Different Dental Implant Systems
Dental implants are a popular choice for patients who need to replace one or more missing teeth and who can endure implant placement surgery and the extensive healing period of about six months. Dental implants have a success rate of about 95% and are an incredibly stable and natural looking way to restore your smile!
When you consult with your dentist about dental implants, they will evaluate the area to be treated and speak with you about your lifestyle and habits before they determine what type of implant system will be appropriate for you. Most dentists have a particular type that they prefer, but will use whatever system will best suit your individual needs.
Top Implant Systems
These are the six most respected and well-known companies that produce widely used implant systems:
- Nobel BioCare
- BioHorizon
- Dentsply
- Straumann
- Zimmer Biomet
- MIS
While there are over 100 manufacturing companies throughout the world that produce implant parts, opting for a system from one of the top companies can be beneficial down the road. Dentists the world over as well as dental labs are more likely to be familiar with the more popular implant systems and therefore can provide emergency service to patients that may be unable to get to their personal dentist. A generic implant system may come with a lower price tag but if you break part of your implant or develop a problem that requires immediate attention, another dentist and their preferred lab may not have have the necessary tools to treat you.
If you are in need of a dental implant, speak with your dentist to see what types of systems they use in their practice before you begin researching on your own. These six companies create high-quality implant systems with biomechanical qualities which are thoroughly researched to give patients the best possible chance of success with their implant treatment. Osseointegration (implant/bone fusion) is crucial in order for an implant to succeed. A high-quality implant has a rough finish that allows for osteoblastic cells to adhere to and create the fusion that is necessary.
Types of Implant Abutments
Once an implant is in place, an abutment is placed on the implant which acts as a bridge between the implant and the restoration, which a crown, a bridge, or a denture. The restoration can either be screwed or cemented in place and your dentist will determine which option is best for your individual case. The abutment your dentist uses may be a stock abutment or a custom made abutment.
Cementable vs Screw-Retained Abutment
When determining what type of restoration to place, your dentist will consider ease-of-use, retrievability, peri-implant tissue issues, and suitability for angled implants.
- Ease of use: Cement-retained implant restorations are generally easier to work with than screw-retained. A cement-retained restoration is placed much the same as a crown or bridge. A screw-retained restoration requires additional steps to ensure a proper fit and that stress is not being applied to the implant before the restoration is screwed down.
- Retrievability: When an implant restoration needs to be replaced, certain cements can make removing the old restoration more difficult than others. A screw retained restoration is more predictable and easier to retrieve than those placed with cement. There are cement available that make it easier for your dentist to remove the restoration and your dentist may also choose to use a temporary cement, all of which are not as secure as a screw.
- Maintaining peri-implant tissue: Using cement to place a dental restoration always poses a risk that excess cement can extrude into the gum pocket around the tooth and cause damage to the gum tissue and surrounding implant. If excess cement is not fully removed, it can pose an increased risk of irritation, swelling, and discomfort at the implant site. Your dentist will take a postoperative x-ray which will show any cement that has creeped into the gum pocket to be sure that no excess cement is left behind. Using a screw retained restoration avoids the risk altogether.
- Use with angled implants: One drawback with a screw retained restorations is that they are not ideal for your front teeth. A screw retained restoration requires an access hole that is drilled through the restoration itself. The hole is filled with composite material to camouflage the hole and protect the screw. This is not easily done on front teeth so dentists often choose to use a cement retained restoration.
Stock Abutments vs Custom Abutments
Most of the time, a stock abutment can be used to place an implant restoration but sometimes, a case may require a custom abutment. Your dentist will determine what type will best suit your individual case.
Custom abutments can be used for either cementable or screw retained implant restorations and can be made from titanium or zirconia. Custom abutments are more expensive but provide better gum tissue management and have a more predictable aesthetic outcome. A dental lab will fabricate a custom abutment at the same time they fabricate your restoration using a model provided by your dentist. Your dentist will make the model from impressions they take of your mouth.
Stock abutments have a huge benefit over custom abutments in that they can be easily replaced by most dentists in the event that you cannot see your own provider. If you are out of town and break your restoration and the abutment, a different dentist would be able to replace a stock abutment more readily than they could a custom abutment. Stock abutments are much more user-friendly and can be either cementable or screw retained.
The gum tissue around the abutment will conform to the shape of the abutment so since stock abutments are a standard size, your dentist may not find that ideal for your gum tissue. In this case, they may choose to use a custom abutment. It is important that the margins of your implant restoration make good contact with neighboring teeth so you may need some adjustments to ensure that there is room to floss, but not so much space that you have a food trap.
Types of Implants
There are two types of implants. Your dentist will review your options and together, you will determine which type will best suit your individual needs and lifestyle. Implants can be fabricated using titanium or zirconia. Zirconia implants are gaining in popularity especially for patients with metal allergies.
Titanium Implants
Titanium implants have been used since the 1960s and have great biocompatibility and a 95% success rate! Biocompatibility is crucial for implants to be able to integrate with jaw bone structure. Titanium implants have a rough finish that allows for osteoblastic cells to adhere to the surface of the implant and create the necessary fusion between the implant and bone for a stable base for the implant restoration.
Titanium implants are able to support all implant restorations including implant supported dentures. If you have a metal sensitivity or other concerns about titanium implants, speak to your doctor about zirconia implants which can be used with limitations.
Zirconia Implants
Zirconia implants have not been around as long as titanium implants, only for about 12 years, so they do not have the recorded long-term success rate of titanium implants. Zirconia implants are an excellent option for patients with metal sensitivities though they do contain trace amounts of hafnium and yttruim used to improve its properties. Zirconia implants are able to integrate with your bone similar to titanium and are still very strong, even though they are composed mostly of ceramic material.
Zirconia implants are fabricated as a single piece and are more challenging to place so bone volume will be a determining factor when your dentist is deciding what type of implant is best for you. One big benefit to zirconia implants is the fact that there is no metal that can risk showing through the gumline, though this rarely happens with titanium implants. It should also be noted that any restoration on a zirconia implant must be cemented in place, it cannot be screw retained.
Types of Implant Crowns
Implant crowns can be fabricated from ceramic, porcelain, porcelain fused to metal (PFM), e-max, gold, or zirconia. Most patients prefer ceramic or porcelain since they are the most natural looking and can be tinted to match the rest of the teeth.
Crowns made from gold or other base models and PFM crowns are much stronger and more durable than their porcelain and ceramic counterparts but patients run the risk of metal eventually showing through PFM crowns as they age.
If you have one or more missing teeth, it is important to know what your options are when considering an implant restoration. Speak with your dentist to discuss your goals for your smile and determine what implant system will be best for you and your individual lifestyle and habits!