MBR_ISSUE 43_LOWRES

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Malta Business Review DENTAL HEALTHCARE EXTRACTION AND IMMEDIATE IMPLANT REPLACEMENT Up until the introduction of dental implants, a single tooth replacement was usually performed with a removable denture wedged in between adjacent teeth or a dental bridge attached to 1 or 2 adjacent teeth. Nowadays most single teeth are replaced with dental implants. A dental implant is the insertion of a screw or fixture into the bone site of the missing tooth. Following 3-6months of healing the top part of the implant is exposed and a tooth/crown is attached onto it. This is the basic manner of completing an implant-retained crown. Today the choices on materials and the manner of which the job is completed my vary considerably. Here are a few options, which must be weighed out and selected to obtain the best aesthetic and functional result: The Implant The majority of implants are made of highgrade titanium. These implants are extensively researched and carry excellent success rates. These are also metal-free implants made out of zirconium. These so-called biological implants have many advantages including: • Hypoallergenic • High biocompatibility • One-stage surgery • Excellent aesthetics • Corrosion resistance • Holistic friendly • Strong and comfortable Implants also come in various sizes, shapes and forms so the right implant must be chosen for the right place. Before Treatment The Crown Implant crowns are also available in different materials. The material of choice was once porcelain fired onto cast gold. Then pre-fabricated titanium abutments were introduced allowing a conventional crown to be cemented onto it. Then came the revolution of maximising aesthetics and eliminating any metal in the crown allowing room for an all-ceramic crown made from zirconia. This metal-free zirconia framework allows the firing of porcelain onto it maximising the aesthetics especially in the anterior area. The main advantages of allceramic crowns are superior aesthetics with no metal edge, high biocompatibility and the ability to perform these in single day visits. Surrounding Bone The implant must be inserted into an area with sound and sufficient bone. If the area does not have enough bone then a bone graft must be performed to allow complete coverage of the implant at insertion and forever after its completion. There are many bone grafting materials available to buy; cow bone, human bone and other inorganic bone substitutes. This has become the norm for most of the aesthetic cases. After Treatment A young woman presents with a broken tooth and a failed root canal treatment exhibiting recurrent swellings and exudate. The tooth was extracted, the socket cleaned and disinfected and an implant was immediately inserted. A minor bone augmentation was also placed in the socket to aid with the final aesthetics of the gum tissue. A temporary fixed acrylic-resin crown was also attached onto the implant to further help the gingiva maintain its contour. In this manner the patient also benefits from a fixed tooth as a temporary solution. 4months after the extraction and implant insertion, the temporary crown was replaced with an all-ceramic highly aesthetic crown. This sequence of treatment is not always possible but when it is, the aesthetics of the final product is highly dependant on it. Ask you dentist! A Case Scenario Gingival tissue More often than not the bone and surrounding gum in the site of a missing tooth is to some degree resorbed. This results in an obvious drop in the gum level and/or width of the ridge. Replacing a tooth would result in either a long-looking crown or a crown with spaces in between the other adjacent teeth. This creates poor aesthetics and discomfort on eating, as spaces are obvious food traps. The bone and gum grafts restore the implant site to normality allowing for a firm anchorage and a tight gingival cuff synonymous with good hygiene. <strong>MBR</strong> DR JEAN PAUL DEMAJO Dental and Implant Surgeon 24
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