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Implant Dentistry in the 21st Century By Dr Lynette Ng I had a patient, Mr T, who for years suffered from ugly, darkened and loose teeth due to severe gum disease. The teeth could not be saved and he was informed by a previous dentist to have them removed and replaced with a complete removable denture. Although the treatment was correctly given, the patient felt that he was suffering more than when he had those horrible looking teeth. He was no longer able to bite into an apple or enjoy his favourite steak. It also affected his social and work life as the denture would often dislodge during speech, causing extreme embarrassment. Fast forward to the present, and Mr T is confident to meet clients for business lunches. He enjoys his favourite foods. This is the miracle of implant dentistry. Dental implant treatment is highly satisfying. Dental implant restorations restore the patient’s smile, function, and even confidence and self esteem. A dental implant supported restoration is a one-for-one replacement of a missing tooth. Although we are still unable to grow a tooth, the dental implant restoration truly mimics nature as closely as possible. History Over 30 years ago, Swedish research scientist and surgeon, Professor P-I Branemark, M.D., Ph.D., developed the concept of dental implant osseointegration – a biologic bonding of living bone to the pure threaded titanium implants. Using a one or two-stage surgical technique. Branemark showed that this bonding between bone and titanium could serve as a firm and long- lasting anchorage to stabilize dental bridges and other body replacement part. Since 1965, thousands of patients have been successfully treated with dental implants in Sweden, and now throughout the world. This treatment was first introduced to the United States in 1982, and in 1988, the American Dental Association granted full approval of this method of treatment. In Singapore, this treatment has been carried out since 1986. Painless Dental Implant treatment When I was a student in dental school in the early 90s, dental implant treatment was still something relatively new. Dental implant success rate was less predictable and there was lack of long term data from properly carried out patient studies. Asian patients were also slower to accept dental implant treatment due to the need for surgery and the fear of pain during and post treatment. There are many pain free techniques now available. Many of my patients are surprised at how comfortable dental treatment is including, implant surgeries. Dental surgeons like myself believe strongly in painless dentistry. I often remind patients that pain is part of our natural body’s defence but pain can be properly managed. Improved pain killers such as Arcoxia have lower side effects, and only need to be taken once a day. It is often prescribed to patients 1 hour prior to surgery to ensure that the patient is comfortable throughout and after the procedure. Arcoxia belongs to a group of medicines called cyclooxygenase-2 (COX-2) specific inhibitors (also known as Coxibs). The body produces two similar enzymes called COX-1 and COX-2. COX-1, is involved with protecting the stomach. Arcoxia reduces pain and inflammation by blocking COX- 2, and does not block COX-1. Other anti-inflammatory medicines (NSAIDS) block both COX-1 and COX-2. Arcoxia relieves pain and inflammation with less risk of stomach ulcers compared to NSAIDS. Painless injection systems such as The Wand® have been developed in the recent years. The Wand® is essentially a computer-controlled dental injection. The flow rate of the local anaesthetic is controlled by a computer. This means that the injection is guaranteed to be slow and steady and therefore comfortable. Most people who have had a bad experience with injections because the anaesthetic was fired in too quickly. The Wand® removes this risk and can be very reassuring for people with previous bad experiences. Patients can also enjoy a movie during surgery with in-chair movie goggles. For patients with very bad dental phobia, dental implant treatment is not impossible. Intravenous (IV) sedation can be used during dental implant surgery. The patient remains conscious during IV sedation, and is able to understand and respond to requests from the dentist. In most people, IV sedation induces a state of deep relaxation and a feeling of not being bothered by what's going on. Secondly, the drugs used such as diazepam can produce either partial or full memory loss (amnesia) during surgery. As a result, time will appear to pass very quickly and patients do not recall much, or perhaps even nothing at all, of what happened. Advancements Over the years, much advancement has also been made to implant dentistry. Dental implants with enhanced (rough) surfaces are now the system of choice. Dental implant restorations are extremely predictable, due to advancement in implant fixture surfaces and restorative components. They have become a routine treatment in 21st century dentistry. Success rates of implant surgeries are in the high 90 percentile and long term survival of these restorations range from 85 to 100% over 10 to 25 years. Patients have to be cautioned that these findings are reflective of only reputable brands. There are thousands of implant brands out there and only the reputable ones carry out proper long term studies of their system. Choice of the dentist and system should not only depend on price but on the experience of the practitioner and the systems that the clinic uses. Present day implant dentistry is more concerned with gingival (gum) aesthetics. Dentists are concerned with copying the natural contour of neighbouring teeth and preserving bone. The dental implant supported crown can be created indistinguishable from a natural tooth. Dental implant treatment times have also shortened. In the past, dental implants were only restored after 6 months of healing time. Now dental implants can be immediately loaded or loaded early in 3 to 4 months. Again patients are cautioned, as these treatment times apply to enhanced surface implants and patients must have good bone quality amongst other favourable factors. Zooming back to Mr T, he had 5 dental implants placed in the lower jaw at the chin region. I adjusted his old full denture into a temporary bridge and anchored it to the dental implants immediately after surgery. In a matter of 2 hours, Mr T’s woes with his denture were solved and he could not be happier. After another 3 months, he received his new dental implant supported bridge and he tells me he has been given a whole new lease of life. There are many other restorative options in implant dentistry to suit many different patients. For the more financially conscious, in a similar case to Mr T, only 2 implants need to be placed to adequately secure a full denture so strong that the patient can bite into an apple without the denture dislodging. Over the years, I have restored many edentulous patients and seen how dental implants have restored not only oral function but improved all aspects of the patents’ lives. Dental implant treatment is highly satisfying, not only for the patient but also for the dental practitioner. I look forward to changing more lives in the years to come.
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