How to Decrease Risk of Implant Failure with Computer Guided Implant

What are Dental Implants?

An implant is a metallic fixture that is inserted into the jaw bone, and it serves as a replacement root for an artificial tooth. Dental implants have recently become a popular choice as a tooth replacement option, both among patients, owing to their excellent durability, lifelike appearance, and lifelong durability. Millions of implants are placed by dentists throughout the world each year, and these numbers are expected to grow considerably in the future.

Now you might wonder “there are millions of dentists practising implant dentistry in Singapore. Why should I choose Dental Designs Clinic”?

The reason is simple. In addition to the unmatched expertise and skills of our dentists, we use state-of-the-art computer-guided implant surgical techniques. Therefore, the implants placed by our dentists have a higher dental implant success rate, superior functionality, and excellent aesthetics.

Why are Dental Implants the Best Tooth Replacement Option?

Dental Implants

Perhaps the most critical reason why dental implants are superior to other tooth replacement options is their unique capability to promote bone formation and create intimate contact with the surrounding jaw bone. This property, known as osseointegration, allows any prosthesis which is attached to the implant for tooth replacement to remain firmly stable and fully functional inside the jaws. As a result, the implant-supported artificial teeth not only restore your ability to speak and eat without difficulty but also restore your smile and facial aesthetics.

Since the first use of Titanium-based dental implants as a tooth replacement option in the 1960s, there have been significant improvements to the implant shape, design and surface morphology. Nowadays, cylindrical implants with improved thread designs have significantly enhanced the osseointegration potential and reduced dental implant risk of failure. Moreover, different types of surface modifications and coatings have allowed the dentists to reduce the time requirements for the implants to achieve stability inside the jawbones. However, the most crucial achievement in implant dentistry can be attributed to the introduction of 3D-imaging and computer-guided surgical implant placement.

What is Computer Guided Implant Surgery

Computer Guided Implant Surgery
Female dentist with teeth x-ray on screen

Currently, most of dentists throughout the world are placing implants by using a technique known as the “freehand” surgical technique. This means that they will look at the x-ray images and models of your teeth and bones, and then decide the location and angulation of the implant site. However, during the surgery, they virtually go in blindly! So, there are higher chances of implant placement at the wrong location. This can lead to implant loosening, infection and even implant failure[1].

We don’t want this to happen to our patients. That is why perform computer-guided implant surgery which allows us to visualize and plan each step of your implant treatment, right from the imaging and diagnosis to implant insertion. This technology helps us in precisely determining the best location and angulation for inserting the implant. At Dental Designs Clinic, we use the following state of the art equipment to maximize the success of teeth we replace with dental implants:

1. 3D X-ray/ Cone Beam Computed Tomography (CBCT)

The CBCT/3D x-ray imaging is used in cases where the conventional x-ray images may not be enough. We use the 3D imaging technology to visualize a 3-dimensional image of your jaw bone where the implant needs to be inserted. This technology also helps us in choosing the right size, shape and type of dental implant for replacing your teeth and to minimize dental implant risk for failure or infection. In addition, we also use CBCT to visualize and protect any important dental structures or nerves which may get damaged during implant insertion.

2. Intra-oral Scanners

At Dental Designs Clinic, we understand that using physical impression materials for making impressions during implant preparation is quite inconvenient for the patient. Also, there are very high chances of error when impression materials are used as they can undergo dimensional changes with time. Keeping this in view, we use intra-oral scanners to make digital impressions of your teeth. These digital impressions are not only highly accurate, but we also feed these images into special software which helps us in making a detailed plan for implant insertion and in preparation of the prosthesis which will be used for replacing the natural teeth.

3. 3D Printing Technology

Also, our state-of-the-art 3D printers allow us to utilize the digital impression of your teeth in preparing a highly accurate, precisely fitting and naturally beautiful prosthesis for replacing your missing teeth. The 3D printing technology eliminates the errors which can arise during the laboratory preparation of your implant-supported crowns or bridges.

Why is Computer-guided Implant Surgery Better than Conventional Implant Insertion?

Now, you might be wondering why guided dental implants are the best. Here are a few reasons:

With conventional implant technology, it can take weeks after your initial implant healing is completed to have your teeth replaced. At Dental Designs Clinic, we understand that your smile is your most important asset and therefore, using computer-guided implant placement techniques, as the implant is placed in the most optimal position, we are able to scan and create the tooth crown to place over the implant much more quickly.

