How do Dental Implants work ?

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A Dental Implant Works Almost like a Natural Tooth
A Dental Implant Works Almost like a Natural Tooth

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For thousands of years, mankind has tried to replace missing out of ivory as early as 700 B.C. History tells us of man’s ongoing efforts to create false teeth, ranging from those made with human teeth in the 1700s to the first porcelain false teeth, invented in Italy in 1837.

Moreover, archeological records show that some civilizations tried to create a crude dental implant. Egyptians and South Americans tried pounding pieces of sea shells and hand-shaped ivory into the gumline. Centuries later, in the 1800s, when implants made of human teeth failed, inventors tried gold and platinum implants. The quantum leap in oral implantology was achieved in Sweden in the early 1950s.


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History of Modern Dental Implants

In 1952, in a modestly appointed laboratory in the university town of Lund, Sweden, Professor Per-Ingvar Bränemark, M.D. made a discovery by accident. A physician and researcher interested in wound healing, Dr.

Bränemark was using living rabbits to study bone biology. He inserted tiny metal tubes into the rabbits’ bones so that he could place a microscope to study bone tissue. The tubes were made of titanium, a light, strong, non-corrosive metal. 

After several months, Bränemark attempted to remove the titanium sleeves from the rabbits’ bones. Bränemark was surprised to discover that he was unable to extract them. The titanium had formed an irreversible bond with the living bone.

Close physical approximation between the surface of a dental implant and vital bone is a key structural characteristic of osseointegration, which also has important functional parameters.
Close physical approximation between the surface of a dental implant and vital bone is a key structural characteristic of osseointegration, which also has important functional parameters.

His curiosity aroused, Dr. Bränemark subsequently demonstrated that, under carefully controlled conditions, bone could be integrated with titanium with a very high degree of predictability. The titanium did not appear to cause inflammation in the surrounding soft tissue, nor was it rejected by the living bone. Bränemark named the process of bone bonding to titanium osseo-integration. Before marketing his implants he spent ten years testing them on animals and fifteen years testing them on a group of Swedish patients who had no teeth.

In 1965 the first practical application of osseo-integration in dentistry was used. A man who had lost all his teeth received the first titanium dental implants. However, it was 1982 before the Food and Drug Administration gave approval for the use of titanium dental implants in the United States.

Diagram showing the similarities between an implant-supported crown and a natural tooth. Such a crown (below) does not require the adjacent teeth to be ground down unlike conventional fixed bridges.
Diagram showing the similarities between an implant-supported crown and a natural tooth. Such a crown (below) does not require the adjacent teeth to be ground down unlike conventional fixed bridges.

What Are Dental Implants?

Dental implants are metal posts inserted into the jawbone and serve as replacement roots for missing teeth. The replacement teeth that are later attached to the implants, look, feel, and function like natural teeth. Implants are made of medically pure titanium, the same metal also used in the manufacture of orthopaedic appliances such as hips, knees, wrists, and elbows. Thanks to the process of osseo-integration, the jawbone fuses to the titanium implants, creating anchors for new, prosthetic teeth.

Dental implant-supported teeth consist of three basic components:

Implant: A titanium post or “fixture, inserted If the jawbone, which functions as an artificial root. It is often shaped like a screw.

Abutment: An extension to the implant, this cap-like device screws onto the implant and holds the artificial tooth. The abutment appears just above the gumline.

Crown: Also referred to as the “tooth.”

The Implant

The average titanium implant measures one-half to three-quarters of an inch and is gently screwed or pressed into the jawbone, where it becomes the foundation for the new, prosthetic teeth. Once new bone grows around them, implants become permanent. The titanium fixtures are immovable.

More than three decades of research in Sweden and the United States has recognized titanium for its biological compatibility with the human body.Studies show that the earliest patients treated with titanium osseo-integrated implants continue  to have good dental function.

