An introduction to dental implants
Most scientific advances are made through accidental discoveries. For example, Dr Alexander Flemming had left a few bacterial culture dishes unattended over a period of time and had observed a fungal growth in the dishes that had inhibited bacterial growth. This had led to the discovery of penicillin, which had directly led to the birth of modern medicine as we know it.
The same way, Dr Per Ingvar Branemark had been conducting experiments with placement of titanium inserts into the bones of rabbits. Upon completion of the experiments, he had tried to retrieve the inserts as they were expensive. It was then that he discovered that the titanium inserts had completely fused with the bone. This is the phenomenon of osseointegration where the titanium and bone become one without any distinguishable joint.
Later research by Dr Branemark had led to dental implants and he founded Nobel Biocare for the manufacture of implants. Constantly evolving research has led to the development of various types of dental implants. The first dental implants were single tooth units, which were used to replace a single missing tooth. We now had special dental implants such as All-on-4 dental implants and zygoma implants. These implant systems utilize a minimal number of implants to rehabilitate an entire edentulous arch.
Dental implants come closest to natural teeth when it comes to its ability to bear biting forces and esthetics. Just like natural teeth require a lot of care to last a lifetime, dental implants too require a lot of care to last a lifetime. This involves the maintenance of scrupulous oral hygiene through not only tooth brushing, but also through the use of dental floss and mouth washes. Implant failure rate is also very low when all the instructions are followed for their upkeep by the patients.
Patient with missing right maxillary molar teeth
The patient is a young man who had prematurely lost the right molars in his upper jaw due to dental decay. This partially edentulous state had led to a lot of difficulty with chewing food along with entrapment of the tongue during chewing and speech. He had started chewing mainly with the left side of his jaw.
He had visited a local dental clinic for information regarding dental implant surgery in India. He had felt apprehensive as this is a surgical procedure. The local dentist had also advised him to go for dental implants considering his young age. He had also informed the patient that sinus augmentation might be required due to the length of time the patient had been edentulous. It was also explained to the patient that he needed to go to a specialty treatment center for dental implants. The patient was then referred to our hospital for dental implant surgery.
India is a major hub for medical tourism from all parts of the world. Many patients come to India because of the high quality of care allied with the low cost of treatment here. Our country boasts of a very well developed infrastructure for the delivery of quality healthcare. Chennai is considered to be the healthcare capital of India.
Patients seeking the services of a quality dental implant surgeon in India form a major part of medical tourism to our country. There has been a profusion of dental implant clinics lately because of this. Edentulous mandibles are more often encountered than edentulous maxillae. Reasons for this can be varied and can depend upon food habits and diet.
Initial examination and treatment planning
Dr SM Balaji, director, Balaji Dental and Craniofacial Hospital, examined the patient. He ordered CBCT for treatment planning. Our hospital was the first in South India to acquire the CBCT imaging system. CBCT enables the best treatment planning for placement of maxillary dental implants and mandibular dental implants. Soft tissue contour and the maxillary sinuses are well visualized in CBCT images.
The patient was informed that bone height was inadequate in the maxilla for implant placement. It was explained that the sinus lift surgery would enable building up the bone height in the maxilla for implant placement. Bio-Oss would be used to enable the sinus lift procedure. This is close to being the ideal bone graft material for maxillary bone augmentation.
Bone grafts from the ribs would be required in cases where there is bone loss in the mandible. The patient readily agreed to the procedure. A presurgical systematic review was conducted after obtaining consent from the patient.
Importance of adequate maxillary bone height
Adequate bony height of the maxilla is very essential for long term success of the implant. The Schneiderian membrane, which lines the maxillary sinus should not be perforated during implant fixation. Perforation of this membrane would lead to long term sinus problems with maxillary sinusitis and chronic maxillary sinus infection. Sinus lift procedure increases the height of the bone of the maxilla, thus making is possible for implant fixation in the maxilla.
Bone height begins to reduce within six months of extraction of maxillary teeth. This is more pronounced in the case of loss of maxillary molars. The use of Bio-Oss provides quick formation of new bone by means of consolidation of the Bio-Oss placed through the lateral window created in the maxilla.
Implant placement and Maxillary sinus lift procedure
Under general anesthesia, a mucogingivoperiosteal flap was first raised in the right posterior maxillary region. Following this, a lateral window was then made in the maxillary bone using a surgical bur. The Schneiderian membrane was then gently separated from the floor of the maxillary sinus. A space was soon created between the floor of the maxillary sinus and the membrane. Extreme care was taken during to procedure to ensure that there was no tearing of the membrane. The ensuing space between the Schneiderian membrane and maxillary bone was then densely packed with Bio-Oss.
This Bio-Oss would soon consolidate into new bone and this would serve as bony support for the implant. A dental implant was then placed in the maxilla in the molar region. Our hospital is a specialty center that has been certified as such by Nobel Biocare for the placement of dental implants. Following this, the flap was then closed with sutures. An implant supported artificial tooth or dental crown would be fixed to the implant in 4-6 months after adequate bony consolidation of the Bio-Oss.
The patient tolerated the procedure well and recovered uneventfully from general anesthesia.