Questions about implants

[Tony932]

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This is NOT a request for medical advice. Rather, I am curious about dental implants.

1. When a molar is extracted, and an implant is planned for the future, do the adjacent teeth shift during the months prior to implant installation?

2. Are most general dentists willing to place a crown on an implant that was placed by a dentist that he is not familiar with? In other words, are most general dentists willing to place a crown on ALL brands of implants?

Thank you in advance.

 

[eric275]

This is NOT a request for medical advice. Rather, I am curious about dental implants.

1. When a molar is extracted, and an implant is planned for the future, do the adjacent teeth shift during the months prior to implant installation?

2. Are most general dentists willing to place a crown on an implant that was placed by a dentist that he is not familiar with? In other words, are most general dentists willing to place a crown on ALL brands of implants?

Thank you in advance.

1 - Typically no, If the patient is going to be unable to have the space restored in a timely fashion it is usually a good idea to deliver some type of space maintaing appliance.
2 - It usually is less dependent on whether the implant was placed by another dentist, but if the restoring dentist has the required impression copings and drivers to even make the impression or deliver the definitive restoration. My statement is assuming that the implant is not in some crazy location or angulation in relation to the ideal placement. If that were the case I personally would not restore the implant and encourage the patient to have implant removed and placed in the correct position by the original doc. Or let the original dentist restore the compromised implant placement and deal with any future problems.

 

[Tony932]

Thank you. So a few decades from now, when patients need a crown revision on a healthy implant, and their original dentist is retired, do they need to know the brand and model of their old implant, or can the new dentist just pull the old crown and make an impression on the old abutment and send for a new crown?

 

[chill45]

1. Agreed ^^^ if done in a timely fashion no. Unless a sinus lift is required they can usually immediately place the implant after extraction. With a new implant system called Keystone, they can sometimes bypass the sinus lift as these implant are MONSTROUS in size by being very fat (between 7 and 9 mm) and fairly short (again between 7 and 9 mm I believe). Pretty cool to see.

2. Again agreed ^^^ usually implants are part of a bigger treatment plan and the general dentist refers the patient to a periodontist or oral surgeon to have the implant place. These guys (or gals) will place whatever implant system the general dentist wants (or lose future business). If a patient has an implant and then comes sees a new general dentist not familiar with that company the perio/os should provide them with the impression copings they need and give them a lab that can help with the restoration.

3. They will need to know the brand and size of the implant system most likely. Though not complete this website is pretty cool to look at http://whatimplantisthat.com I'm not sure how much literature is out there on this but "a few decades" is quite a long time for an implant to hold up. I know most are only guaranteed for 5 years though it is pretty much understood that there expected life expectancy is around 20-25 years. Root canals are largely regarded to only be good for about 10 years though some have lasted 30+ so who knows. Good questions though.

 

[Tony932]

(message deleted by O.P.)

 

[Tony932]

1. Agreed. If done in a timely fashion no.

1. How many months can a patient go without a space-maintaining appliance before tooth shifting occurs?

2. Are there several implants brands that have identical threads and abutments for the sake of standardization? If so, would it behoove the implant candidate to seek a dentist who uses one of these brands? An analogy would be car tires. There are hundreds of brands of car tires that will fit on the same rim.

 

[txaggie03]

The shifting starts immediately after the extraction. However it is a slow process. The question should be, how much shifting is detrimental?

There are a ton of variables that can speed up the shifting, as well. Amount of bone loss prior to extraction (both extraction site and adjacent teeth), patient's oral habits (tongue movement, chewing, clenching, etc.), opposing dentition, medications, systemic diseases, etc.

One thing hindering standardization of something like a dental implant is the sheer speed of change in the industry. Everything from size, taper, coatings, shape, tissue/bone level, types of healing caps, custom abutments, milled custom abutments, etc. By standardizing something like that actually impedes the customization of the treatment to the patient. Cars are similar, patient's needs are all over the place.

 

[chill45]

2. Are there several implants brands that have identical threads and abutments for the sake of standardization? If so, would it behoove the implant candidate to seek a dentist who uses one of these brands? An analogy would be car tires. There are hundreds of brands of car tires that will fit on the same rim.

Implant systems do not necessarily want to be standardized I would imagine. Most of the top names (Biomet 3i, Straumann, Zimmer, Biohorizon, etc.) operate in their own fashion. I would think the situation you describe (where the gp doesn't know the implant company or size) is pretty rare, so each company just makes components that are compatible with their system. They even go as far as making sure their components are not compatible with other implant systems for the sake of increasing their sales of implants because of advancing technology in impressing the abutments used. For example 3i uses a special encode abutment with different notches on it that can be laser scanned bypassing the impression altogether to get a crown (or if an impression is still used it takes an entire step and another impression out of the process making it shorter and less follow ups by the patient) so this technology would entice a gp to use a 3i implant. If I were the gp and looking at failing crown I would just take it to an oral surgeon known to place several types of implants and see if he/she could help identifying it. Otherwise since the technology is changing so rapidly by the time that crown failed (which would take many many years in most cases, usually outlasting the implant itself) the components used to restore it may be obsolete as well.

 

[Tony932]

Thanks chill45. Perhaps as implant patents expire, inexpensive replacement abutments will be produced for most implant systems even if the original manufacturer is no longer in business. There will always be a demand for implant crown revision. Or more likely, more advanced abutments will be produced that are compatible with old implants. Kinda like putting a state-of-the-art air conditioning system into a house built in 1940.