Missing teeth can affect a person’s overall health. Historically, dentures or bridge restorations were used as replacements for ones lost teeth, but with limited results. Dental implants, however, are natural-looking replacements for missing teeth that provide the same function as your natural tooth root.
Restorations of missing teeth through dental implants have greater success and significantly more patient satisfaction. The effects of missing teeth are detrimental to one’s long-term oral and medical health because teeth provide more functions than just the ability to chew. They are necessary for the health of the gum as well as for the jaw tissues.
A prolonged absence of a tooth will severely limit the possibilities for restorations. Missing teeth severely affect an individual’s confidence; well being and can make one look older than they actually are. A tooth should be replaced as soon as it is lost, this will retain one’s oral health by preventing bone loss, reducing movement of surrounding teeth and avoiding excess decay. It can also improve your smile and the shape of your face.
Dental Implants are permanent and quite an appealing solution to replace missing or extracted teeth. This is because of their proven success! They are not susceptible to cavities. They are better than other alternatives like bridges because no additional teeth need to be altered to place the new tooth. They are designed to mirror the size, shape, and function of a patient’s natural tooth root, and finally, when doing an implant, there is no need to grind down healthy adjacent teeth. The implant provides support for the crown.
The process is not as complicated as one may think. With the TTPHIL Technique the first step is to install the implant itself, and then within 7 to 9 days, once the implant is healed, an abutment and crown will be placed. A permanent crown is placed to restore the implant to the tooth’s natural appearance and function. Wondering whether you are a good candidate for a dental implant?
“All patients older than 18 years are candidates for implant surgery.”
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Missing teeth are bad news for your dental health. When you’ve lost teeth, you leave your gums vulnerable to irritation and your remaining teeth at risk for shifting and falling out. While dentures and bridges used to be the only options for people with tooth loss, a newer solution is becoming the gold standard for tooth replacement: dental implants.
With dental implants, you don’t have to worry about many of the problems that accompany dentures, like special care requirements and slippage that causes speech and eating difficulties. Dental implants look and act like your natural teeth, and they don’t require special attention. No one will know you’ve got an implant except you and your dental specialist dentist. Learn more about dental implants in this infographic from DentiStar. If you have friends and family members who are dealing with tooth loss, share this information with them so they can talk to their own family dental care providers about their treatment options.
All on 4 treatment technique for complete rehabilitation of the edentulous (No teeth present in the jaw), is a surgical and prosthetic medical procedure which is fixed rehabilitation option with Dental Implants. All on 4 concept was developed in 1990’s through studies funded by Nobel Biocare in collaboration with a Portuguese dentist Paulo Maló. This technique is rehabilitation in the edentulous maxilla and mandible with fixed prosthesis by placing 4 implants in the anterior maxilla( front upper jaw before sinus and mental foramen), where bone density is higher, allowing the highest success rate. The four implants support a fixed prosthesis with 12 to 14 teeth in each jaw and it is placed immediately on the day of surgery. Allon 4 is a registered trademark of Nobel Biocare. This technique is time tested and widely accepted in many parts of the world.
Nowadays this concept is copied by various implant companies at a cheaper and affordable prices. These companies which also give life time warranty on all on technique. 2.Procedure Description of all on 4 technique at The Dental Specialists, Hyderabad, India: All on 4 treatment concept provides a permanent, screw retained and cement , same day replacement for the entire upper and lower teeth set. The procedure is best indicated for patients with major bone loss, tooth loss or decay. Tooth loss leads to jaw bone which poses the problem of reconstruction of the jaw bone. Conventional technique requires almost six to twelve months to restore the implants. Moreover we need to transplant bone from various other parts of the body like iliac crest or skull. Why 12 months is because we have to graft initially and wait for 3 to 6 months till the artificial or natural bone gets integrated. And achieve good bone density. Later we place implants and again wait for 3 to 6 months till the implants get osseointegrated. Many of the patients can not undergo transplantation of bone for general health reasons (diabetes and others). The All on 4 treatment concept, will address these drawbacks because it consists in establishing a fully customized denture (bridge) based only on four titanium Tall and Tilted implants. These implants act as “pillars” to the bridge that supports the prosthetic teeth. The invented process takes advantage of existing bone, even if scarce, avoiding having to use bone grafts. The posterior back implants are angled at approximately 45 degrees to avoid compromising the sinus cavity in the upper jaw and the nerve canal in the jaw.
