same success and longevity rates as delayed placement and has been found to preserve soft tissue and bone at the site of the implant. However, prior to selecting this placement method, a patient’s dental history and bone and tissue condition should be closely evaluated to ensure the proper conditions for immediate implant placement are met. Failure to do so prior to placement may result in the failure of the implant.
Immediate provisionalization refers to a clinical protocol for the placement of an interim prosthesis, with or without occlusal contact with the opposing dentition, at the same clinical visit. Prior to the placement of an implant, extraction of the infected or damaged tooth is required. In the past, the patient has then been fitted with a removable prosthesis for the extraction site until the permanent implant is placed. However, the use of immediate provisionalization has been shown to have several benefits. This method not only aides in bone stabilization and the prevention of bone loss, but also has high rates of patient satisfaction. Following the extraction, an implant is immediately placed in the fresh extraction site and non-functionally loaded with an infra-occlusion provisional restoration. In addition to its bone stabilizing effects, immediate provisionalization has also been shown to reduce the treatment time required and provide patients with immediate social and psychological well-being.
In dentistry, an implant is a biocompatible alloplastic material or device that is surgically placed into orofacial tissues and used for anchorage or for functional, therapeutic, and/or esthetic purposes. Dental implants often consist of more than one part including the implant abutment, the implant-abutment junction, implant hardware, and the prosthesis. Implants may be required due to damage, illness, or trauma sustained by a patient to the teeth, gums, or other oral tissues and structures. Dental implants come in several different types and may be placed in either a single stage, or two-stage procedure. In addition, they may be located in the jawbone or on the jawbone and may or may not require bone augmentation surgery prior to placement. Implants can be used to support a single tooth prosthesis, a partial denture prosthesis, a full denture prosthesis, or a variety of other dental restorations. The type of restorative work needed will often help decide which type of implant is used.
Implant anchorage refers to the use of a dental implant as support for orthodontic tooth movement or arch expansion. In orthodontics, implant anchorage is used to resist the forces that are applied to the teeth. In the past, devices such as headgear, a transverse palatal bar, or a Nance bow were required in order to achieve strong to moderate anchorage. However, such devices had many drawbacks including lack of patient consistency, insufficient strength, and physical side effects. The use of implant anchorage methods eliminates the need for these orthodontic devices and aids in tooth movement with a less invasive approach. Though implant anchorage in dentistry requires bonding with the bone, in orthodontics, mechanical binding takes place to promote the movement of teeth. There are many types of implant anchorages available including onplants, miniplates, palatal plates, and miniscrews. Most implant anchorages are made of titanium, titanium alloys, or stainless steel.
The implant apex is the portion of a root-form dental implant that first engages an osteotomy during its insertion. It may incorporate self-tapping characteristics. A root-form dental implant, also known as an endosteal implant, is the most common type of implant with a screw base that is shaped like the root of a tooth. The implant apex of an endosteal implant is usually tapered for easier placement into the site of the osteotomy. Since a root-form implant is inserted directly into the bone of the jaw, sufficient bone depth, width, and quality must be present in the patient for the procedure to be performed. In patients that do not have enough bone, a different type of implant or a bone grafting procedure may be considered. Following the placement of the implant, it is left to heal for up to six months before being uncovered and having a new tooth attached.