The reliability of dental implants has advanced over the past 10 years; however, patient acceptance of it has not. A study in the United Kingdom found no difference in oral health quality of life between patients with conventional dentures and implant-retained mandibular overdentures. In fact, one out of 4 refused them and chose conventional dentures instead, even though dental implants help preserve alveolar and basal bone. Dental implant treatment involves a closely working team of oral surgeons, periodontists, endodontists, radiologists, and clinical assistants. The role of the general dentist is to assess the medical/dental history of the patient—periodontal disease, diabetes, smoking, bruxism, and metabolic bone disease—and to obtain informed consent. After the complete diagnostic assessment with mounted cast and wax-up, the general dentist also designs the treatment plan. Factors to consider include adequate bone volume (1 mm around the implant), the need for lip support, evaluation of the adjacent teeth for restorative coverage, sufficient access for oral hygiene, and evaluation of anatomical limitations, etc. The implant number depends on how many adjacent teeth are missing and the length of the span. Attaching implants to natural teeth can cause movement of the natural dentition, so this is to be avoided. When gingival recession is probable or when cement removal is difficult, screw-retained crowns should be used. With edentulous patients, the standard of care is 2 implants, with the overdenture resting on mucosal tissue. Maxillary prostheses can be implant-supported porcelain-fused-to-metal; alternatives are overdentures on 4 to 6 implants or ceramometal full-arch fixed reconstruction. Immediate loading can be successful on single-implant crowns when there is no periodontal disease history. One study revealed that there is no significant difference between patients who lost teeth due to periodontal disease and those who experienced implant failure. Other studies indicate that patients with a periodontal disease history have a higher incidence of bone and implant loss. Other systemic diseases which may affect successful implant placement and reconstruction include diabetes and osteoporosis, with a higher failure rate due to diabetes.
(Source: The Oral Care Report, 2007, Volume 17, Number 2)