10 reasons why we (THE DENTAL SPECIALISTS Team) stopped using single piece Implants. This article Compares the SINGLE PIECE IMPLANT DESIGN, CONVENTIONAL IMPLANT DESIGN AND TTPHIL IMPLANT DESIGN. TTPHIL IMPLANT DESIGN takes the advantage of SINGLE PIECE IMPLANTS – BICORTICAL ANCHORAGE. thus able to give the teeth Immediately (IMMEDIATE LOADING), also take the advantage of CONVENTIONAL IMPLANTS by giving the multiunit connection which is Precision fit making it into a Single Piece after tightening the Implant to multi unit abutment at 25 to 35 Newton Centimeter Torque. This will lead to a morse connection fit – not leading to any more Screw loosening which used to happen before. This article is nothing to promote or criticise one particular company. This article is related to the design and technique of the Implant and not the company.
1.Narrow Diameter Implants (Conical in Shape) : Very thin Implants. Hence more number (Minimum 8 -12 in each Jaw) of Implants are required to restore full mouth rehabilitation. Threading only at the tip at the apical apart. Hence less surface area. Some single piece implant designs have threads all over but they are conical in shape. The surface area is less when compared to TTPHIL Implants. Same with the conventional Implants. The conventional implants definitely in this regard have better surface area when compared to Single piece implants. TTPHIL implants have the advantage
2.Bone Implant Contact(BIC): BIC ratio is very less- No Osseointegration during the surgery time. Polished Surface all over- Thin Implants- Less Surface area- less osseointegration. Since they are conical implants and have smooth surface area, the implants have less surface area when compared to conventional Implants. The Single piece implants believes in OSSEOFIXATION and NOT OSSEOINTEGRATION because it engages the bicortical bone at the Basal Implants. TTPHIL Implants have an advantage of both Single Piece implants and Conventional Implants. It has both OSSEOINTEGRATION and OSSEOFIXATION. It compresses the bone during the insertion of the implant adding advantage of high torque stability.
3. Implant retention: because it engages only the cortical bone. Threads only in tip: leads to spinning or failure of Implant in some cases. Single piece compression threads have this advantage but they are conical and have very less surface area when compared to conventional implants which have parallel or tappered implant design.
4. Need to load the implants for sure if there is no primary stability also (Because it is Single Piece- Implant and Abutment is connected)- leads to failure in some cases. The most important factor for immediate implantation is primary stability. In 2 piece implants the advantage is that we can leav the implant burried which will allow it to osseointegrate ( bone formation around the Implant). This option is not available in single piece implants.
5. Can not be tilted beyond 15 degrees. Sometimes the connection between the abutment and the Implant fixture breaks and the implant becomes useless. Most of the designs in single piece are rigid which will lead to neck failure. Nowadays some of the single piece implants the companies claim that they can be twisted to any angle but the criteria is not twisting. The purpose of the twisting or bending the abutment is to make it parallel to the adjacent implant which is not possible in single piece implants. The precision can never be matched to the 2 piece implants. In TTPHIL Implants we make the customised abutments or multi unit abutments in CAD CAM machine to make precise prosthesis. The final output the crown and bridge is definitely better.
6. Neck Connection: Implant and Abutment connection is very thin and can break while tightening at high torques or tilting the abutment to make it parallel to the adjacent implant. Tilting the abutment can never become parallel to the adjacent implant. Imagine the robots doing the precise fabrication with CAD CAM Machine and tilting the abutment manually in the mouth.
7. No US FDA approval
8. Cannot be loaded individually. Needs to be connected to the other implant or tooth which is not suggested. Need to place 2 implants instead of one especially in the load bearing areas. Because the single piece implants are narrow and some noty having the threads in the crestal surface the surface area of these implants or the bone implant contact ratio is very less when compared to conventional implants they need to be placed more in number.
9. Too much Tilting of the implants is not possible because the implant and abutment is in one piece. Especially in upper anteriors and when there is no bone tall and tilted implants are necessary to engage the cortical bone- Nasal floor.
10. Palatal placement of the implant is not possible because it cannot be bent. The abutment when bent can break at the neck of the implant.
11. NO OPTION OF RETRIEVABILITY. The Single piece implants after placement to connect them or to give crowns above them needs to be cemented. This cement seeps into the gum which is irritating factor to the gum which can lead to bone loss. The most important factor is that the prosthesis needs to be cemented. The single piece implant companies to avoid the complications which are inevitable in any kind of implants cannot be retrieved. Because they are cemented the whole prosthesis needs to be cut for repair purpose which is very traumatic to the patient.
