Implantology

Replacement of missing teeth by implant-borne restorations has become treatment modality accepted by scientific community for patients with complete or partial loss of teeth. But conventional dental implant therapy’s biggest drawback has been the length of time required by traditional placement protocols. The original protocol requires implant to be inserted 4-6 months prior to loading with multiple surgeries is common. Patients undergoing such treatment have to wait for a long time before they can enjoy the benefits of better appearance, chewing, speech and self confidence.

The 3 visit permanent teeth procedure performed at Mahendra’s dental enables the patient to enjoy all the benefits of permanent fixed bridges at the earliest of 72 hours. The improvised technique is more reliable than traditional techniques. Difficult or hopeless cases are also easily done as the technique is based on basal implants and immediate loading implants developed by Ihde Dental, a Swiss dental implant company. With the help of this technology, we have also treated diabetic patients, smokers and patients with severe gum disease with equal success. Bone buildup procedures are not at all necessary when this technique is applied.

With the help of this technology, we are able to treat 98% of the cases in a procedure which has “fixed teeth”, as a result within three days. Our technique does not need any bone augmentation, sinus surgery and bone grafts which anyway nobody wants. By avoiding these procedures, the patients get fixed teeth faster and at lower costs.

Considerations     KOS Single Piece Implants              Two Piece Implants
Basic design Immediate Loading  – i.e. patient can be given the crown(s) / bridge(s) the very next day Delayed Loading – very often a waiting period of minimum of 3 months is necessary before loading the implants with prosthesis.
Implant Placement Procedures Single sitting surgical procedure and very often flapless (no open surgical procedures,subject to adequate bone availability are necessary). Implant procedures are less time consuming than that required for bridgework. Very often more complex surgical procedures are necessary, spread over 2 or 3 sittings in a period of 3-6 months (Implant placement, Healing Screw placement & Abutment Placement)
Prosthodontic Procedures Very simple. Conventional impressions of implants can be made just as is the case with routine bridgework. Very less chair side time. Requires more complex procedures and chair side time.
Armamentarium Simple – the implant surgery kit is very simple with very few instruments Complex – a wide array of instruments are required for placement of two-piece implants
Cost Very cost effective – costs are comparable to that of conventional PFM bridgework Expensive
From the patient’s point of view Less complex placement procedure, less number of sittings and crown(s) & bridges can be cemented in a day or two… more or less like that of a conventional bridgework & costs are comparable with that of conventional bridgework

More complex placement procedure involving two or more surgical phases.

Crowns / bridges are cemented only after 3 months after the healing phase. Much more expensive than the conventional bridgework.

Long term maintenance Being a single piece, the strength provided by the implant is excellent and there is no separate root portion and abutment portion. Maintenance is very simple… maintenance is just the same as that of conventional bridgework

Being two piece, the relation between the root portion and the abutment portion can present problems.

Studies have proved that two piece implants experience higher mechanical stress under oblique loading. Maintenance of these implants are more complex… very often screws (when used) are to be tightened at periodic intervals as there will be micro-movement between the implant and the abutment.

 Maintenance of these implants are more complex… very often screws (when used) are to be tightened at periodic intervals as there will be micro-movement between the implant and the abutment.

However, it is to be kept in mind that KOS Single piece implants are not indicated in all cases & they are to be used only in cases where there is good D1 / D2 bone.

KOS Implants are approved by the European Union and due to be approved by the US-FDA shortly.

Three other systems introduced by Dr. Ihde Dental are BCS, BOI & the Leone (Two Piece) Implant systems. These along with KOS are able to provide excellent implant solutions in all types of edentulous situations, avoiding complex surgical procedures

KOS Implants: The Allfit® KOS® dental implant system is made of the highly fracture-resistant Ti6Al4V ELI titanium alloy pursuant to ASTM F136. Single-piece implants with apical compression thread and straight, flexible or angled solid abutment. Suitable for crowns, bridges and bar connectors. The compression screw design facilitates immediate prosthetic loading, provided the surgical placement was done correctly (insertion of the restoration within three days or less). The salient features of KOS implants are:* Perfectly manufactured precision implant with double-sandblasted endosseous section.

  • Highly fracture-resistant titanium alloy.
  • Single-piece implant with apical compression screw thread.
  • Straight solid abutment.
  • Facilitates immediate loading if the surgical placement was correct.