Today, many types of implants are available for various needs of patients. There are implants for soft bone, implants that bond to bone more quickly, those that work well in very dense bone, and those for varying bone widths and heights. Implant shapes and surfaces are designed to bond quickly and predictably with the surrounding bone.

a The implant is inserted at 25 rpm. b The final cover screw is placed in position.
a The implant is inserted at 25 rpm. b The final cover screw is placed in position.

The Implant Abutment

Also made of titanium, the abutment is a cap-like structure that is about one-third the size of the implant. The abutment is screwed into the internal thread of implant and may be positioned slightly above or even below the gumline. It provides a base on which the crown will be placed. You might think of the abutment as the “shaved down” natural tooth on which dentists cement traditional crowns.

The Crown

The crown, or prosthetic tooth, is also commonly referred to as the restoration. Crowns usually have a substructure or core that is made of metal, often gold because of its strength. In other cases, the core may be made of ceramic or zirconium, a hard, grayish-white metal that resists corrosion. The core structure is typically fused with an outer coating of porcelain, the dental material that most closely resembles the appearance of natural teeth. Crowns are custom-designed and shaded so that they look like natural teeth.

Understanding Dental Terminology

As you begin to investigate dental implants, you may come across terms that are confusing. So, let’s take a moment to clarify the other common terms you will likely hear, such as “restorations,” “prosthesis”, “bridges,” and “dentures.”

Often these terms can be used interchangeably, which creates some of the confusion for those new to the topic. Perhaps this short glossary will help you navigate more smoothly.

Restoration: This term simply refers to your teeth being restored. The words restoration and crowns are often used interchangeably. When it’s time to receive your permanent crowns, you will be in the restoration phase of the process.

Prosthesis: This term refers to your new, “man-made” teeth. They are artificial replacement teeth. “Prosthesis” could refer to a single tooth, a bridge, or a denture-all of which can be used with implants.

Bridge: A bridge refers to several teeth, bonded together, used to fill the space where natural teeth are missing. As you’re discovering, modified bridges are used with implants. A bridge is commonly referred to as a prosthesis.

Denture: Modified dentures, also used with implants, may be referred to as a prosthesis or your prosthetic teeth. Implant-supported dentures may be removable or may be securely fastened To the implants.


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Who Performs the Dental Implant Surgery in a Malaysian Dental Setting ?

Several types of dental professionals in Malaysia perform dental implant surgery. Today, oral surgeons, periodontists, and prosthodontists have the most experience in implant placement. In addition, many general dentists who have received training in implant surgery provide this service.

Implant Procedures

The Standard 2 Stage Dental Implant Procedure done in Malaysia

The standard procedure for dental implant treatment takes place over a three- to six-month period. Why does it take this long? Once the implants are inserted into the jawbone, it takes several months for the bone to fuse, or osseointegrate with the titanium implants. Here’s an overview of the entire three-stage process.

Stage I. The implant is inserted into the bone.
Stage I. The implant is inserted into the bone. 

Stage I

In the first stage of treatment, if diseased or damaged teeth are present, they are carefully extracted with attention paid to preserving the adjacent bone. Generally, after extraction, the titanium implants are surgically inserted into the jawbone. The gums are sutured closed and the bone is allowed to fuse with the implants. So the patient won’t be totally without teeth during the months the bone is attaching to the implants, he or she is usually given a temporary prosthesis to wear. The prosthesis may be a removable partial denture or a bridge that is bonded to adjacent natural teeth.

Bone Fuses with Implant
Bone Fuses with Implant

Stage II

In the second stage, three to six months later, the patient returns to the dental specialist. The patient’s gums are anesthetized and a small incision is made in the gum to uncover the implants. The abutments are attached to the implants. Temporary crowns are then placed on the abutments. Now the implants are capable of withstanding the pressure applied during chewing. 

Stage II. Three to six months later, abutment is placed on the implant.
Stage II. Three to six months later, abutment is placed on the implant.