To go into depth and detailed description why Single piece Implants are not successful. Read the link below…
Immediate loading Implants with TTPHIL ™ Technique
What is TTPHIL ™technique?
T – Tall implants measuring 16 to 57.5 mm depending on the engagement of the Bicortical Basal bone support
T – Tilted implants placed at an angulation of 15 to 70 degrees.
PH – PinHole – Flapless procedure
IL – Immediate Loading (Provisional Prosthesis in 2 hrs and Permanent Prosthesis in two days)
WHYTTPHIL- ALL TILT TMTechnique? Rationale: Set of reasons and logical basis. A Justification…
Surgical Phase Advantages
1.Immediate Loading- Permanent CAD CAM Ceramic teeth in just 2 days.
2.Avoid Sinus Lifting procedures and other Bone Augmentation procedures unless really needed for aesthetic reasons. – Secondary Morbidity Invasive procedures- Avoidance of additional surgical risks.
3.Local Anesthesia procedure – Minimal Anesthesia
5.Can be done in Heart Patients/ Smokers/ Diabetic Patients/ Gum diseases
6.High success rates
7.Low cost to the patient and time saving ( Avoids bone grafting procedures)
8.No healing time required- Immediate function the same day- Permanent prosthesis in 2 days
9.Less post operative pain
10.Most advanced system
11.High success rate in patients with less bone height
12.Employs cortical bone areas which are resistant to infection and resorption.
Prosthetic Phase Advantages
Latest CAD CAM Abutments which are customised have a Q- lock Morse connection when torqued at 25 Newton centimeter becomes cold welded. This cold welding property prevents screw loosening.
Single piece implants have abutments and Implant fixture in one piece, hence needs to be cemented. There is no option for screw retention at all. In TTPHIL ™ Technique the restorations ( Implant Supported Crowns and Bridges ) can be either cement retained or screw retained depending on the case. The main advantage of screw retention is retrievability– In case of any complication ( For eg: Gums shrinkage: Most common in immediate Implantation and loading) we can remove the ceramic prosthesis simply and add ceramic where required.
Aesthetics is better in cement retained restorations but now with the Pre Angulated abutments with Micky Mouse screw this also has a solution. But very expensive..
Retrievability – Screw retained better than Cement retained. In case of any complication the bridge can be removed and can diagnose the situation easily.
Retention: In case of less mouth opening less than 7 mm abutments are used screw retained is always better when compared to cement retained restortions
Immediate implant placement: Screw retained restoration better because of repairability and maintenance.
Passivity and provisionals ( Temporary teeth): Both are good
Occlusion: In screw retained restoration you can get it removed and add ons can be done later after osseous integration of the implants. Progressive loading is possible in screw retained restorations.
Immediate loading: Both cement and screw retained can be done.
Impression procedure: Its easy to do cement retained restorations. The doctor should be a Prosthodontist or skilled dental surgeon to take accurate impressions.
Long term Planning: Screw retained restoration is always better than cement retained restoration.
8 DIFFERENCES BETWEEN TTPHIL IMPLANT TECHNIQUE AND CONVENTIONAL IMPLANT TECHNIQUE. 8 REASONS WHY WE CHOOSE TTPHIL TECHNIQUE at THE DENTAL SPECIALISTS: ADVANCED DENTAL IMPLANT CENTRE
1.Load Transmission is in the basal Cortical Bone – Because these implants are Tall and Tilted beyond 16mm to engage the cortical basal bone which is highly resistant to resorption. This cortical bone is highly mineralized and more resistant to infections as well as its ready from day 1 to take the loads. Conventional implants the load transmission is in crestal cortical plate leading to crestal bone loss. In thus area it leads to bacterial attack.
2.Polished collar in the crestal region: No penetration of bacteria. No source of Infection and Peri– implantitis – Hence No bone losS
3. TTPHIL™ Implants require only patients own, residual bone for anchorage and primary stability.
4. No risky augmentation procedures required- No time delay for augmentation Graft to take up- No secondary morbidity chances
5. Immediate loading- No edentulous phase- No waiting period. 2nd day permanent teeth- Direct Metal Laser Sintered CAD CAM teeth- Improves quality of life..
6. Simple and easy Surgical Phase- No bleeding- Flapless technique- No sutures- Minimal anesthesia- Just 0.2ml. Minimal bleeding- Minimal medication- Minimal discomfort during and after – It will not take more than 30 minutes for full mouth implant placement. Simple Single implant cases takes just 5 minutes. Post operative pain minimum.
