The ADA Practical Guide to Dental Implants

Luigi O. Massa, J. Anthony von Fraunhofer

• Publisher: Wiley-Blackwell
• Year: 2021
• Print ISBN: 9781119630692
• eBook ISBN: 9781119630685
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

This clinically oriented book givesdental practitioners and students a hands-on guide to incorporating dental implants into their practices. Taking a clear and concise approach to the subject, the book offers basic information on all aspects of dental implants. Topics coveredencompass the pros and consof implants, patient factors, clinical considerations to success and failure, and implant restoration. Photographs, radiographs, and illustrations support the text, demonstrating the concepts discussed.

The ADA Practical Guide to Dental Implants starts with a brief history of the subject then examines the clinical and economic considerations for implants. Patient factors, including systemic, oral, and periodontal health, diet, age, gender, and more are discussed. The book also looks at the experience of the clinician, followed by clinical considerations such as case planning, implant design, surgical techniques, antibiotics, and more.The last chapters cover post-surgical follow-up and the many factors that lead to a successful outcome.

• Discusses all aspects of dental implantology in the practice setting
• Supports dental practitioners in incorporating dental implants into their practices
• Considers pros and cons, patient factors, clinical considerations, success and failure, and implant restoration
• Offers foundational information on dental implants in an easy-to-read format
• Includes photographs and drawings to depict the concepts discussed

The ADA Practical Guide to Dental Implants is a useful introduction and guide to dental implants for any practitioner interested in incorporating implants into clinical practice.

1
Why Dental Implants?

Why dental implants? There is one simple answer: there is an overwhelming need. Within the last one to two generations, there have been vast societal changes, including the fact that people are now living longer with greater motivation to maintain the function and esthetics of their natural teeth. It was common for people just 60 or so years ago to lose most, if not all, of their teeth well before retirement age. As a result, dentistry prior to the 1960s was largely focused on providing restorations for carious teeth and fabricating removable appliances such as removable partial dentures (RPDs) and complete dentures (CDs) as the final dental solutions for missing teeth.

Partial and Complete Edentulism in the Twenty‐First Century

The population is aging and, by 2030, more that 20% of the U. S. population will be aged 65 years or older, Fig. 1.1 [1].

These projected data indicate that within 10–12 years, about 20% of the population will be “senior citizens,” namely 65 years or older [1]. Although advances in medicine and pharmacology, together with improved nutrition, dietary awareness and exercise, have significantly improved the average life expectancy, the outlook for maintained and even improved dental hygiene as well as overall oral health still looks bleak. In fact, partial or complete edentulism is increasing. Whereas fluoridation has markedly reduced dental caries [2, 3], the prevalence of tooth loss through periodontal disease, enamel erosion, wear, trauma and disease (e.g., cancer) is growing [4–7].

Figure 1.1 Projected aging of the United States.

(Source: Based on United States Census Bureau. Release Number CB20‐99: 65 and Older Population Grows Rapidly as Baby Boomers Age. Washington, DC, June 25, 2020).

Figure 1.2 Prevalence of edentulism by race and ethnicity in adults ≥65 years [9].

(Source: Based on Centers for Disease Control and Prevention. Edentulism and tooth retention. Atlanta, Ga., September 10, 2019).

According to the American College of Prosthodontics, more than 35 million Americans are edentulous, and 178 million people are missing at least one tooth and these numbers are expected to grow over the next two decades [8].

What is distressing about these statistics is that edentulism affects our most vulnerable populations – the aging and the economically disadvantaged, Fig. 1.2. In the geriatric population, for example, the ratio of edentulous to dentate individuals is 2 : 1, with about 23 million being completely edentulous and some 12 million are edentulous in one arch. About 90% of edentulous patients have dentures and some 15% of edentulous patients will have dentures made each year [8].

The consequences of partial or complete edentulism are well‐known and include many facets of the quality of life (QoL) as well as facial appearance, self‐image and self‐confidence. Overall, health consequences of edentulism encompass significant nutritional changes, digestive issues, obesity, diabetes, and coronary artery disease to name but a few.

The Reality of Dental Implants

Although there have been minor variations over the past few years, the current life expectancy for the U.S. population in 2020 is 78.93 years [10], and we can anticipate increases in tooth failures. Vertical root fractures, endodontic failures, restorative failures, and periodontal disease may result in tooth loss. In contrast to the practice of dentistry in the nineteenth and twentieth centuries, modern dentistry focuses on the replacement of lost teeth utilizing implants, combined with comprehensive analysis of function and esthetics.

In modern dentistry, the dental implant is the best tooth replacement option for nearly all situations where a tooth is missing or is failing. The primary reason for this is the extremely high success rate achieved with dental implants. Saving teeth at all costs is no longer the norm because of the unpredictability of the longevity of heroic dentistry. In other words, preserving bone and tissue regeneration are now considered to be more important than trying to prolong tooth retention. This approach not only promotes bone healing and preservation but ensures that implants are placed in a predictable and solid bony environment with a high rate of success.

The consensus regarding dental implants within the international dental community can be summarized in Table 1.1. Whereas the order of the comments may vary with the individual clinician, most would agree that these comments are valid and pertinent.

Implants and the Edentulous Patient

Over 32 million people in the U.S. wear partial or CDs [11] and approximately 33% of these patients complain that their dentures fit poorly, tend to loosen or dislodge during activities such as chewing and laughing, and/or there is pain on mastication. Flat ridges and/or shallow palatal vaults add to denture retention and instability problems and most dentists are aware that the mandibular CD presents retention issues.

Table 1.1 Advantages of dental implants.

Implant dentistry is the future of dentistry. There is copious scientific literature on dental implantology. The 95–97% success rate of dental implants makes them an extremely predictable treatment. There is an overwhelming need for tooth replacement and predictable treatment of failing teeth. Implant‐retained prosthetics are a very satisfactory solution to the growing prevalence of edentulism in our aging population.

Limitations and/or restrictions on diet, especially which foods can or cannot be eaten, also play a major role in the decision to seek dental implants. It is likely that a significant percentage of those patients experiencing pain or discomfort on chewing will not use their dentures during eating. Due to the decreased mastication forces associated with dentures, edentulous patients have been found to consume less food and have lower intakes of protein, intrinsic and milk sugars, non‐starch polysaccharides (fibrous matter), calcium, non‐heme iron, nia...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright Page
• Preface
• 1 Why Dental Implants?
• 2 A Brief History of Dental Implants
• 3 Design of Implants
• 4 Patient Factors
• 5 Patient Consults
• 6 Treatment Planning and Evaluating Implant Sites
• 7 Implant Scenarios
• 8 Implant Surgery
• 9 Bone Grafting
• 10 Guided Surgery
• 11 Complicated Implant Placement: Immediate Sites
• 12 Full Arch Cases
• 13 Screw‐Retention vs Cement Retention of Restorations
• 14 Restoring Dental Implants
• 15 Dental Implant Failures
• 16 Economics of Dental Implants
• 17 Maintaining Dental Implants
• Appendix A: Appendix ARestoring Dental Implants
• Appendix B: Appendix BAbutments
• Appendix C: Appendix CBone Graft Materials
• Index
• End User License Agreement