Best Dental Implant Treatment in India(Mumbai, Delhi)

1.Endosteal Implants (Conventional Implants)

2.)Subperiosteal Implants

These Implants are placed on or above the jawbone and under the gum to protrude through the gum, holding the replacement tooth.This is a type of Implant where the artificial tooth is placed beneath the periosteum that overlies the cortex. Here the jaw bone is not necessarily drilled. Much of the support is provided by the gums and how the Implant lies on the bony cortex ,it may be unilateral, complete or circumferential.

3.)Transosteal (Bi-Cortical Implants)

Types Of Implants Based On SURFACE

Classification Based On The Surface of Implant :

1) Smooth Surface Implants :

Machined surface Implants are those whose surfaces have been machined for better anchorage. They are smoothened which allows less bacterial contamination and retention, therefore less chances of bacterial infections.

2) Rough Surface Implants :

Textured surface implants have a rough surface due to surface irregularities (design) for increased surface area. They can also be roughened by surface treatment like titanium plasma spray,grit blasting, acid etching, alkaline etching & calcium phosphate coating etc. It is done to increase the surface area in order to achieve better osseointegration.

3) Mixed Surface Implants :

They have both smooth and rough surface characteristics within the same implant and hence carry goodness of both the types.

Implant Placement Methods

Surgical Implant placement may be carried out in One- or Two-stage methods.

One-stage method :

is also known as the Non-Submerged method. Using this technique, the bone is prepared to receive the Implant. The Implant is fitted into the prepared bone (osteotomy). However, the coronal part of the Implant is kept above the bone crest, protruding through the soft tissue, and is exposed to the oral environment during the healing stage.
The restoration can be attached immediately after the Implant placement surgery or may also be delayed.

Features of ONE-STAGE METHOD :

The avoidance of a second surgical procedure.

The lack of a micro-gap between the Implant and the abutment at the alveolar bone crest level, resulting in a less crestal bone resorption.

The prosthetic procedure is simplified and less chair time per patient is required

A non-loaded, Immediate, or Delay-loaded protocol can be implemented.

Examples of the implants that can be placed using the one-stage technique include the Ihde Dental,Germany (Simpladent) ;Solid-Screw Implant® (Straumann,UK, Crawley, W Sussex), AdVent Implant® (Zimmer, FLA, USA) and Single-stage Implant System® (BioHorizons, AL, USA).

Two-stage method :

The Two-stage method is also known as the submerged technique. In this method, two surgical procedures are carried out. The first surgery involves installing the Implant into the bone, and a cover-screw (also known as a sealing-screw) is attached to the Implant platform.The raised flap is then repositioned and sutured to conceal the cover-screw and the Implant.

The second stage surgery is carried out. In this stage, the Implant site is re-opened, the cover-screw is accessed and then replaced with a healing abutment, which is also known as a sulcus former or transmucosal abutment .Afterwards, the healing abutment is replaced with a provisional or final restoration. This Method is suitable for use when the quality of bone is not optimum and when bone graft materials are used in conjunction with the implant.

Examples of an implant system used for the two-stage procedure include the Fixture MK III® (Nobel Biocare, Uxbridge, UK), MAX 2.5® Implant (Bicon Inc, Boston, MA, USA) and OSSEOTITE® 2 Certain Implant (BIOMET 3i, Maidenhead, UK). The Type of Implant to be used ,the Technique of placement and the protocols to be followed varies according to the condition of the patient's Bone and his esthetic and functional demands.

Let's have a look at the various treatment Protocols. Some options that are covered under Conventional Implantology :

All on six Concept

This is the old conventional approach in which we generally place 6 Implants in upper and 6 in lower implants that provide sufficient support to the prosthesis. This technique is generally used in a Two-stage procedure.
While doing an All on Six procedure, typically bone grafting is not required, so they are the perfect solution for patients that have high bone density or good volume in their jaw. So,Conventional Implants are usually placed in patients with good quality and quantity of bone.

Before the Procedure:

Though the All on Six procedure is a Graftless solution in Implantology, still, few cases might demand Bone grafting depending on the patient's bone density and other factors. Each patient differs from the other in respect to the bone density, quality and mineralisation and so it’s important for the Implantologist to thoroughly screen and evaluate the patient’s bone,his functional requirements and aesthetic expectations before planning for the Conventional Implants.