7.Extractions and Implants are done on the same appointment. Same Anesthesia- Same Post Operative medications. Even if the teeth have periodontal infection, the teeth are removed, bone
curettage is done and TTPHIL™implants are placed at the same time. Patients are never with out the teeth. Immediate provisional are given in 2 hours. Permanent CAD CAM DMLS teeth are given on the second day.
8. The Implant Design will allow better bone healing and osteonal remodeling.
10 reasons why we at THE DENTAL SPECIALISTS stopped using single piece Implants
1.Narrow Diameter Implants: Very thin Implants. Hence more number (Minimum 10-12 in each Jaw) of Implants are required to restore full mouth rehabilitation.
2.Bone Implant Contact(BIC): BIC ratio is very less- No Osseointegration. Polished Surface all over- Thin Implants- Less Surface area- less osseo integration
3. Implant retention: because it engages only the cortical bone. Threads only in tip: leads to spinning or failure of Implant.
4. Need to load the implants for sure if there is no primary stability also (Because it is Single Piece- Implant and Abutment is connected)- leads to failure.
5. Can not be tilted beyond 15 degrees. Abutment breaks and the implant becomes useless.
6. Neck Connection: Implant and Abutment connection is very thin and can break while tightening at high torques or tilting the abutment to make it parallel to the adjacent implant.
7. No US FDA approval
8. Cannot be loaded individually. Needs to be connected to the other implant or tooth which is not suggested. Need to place 2 implants instead of one especially in the load bearing areas.
9. Tilting of the implants is not possible because the implant and abutment is in one piece. Especially in upper anteriors and when there is no bone tall and tilted implants are necessary to engage the cortical bone- Nasal floor.
10. Palatal placement of the implant is not possible because it cannot be bent. The abutment when bent can break at the neck of the implant.
Paulo Malo: The Pioneer and inventer of All on 4 technique says in his own words that the screw retention is always better than cement retained bridges.
Listen to him…
Hello I’m Dr. Venkat Nag. The hot topic in implant dentistry today is kind of an old technique is holding your crown in with a screw or holding your dental implant crown in with cement so it’s cement retained versus screw retained crowns and implant bridges so that’s the topic is which one’s better.Well the reality is one isn’t better than the other and they should on a case-by-case basis be evaluated for what’s really right for you there are people that are very feel very strongly that everything should be retained and everything should be a cement retained but the reality is I do a little bit of both I do what’s best for my patients regardless of perhaps sometimes what they want or what they’ve read on the internet so let me just give you a some basics so screw retained means that the bthe implant holds in place by a screw there is no no cement that holds it if the implant goes into the bone that’s screwed into the bone that stays there but the crown can come on and off with the screw so we know one of the big advantages of screw retained is retrieveability that means if you have to take it out you can for most dental implants.
We often get questions from patients about their smoking habits and how it impacts their teeth. Also, some are concerned if smoking affects their ability to get dental implants.
Question: I am a smoker for the past 25 years. Can I get Immediate Implants done with TTPHIL technique?
Most of my patients who are smokers ask me about the success rates of Dental Implants in Smokers when compared with others. The clear answer is that there is no problem with Smoking. There is no direct relation between Smoking and Dental Implants. Smoking indirectly affects the gums if not taken care of properly leading to peri-implantitis. Whatever you smoke and how often you smoke you can definitely have an immediate load implant – one of the reasons of course is that you don’t have a bone limitation, you don’t need a bone transplant – all these procedures which are contraindicated for smokers are not necessary and therefore you have the same chance as any other patient.
Some heavy smokers even ask us if we can interrupt the operation – of course, yes we can give you a break and you relax a little bit, you smoke a cigarette and then we continue with the influent procedure with an impression. So don’t be worried, you don’t have to limit yourself. You can just live your normal life and we give you the immediate load implants. Smoking doesn’t impact dental implant as it is a complete flapless technique and there is no chance of Infection. Basal Implantology is based on the concept of bicortical anchorage which will allow immediate stabilization of the implant and loading of the implant.
