1. What is a dental implant? A: A dental implant is a restoration used to replace a missing tooth. A natural tooth consists of a crown and a root. The crown is the part of the tooth visible in the mouth that is covered with white enamel. The root is the part of the tooth that supports the crown and penetrates deep into the jawbone. The root is part of the tooth and the implant is an effective replacement for the natural root. Usually the implant consists of three parts: the implant itself, which is the part that goes directly into the jawbone; the abutment, which is the device that connects the implant to the crown; and the clinical crown or denture. Nowadays, the main material used for implants is titanium, which is biocompatible, ductile and durable, and is the only metal that can be stably bonded with bone tissue. The way it is connected to the bone is called “osseointegration”. 2.What is osseointegration? The working principle of the implant is called “osseointegration”. This process was first discovered by Swedish researcher Per-Ingvar Branemark in 1960, when the implant was surgically placed in the jawbone to achieve “osseointegration”. The implant and its upper crown can be used for different designs and functions. They can be used for the restoration of a single missing tooth or even for the restoration of an entire arch. The restored denture usually matches the color of the natural tooth enamel, providing a perfect natural appearance and a beautiful smile. 3. Are implants right for me? For most people, when starting to read this article, it means that there are already missing teeth. Dental implants are an ideal material for restoring missing teeth, whether caused by trauma or decay. Dental implants are used for: ・Single missing tooth —– to avoid fixed bridges ・Several missing teeth —– to avoid fixed bridges or partial denture restorations ・Full missing teeth —– to avoid full dentures With dental implants, you can eat whatever you want because the implant restored denture can withstand strong biting forces and is stable enough, while aesthetically resembling natural teeth The dental implants can restore the maximum amount of beauty to your smile. 4. How can I know if I am suitable for implant restorations? If you think a dental implant restoration is suitable for you, then contact your dentist for a thorough evaluation. However, if there are untreated tooth, gum or jawbone lesions in the implant area, implants are not suitable, as this will reduce the success rate of the implant surgery and affect the bonding and stability of the implant itself. Therefore, a thorough examination of the entire mouth (including teeth and jawbone) is required, as well as an evaluation of the occlusion. 5. Pre-examination (1) What is the best situation during the examination? The dentist or implantologist will irradiate x-rays, focusing mainly on the area to be implanted. In general, the clinician carefully examines the remaining teeth and the area of the jawbone to be treated with x-rays. Many dentists take surface tomograms to better visualize all the teeth and jaws in the upper and lower jaws, as well as to make some diagnoses of pathological diseases. The surface tomogram can also be used to assess the available jaw height and the position of other anatomical structures, all in order to make a perfect evaluation for the next implant. (2) CT scan The most accurate method of imaging analysis at this stage is the CT scan, also called CAT scan. CT films are taken by the dentist to diagnose, analyze and guide the treatment plan for the implant procedure. In understanding the entire diagnostic process, you may be more inclined to become a radiologist. There is another CT scan technique called Cone Beam CT (CBCT). CBCT can produce less radiation dose and is easily viewed in the radiology department or even in the office. All types of CT can provide detailed, three-dimensional images while accurately measuring the height and width of the available jaws and adjacent anatomical structures (such as the maxillary sinus and inferior alveolar nerve) for which the surgeon must take special care. Since all radiation doses are cumulative and the potential hazards of over-radiation have been documented, it is important to keep the radiation dose within the risk range and minimize the number of exposures to improve diagnostic imaging accuracy. (3) Additional examinations Other diagnostic studies are also necessary for implant surgery. A good periodontal examination requires that the presence of gum disease be observed and, if present, an effective treatment plan be developed. Likewise, it is as important to test each tooth and actively treat cavities and other dental diseases. Oral impressions are necessary in all aspects of implant treatment to assess the occlusal status and the position of the implant in relation to the remaining teeth and the dental arch, and photographs are also necessary to assist in the treatment and documentation of all phases of the implant. 6. How are the implants placed? Most dental implant procedures are performed in the dental office or in a hospital outpatient clinic. Local block anesthesia is sufficient for most of them, but nowadays there is another form of anesthesia called sedation or intravenous anesthesia. Some additional procedures, such as bone grafting, can be performed in two stages or at the same time as the implant is placed. Each implant procedure is different and is closely related to the clinical environment, the patient’s own condition and the skill level of the surgeon. 7. Why is the surgical procedure divided into three steps? The most widely used surgical procedure for implant surgery is the staged procedure. The first stage consists of surgically burying the implant (replacement root) into the jawbone, which can effectively protect the implant during the healing process. At the end of healing, surgery is required to remove the healing abutment from the implant surface. In the second stage, the surgeon first checks the bone healing of the implant and then attaches some form of stake through the gum to the mouth, which is called a healing abutment. This part is called the healing abutment and can be formed either by lathe or by conventional laboratory work. The gingiva heals around the abutment and forms a dentin sleeve or dentin shoulder collar to facilitate the eventual prosthetic restoration by the dentist. Studies have demonstrated the feasibility of placing a healing abutment in conjunction with a one-stage implant procedure. Although somewhat limited in some respects, it eliminates the need for a phase II procedure, thereby reducing the risk of prolonged implant exposure. However, the implant still needs a long enough period of time for bone healing. The healing abutment needs to be able to support sufficient occlusal forces before reaching the stage of perfect bone healing. Once the implant has healed well and has formed an osseointegration, the healing abutment is then replaced in the final restoration. The final restorative process involves the attachment of the final denture to the implant that has formed an osseointegration. 8. What is the total success rate of dental implants? Despite numerous clinical and laboratory studies, dental implant technology does not have a 100% success rate. However, the success rate has increased significantly since the beginning of implantology and is now proud to reach a success rate of over 90%. Long-term success rates are also above 90 %, if not higher. When an implant does not successfully achieve osseointegration, the implant is removed, indicating that the implant is not very easy to achieve osseointegration. In this case, your dentist will advise you to place a new implant, but it will take longer to heal and may require a bone graft restoration. 9. How long does it take for the implant to heal? The healing time varies from person to person. The quality of the patient’s jawbone and the presence or absence of additional surgery are closely related. However, in general, implant healing takes 2-4 months (without additional occlusal forces being applied). Recent in-depth studies on the mechanism suggest that a good bonding of bone and titanium promotes healing and that individual implant manufacturers shorten the healing time of their products (which does not meet the conventional criteria). In recent years, studies have confirmed that the dentist can load implants attached to the denture during the same period or for a short period after implantation. Although this is now common, a healing time of 2-4 months is still the time that needs to be experienced before a denture can be restored.