Dental Implants: Their Design and Manufacture

Abstract

Edentulousness due to diseases, trauma, or developmental anomalies is a worldwide problem. Implants have been used to support dental prostheses for many decades, but they are not always received with enthusiastic response from the patients. This situation has changed dramatically with the development of endosseous osseointegrated dental implants. They are the nearest equivalent replacement to the natural tooth and are therefore a useful addition in the management of patients who have missing teeth. There are a number of dental implant systems that offer predictable long-term results backed by good scientific research and clinical trials. First of all, it may be helpful to understand some of the commonly used terms in implantology, given in Table 5.1.

Appendices

Problems

• 1. Design a device to measure the maximum biting force for human subjects for all pairs of teeth. How will the force vary with age or gender and disease process? Think about whether it could be used as a device to check dental health.

• 2. Sketch the sections of the mandible and maxilla of an adult Bengali male with approximate sizes. You may consult a dental surgeon and study X-rays. Will this help you to find the diameters and length of the screw-root–type implant? If yes, try to find the approximate sizes. What type of thread profile will be suitable for a dental screw-root–type implant?

• 3. How does surface texture (roughness) or various bioactive coatings affect the screw root to anchor with bone? What might be the life expectancy of such constructs in human patients?

• 4. How do you plan to manufacture a screw-root–type dental implant and enhance its surface to improve osseointegration?

Glossary of Dental Terminology

This list is provided to help readers quickly identify the meaning of the terms used in this chapter and also elsewhere.

Abutment:

The teeth on either side of a missing tooth. Abutments are the part of the bridge used to support the replacement of the missing teeth (pontics)

Amalgam:

Silver filling. Amalgams are usually placed on the back teeth (posterior teeth)

Anesthesia:

Relieves the sensation of pain

Anterior teeth:

The front teeth (incisors and cupids)

Arch:

The upper or lower jaw

Back teeth:

See “posterior teeth”

Bicuspids:

The first and second bicuspids are the fourth and fifth teeth from the center of the mouth to the back of the mouth. These are the back teeth that are used for chewing; they only have two points (cusps)

Bitewing:

X-ray that shows the upper and lower teeth’s biting surfaces on the same film. This X-ray shows the portion of the teeth above the gumline

Bridge:

A fixed appliance (prosthesis) that replaces missing teeth. A bridge is a series of crowns (abutments and pontics)

Bruxism:

Clenching or grinding of the teeth

Calculus:

The sticky film on teeth (plaque) that has hardened. Also known as tartar

Canal:

The narrow chamber inside the root of the tooth that contains the nerve and blood vessels

Caries:

Correct technical term for decay

Cleaning:

See “prophylaxis”

Complete series:

See “full mouth X-rays”

Composite filling:

Tooth-colored filling. Insurance companies usually only allow them on the front teeth (anterior teeth). When composites are done on the back teeth (posterior teeth), the insurance company usually pays for them as an amalgam. Composites are also known as resin fillings

Crown:

Full coverage for a tooth

Curettage:

Surgical scraping of bacteria from the soft tissue. This is a periodontal procedure and is usually performed one quadrant at a time

Cusps:

The high points on the chewing surfaces of the back teeth (posterior teeth)

Cuspids:

The third tooth from the center of the mouth to the back of the mouth. These are the front teeth that have one rounded or pointed edge used for biting. Also known as canines

Deciduous teeth:

See “primary teeth”

Denture:

A removable appliance (prosthesis) that replaces all of the teeth in either the upper or lower jaw

Diagnostic:

Procedures performed by the dentist to identify what's going on in the mouth. The most common procedures are the exam and X-ray, which Trojan classifies as preventive

Edentulous:

All the teeth are missing in either the upper or lower arch

Endo:

See “endodontics”

Endodontics (Endo):

The treatment of diseases or injuries that affect the root tip or nerve of the tooth. The most common procedure is a root canal

Fluoride:

Topical application of a gel or liquid that prevents decay

F.M.X.:

Full mouth X-rays

Front teeth:

See “anterior teeth”

Full mouth X-rays (F.M.X.):

X-rays showing all the teeth. Includes 14 periapicals and 2 or 4 bitewings. Also known as a complete series

General anesthesia:

Relieves the sensation of pain in the whole body. General anesthesia renders a patient unconscious

Gingiva:

The gums

Impaction:

An unerupted or partially erupted tooth that will not fully erupt because it is obstructed by another tooth, bone, or soft tissue

Implant:

A post that is implanted in the bone. A crown, bridge, or denture is then placed over the implant

Incisors:

