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Dentistry Ohio

'Living' Article March 2012- Is your dental implant at risk?

Landen Living

March 2012

One of the most significant elements to rise on the dental horizon during my career has been the predictable, versatile and game-changing availability of titanium dental implants.  Implants can be utilized to anchor and stabilize dental prosthesis like dentures and partial dentures.  Bridges can be built between a pair of dental implants.  But in my office they are far and away most frequently used to replace a single missing tooth. 

Dental implants are extremely successful but like a natural tooth they are susceptible to inflammation in the gum tissue and bone that surrounds and supports the implant.  When bone is lost around an implant there can be a number of factors that contribute to the pathology.  With poor dental hygiene implants can fall victim to plaque-based periodontal/gum disease just like we see with natural teeth.  Bone loss and implant failure can also occur if too much biting pressure is routinely loaded onto the implant. 

Within the past two or three years however, multiple studies have surfaced that expose the single biggest contributor to bone loss surrounding dental implants.  The offender we now clearly understand is often dental cement.  Dental cement?  Yes, dental cement. 

Typical dental implants are shaped and sized somewhat like a tooth root and are threaded into the bone that typically supports teeth.  At the time of surgical placement the top of the implant is intentionally positioned below the gumline level.  In most cases a tall healing cap is screwed into the implant to extend it through the gum tissue which allows for proper healing.  At roughly three months the supporting bone has literally grown or integrated to the surface of the implant and it is ready to be used.  The healing cap is replaced by a tapered screw-retained piece called an abutment and in most cases a dental crown is cemented to the abutment.  What we now know is that all too often excess dental cement is squished below the gumline at the time of crown placement and never fully cleaned up.  Don’t get me wrong.  We dentists are not generally careless or sloppy.  The cement gets hidden below the gum level and often goes undetected.

Now that these cement-based problems are understood there have been a number of responses that responsible dentists have made.  Today it is clear that the abutment piece may be the key.  If the abutment used is a stock piece purchased from the implant supplier the margin where the crown joins the abutment will often be too far beneath the gumline.  It may take more time and money but we now clearly understand that a custom made abutment provides for margins at or just beneath the gumline and is highly preferred.  Under these circumstances it is much easier to find and remove excess cement residue. 

For our implant cases there is a way to completely eliminate the use of dental cements within the mouth.  Crowns can be cemented or bonded to the abutment outside the mouth where all of the excess cement can easily be identified and removed.  For this to work there has to be a hole in the biting surface of the crown that allows for attachment of the crown and abutment with a screw into the dental implant.  The hole is ultimately filled with a tooth colored filling material.  As dental materials continue to improve this safest technique may become the new norm.   

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Mason, OH

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