The days of placing implants on weekends when no one was around have come and gone. This ‘Voodoo’ form of dentistry has now come of age. Implants have now become the treatment of choice. With an average current success rate of around 97%, there is little else in our armamentarium that can achieve this result consistently. And here, I’m talking about the standard threaded ‘Endosseous’ implant. But there are many implants in our current day history that have helped us get to this pinnacle of success. There have been many attempts at changing the dynamics of im plant technology over the history of implant placement, but none have proven to be as consistently successful as the modern threaded implant.
The ‘Mandibular Staple’ im -plant — used specifically by oral surgeons because of its external approach — has been shelved because of its morbidity and unpredictability. Infection was certainly a concern with these implants (as well as the cosmetics of a sub-mandibular scar).
The ‘Zygomatic’ implant has also been ‘put on leave’ — again because of its difficulty in placement nd more common ‘implant fracture’ problems. Again, this was more likely to be placed by an oral surgeon, or at least by someone with extensive knowledge of head and neck anatomy. This implant is a thin pin like implant up to 60mm in length. They are used to bi-pass the maxillary sinus on the mesial and distal and get bony retention from the distal portion of the maxilla as well as the anterior buttress of the Zygomatic arch. The purpose of this implant was to avoid the sinus and allow retention of prosthesis using available bone. This is now avoidable since the maxillary sinus can be displaced vertically to re-create some of the ‘lost bone’ from a pneumatized sinus.
The ‘Subperiosteal’ implant (a type of snow shoe approach under the periostium and over the mandible) is still a good choice for very selective circumstances. This could be considered by some as an invisible denture framework. Although the implant is not used as routinely as it once was, it certainly can be an implant for specific use if the patient doesn’t want bone grafting, can’t afford the extreme costs of the standard implant treatment plan, has time constraints and needs help securing teeth in his/her mouth. This implant is extremely technique sensitive. This implant is used to retain removable prosthetics more generally, but can be used for fixed prosthetics bilaterally in the mandible when the nerve is dehiscent, or there is absolutely no bone available for normal Endosseous implant placement. This implant can be used where the anterior teeth are too good to consider removal and fixed teeth are required posteri- or to them. This is generally not the treatment of choice and can have extensive complications, but neither is it to be considered a venture into the world of ‘malpractice’. Studies show a prosthetic success rate as good as or better than the Endosseous implant even when complications arose with the actual Subperiosteal Implant itself. It has been — and still is — a viable treatment option.
The ‘Blade’ implant was (and still is) used by some implant dentists to placed fixed and removable prosthetics in bone that was too narrow for the traditional implant. In the proper hands, these implants deliver very acceptable results. They are again very technique sensitive. They are definitely not the implant of choice now that we can do grafting to these ‘B’ style ridges that are too thin for the standard Endosseous implant. I still have some blade implants functioning very nicely after twenty three years of service for the patient. When the patient is asked if they would like their ‘blade’ replaced with the more traditional Endosseous implants, their answer is — of course — ‘NO!’
The ‘Endodontic Implant’ is also a thing of the past. This implant was a titanium rod or pin placed through the endodontically treated tooth (usually mandibular anterior teeth) and into the bone. There was no anatomic structure to violate, and they prolonged the time a tooth could be held in the mouth. Now, with the success of the Endosseous Implant, there is no reason to put the patient through the cost — or discomfort — of this style of implant. The tooth is simply removed, and a single implant is used to replace the lost tooth. This is a more expensive procedure, but it is certainly more predictable.
As well as the above models of implants, twenty or so years ago the dense Hydroxyl-Appetite crystals were used in a tunnel under the periostium in an attempt to regain the bone on the crest of the ridge that had been lost through denture abuse. We soon found out that this material didn’t stay put, and tended to migrate off of the crest of the ridge and into the sulcus. This made the ridge seem even smaller, and although some of them worked, they were more trouble than help.
The last implant I want to bring to your attention is the mucosal insert. This is a small ‘button’ type of insert placed on the ridge area in a denture that can ‘snap’ into a female keratinized hole in the mucosa of the maxillary or mandibular ridge. Although they are slowly falling out of favor, they still have a role for the 80 plus year old patient who simply wants their denture to feel more stable. A quick fix, and very inexpensive compared to the Endosseous implant.
The newest technology is the mini-implant. Although there are no long term studies on this style of implant, in certain circumstances it could be said to make a lot of sense. For the elderly patient who needs retention of a complete denture and is not biting with the force of a twenty year old, it is a cheap ‘quick fix’ approach which might be exactly what the patient needed. There is always the worry of implant fracture, but because of their reduced costs, they are easily removed and/or replaced with new ones.
Implant dentistry has come a long way. We should not forget the pioneers who have forged their way through technology to the point we are at now. The Asian’s used bamboo sticks hammered into the jaw to replace missing teeth. The Egyptians used small fragments of sea shells sharpened and hammered into the jaw to replace missing teeth. Implants have been around for a long time. There have been a lot of mistakes and failures along the way. But we should not forget that “in some cases” — there is an alternative treatment available to the patient.
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