Long Term Advantage of Computer Guided Implant Surgery

Dental Treatment

When we choose to have an implant in our body, we want it to last a long time. As the teeth are used every day, they are subjected to a lot of daily stresses during chewing, acids from the food we eat, normal wear and tear, and of course, any accidents that may happen unexpectedly, such as a fall or physical trauma. Therefore, it is inevitable that some time through the years, they may require repair or replacement of the exposed portion.

A dental implant has two main parts, the implant body which is placed during the computer-guided implant surgery, and the tooth replacement portion, the implant crown. The crown portion is attached to the implant body by two methods:

  1. Screw retained implant crown: This is held in by a small screw so that it can be easily accessed and in future, repairs can be made more easily. This is more difficult to do as the implant needs to be placed in a favourable position for the screw retained implant crown.
  2. Cement on implant crown: This is a traditionally used method whereby the crown is irreversibly cemented on. It’s typically used when the implant body has been placed in a poor position. if in future the crown chips or needs to be replaced due to wear and tear, or accidents, the dentist would have to drill through the cemented on crown and in some cases, replacement the whole implant (through another surgery!)

With Computer-guided implant surgery, the implants are placed precisely in the jaw bone, so that we can use screw-retained implant crowns for your long term benefit.

At Dental Designs Clinic, we use a 3D intra-oral scanner to take accurate molds of your teeth, which have fewer errors and are more comfortable than the usual technique, which is with manual dental molding. The 3D teeth model is then merged with the 3D x-ray of your jaw bone and used together to determine the most optimal position within the bone for your implant. This allows us to be able to maximise the success rate of the implant, as well as avoiding crucial anatomical structures such as the lower jaw nerve, mental nerve, sinuses, and the roots of other teeth. The guide is then 3D printed with biocompatible resin. Each computer-guided implant guide is individually customised for each implant that we place.

Read more on dental implants here

[1] https://www.cda.org/Portals/0/journal/journal_032015.pdf

References

  1. Surface Treatments Of Titanium Dental Implants For Rapid Osseointegration
    L. Guéhennec-A. Soueidan-P. Layrolle-Y. Amouriq - (https://www.sciencedirect.com/science/article/abs/pii/S0109564106001850)
  2. Osseointegrated dental implants
    (https://europepmc.org/article/med/3514290)
  3. Dental Implants: A Review
    Roland Meffert-Burton Langer-Michael Fritz - (https://aap.onlinelibrary.wiley.com/doi/abs/10.1902/jop.1992.63.11.859)
  4. Current Trends in Dental Implants
     Gaviria- Laura- Salcido-John Paul- Guda- Teja- Ong-Joo L. - (https://synapse.koreamed.org/DOIx.php?id=10.5125%2Fjkaoms.2014.40.2.50)
  5. Interventions For Replacing Missing Teeth: Different Types Of Dental Implants - Esposito, M - 2014: Cochrane Library
    Marco Esposito-Yasmin Ardebili-Helen Worthington - (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003815.pub4/abstract)
  1. Smoking, Radiotherapy, Diabetes and Osteoporosis As Risk Factors For Dental Implant Failure: a Meta-analysis
  2. Hui Chen-Nizhou Liu-Xinchen Xu-Xinhua Qu-Eryi Lu - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733795/)

10 Things You Need to know before Having a Tooth Implant

What Are Dental Implants?

Dental implants are replacements of your teeth that might have accidentally been knocked out or need to be reduced due to cavities. Dental implants are replacements for damaged teeth that look and feel like your natural teeth. Computer-aided implant surgery is the result of advances in digital technology that allows you to experience a more pleasant experience in the dentist chair due to a shorter procedure, less pain experienced due to small surgical incisions made, and less downtime in recovery from the invasive implant process.

Implant dentistry is about a mixture of careful planning, knowledge, accuracy, precision and sound clinical judgment, as well as surgical and restorative skills.  The traditional implant method relies on the dentist to place the implant. This may result in implant malpositioning, which is when the implant is improperly placed, due to factors such as hand stability. There are also surgical guides using diagnostic wax-up models which are prone to errors due to the variability in the quality of the plaster model, and also because it is based on the gum even though implants are placed within the bone. With a fully digital guided dental implant technique, this risk is able to be eliminated

What’s the Difference Between Traditional Tooth Implants and Guided Dental Implants?