Cigarette smoking has long been known to be associated with a variety of oral conditions including periodontal diseases which are inflammatory diseases affecting the tissues that surround and support the teeth, bone loss, tissue loss, tooth loss and dental implant failure. Nicotine in tobacco has been shown to reduce the blood flow in the mouth, pipe-smoking can be worse than cigarettes due to the higher temperatures generated in the upper jaw and excessive tooth wear as the teeth clench the pipe. Not only is smoking detrimental to implants it’s also bad for conventional bridgework. Smokers also experience a slower healing time when following implant replacements. If you’re a smoker and considering dental implants be sure to talk to your doctor about any increased health risks. So do not neglect your gums. This can lead to implant failure. #Smoking and Dental Implants
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This post is not to support one particular technique. Each technique has its own pros and cons. We need to decide which is best for your particular case. Every case is different. Every patient is different. Each one has its own priorities. Your dentist will help you make the right decision about implant and implant technique but it will indeed be good for you to read this article so you can actively participate in that critical decision making.
In this post, we would like to tell the advantages of our technique and not to criticize the other techniques. We do both Single piece implants and Two-piece Implants in our practice. We decide which implant technique to be used based on the patient location, budget, treatment planning, the number of teeth missing, location of the teeth missing- Front / Back, Upper Jaw/ Lower Jaw.
The first and foremost thing one should note is that Single piece implants have abutments and Implant fixture in one piece, hence needs to be cemented. There is no option for screw retention at all. In TTPHIL ™ Technique the restorations ( Implant-Supported Crowns and Bridges ) can be either cement retained or screw-retained depending on the case.
The other thing one should understand is that whether we are doing immediate loading or delayed loading. In Immediate loading, we need to splint or connect the bridges if multiple teeth need to be replaced for equal force distribution in either of the techniques. Because of this reason we prefer screw retention when we are replacing many teeth. If one of the implants has a problem in future, in case of cement-retained implant crown and bridge it is impossible to retrieve. We cannot repair the bridge. The whole bridge needs to be cut which is traumatic. If you are planning to get a single implant replaced you can choose cement or screw-retained option in case of front tooth missing. In case of back tooth missing it is advised to go for screw-retained restorations because it is not located in the esthetic region. Now the recent developments in case of front tooth/ teeth replacements we are using pre angulated abutments.
Why we at The Dental Specialists prefer cemented restorations is because in these situations having screw access in a visible area is unacceptable. When screw access to the implants are in aesthetic areas, the screw access can be redirected at times with the use of pre-angled abutments or the restoration should be retained with custom-made CAD-CAM abutments and cement-retained Implant-supported restorations can be attached to implants with screws or can be cemented to abutments which are secured to implants with screws.
We will outline the advantages and disadvantages of each method of retention under 10 broad areas –
4. Immediate Implant placement
9. Impression procedures
10.Long term treatment planning
This post is mainly regarding Single Visit Dental Implant treatment. In most of the cases, we at The Dental Specialists place Flapless or Pinhole or Keyhole Implants ( without opening the gums) based on the clinical and radiographic guide assessment. But sometimes when the bone availability is less we prefer to open the gums and place the implants and bone grafts for better visibility and safety and long term results. Both the flapless (Less when compared to Flap Opening) and flap opening procedures lead to gum shrinkages when we load immediately. Usually, we replace the crowns and bridges immediately within 2 days to a week depending on the case. We used to do single piece implants for multiple and full mouth rehabilitations for Single Visit Dental Implants before, but because of three reasons we now prefer screw-retained restorations-
First reason: We can expect some gum shrinkage which cannot be repaired in cemented bridges. In screw-retained bridges with multi-unit abutments and CAD-CAM MLS and ZIRCONIA technology, we can repair it by sending it to the ceramic laboratory Though screw-retained restorations are more expensive they can be maintained and repaired.
Second reason: In cemented retained restorations the cement gets entrapped in the gums which leads to gum shrinkage leading to inflammatory changes because of the left out cement particles in the gum sulcus which later leads to bone loss.
Third reason: We need to cut the whole restoration or the bridge if any issue comes. If it is one single tooth replacement it is easy to cut but if multiple teeth replacements or full mouth replacements have to be done cutting the bridge is not easy. The only advantage of cement-retained restoration is that the bridge will not come out but what if there are any issues in the implants? We should expect those and get the implants done. We are getting them done once for all. Now it’s for you to choose whether to go for cement or screw-retained restorations based on the above details.
Comparison: Single Piece Implant vs. TTPHIL
Aesthetics is better in cement-retained restorations but now with the Pre Angulated abutments with Micky Mouse screw this also has a solution. But very expensive.
