Good morning. This is Dr. Daniel Vinograd, a biological dentist in San Diego, California, and today, I’d like to speak a little bit about dental implants. So, it’s interesting how much implants have actually progressed over the last couple of decades. I remember, maybe over 20 years ago when I first started placing dental implants, I was considered a little bit on the fringe.
Dentists who placed implants were not looked upon very favorably. In fact, there was a lot of pressure on people who started placing dental implants, and it was considered, pretty much, outside of the realm of dentistry or at least prudent dentistry as some people saw it. There was some truth to that because they’re quite invasive. There were large blades that were placed on the mandibles just to restore one tooth.
So, fast forward 25 years, and now, we’re really looking at dental implants as the fastest growing area in dentistry in one that has possibly got a 50% success rate to over 99% success rate if done properly. So, this is probably an important consideration for most patients that are either going to lose a tooth or have lost a tooth that is important for their function.
Now, in the biological point-of-view, a lot of people ask me what I think about dental implants, what I think about root canals, etc., and my biggest concern is actually from a biological point-of-view is obviously bacterial infection. When you have a root canal that is the focus of bacterial infection or a tooth that is quite involved periodontally where the gums are inflamed and infected, that, in itself, to me, is a much, much greater challenge to the body than anything else.
So, having said that, when do we decide to place an implant versus, let’s say, a bridge or a root canal? A lot of those considerations have to do with your general health. Also, important to look at, for example, if you have two adjacent teeth lost or to be lost that have large restorations, I would probably consider placing a bridge there because, really, there is not going to be a great loss. As a matter of fact, sometimes, it’s an improvement on the adjacent teeth. However, when you have a couple of virgin teeth on each side, then you really, definitely need to look into an implant.
Now, what are the considerations for a dental implant? What are the requirements? Mostly, it’s just about having a healthy bone which 95% of the population has, but also, you need to have enough bone for an implant to be placed. There are a number of different dental implants in the market, and when the modern generation of implants came out, people were placing implants that were quite, quite big, 18-, 20-millimeter long implants which is really quite a huge implant and quite invasive.
In the last decade or so, dental implants have gotten smaller. As a matter of fact, there are a lot of research papers that have come out showing that smaller implants integrate better and have equal longevity to longer implants. So, really, the movement has been towards shorter, better designed implants.
Today, a lot of dental implants are in the 10-15 millimeter range, which is still large and invasive, not compared to where they used to be, but there are other options today which I’d like to talk about. That’s mini-short implants. Now, there’s a difference between the mini implants that are placed for dentures, which are very thin, and implants such as Bicon which is the ones that I use. They’re actually much shorter but very well-designed, and they have a lot of surface that a bone can integrate to.
So, usually, my dental implants are about 6 millimeters long which actually makes a huge difference in my ability to place them without being so invasive, without needing so much bone, and that often translate to not only a less invasive procedure but a shorter recuperation time and often less costly. That is because often when we don’t have enough bone, we have to actually look at either grafting bone into the area, repositioning nerves, or actually lifting sinuses to create space for the implants. Those are all invasive procedures, and they are also a bit costly and, obviously, problematic as far as possible complications and bringing new variables into the equation. So, the ability to place a 6 millimeter implant allows us to have tremendous versatility, lowering costs and allowing us to place in some areas where a regular implant would not be placed.
A lot of people at the beginning were actually doubting how sturdy or how much these dental implants could actually last, and all research has shown that they are equally effective, efficient, and actually a little bit more successful than some of the longer implants.
One of the important aspects on implants from a biocompatible point-of-view is the material that the dental implant is made from. Most implants, I would say, a great majority of them are made of titanium, which is probably the most biocompatible metal there is. In Europe, they have been using zirconia implants, and I know a lot of people ask for zirconia implants. There’s not really a problem with the zirconia itself. Actually, it’s very biocompatible.
The problem is the zirconia implants are one piece. They’re very long, very invasive, and by being only one piece while most of the titanium implants are two pieces, you actually have to place this implant in a perfect position to be able to place a crown on them. That actually translate often into a need for the dentist to re-prepare the top part of the implant where the crown is going to go and create some microfractures. So, there have been issues with fractures, and there are issues with them being very invasive and really difficult to place, making the outcome less certain.
If you would have tremendous amount of bone and easy line of insertion for the implant, they could work quite well, but in most cases, it is a challenge. So, for that reason, I have shied away from them. I understand in Europe they are working on a two piece zirconia implant, and when that takes place, I will revisit that.
In the meantime, the fact that the Bicon implants are so short and so small, they seem to be so uninvasive that, at this point, I favor those, and that’s definitely what I would place on myself or a family member. In addition to that, we need to think about the possibility of getting those implants with biocompatible materials that coat them, making them more biocompatible.
Ultimately, there’s a lot of research. You can go on the internet and seek a lot of information out. In my practice, I just really am very observant, and most patients talk to me a lot. When I see that a procedure is actually being well-received by most people’s bodies, most people’s jaws, that in itself is very reassuring, and what I see in the dental implants I placed is the body really loves them. They get integrated quite nicely, particularly the design of these Bicon implants. There are very, very few problems. Leakage used to be a problem with a lot of them, and the design of these as well as a few others that have improved on their design are really now at a point that if they are well placed, they have over 99% chance of success.
So, I hope that has been helpful. I have really expanded the place of dental implants in my practice because I feel it’s a very clean, a very successful procedure that has actually been well-received by patients, both in its function and its biocompatibility.
All the best and I hope you all have a great day.