Stage III

Several weeks later, the dental specialist will take impressions, or imprints, of the inside of the patient’s mouth, including the implant abutments, in preparation for making the permanent crowns. The impressions are sent to the dental laboratory, where a technician will make a model or cast; these casts are used to make the final implant crowns. Once the crowns are made, the patient will return to the dental office to try the crowns for fit. The dental professional will evaluate the accuracy of the fit with an x-ray. Once fitted with precision, the crowns will be affixed to the top of the implants.

This phase is referred to as loading the implants. The dentist makes sure the shape, color, and fit of the new teeth blend with any natural teeth.

Stage III, Several weeks later the crown is placed
Stage III, Several weeks later the crown is placed

The One-Stage Surgical Procedure

We have discussed the standard implant procedure involving two stages of surgery. In some instances, however, a one-stage surgical procedure can eliminate the need for a second surgery. During the one-stage operation, the dental specialist places the implants and the abutments at the same time, then he or she places the small healing caps on top of the implants. With the caps in place, the gum tissue does not grow over the implants during the months of osseointegration. With this approach, it’s not necessary to have a second surgical procedure to uncover the implants.

In the one-stage procedure, the patient usually does not receive a temporary prosthesis. If he or she does receive one, it is usually a removable denture that sits loosely over the healing abutments. This denture is not stabilized or fixed to the abutments. The one-stage technique is frequently used in the back of the mouth l where teeth are not visible; in these situations, temporary teeth are not really l needed for cosmetic purposes.

Whether your dentist chooses to use the one-stage surgical process depends on several factors. These factors include the initial stability of the implant, the type of the implant system used, the type of temporary restoration used, and the experience and preference of the doctor. When bone grafting procedures are done at the same time as implant placement, a one-stage procedure may not advisable.

Immediately Loaded Implant Procedure

In recent years, some implant specialists have begun loading, or placing the crowns, at the same time the implants are inserted. This is referred to as an immediately loaded implant procedure. It is an accelerated process in which the patient makes one trip to the dentist and leaves with “teeth.” No second surgery, No months of waiting. Essentially, stages one and two of the standard procedure are combined. In one procedure, the implants are inserted, the l abutments are also attached to the implants, and the temporary crowns are placed.

One such immediately loaded implant procedure is the Teeth in a Day™ program. This approach is frequently used for l patients who are having lower teeth replaced, since the lower jawbone is l typically stronger than the upper one. The l process, however, has also been used l successfully in the upper jaw. Patients must also meet several criteria to be candidates for immediately loaded implants. Their l clinical examinations and x-rays must show that the bone is sufficient to support the l immediate placement of implants and crowns.

The implant specialist can manually determine whether the jaw can accommodate the implant (and the crowns) by gauging the tightness of the implant when it’s being placed into the bone. The l specialist may also elect to test the security of the implant in the bone with a machine that usés a technology called resonance frequency analysis.

Even though the entire procedure is completed in one day, it still takes several months for the bone to fuse to the titanium implants. The patient returns about three months later to receive the custom-made permanent crowns. This approach eliminates the need for the patient to wait several months between the insertion of the implants and the attachment of abutments and crowns.

Other dental implant specialists follow variations of the immediately loaded implant procedures. For example, some doctors provide temporary fixed bridge within a few days after implant placement. Other doctors are using the immediate placement procedure in cases where a patient has lost one tooth as the result of trauma. In addition to providing. an immediate cosmetic solution, the intent is to also preserve as much bone as possible by inserting the implant at the time the tooth is lost. 

Replacing Teeth with Implants

Replacing a Single Tooth

If a single tooth has been cracked, broken or knocked out, an implant is often an appropriate solution. Often these patients with a missing tooth have met with some type of accident and wish to have the tooth replaced. These individuals usually have healthy gums, bone, and surrounding teeth. They are usually not seeking treatment due to periodontal disease.

A single tooth is supported by a single implant.
A single tooth is supported by a single implant.