Retrievability – Screw retained better than Cement retained. In case of any complication, the bridge can be removed and the situation can be diagnosed easily.
Retention: In case of less mouth opening less than 7 mm abutments are used; screw retained is always better when compared to cement-retained restorations
Immediate implant placement: Screw retained restoration better because of repairability and maintenance.
Passivity and provisionals( Temporary teeth): Both are good
Occlusion: In screw-retained restoration, you can get it removed, and add ons can be done later after osseous integration of the implants. Progressive loading is possible in screw-retained restorations.
Immediate loading: Both cement and screw-retained can be done.
Impression procedure: It’s easy to do cement-retained restorations. The doctor should be a Prosthodontist or skilled dental surgeon to take accurate impressions.
Long term Planning: Screw retained restoration is always better than cement-retained restoration.
We would also recommend you to read the articles below for more information on Single piece implants and TTPHIL.
Feel free to call us on 00919963511139/ 00919959448800/ +919177671117. It’s important for our team to clarify your doubts before you make a decision. The best way is to email us your X-rays, OPG, CBCT, and Intra Oral photos to email@example.com. Our team will call you or email you, whichever you are comfortable with.
Single Piece / One Piece / Monobloc Implants- Disadvantages
What are the types of Dental Implants? – Single Piece or One Piece Implants and Two Piece Implants.
There are 3 parts in a Dental Implant- Implant Fixture, Implant Abutment, and Implant crown. There are many disadvantages of Single Piece Implants but we place them in some limited cases where the load or stress is less, especially in the front lower teeth.
In a Single piece or One Piece Implant, the difference is that the Abutment and Implant fixture is one piece during the fabrication. In a Two-Piece Implant the abutment and Implant fixture are separate and are connected with a screw. The major disadvantage of the conventional two-piece system is the screw loosening. The latest BIOLOCK connection CAD CAM technology makes the two-piece implant into a one-piece implant by tightening the screw at 30 Newton Centimetre torque. We at The Dental Specialists use the advanced morse connection technology to convert the two-piece implants to One piece implants (No more Screw loosenings as it used to happen in Conventional Two-Piece Implants).
At The Dental Specialists, we follow the unique advanced TTPHIL technique for most of our implants. The absence of a micro gap between the implant and the prosthetic abutment (Q-lock Morse connection CAD CAM technology) at the bone crest level offers TTPHIL implants many clinical and technical advantages like strong unibody design, no split parts,single-stage surgery with either flap or flapless approach and simple prosthetic technique.
The only advantage of single or one piece implant is that it reduces the cost of the abutment because it is manufactured in one piece. Hence it is cheaper when compared to a two-piece implant. There are too many disadvantages of single piece implants when compared to TTPHIL-ALL TILT™ Technique. The prosthetic options in Single piece implants or One-piece implants are very less. Hence the crown and bridges’ aesthetic quality is very poor. Single piece implants or One-piece implants cannot be placed in tilted fashion because they come with straight abutments.
Must read for those who want to undergo Single piece implants.
15 reasons why we don’t use Single piece or One piece implants in all situations…
1. Abutments cannot be customised. The company manufactures the abutment with implant. Hence no customisation possible. The Single or one piece implants can only be bended. They can never be made parallel to the adjacent implant abutment which is possible in the laboratory by CAD CAM Designing. We used to do lot of trimming and abutment shaping in the patients mouth. This leads to lot of titanium dusting which is not good if swallowed. Only Direct impressions (Impressions need to be taken directly) which will take up lot of time keeping the patients mouth open for a long time which is traumatic for the implant patient. If its a full mouth case we have do lot of work chair side. This problem can be avoided in conventional Implants, where the Indirect Impressions (Customisation of the abutment is possible and is done in the laboratory reducing the chair side time) can be taken, avoiding the patient to keep his mouth open for so long. Abutment milling done in the mouth and abutment milling done in the dental laboratory with the aid of CAD CAM ROBOTIC TECHNOLOGY (Computer Aided Designing, Computer Aided Machining) Which is precise according to you- Milling in the mouth or Milling in the laboratory?
TTPHIL Implants takes the advantage of fabricating the abutments and prosthesis with CAD CAM technology. Hence reducing the chair side time keeping the mouth open for so long, making the patient comfortable and less traumatic to the Implant Patient.
