By dentist Dr. Richard Mitchell
The different types of dental implant can appear confusing at first. For a start, there are many different dental implant manufacturers, each with their own design. And then there are several types of implant technique - (how the implant is positioned, and how it is fixed to the jaw bone). And finally there are different types of implant materials.
But it's NOT as complicated as it looks! We can boil down the different types of dental implant to just a few options.
First; what about all the different dental implant manufacturers these days? The market for dental implants has boomed over the last 10 years, and new companies are appearing, offering new designs of implant. (You can read more about this at dental implant manufacturers).
But don't worry - all types of dental implant have to be approved by the health authorities in the country they are sold in (for example, the FDA in the USA), and they all have to meet stringent health requirements.
So the exact manufacturer name doesn't really matter too much. Of course, some implant manufacturers have been around a lot longer than others, and have a longer track record of success. Most dentists will prefer to stick to the big, established manufacturers.
So, don't worry about which make of implant you might be getting - trust your dentist to use the one he's most comfortable with!
Next, you might wonder about the actual material that a dental implant is made of.
All types of dental implant use only 1 of 2 materials.
The most popular material by far is surgical-grade titanium. The other option is a type of ceramic called Zirconia. What's the difference? Titanium is the original material used for dental implants. It has several properties that make it almost ideal;
What about Zirconia? This is a very special material - half metal, half glass. It has the nickname "ceramic steel". It has 2 main advantages over titanium.
But there are some concerns about the strength of Zirconia over time. This potential problem has largely been fixed now, but many dentists are still shy about using Zirconia types of dental implant, until we have more years of evidence.
The other thing about Zirconia is that, although it is bio-compatible with the human body, it doesn't get the same degree of osseointegration as titanium. This means that it doesn't become quite as firmly fixed in your jaw bone after the healing period. You can read more about this at ceramic dental implants.
FINALLY, we get to the types of dental implant technique.
The most common technique is to use a dental implant that is shaped approximately like a tooth root. It is roughly the same length and thickness as a tooth root, although some may be longer, and some may be shorter, depending on how much jaw bone is available in the spot you want the implant to go.
This type of dental implant is also called a "root form implant", because it is about the shape and size of a tooth root. Technically, it is called an endosteal implant or an endosseous implant. This is just medical jargon for something that goes into the jaw bone. It is positioned where the missing tooth root used to be, in line with the tooth roots either side of the gap.
A root form implant also has a screw thread on it, and it is gently screwed into the jaw bone, until it is just level with the gum, or even slightly below gum level. Then the gum is stitched over the top for a few months until the implant has healed into place - become fused to your jaw bone by osseointegration. Obviously, this type of dental implant needs enough depth of bone to give it adequate support.
If your jaw bone has shrunk down due to gum disease or simply from the passage of time, you have 2 options; your dentist may be able to build up the jaw bone with a bone graft, OR he may recommend a different type of dental implant, especially if the aim of the implant treatment is to anchor down a full denture.
The next type of dental implant is called a sub-periosteal implant. This does NOT go into the jaw bone. Instead, it rests on top of the jaw bone, in direct contact with the bone surface but UNDER the gum.
Imagine that you have no lower teeth left, for example. You only have your lower gum and lower jaw bone. Perhaps the jaw bone has shrunk down so much that there isn't enough bone to anchor any root form implants. So, your jaw is small when you look at it from top to bottom, and is ALSO narrow, when you feel how thick it is with your thumb on your chin and your finger inside your mouth under your tongue.
The sub-periosteal implant involves some surgery to your lower jaw, where under local anesthesia, the gum is surgically peeled back from the underlying jaw bone, from the left side round to the right side. Then a custom-made titanium plate that matches the shape of your jaw bone exactly, is positioned on to the exposed upper surface of the bone.
