Comparison of crestal single piece implants & two-three piece implants

Foremost thing before opting for any implant we ought to see the basic design of the implant. The single piece implant and the abutment are fused because they are manufactured as one piece while two-three piece implants and the abutment are separate. The abutment is either cemented or cold welded. But if the abutment is secured with a screw onto the implant, then it can be referred as three pieces.

A wide range of sizes and designs are available in single piece implants suiting various bone types which even help avoid bone augmentation and sinus lifts. Two-three piece implants have limited sizes and designs available thereby limiting their application. Single piece implants as its name suggests are concluded as single sitting surgical procedure and very often flapless without any necessary invasive surgical procedures.

These Implant procedures consumes less time than bridgework. Two-three piece implants usually very often requires more complex surgical procedures, over 2 or 3 sittings for 3-6 months (Implant placement, Healing Screw & Abutment Placement).single piece implants are a treat to the patients because of Immediate Loading – i.e. patient can be given the crown / bridge in the very next appointment. Two-three piece implants has to undergo delayed loading – approximately a waiting period of minimum of 3 months before loading the prosthesis onto the implants.

According to dentist point of view, for a single piece implant conventional impressions of the implants can be taken just as is the case with conventional bridgework. In case of two-three piece implants the prosthetic procedures requires more complex procedures and is time consuming. Single piece implants mostly work out a lot more cost effective in comparison with two/three piece implants which is expensive with respect to the costs of the implants.

For 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 which makes it very simple. Two piece implants being two piece implants, the relation between the root portion and the abutment portion can present problems due to 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. There are pros and cons of every dental treatment option available, single piece implants are not indicated in all the cases i.e. it’s indicated only in cases of good D1/D2 bone.

SMILE LINE

Mid – line

Heartwell defines the dental mid-line as vertical imaginary line that doesn’t necessarily coincide with the facial mid-line which runs vertically from the nasion, subnasal point, interincisal point & pogonion, perpendicular to the interpupillary line. Ideally the papilla between the maxillary centrals acts as a placement landmark & coincides with the mid-line of the face. In 75% of cases maxillary & mandibular midlines doesn’t coincide which is not esthetically unpleasant as mandibular teeth are not usually exposed while smiling. It demonstrates that the lower mid-line is not reference for the maxillary midline placement in cases of lost midline (premature tooth extraction).In any unrestored dentition slanting is an unacceptable major flaw.

Incisal length

The position of incisal edge of the maxillary central incisor is the important determinant in the creation of smile which sets a parameter upon which rest of the treatment is built. Elongation of incisal edge is often indicated to correct incisal wear, inadequate tooth display while shortening of incisal edge is required to compensate for unaesthetic elongation by periodontal recession. The visibility of central incisor while smiling rather than lips at rest tends to render an older appearance to the dentition. Therefore the visibility of the teeth when the mandible and lips are at rest is one of the most important factors in dental esthetics. In case of compromised incisal edges the upper and lower lips, exposed portion of the teeth are used as the reference points. When the mouth is slightly open, approximately 3.5mm of the incisal portion of the maxillary teeth is visible in a young person while mandibular teeth are barely visible. As age increases, the muscles become lax and slowly diminish the display of the maxillary incisors, while the visibility of mandibular incisors increases. The pronunciation of F and V sounds should also be used to determine the superior/inferior length of the incisal edges & buccolingual placement of the upper maxillary incisors is evaluated. For the veneers the S sound is used to determine the vertical height of dimension i.e the mandibular incisors should be in gentle touch with the palatal surfaces of the mandibular incisors being 1mm behind and 1mm below.

 

Zenith points

Zenith points are the most apical points of the clinical crowns i.e height of contour. They are located distal to a line drawn vertically through middle of each anterior tooth dictated by the root form anatomy, cementoenamel junction, osseous crest where the gingiva is scalloped the most. In Diastema closure the zenith points should be repositioned distally to avoid mesially tilted appearance. The extreme distal positions of the gingival zeniths will result in an exaggerated triangular form. In order to avoid this zenith points should be moved mesially to create an illusion of bodily shifted central incisors towards the mid-line. Zenith points are moved apically through elongation in cases of shorter teeth. Zenith points can enhance the perception of the tooth axis as well as the length and the gingival shapes, achieved by horizontal or vertical alterations.

Immediate Implants in the Aesthetic Zone

Dentistry has come a long way & the most foreseeable treatment plan to replace missing teeth is Dental Implant. However, the biggest concern about the success of implants in the anterior region is esthetics.

The two prime factors for the implant success in esthetic zone are the amount of alveolar bone present and soft tissue around the implant. The objective criteria for any kind of dental treatment justifying esthetics are gingival health, gingival zenith, tooth long axis, tooth characterization, surface texture & color,interdental contact point,incisal edge configuration, lower lip line, smile symmetry, midline & occlusal plan orientatin.Out of all these factors gingival zenith is an important factor to look for which affects others, because without its control the dental implant esthetics can be compromised.

Therefore,in order to maintain an harmonious relationship between intra oral components such as tooth shape,size,shade,position,gingival architecture level along with extra oral components such as smile line, vertical component of the face are rudimentary to dental esthetics & should be evaluated clinically before implant placement. Post extraction a cascade of healing process results in 25% of bone resorption. This process ultimately leads to resorption jeopardizing esthetics.