The central and lateral incisors are the first and second teeth from the center of the mouth to the back of the mouth. These are the front teeth with the flat edges for biting

Inlay:

A laboratory-processed restoration made of metal, acrylic, or porcelain. This filling does not involve the high points of the tooth (cusps)

Local anesthesia:

Relieves the sensation of pain in a localized area

Mandible:

The lower jaw

Maxilla:

The upper jaw

Molars:

The first, second, and third molars are the sixth, seventh, and eighth teeth from the center of the mouth to the back of the mouth. The back teeth with the large chewing surface on top. They have four points (cusps)

Nightguard:

A removable acrylic appliance to minimize the effects of grinding the teeth (bruxism) or joint problems (TMJ). Usually worn at night to prevent the grinding of teeth or to relieve joint pain. Also known as an occlusal guard

Occlusal:

The chewing surfaces of the back teeth

Occlusal guard:

See “nightguard”

Onlay:

A laboratory-processed restoration made of metal, porcelain, or acrylic that replaces one or more of the highest points of the tooth (cusps)

Oral surgery (O.S.):

Surgery of the mouth

Ortho:

See “orthodontics”

Orthodontics (Ortho):

Straightening of the teeth

O.S.:

See “oral surgery”

P.A.:

Common dental language for a periapical. See “periapical”

Palate:

Roof of the mouth

Panorex:

An X-ray taken outside the mouth that shows all the teeth on one film

Partial denture:

A removable appliance (prosthesis) that replaces some of the teeth in either the upper or lower jaw. See illustration below

Pedo:

See “pedodontics”

Pedodontics (Pedo):

The treatment of children’s teeth

Periapical:

An X-ray that shows the whole tooth (above and below the gumline). Also known as a single film or P.A.

Perio:

See “periodontics”

Perio charting:

Measures the depth that the gums have detached from the side of the tooth, forming a pocket (perio pocket)

Periodontal maintenance:

Cleaning of the teeth following periodontal treatment, includes perio charting. Procedure code 4910. Also known as a perio prophy or perio recall

Periodontics (Perio):

The treatment of diseases of the gum or bone (supporting structure)

Perio pocket:

The pocket that forms when the gums detach from the side of the tooth

Perio prophy:

See “periodontal maintenance”

Perio recall:

See “periodontal maintenance”

Permanent first and second molars:

The adult first and second molars, the sixth and seventh teeth from the center of the mouth to the back of the mouth. Does not include the third molar (wisdom tooth)

Permanent molars:

The adult first, second, and third molars

Permanent dentition:

See “permanent teeth”

Permanent teeth:

The adult teeth. Also known as the permanent dentition

Plaque:

A sticky film on the teeth. If it is not removed by brushing, it can harden into calculus

Pontic:

The part of a bridge that replaces the missing teeth

Posterior teeth:

The back teeth (bicuspids and molars)

Preventive:

Procedure performed to prevent decay and gum disease. The procedures that Trojan classifies as preventive are the exam, X-rays, and prophylaxis. The exam and X-rays are also known as diagnostic procedures

Primary dentition:

See “primary teeth”

Primary teeth:

The baby teeth. Also known as the primary dentition. The baby teeth are replaced by the adult teeth (permanent teeth)

Prophy:

See “prophylaxis”

Prophylaxis:

Cleaning the teeth. Also known as a prophy

Prosthetics:

A fixed or removable appliance to replace missing teeth. Example: bridges, dentures, and partials. Sometimes single crowns are considered prosthetics

Prosthodontics:

Dealing with the replacement of missing teeth

Quadrant:

One of the four equal sections of the mouth. The upper right, upper left, lower right, or lower left

Root canal therapy (R.C.T.):

The nerve of the tooth is removed from the canal inside the root and replaced with a filling material

Root planing:

Deep cleaning of the teeth to remove calculus below the gumline. This is not a prophylaxis. This is a periodontal procedure and is usually performed one quadrant at a time

Sealant:

Clear application of acrylic placed over the biting surface of the tooth to prevent decay

Single film:

See “periapical”

Tartar:

See “calculus”

Temporomandibular joint (TMJ):

Temporo (temporal bone), mandibular (lower jaw). This is the connecting hinge between the lower jaw and base of the skull.

Third molar:

See “wisdom tooth”

TMJ:

Temporomandibular joint

Virgin teeth:

Teeth that have no decay or fillings

Wisdom tooth:

The third molar, the eighth tooth from the center of mouth to the back of the mouth. Wisdom teeth are often impacted (obstructed from erupting) and have to be extracted