During the Procedure:

After pain management, Conventional implants are placed in the upper and lower jaws. An interim or Provisional prosthesis can be given to the patients over the implants for the meanwhile while healing is taking place. Post healing of the Implants, a definitive prosthesis in the form of a removable overdenture or a bridge can be secured over the implants.

After the Procedure:

Post procedure care

After a period of roughly 3 months , as the healing progresses and the soft tissues and the bone adapt to the Implant , the patient should be cautious in eating hard and chewy food items. The patient should practice a soft diet and maintain good oral hygiene, all the instructions told by the specialist should be strictly followed.

All On Four Concept

This technique of Implant placement has been into existence almost since the past 20 yrs. The concept was first successfully practiced by Dr Paulo Malo in 1998 in one patient and since then it has been into practice and has provided functional and esthetic results to countless patients.
According to this technique, only 4 Implants are placed in each arch, and Full mouth Rehabilitation is achieved using only these 4 Implants.

The Procedure :

Two Implants are placed axially in the anterior region and 2 Implants tilted upto 45 degree are placed in the posterior region on either side of the arch. A fixed Acrylic Bridge (Not Permanent) is then given as the prosthesis.If the condition of the patient and his bone allows , this prosthesis is usually given as an Immediate Prosthesis.This implies that the patient gets the complete treatment done within 3-5 days.

How Does It Work ??

The two posterior tilted implants offer greater surface contact between the Bone and the Implants and so even in case of minimum available bone in the mandible, the support from the existing bone is increased. In the upper arch , the tilted Implants in the Good quality anterior maxillary bone allows for better anchorage.

Advantages of All On 4

Feasible in moderate to severe Bone resorption cases wherein conventional implant placement can not be achieved due to unavailability of bone evenly throughout the jaw.

Graftless solution of Implant Placement.

Obviously , since the number of Implants are reduced , the treatment is less exhaustive for the patients. The surgery is less invasive and involves less number of visits to the implantologist.

A provisional acrylic prosthesis can be given to the patient within 2-3 days or usually even on the day of surgery.

Disadvantages of All on 4

The System is under engineered (Less Implants Used) The natural teeth have multiple roots and each tooth has its own root. This supports the teeth for a strong bite. However, with this procedure you will only have four roots.

If one of your angulated Implants fails, the whole system will fail and it will destroy a lot of bone during its removal. It may hold for only a few years before complications develop.

The Prosthesis is fabricated as cantilever on either side(molar areas) is very detrimental, as these areas take up maximum biting force,so more chances of tilted Implant Failures.

Plastic denture teeth as your final bridge. This is similar to a fixed denture and your teeth will stain, break more easily, and need replacement after every few years.

Conventional Implants in Partially Edentulous Patients

Removable Partial Dentures are an affordable and effective treatment option for partial edentulism. But in the past few years, Implant-supported fixed partial denture has gained popularity as an alternative treatment option for rehabilitation of patients who are partially edentulous.

Implant treatment edges over removable dentures in terms of esthetics, comfort and function and self-esteem . But prosthetic rehabilitation of partially edentulous patients should involve thorough evaluation of clinical aspects such as type of occlusion, vertical dimension, orientation of the occlusal plane, presence of functional or skeletal deficits, free-way space, size, number and location of edentulous areas. Therefore, radiological evaluation of bone support using an OPG or CBCT is important in these cases.

The design, the number and the arrangement of Implants to be planned in a partially edentulous case is largely determined by Topography of Bone and the location of adjacent and opposing teeth.
The radiological examination of the bone support using a radiological guide is important in cases where multiple Implants would be placed.The radiological template’s purpose is to give a visual representation of the future Implant referring to ideal positioning in imaging.
Prosthetic rehabilitation of partially edentulous patients with Implant-supported prostheses has many advantages such as fixity, good resistance and psychological comfort for the patient. However, it is important to respect the design, biomechanical, esthetic and occlusal requirements to obtain a satisfactory result.

Bone Augmentation Procedures(Bone Graft Procedures)

SINUS LIFT PROCEDURE / SURGERY

It is a surgical procedure which is done to increase the amount of bone in the posterior maxillary region (upper jaw bone area) or in the area of upper premolar and molar teeth by lifting the membrane of sinus (aka Schneiderian membrane ) and placing a bone graft.

Sinus lift procedure is also known as Maxillary sinus floor augmentation, sinus graft, sinus augmentation or sinus procedure. After the loss of teeth, the alveolar process starts to remodel.The socket of the extracted collapses during healing leaving an edentulous ridge. This collapse causes a loss in both height and width of the surrounding bone. Also, after the loss of a maxillary molar or premolar, the maxillary sinus is pneumatized in this region which further diminishes the thickness of the underlying bone.