Then the gum is positioned back in place, over the titanium plate, and stitched into place. While the gum heals up, the surface of the bone also grows into the surface of the titanium plate, and fuses to it. After a few months, you have a solid foundation. Now you can get 4 clip attachments fitted to the titanium frame, and use these to anchor down a lower denture.
There are 2 ways to get the sub-periosteal implant made up in exactly the same shape as your jaw; the traditional way involves a preliminary surgery when the gum is numbed with local anaesthetic, peeled back to expose the jaw bone, and a small mould ("impression") is taken directly over the jaw bone.
Then the gum is stitched back into place, and the impression is sent to the dental laboratory. Here it is cast into a model of your jaw, than then a titanium plate is cast over the "surface" of your jaw, matching the shape precisely. A week or so later, you have the second stage surgery when the titanium plate is fitted under your gum.
The second, more "hi-tech" way of getting the exact shape of your jaw is to get a very high-quality CT scan of your jaw, and the jaw bone model can then be created by 3-D printing. Then the titanium implant can be cast onto the model.
This technique is a recent development, and is currently more expensive. Also, the accuracy of the fit may not be as good as the direct impression technique. But the CT scan method saves you a surgery.
The THIRD type of dental implant is called a "blade implant". This is useful when your jaw bone is narrow (ie. not very thick), but you still have some depth from top to bottom. The implant is literally shaped like the blade of a small penknife. Some used to be made of surgical-grade steel, but most are made of titanium.
These types of dental implant are NOT usually custom-made, but come in a variety of shapes and sizes. Your dentist will select one that matches the shape of your jaw after taking X-rays and measurements. The gum is numbed up, and then peeled back to expose the bone. Then the blade implant is held vertically over the top of the jaw bone, with the sharp edge facing down, and it is tapped into the bone, usually about 5 to 7mm.
The top edge of the blade is left roughly at gum level, and the gum is stitched back into place. Over the next few months, the titanium will become fused to the jaw bone, and then you can get some attachments fitted to the top of the blade to support some new teeth, perhaps a bridge or a denture.
The FOURTH type of dental implant is called a "plate form implant". Technically, this is also a sub-periosteal implant, but it is different to the big custom-made implant described above, because it's smaller, anti is not custom-made.
A plate form implant is used when the jaw bone is too narrow or too low for a normal root form implant. As the name suggests, the plate form implant is a flat, long implant shaped like a small flat plate which rests directly on top of the jawbone but under the gum.
Again, the gum is numbed up and then peeled back to expose the bone, in a small area of your jaw. The small flat plate implant is then positioned onto the surface of the bone (it doesn't fit the surface as precisely as the bigger sub-periosteal implant, custom-made from and impression or a CT scan). Then the gum is stitched back into place. Over the healing period, a thin layer of bone grows around the implant, and gives it a firm foundation.
Once healing is complete (3-6 months), you can get an attachment fitted to the top of the implant, which can then support new teeth. Because this implant is not custom-made and is relatively small, it cannot support the full weight of a single tooth; it's better used to support and retain a lower denture. Also, the lifespan is generally shorter than the other 3 types of dental implant.
A FIFTH type of dental implant is called the "mini dental implant". These are really like the normal root from implants, because they go into the jaw bone, but they are much smaller than conventional implants. They are shorter and also thinner. Generally 5 or 6 are placed side-by-side in the lower front jaw, to help anchor down a lower denture. Because they are smaller, it's expected that 1 or 2 will fail and come out, but the others will remain in place and continue to retain the lower denture.
When writing about the different types of dental implant, I feel I also have to mention the All on 4 dental implant technique, because many people ask me about it. Actually, it's just a variation of the root form dental implant method, because it uses those implants. The root form dental implants (endosteal or endosseos) are the strongest and most secure, and the All on 4 techniques relies on a really solid foundation that's only possible with full depth implants. Read more about this method HERE.
You can read more at the American Academy of Implant Dentistry website.
Page written by dentist Dr. Richard Mitchell LinkedIn Profile