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 –
1.Aesthetics
2.Retrievability
3. Retention
4. Immediate Implant placement
5. Passivity
6. Provisionals
7. Occlusion
8.Immediate loading
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.
http://www.thedentalspecialists.in/2016/10/12/single-piece-implants-disadvantages/
http://www.thedentalspecialists.in/treatment/ttphil-technique-permanent-teeth-2-9-days/
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 dentalspecialistsindia@gmail.com. Our team will call you or email you, whichever you are comfortable with.
Still have questions about Dental Implants? We’d love to talk with you. Don’t hesitate to request an appointment online , over the phone or our website to contact us @thedentalspecialists.in
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