Dentistry is a specialized branch of medicine that deals with the study, diagnosis, prevention and treatment of diseases and conditions of the oral cavity (mouth with all structures within including teeth, gums, tongue, etc.). As per World Health Organization (WHO), it is appropriately defined as the ‘art and science’ of preventing, diagnosing and treating diseases, injuries and malformations of the teeth, jaws and mouth. It is really an art as well as science which makes smiles better while also treating many diseases.
A dentist is a medical professional who aims to improve the quality of lives by preventing and treating oral diseases and conditions. The dentist's supporting team is also very important, and it aids in providing oral health services and also handling many procedures apart from assisting the dentist. It includes dental assistants, dental hygienists, dental technicians, and in some states, dental therapists.
The dentists achieve the above by:
- Promoting good oral health practices and educating people about them
- Patient education
- Diagnosing dental diseases and conditions including dental decay, gum diseases, etc.
- They may also diagnose some general conditions by just looking at oral cavity, because some diseases and conditions have oral manifestations
- Providing preventive dental and oral care, like restoring slightly decayed teeth, covering them with thin layer of restorative materials, providing treatments to prevent further problems by cleaning, scaling, root planning, application of fluoride, etc.
- Prescribing appropriate medicines to treat some oral diseases, to prevent or allay infections, and for all three prophylactic, preventive and promotive purposes
- Treating and restoring decayed teeth by appropriate materials
- Replacing lost teeth by implants, dentures, partial dentures, etc.
- Treating other conditions of mouth, related structures and even jaw
- Also undertaking some surgical procedures, most common of them being tooth extraction
- Providing orthodontic treatment to adjust and correct mal-aligned teeth
- And many other functions as per further specialization.
Types of Dental Implants
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As individuals, we all resorb at different rates and some patients may suffer severe bone atrophy leaving a flat ridge that is unable to retain a denture without it floating. Then, the maxillary sinus enlarges as we age and this may create a paper thin bone in the upper jaw. Osseous (bone) grafting can be used to raise the floor of the sinus and create adequate support to place root form implants. In the lower jaw as the bone resorbs, the inferior alveolar nerve (a large nerve running through the mandible) may interfere with implant placement. To circumvent this problem, the inferior alveolar nerve can be repositioned to allow implant placement.
Implants are constructed of titanium or titanium alloy. Extensive studies have demonstrated that titanium is completely biocompatible, causes no allergic reactions and is completely accepted by the body. During the fabrication of the implant, an oxide layer forms on the titanium surface upon which the bone will fuse (Osseointegrate). Additionally, the surface of the titanium can be treated with hydroxyappatite or sprayed with titanium (TPS) to improve the osseointegration.
Dental implants are divided in two categories based on whether they are placed within the bone (Endosseous) or on top of the bone (Subperiosteal).
Endosseous implants are placed within the bone and are subdivided into two groups, root form and blade form. These types of implants are placed to secure either single crowns, fixed bridges or to retain removable prosthesis (dentures).
Blade form implants, also known as plate form, are flatter in appearance and are utilized when there is insufficient width of bone but adequate depth is present. They are available in various shapes to fit in and around anatomical structures such as the maxillary sinus and inferior alveolar nerve. Blade implants have been used to treat edentulous jaws since 1960.
The other main category of implant type are Subperiosteal implants, which lie on top of the bone below the gum tissue and have posts that project through the gun tissue into the oral cavity. These are custom fabricated implants that are made from an impression of the patients jaw bone. Ball attachments or other retaining devices are placed on the posts that project through the gum tissue and are used to retain a removable prosthesis (denture). Subperiosteal implants are utilized when insufficient bone is present to accommodate either a root form or a blade implant and anatomical structures limit endosseous implant placement.
Types of human bone
There are four types of bone in the human face and the length of treatment for placing and restoring implants with a “Tooth” and crown depends on which type of bone the implant is placed in. Implants have to integrate with the surrounding bone before a tooth and crown is placed on it.four types of bone in the human face
- Type I bone is comparable to oak wood, which is very hard and dense. This type of bone has less blood supply than all of the rest of the types of bone. The blood supply is required for the bone to harden or calcify the bone next to the implant. Therefore, it takes approximately 5 months for this type to integrate with an implant as opposed to 4 months for type II bone.
- Type II bone is comparable to pine wood, which isn’t as hard as type I. This type of bone usually takes 4 months to integrate with an implant.
- Type III bone is like balsa wood, which isn’t as dense as type II. Since the density isn’t as great as type II, it takes more time to “Fill in” and integrate with an implant. Six months time is suggested before loading an implant placed in this type of bone. Extended gradual loading of the implant can, however, improve the bone density.
- Type IV bone is comparable to styrofoam, which is the least dense of all of the bone types. This type takes the longest length of time to integrate with the implant after placement, which is usually 8 months. Additional implants should be placed to improve implant/bone loading distribution. Incremental loading of the implants over time will improve bone density. Bone grafting or augmentation of bone are often required.