Overall, this leads to a loss in volume of bone that is available for implantation of Dental Implant which relies on osseointegration (bone integration), to replace missing teeth.
The goal of the sinus lift is to graft extra bone into the maxillary sinus, so more bone is available to support a dental implant. Sinus augmentation (sinus lift) is performed when the floor of the sinus is too close to an area where dental implants are to be placed. This procedure is performed to ensure a secure place for the Implants while protecting the sinus.
After the sinus lifting has been done, bone grafts are placed which helps in restoring the quantity of jawbone required to hold the Implants in place. The bone that is chosen for grafting is generally a combination of Freeze-Dried bone,artificial synthetic bone and autogenous bone.

Main drawback of Bone Grafting procedures :

The outcome of successful results is not predictable and depends upon several factors. Satisfactory results can be generally achieved by using only the patient's own bone (autogenous grafting).

Not much success in already infected areas.

Duration of the overall treatment increases when bone grafting has to be done , ranging from 8-24 months.It may extend even beyond this depending upon the underlying systemic condition of the patient and the quality of bone. This becomes really exhausting for the patient.

We might not be able to achieve the same results in every region of the jaw.

Affordability becomes a major issue as the overall cost of the treatment drastically increases.

Contraindications of Conventional Implantology

(Where It Fails .. )

There are certain medical contraindications to Conventional Implant Treatment, as certain complications may arise which can be serious or even life risking for some patients.

Contraindications may be divided into three categories:

Absolute contraindications:

Dental implants should not be considered at all as a treatment option.These could be :

Recent myocardial infarction Or any other cardiac attack

Uncontrolled Hypertension

Uncontrolled Diabetes

Severe Renal Disorders

Generalised Osteoporosis

Heart valve Prosthesis

Chronic Alcoholism

Heavy Smoker

Radiotherapy in progress

Relative contraindications :

Dental implants can be considered only once after a specific problem has been dealt with.These are :

Insufficient size of the available alveolar bone. As the size could be recovered by bone augmentation. The relative contraindications are only valid during the period the body is compromised. After bringing down the parameters to an acceptable level, the Implants can be placed but these cases require constant monitoring along with strict home care hygiene and constant follow-ups to the dentist for prophylactic sessions.

Local contraindications :

Dental Implants may be done by carrying out certain extra precautions regarding problems involving the mouth or jaws.These are :

1. Lesions in the mouth (dermatosis) Treat the lesions before the treatment ; Use strict asepsis during Implant surgery

2. Poor oral hygiene or tooth infection near the site of the implant like a failed endodontic treatment. Treat the infection before the procedure Improving oral hygiene habits before the procedure.

3. Malocclusion Undergo an orthodontic treatment before Implant treatment.

4. Unfavorable position of the Inferior alveolar nerve and other Vital anatomical structures of the mandible Take extra precautions before placing an implant in the mandible use of CBCT and other measurement tools Finding an alternative to conventional dental implants.

5. Poor Periodontal condition Performing a Gingival graft Treating the periodontal or gingival disease to stabilize it Finding an alternative to conventional dental implants.

6. Bruxism Solutions Wearing a mouthguard device to prevent damage to the teeth and implants at night Finding an alternative to conventional dental implants.

7. Unfavorable maxillary sinus Evaluating the position and anatomy of the maxillary sinuses Taking extra precautions when inserting implants in the upper posterior jaw. Performing a sinus lift surgery and grafting bone Finding an alternative to conventional dental implants.

8. Insufficient alveolar bone density or volume Performing a bone graft or sinus lift before the Implant Finding an alternative to conventional dental implants Considering there are numerous contraindications & Limitations of the Conventional Implants , an alternative Implant treatment option should be adopted which can be practiced despite these conditions of the patient and the bone.
It is well known that since the prevalence of the systemic diseases is very high after the 4th decade of life in almost all the countries, and the fact that most of the patients seeking Implant treatment lie within this age group, Finding and opting for an alternative and better system that could survive these conditions becomes almost indispensable.
This has led to a new system of Implantology , which has fewer to almost no contraindications. It's surprising yet true that even the worst and the rejected cases of conventional Implantology can be successfully executed and completed under this new system of Implantology . This is Cortico-Basal ( Strategic/Cortical/Basal) Implantology.