When a patient has a traumatized, or “injured” tooth, a restorative dentist may recommend placing the implant at the same time the traumatized tooth is removed. The single implant also allows for the restoration of the missing tooth without disturbing adjacent, natural teeth. By contrast, a conventional bridge would require shaving down the flanking teeth so the crowns, as part of the bridge, could be cemented into place.

Replacing Multiple Teeth with Dental Implants in Malaysia

Generally, implants can be used to replace multiple missing teeth without disturbing adjacent healthy teeth. Whether or not to have implants depends on both x-rays of the jawbone and a clinical exam by a dental health professional. He or she will examine the health of the gum tissue and also carefully check the space created by the missing teeth to see whether it will accommodate several teeth. For example, if an individual has lost three teeth, is there adequate space to insert three implants and artificial crowns? Or have the existing teeth shifted, narrowing the space between the natural teeth?

If all criteria are met, replacing multiple missing teeth is often best accomplished with the use of an implant bridge, which contains one or more teeth. A bridge? Yes, a special implant bridge. If the concept of dental implants is new to you, like many individuals you may have thought a dental implant is a single implant screwed into place for each missing tooth. This, however, is not the case when several teeth are being replaced. 

Rather, it works this way. When an implant bridge is used, a modified bridge is fabricated, similar to the traditional bridges you may have seen . However, this bridge does not attach to other natural teèth. An implant bridge is attached to the implants. The bridge holds the artificial crowns

The bridge is almost always fixed, but in special cases it may be removable. To make the bridge removable, a thin bar is placed on top of the implant abutments and the bridge clamps onto the bar. An individual may remove the teeth at will. If the bridge is fixed, there will be no bar; the bridge will be screwed or cemented onto the abutments, in which case only your dentist can remove it.

Multiple teeth are replaced by a modified bridge supported here by three implants.
Multiple teeth are replaced by a modified bridge supported here by three implants.

Replacing multiple teeth is usually accomplished more quickly with lower teeth than with uppers. Why? The lower jawbone is typically thicker and better suited to receiving implants. The bone in the upper arch, or upper jawbone, is capable of receiving implants; however, the bone is usually more porous and may require more weeks of healing before the abutment can be placed and temporary crowns loaded.

Replacing All Teeth

Patients who are totally edentulous are missing all their teeth. Depending on their oral health, these patients can receive a full set of implants by going through the standard procedure.

The approach taken is similar to the one used to replace multiple teeth. For example, rather than trying to replace all fourteen lower jaw téeth, a ten- to twelve-tooth bridge may be used with the support of only five, six, or seven implants. In the upper jaw, ten implants may be inserted to support a twelve- to fourteen-tooth bridge. Such an arrangement of implants provides teeth for chewing and is also pleasing esthetically.

Similarly, a special denture may be fabricated to use with the implants.

Just as the implant bridge is not a traditional bridge, an implant denture is not a traditional denture. An implant denture does not fit against the gums. Instead, the pink artificial gum of the implant denture rests on the abutments, which extend up through the natural gumline. As a result the special denture does not “ride” the gums. It is fixed and secure. The person wearing the implant denture has the same secure feeling with a full set of teeth as the person with one single implanted tooth.

To replace all lower teeth, a modified bridge is placed on several implants.
To replace all lower teeth, a modified bridge is placed on several implants.

The modified denture may be fixed or removable. The removable denture clamps to a metal bar atop the implants. The fixed denture is screwed or cemented to the implant abutment.

A modified bridge, placed on several implants, replaces all upper teeth
A modified bridge, placed on several implants, replaces all upper teeth

How Successful Are Dental Implants in Malaysia?

Some of the early patients have had dental implants in place for more than thirty years. Studies show success rates ranging from 90 to 97 percent for individual implants. Implants to replace the upper and lower front teeth have the highest success rates of 95 percent. These areas have greater success rates because these sections of jaws typically have the strongest bone. Upper and lower back implants have success rates of 90 to 93 percent. The bone in upper and lower back jaw is usually not as strong.


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