Hence the process to salvage the bone resorption begins with atraumatic resorption where the buccal bone is not lost and placement of immediate implants becomes quite easy.

At the same time implants placed immediately after extraction maximizes preservation of the remaining bone structure, maintaineance of soft tissue profile through temporary provisional, decreased total number of surgical phases and reduction for comprehensive time.

 This procedure has become a routine since they have as much as survival rates as compared to implants placed post extraction. This protocol of immediately placing implants is widely accepted by the clinicians especially by the patients with maximum comfort & short treatment duration. Amidst all the procedures the most important criteria probably for the best outcome are intact bone wall & an ideal implant position.

Treatment of Gummy Smiles

How awkward are you to imagine yourself to flash your smile with those extra gums being visible when you have been invited to a momentous event? This is usually followed by an embarrassing condition & hesitation to communicate, isn’t it? These are called as gummy smiles. At Dr. Sachdeva’s Dental Institute, we offer an exquisite treatment to ensure that people don’t have to go through such self conscious circumstances. This is repaired under supervision of experts after discussing various possible treatment options implants, crowns etc of best quality ensuring that your gummy smile vanishes without any side effects.

How can we help with those gummy smiles?

If you are struggling to get rid of a gummy smile, we are here to guide with the treatment options. Contouring of gums is one of the widely advocated options by making your teeth look longer to cover the excess part of your gums in order to repair the smile. However, before proceeding with the treatment, it’s required to do a detailed study of the dental structure, undergo series of tests and identify the source of the problem. Quite often the irregularity in the structure of your gums is a consequence of genetic disorder. In some cases, the treatment is often a combination of the contouring of gums along with fixing of veneers.

This procedure including a surgery seems to be painful, isn’t it?

Gum surgery is not a cup of tea for everyone. Hence, if you opt for treatment at a reputed place like Dr.Sachdeva’s Dental Institute; we don’t fail to deliver the best treatment with all the required precautions to minimize risk of any pain or discomfort. In addition, we aim to finish this hassle free for the patient who can take advantage at the convenience of all facilities under one roof. We provide every facility from implants to various other treatments made available at one place. This is to assure that when you step in for treatment at our clinic, you don’t have to rush from pillar to post with the burden.

Post treatment safety measures

Previously repairing gums used to be a tiresome process. Nowadays you don’t have to spare days recovering because after the treatment, soon you can get back to most of your daily routine. The doctors will help you follow the precautions that are must for the intial few days. Also, our doctors are most likely to advice routine follow-ups in order to keep a check on your progress. This is done to provide the additional instructions to follow during your healing time to increase the pace of recovery.

Porcelain Laminate Veneers – INSIGHT

With the recent increase in patient’s demand for esthetics in the anterior region porcelain laminate veneers have become the esthetic alternative to ceramic crowns and the traditional porcelain-fused-to-metal. Its use has been advocated as it exhibits natural fluorescence, enamel mass and absorb, reflect, and transmit light exactly as natural tooth structure with conservative preparation. The actual approximate thickness of a porcelain laminate veneer is 0.4 to 0.7 mm which closely resembles that of the natural tooth enamel. The application & case selection of the porcelain veneers ranges from the restoration of small proximal lesions, moderate incisal chipping, developmental defects of the facial surface of the tooth, intact anterior damaged by staining,Diastema,cover discolored or misshapen tooth. As compared to composite restorations with a questionable longevity being susceptible to discolorations, marginal fractures and wear porcelain veneers are superior in esthetic quality and longevity as the biocompatibility and nonporous surface of the porcelain prevents plaque adherence, the applicability of the supragingival technique ensures excellent periodontal health.

Regards :

Dr.Rajat Sachdeva

Soft Tissue Grafting to improve the Attached Mucosa at Dental Implants

This is in preposition of a treatment planning of an appropriate surgical technique for increasing the width of the attached mucosa in order to maintain Peri-implant health. The soft tissue around gingival being divided into gingival and mobile alveolar mucosa, the gingival width varies individually as 2-9 mm.There is a time-point to distinguish the peri-implant mucosa from the gingival around the teeth:

  • The peri-implant connective tissue has less number of fibroblasts & more collagen fibers’ as compared to gingiva.
  • The junctional epithelium is more permeable with scarce number of blood vessels than that of around the tooth.
  • The peri-implant connective tissue fibers’ run in a parallel direction to the implant or abutment surface without being attached rather being perpendicular to the root cementum.

It has been concluded that presence of non-elastic collagen fibers’ in the connective tissue is responsible for keratinization.

Based on findings, >2 mm of keratinized tissue is required for maintenance of healthy gingival tissues.However,around the dental implants, the crucial role of an adequate width of keratinized /attached mucosa for the clinical success is still controversial.

Recent studies have shown that lack of adequate width of

Keratinized alveolar mucosa around dental implants is associated with more plaque accumulation, inflammation, soft tissue recession, attachment loss. Since implant surgery includes one or two stage bone augmentation procedures, displacement of the mucogingival Junction does occur.hence, in order to regulate the width of keratinized attached mucosa, two different peri-implant soft tissue augmentation procedures can be concluded:

  • Increase in soft tissue volume using a sub epithelial connective tissue graft or soft tissue replacement graft
  • Enlargement of keratinized mucosa width by means of an apically repositioned flap/vestibuloplasty.