Technique for Permanent teeth in 72 hours

Full mouth Dental Implants:

For full mouth procedures, a full set of permanent ceramic teeth are fixed on the implants. Fabrication of permanent teeth takes place in a lab for a refined and good quality make. Temporary teeth are fixed the same day while the permanent teeth are being fabricated. Permanent teeth can either be zirconia (metal free ceramic) or regular porcelain fused to metal or metal reinforced acrylic hybrid denture. Within 72 hours the temporaries are removed and permanents are placed in the upper and lower jaw from left second molar to right second molar.

In certain techniques like where less number of tooth implants (4 or 6) are placed, the implant dentist are forced to fix temporary plastic teeth, which are then replaced after 3 or 6 months. In these techniques the risk of implant failure is very high. The patient ends up getting just 10/12 teeth whereas they need molars for efficient chewing.

At our center, we place 6 to 8 implants in the lower jaw and 8 to 10 implants in the upper jaw(in most cases). We use a combination of compression implants, basal implants and pterygoid implants and easily manage to give a full set of permanent teeth within 3 days(in cases with absolute hopeless or negligible bone availability there may be a variable treatment line). By using this combination we easily manage to give our patients a full set of fixed teeth without any bone graft procedure or sinus lift. Recovery from implant procedure is quick as it is a flapless technique which causes little or no pain.

Single or Multiple teeth replacement:

One or more implants are placed and then the permanent ceramic crown or crowns are fixed within 3 days. On the day the implant or implants are fixed, temporary plastic crowns are placed, so that the patient does not go back from the clinic with missing teeth. By 3rd day, final permanent ceramic crown is fixed. The risk factor of immediate crown in single implants is slightly higher compared to multiple implants. As such, in very few cases of single implants, we may place a temporary crown for 2-3 months and the permanent ceramic crown is then replaced later.

  Time Factor  for Permanent teeth in 72 hours

Day 1 – Tooth extraction, if required + implant placement + placement of temporary crowns

Day 2- Healing and rest day – lab fabrication of ceramic/zirconia crown

Day 3- Cementation of permanent (ceramic/zirconia) crowns

*A compulsory 10-12 day follow-up is required post implant placement so to adjust the bite as needed.

With this technique, teeth are extracted and the implant placed during the same surgical visit. A fixed acyrlic bridge is fabricated on the same day of surgery. Impressions are taken for permanent ceramic teeth which are prepared and fixed on the third day. The timeline for Permanent teeth in 72 hours  is thus completed within one trip. The technique differs from permanent teeth in a day or teeth in an hour. 

 Comparison between “Permanent Teeth in 72 hours” and “Teeth in a Day” and “Teeth in an Hour”

No.of visits cost Type of prosthesis Type of implant Temporary crown Permanent crown
Permanent teeth in 72 hours 3 days Cost effective Ceramic/ zirconia Single piece, basal, pterygoid implants combinations. No screw looseningNo crestal bone loss. On day of implant placement. In 3 days
Teeth in a day 1st visit: taking CT to prepare surgical guide.2nd visit: 2-3 weeks after 1 day procedure. Expensive Acrylic/plastic Screw based implants, screw loosening is problematic. On day of implant placement. 2-3 months later
Teeth in an hour 1st visit: Ct and surgical guide preparation.2nd visit: 2-3 weeks after 1 hour procedure. Expensive Acrylic/plastic Screw based implants,screw loosening is problematic. On day of implant placement. 2-3 months later

 

Benefits with Permanent teeth in 72 hours

» Flapless technique requires minimal recovery time and is minimally invasive.

» Bone grafting may not be needed like in other approaches

» Allows for easy maintenance through proper oral hygiene

» Relieves the many frustrations of removable appliances

» Ensures long-term results with the potential to last a lifetime

» Enhances self-confidence and overall quality of life

Comparison of “Permanent teeth in 72 hours”  “with other techniques”

No.of visits Cost Type of prosthesis Type of implant Temporary crown Permanent crown
Permanent teeth in 72 hours 3 days Cost effective Ceramic/ zirconia Single piece, basal, pterygoid implants combinations. No screw looseningNo crestal bone loss. On day of implant placement. In 3 days
Teeth in a day 1st visit: taking CT to prepare surgical guide.2nd visit: 2-3 weeks after 1-day procedure. Expensive Acrylic/plastic Screw based implants,screw loosening is problematic. On the day of implant placement. 2-3 months later
Teeth in an hour 1st visit: Ct and surgical guide preparation.2nd visit: 2-3 weeks after 1-hour procedure. Expensive Acrylic/plastic Screw based implants,screw loosening is problematic. On the day of implant placement. 2-3 months later