Traditional implants are usually more painful than computer-guided dental implants because it involves an incision of the gum to allow access to the jawbone and which will require stitches to close up.

This process of placing an implant relies on the dentist’s vision or feel, whoever places it is going to make an incision on gum and reflect the tissue back to the bone. On the other hand, computer-guided implant surgery due to the keyhole incision made is much less painful and requires less time. As the area is small, most of the time we do not need any stitches. Many patients tell us that they experience little to no pain during and even after the process of placing the implant, as we use a local anaesthetic to gently numb the gums and teeth around the implant. This process also takes less time than the traditional method of implants, resulting in a more pleasant session at the dentist’s chair for you.

What Do You Need to Know Before Your Dental Implant?

Dental Implant illustration

Making the decision to have a dental implant placed in your mouth is not an easy one. What are the factors and considerations before you opt for implant surgery? We provide the top ten things you need to know before your dental implant surgery.

  1. A dental implant looks and almost feels like having your own tooth back.
    The dental implant-borne restoration looks like your natural tooth as it fuses to your jawbone and becomes part of you.  Dental implants are also preferable to dentures as there is better chewing sensation, better biting strength, and no change in taste or sense of smell.
  2. Freedom and confidence to talk, dine, and laugh.
    Having a restoration done to your tooth means that you now can be able to bite into fruit or swim with confidence without worrying about the dentures coming off, or compared to dentures which may fall out. Having a fixed implant means that you can enjoy the confidence of smiling and laughing with your friends and family without feeling self-conscious about your teeth, as your implant will look similar to your natural teeth.
  3. Preserves your facial structure.
    With dentures, the bone loss in the jaw will result after prolonged use of dentures, causing the jaw bone to recede and eventually collapse.  With implants, the bone integrity is maintained due to the bite forces transmitted to the jaw. This sustains the bone structure and maintains the shape and look of your face structure, lips and cheeks.
  4. Having a gap in your teeth causes an imbalance of teeth.
    Without an implant treatment, your teeth will not be well balanced, and this gap in the teeth will cause the teeth to shift and move in an attempt to fill the gap. In the long run, this movement will damage the balance and health of existing teeth as the the shift might cause food to be stuck in the gaps. Furthermore, the opposing tooth might grow or super-erupt toward the gap, causing problems with loosening or biting on the gum, which might lead to this tooth needs to be extracted.
  5. Guided implants are usually less painful and faster healing than traditional implants.
    Most patients fear implants because they expect it to be a painful process. Computer-guided dental implants can help patients avoid most of the pain associated with the implant, as it allows the dentist to place the implant using a keyhole surgery technique that avoids needing a large incision and stitches. Healing is much better as the surgery site is smaller compared to traditional implant surgery which often results in a large wound.
  6. Minimally removes your existing teeth structure.
    Doing an implant means that you will be saving the teeth that might have been reduced if you have pursued other treatment options. If you are doing a fixed bridge restoration, the teeth adjacent to the implant to the left and the right would need to be reduced down in order to fit the fixed bridge restoration which is fitted over the gap. Doing an implant preserves the existing tooth structure as much as possible and this is the preferred option at our clinic as we are committed to saving your tooth structure as much as possible.
  7. Having an implant early helps reduce problems down the road.
    The analogy is similar to an 18 wheeler truck going down the highway. There will not be any noticeable problems if a couple of wheels are taken away in the short term. Fast forward to a year and there will be abnormal wear and damage to the structure of the teeth that have moved either forward or sideways. After a time, the real issues in balance and bite dynamics would surface in your mouth.
  8. A guided implant has a higher success rate than a regular dental implant.
    Traditionally, a dentist or periodontist typically places an implant with a free hand, according to their visualisation and by making an incision in the gum tissue to reveal the bone underneath. They do this in order to be able to see what and where they are screwing the implant into. This incision made using traditional implant methods is larger than the keyhole guided implant surgery, making recovery time longer.
  9. Implant guide is making sure that the tooth is exactly where the dentist wants to go.
    The implant plan is exported to a computer to create the placement for your implant so that the implant goes exactly where the dentist places it. The dentist mills the placement guide using CADCAM technology. This keyhole guided surgery entails a 3d visualisation of the implant site. First, the dentist takes a digital scan of your jaw using a 3D CEREC scanner and 3D CBCT X-rays. This digital scan is used to produce a customised 3D CADCAM guide which allows us to visualise the bone and eliminates the need to make a large incision on the gum. A small keyhole is made instead, which is comparatively quick and painless compared to the traditional method. This means less recovery time as it is the minimally invasive option. With keyhole guided implant surgery, almost all patients will experience next to no discomfort and post-operation pain due to the visualisation of the process of guided implant placement.
  10. Inform your dentist if you have pre-existing medical conditions.
    It is important to tell your dentist if you have conditions such as diabetes, heart disease, osteoporosis as these will affect the success rate of dental implant surgery. Any allergies, medications, including traditional Chinese medicine, or medical conditions must be raised to the dentist before treatment commences. The gums and teeth will also need to be healthy and having regular scaling and polishing done to maintain their healthy condition.
  11. Find out what brand your dental implant is.
    There are hundreds of different dental implant brands on the market, and most patients do not even know what kind of implant they are choosing to put into their body. The brand is important to ensure that its a good quality implant.  Dental implants are meant to last you for many years, and they will require maintenance over the years as the crown or implant parts wear out. If your implant is of an unknown brand or if it does not have parts to allow repair, the whole implant may need to be removed and replaced with a new implant. The top brands for dental implants are Astra, Straumman, Nobel Biocare and Biomet 3i. Our clinic uses Astra brand implants which are from Sweden and widely used all over the world.

