Choosing the Right Dental Implant

Most dental implants come in the form of cylindrical or conical screws. They can vary in length but are generally between 2.5 and 6 mm in diameter. Here are the differences between cylindrical and conical implants:

• Cylindrical dental implants: These are classic implants, preferably used in a healed area with good bone density. They can be placed in the anterior or posterior region of the mandible. They are not recommended for immediate implantation after tooth extraction.

• Conical dental implants: Conical dental implants are very similar to cylindrical implants, except that they end in a cone shape. They are designed for specific indications, but can also be used as conventional implants. Self-drilling conical implants offer high primary stability and are highly versatile. They are adapted to all situations, whether in tissue that has already healed or immediately after tooth extraction, both in the lower and upper jaw.

Alpha Dent cylindrical dental implant

ETGAR conical dental implant

Zeramex zirconia dental implant

Dental implants are made from perfectly biocompatible and robust biomaterials. The main materials used are titanium and, more recently, zirconia. Titanium is still the most widely used today. The properties of these biomaterials enable the bone to attach naturally to the implant through a process of osseointegration after the implant has been inserted into the jawbone to replace the missing tooth root. Before these biomaterials were used, dental implants did not integrate well with bone.

Titanium dental implants:

• Advantages: Perfect biocompatibility, strong, reliable, permanent with good oral hygiene
• Disadvantages: Possible (but fairly rare) allergic reactions to titanium; less aesthetically pleasing due to greyish appearance

Zirconia dental implants:

• Advantages: Same advantages as titanium implants; more aesthetically pleasing than titanium implants because zirconia is white in color, so no gray border appears at the base of the prosthetic crown
• Disadvantages: Titanium implants have been used longer than zirconia implants; more expensive than titanium implants

A connector is fitted to the head of the dental implant. It works as an anchor for the implant abutment that connects the implant to the prosthetic crown.

Since there are different types of implants and prosthetic crowns, connectors come in different shapes, such as hexagonal, octagonal, conical, ball-shaped, and tri-lobe. What’s important is that the connector’s shape and size are compatible with the abutment that will be screwed onto it.

There are two types of connections:

• External dental implant: The male element is in the implant and the female element is in the prosthetic abutment. As such, the implant fits inside the abutment. This is the oldest type of system.
• Internal dental implant: The male element is in the abutment and the female element is in the implant. The prosthetic abutment is therefore inserted into the implant. This type of fitting was impossible at the beginning of implantology because the thickness of the implant walls was not sufficient. It was incompatible with the mechanical properties of the grade 1 or 2 titanium used at the time. However, the appearance of other materials, such as grade 4 and 5 titanium, made it possible to use internal connections, which are now the most common.

Ziveco internal connection implant

EBI external connection implant

One or more implants are placed in the jaw while the patient is under local anesthesia. In rare cases, general anesthesia may be required. The complete dental implant process then consists of three main stages: placing the implant itself, integrating the implant into the bone, and making and fixing the artificial dental crown.

• Step 1: Implant placement
  The dental surgeon opens the gums to reveal the bone. They then take measurements of the distance between the adjacent teeth to determine the exact position of the implant. They then drill into the bone, making sure to drill perpendicular to the adjacent teeth. The implant is then screwed into the bone. A healing abutment is then placed on the implant and the dental surgeon closes the wound with stitches.

• Step 2: Integrating the implant into the bone
  Within two months of the first operation, the dental surgeon checks that everything is healing well. During this period, the implant gradually integrates into the bone, a process called “osseointegration”. If necessary, soft tissues can be shaped to better fit the crown.

• Step 3: Making the prosthetic dental crown
  Once the implant has been properly integrated into the bone, an impression is taken and sent to a dental technician to create the crown. The technician will take into account the size, shape, and color of the adjacent teeth to achieve a harmonious and as natural result as possible. Finally, the crown is fixed to the implant (which acts as an artificial root) using the prosthetic abutment.

The dimensions of the dental implant are chosen according to the shape of the patient’s jaw and the location of the tooth it will replace.

All implants measure between 10 and 14 mm in length.

As for the diameter of the upper part of the implant, called the platform, these are the most common dimensions:

• Wide platform implant: Diameter between 4.5 and 6 mm. These implants are only used for posterior teeth, particularly molars.
• Standard platform implant: Diameter between 2.5 and 4.2 mm. These short, slender implants are usually used to replace front teeth.

Cases of failure are rare in dental implantology, although they do occur. The success of the procedure depends essentially on two factors: correct oral hygiene and no smoking.

The main risks associated with the placement of a dental implant are as follows:

• Pain and swelling: Medication may be prescribed to relieve pain.
• Bleeding: This may occur in the three days following surgery but is generally not serious.
• Infection: The site where the operation was carried out may become infected. In this case, the dentist will prescribe an antibiotic. To reduce the risk of infection, it is important that the patient maintains good oral hygiene and does not smoke.
• Hematoma: Right after the operation, a hematoma may appear on the face but will disappear shortly afterward. Hematomas are more likely to develop in patients taking anticoagulants.
• Failure of the implant to integrate into the bone: This is a rare complication, which results in the implant being lost during the healing phase. It will then be necessary to perform a new operation after at least two months of healing.

Dental implants also have contraindications:

• Absolute contraindications: Uncontrolled diabetes, immunodepression, recent myocardial infarction, valvular heart disease, glomerulonephritis, osteoporosis with intravenous use of bisphosphonates
• Absolute local contraindications: Radiotherapy in the area in question, for example, to treat a tumor
• Relative contraindications: Smoking and/or drinking alcohol, pregnancy, HIV-positive patients, poor oral hygiene, use of anticoagulants
• Relative local contraindications: Insufficient bone volume (but possibility of bone grafting), gum disease such as oral lichen planus and leukoplakia (which can be treated beforehand), dental infection near the area of the procedure