2. After the implant placement the abutment milling have to be done directly in the mouth itself. There is no other option because the implant fixture and the abutment is connected which is why it is called single piece or one piece implants. If the implants are not milled immediately the abutments touch the opposing teeth not allowing the opposing arch to touch, sometimes in full mouth cases the abutments are not parallel to each other, Hence to make the abutments parallel, they are milled in the mouth (As said in the first point, they can never be made parallel precisely compromising in the final outcome) Disadvantages of milling the abutment in the mouth 1)Milling in the mouth requires lot of chair side time keeping the implant patient’s mouth open for a very long time which is more traumatic to the patient. 2) This leads to lot of titanium dusting which is not good if swallowed. 3) This leads to lot off stresses on the implant affecting the healing of the bone around the implant. 4) Abutment milling in Single piece implants is done with the airotor handpiece with Tungsten carbide burs which is not precise, Moreover leads to lot of frictional heat generation which is not good for bone healing around the implant or Oseointegration 5) Abutment milling in the mouth immediately after implant placement when the stability of the implant is not very good can lead to failure of the implant .
TTPHIL Implants at THE DENTAL SPECIALISTS take the advantage of fabricating the abutments and prosthesis with CAD CAM technology, hence reducing the chair side time keeping the mouth open for so long, making the patient comfortable and less traumatic to the Implant Patient.
3. In certain cases the bone availability and bone density may be less and bone thickness may be less, the implant stability in those cases is compromised or it may not be beyond 40 Newton Centimeter torque (which is the most essential factor for immediate loading). But we are forced to load the implant. Because it is a one piece system we cannot bury it also and keep it for bone integration or Osseointegration which is the most essential thing for long term success of the implant. Crestal Conventional Implants have the advantage of leaving the implant buried in the bone helping it for osseointegration. TTPHIL Implants has the advantage of both OSSEOFIXATION AND OSSEOINTEGRATION. We can at least bury the implant instead of loosing the implant.
TTPHIL implants engage the basal cortical bone which is very strong and least resistant to resorption. The Tall and Tilted implants are the key factor for the success, Hence we at THE DENTAL SPECIALISTS are able to give immediate loading to our implants. We achieve very high torque beyond 80 Newton Centimeter lwhich is strategic and key determinant factor for implant success. We engage all the strategic cortical basal bone which is highly mineralised and hence least resistant to resorption. The difference between the TTPHIL Implants and conventional Implants is that the Conventional Implants there is no bicortical anchorage, hence the stability achieved in most of the cases is less than 40 Newton Centimetre. Even if the conventional Implants achieve high torque during the Implant Insertion, the apical tip of the cortical bone rests in the soft trabecular bone, which is least resistant to resorption. This bone is very soft which helps only for the blood and nutritional supply. TTPHIL Implants engage the Bicortical Basal at the Strategic locations to achieve a very high torque beyond 70 NC, at the same time able to deliver high and precise prosthetic solutions with CAD CAM Zirconia and DMLS CAD CERAMIC CROWNS AND BRIDGES which is screw retained. (This point is discussed in detail in POINT 14)
4. Monobloc implants are very thin when compared to two piece Conventional implants. In the above picture you can see the different implant types. Why the company have to manufacture two piece implants when single piece implants can be done in all the cases. For example when most of the times 6 implants or sometimes 8 implants are placed to replace upper full mouth complete edentulous jaw (When all teeth are missing in upper jaw), why we need to place more number of implants.
. Imagine the surface area of the implants when compared to Single or One piece conical Implants. The TTPHIL Implants almost have double the surface are when compared to one piece implants. Hence 6 implants in most of the cases are sufficient. Why you need to give more money when there is no advantage of placing more number of implants. Usually in the molar region when one implant is sufficient the single implant specialists use two implants which is not required in all the cases unless the edentulous space is more. The single piece implants are core conical, thin and engage the apical cortical bone, they need to be splinted. Hence the place 2 implants instead of one. Approximately 10- 12 single implants are placed for upper jaw. The more number of implants – More expensive it is. Think about it!
5. Less Surface area- Conical Implants- Smooth Surface Implants- More Implants Required- More Money- More Investment. Since these implants are thin we need to place more number of implants. For example In a full mouth rehabilitation in the upper jaw, 6 implants are sufficient to hold the bridge of 14-16 teeth depending on case. The same thing when we use single piece implants we need to place minimum 10 to 12 implants.
6. Single piece or One Piece Implant abutments will not have a finish margin. There can never be precise finish margin since the abutment is already thin we cannot refine it more in the patients mouth. Moreover it will not be done in the laboratory for precise finish margins. Any abutment done outside the mouth we can clearly define the finish margins according to gum levels in individuals.