Why do some tooth implants fall out very quickly, and some implants last a long time?

A dental implant is an artificial prosthesis to replace a missing part of your body, your tooth. Being in the mouth, it is put under a lot of chewing forces every day. Therefore, we want it to last you as long as possible. If the implant is placed in the wrong position, it may not be able to withstand the pressure long term and will fail.

At Dental Designs Clinic, we are able to provide dental implants that are fully computer-guided implants. Planning of the implant is done virtually, and the virtual placement is done on the 3D visualisation. The dentist plans this implant fully on the computer so that it is accurately placed and safely planned. The future implant is done in the implant placement in the software which gives dentists total control of the implant positioning which is so important for the long-term success.

The fully guided implant placement process begins with a digital scan of your jaw using the latest in digital dentistry. Using a state of the art 3D CEREC scanner and 3D CBCT X-rays, our experienced dental team takes a 3D impression of your jaw and designs the placement of the titanium implant. At our clinic, we use Astra implants which have decades of proven reliability, successful implants and longevity.

This follows with milling a 3D impression of your jaw and making a guide exactly according to where the dentist has designed your implant to be placed. The dental implant is placed after extraction of or at the site of the missing tooth. A bone graft may be done during this stage if bone material at the jaw is lacking to support the implant. After the surgery is done, a typical healing period of 3 to 6 months is allowed for the bone to heal and for the implant to stabilise. After this healing period, the crown is placed and the tooth will look similar to your original teeth.

cerec

Using our 3D CBCT X rays, we can determine that the exact placement has been implanted into your mouth. The actual result of the computer-guided implant is able to be reflected after the implant has been placed in the patient’s mouth. This provides you with much peace of mind that your implant has been accurately restored and put in place by our friendly dentists.

We also provide for same-day emergency procedures. If you had an accident resulting in a broken tooth, or if your tooth is fractured and needs to be extracted,  our same-day computer-guided implants can be done in one visit on the same day.

References

  1. Us5725376a - Methods For Manufacturing a Dental Implant Drill Guide and a Dental Implant Superstructure
    (https://patents.google.com/patent/US5725376A/en)
  2. Biomechanical Factors Affecting the Bone-dental Implant Interface
    John Brunski - (https://www.sciencedirect.com/science/article/abs/pii/026766059290049Y)
  3. Dental Implant Design and Its Relationship To Long-term... : Implant Dentistry
    *Graduate student - (https://journals.lww.com/implantdent/fulltext/2003/12040/dental_implant_design_and_its_relationship_to.11.aspx)
  4. Elongation and preload stress in dental implant abutment screws
    (https://europepmc.org/article/med/7590997)
  5. Dental Implant Systems
    Elif Tuna-Oya Aktören-Koray Gençay - (https://www.mdpi.com/1422-0067/11/4/1580)
  6. Accuracy Of Different Types Of Computer-aided Design/computer-aided Manufacturing Surgical Guides For Dental Implant Placement
    Wei Geng-Changying Liu-Yucheng Su-Jun Li-Yanmin Zhou - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538014/)