7. Since the abutment is thin the crown fabricated will have overhanging margins. Especially this will be a big problem when we restore single piece implants in the back region of the jaw. This leads to lot of food lodgement over a period of years. It is impossible to clean and maintain oral hygiene in these cases.
8. No CAD CAM software can be detected for a single piece implants. The crowns have to be done manually. Precision fit can never be given in these implant cases
9. We need to take direct impressions with Alginate or polyether or polyvinyl siloxane impression materials. In all cases we cannot take the impressions with Poly vinyl Siloxane (PVS) or polyether impression material which is more precise because they are rigid impression materials. In case the impression is taken with PVS impression material after the impression is poured with Die stone the cast breaks because the implant abutments are very thin. Precision is a factor when a direct impression are taken for fabrication of the crowns. Now some single piece implantologists use disposable transfers to avoid the breakage of the abutments in the cast. But to make them parallel the laboratory technician does lot of modifications in the laboratory. This will make the patient again to open their mouth for a long time , giving a traumatic experience to the patient. The doctor needs to modify the implants according to the technician who fabricated the prosthesis. In Screw retained technology the technician does according to the doctor’s impressions taking the help of CAD CAM SOFTWARE, which is highly precise.Nothing can go wrong here unless the doctor doesn’t take the impressions properly. The Implant specialist needs to be a Prosthodontist or a very good trained dentist to get precise Screw Retained Prosthetic Solutions- SRPS (Crown and Bridge or Bar supported fixed hybrid dentures or Malo Bridge) Food lodgement is the most important factor to be considered going for single piece implants. Usually to avoid food lodgement the single piece implantologists recommend supra gingival finish line and space between the the crown and bridge and the bone. They consider this as an advantage but for the patient always the patient feels that there is space between the prosthesis and the gums. Most of the patients complain that their tongue goes between the prosthesis and the gum which is very very Irritating, More over there is speech problem because of the gap. They complain that the pronunciation is not like before leading to compromised life.
10. The abutment for a single piece is the same for both front or back teeth cases. Back teeth we need a wide abutment to prevent over hangings and optimum porcelain thickness to prevent ceramic chipping.
11. Sub gingival finish margins is not possible in Single Piece or One Piece Implants. When we open the flap and a flapless technique is not possible in certain cases where bone availability is less, and ridge splitting is indicated these implants are not suggested.
12. Single piece implants are not suggested when the bone density is less which can be diagnosed with the Xray and Hounsfield units. In these cases we will not be able to achieve good torque ( 4oNC) beyond. Still the implant is exposed to the oral environment leading to stresses on the Implant from Day 1, which can lead to an implant failure.
13. Single piece implants are not possible when we use TTPHIL ALL TIL™ Technique,also ALL ON 4 implants technique. New concepts show that the tilted implants taking Bi cortical encourage , the implants can be loaded immediately.
14. Screw retained option is not possible. If any complication or food lodgement occurs in Single Piece implants, then the only option is to cut the crowns because they are cemented. Check the video below.
15. The crowns or bridges in Single Piece implants have to be cemented. This cement gets entrapped between the gums leading to bone loss and gum irritation. What ever cement is used radiopaque or Radiolucent cements its impossible to remove the complete implant residue below the crown and bridge, which goes into the gums. Cement retained prosthetic Solutions have a disadvantage that the implants are all connected to each other. If one of the implant is rejected and pain starts and is mobile( moving) , the whole bridge needs to be cut. This is the most traumatic experience to the doctor and the patient. Patient needs to open his or her mouth for so long to cut the bridge. Cutting the bridge is not so easy when compared to cutting the tooth. The airotor handpiece which rotates at 200000 RPM (Rotations per Minute) needs to cut the metal which should be done very carefully without injuring the cheeks, lips and tongue. Screw retained prosthetics avoids this hazard. As a patient one should be prepared. Both Single piece and conventional Implants can fail. Servicing is easy in conventional Implants because they are screw retained which is not possible in Single Piece Implants.
Our next video shows various advantages of TTPHIL IMPLANTS with CAD CAM HEXED TITANIUM MORSE CONNECTION abutments, which can be placed in all the situations when bone is not there also. We can place the implants in a tilted fashion according to the bone availability which is not possible with either Single piece or even conventional Implant System. This is a unique protocol followed at THE DENTAL SPECIALISTS, HYDERABAD, INDIA. click here to know more..