The Realities of Dental Implant Maintenance

Implant dentistry can effectively meet the restorative needs of both partially and fully edentulous patients. The five-year success rate is currrently in the 95 percent range for most implant cases. However, both the implants and the restorations they support can fail in response to local and systemic etiologic factors.

The ability to assess the reaction of the peri-implant tissues and to maintain their health is linked to improvements in the biology and mechanics that affect implant dentistry.

Implants are being fabricated from a variety of materials, and their surfaces are being modified to enhance integration . Furthermore, the restorative components are being revised to facilitate clinical procedures and to improve esthetics.

Traditional implant maintenance has in the past consisted of clinical assessment of placque control and radiographic evaluation of crestal bone levels. Additionally, it was important to determine the integrity of the connection of the prosthesis to the abutment to the implant body. However, the advent of single tooth and cemented restorations, early and immediate loading, the variety of abutment designs, and a shift in focus to more cosmetically-acceptable restorations has necessitated the development of changes in implant maintenance concepts.

To ensure the continued maintenance of optimum intraoral health, the dental team must understand how to assess the health of the peri-implant tissues, the alveolar bone housing, and the common restorative components associated with dental implants.

To learn more about dental implant maintenance, call 248.357.3100 or visit Dr. Joseph Nemeth & Associates on the web at http://www.drnemeth.com/.

Sinus Augmentation for Implant Planning in the Posterior Maxilla

Successful placement of implants in the posterior maxilla could potentially be compromised by the lack of vertical dimension between the alveolar crest and the floor of the maxillary sinus. Typically, 10 mm of vertical bone is required for predictable implant success (Misch, 1987) although success can be achieved with less than 10mm (Fugazzoto 2007). Moreover, bone density in the posterior maxilla is often poor, which could lead to complications during implant fixation. To address these problems, maxillary sinus elevation surgery was developed to increase the amount of bone available for implant placement.

Anatomy of the Maxillary Sinus

The maxillary sinus is pyramidal in shape and borders the nasal wall, floor of the orbit, and alveolar processes. The maxillary ostium, a non-physiologic drainage port, lies high on the medial wall and opens into the nasal cavity between the middle and lower nasal conchae. The average volume of a fully developed sinus is about 15ml, but the volume expands with age as the sinus pneumatizes. The sinus is lined with pseudostratified ciliated columnar epithelium that covers a loose, highly vascular, connective tissue. Beneath the connective tissue lies the periostium, which tightly approximates the bony wall. These structures - epithelium, connective tissue, and periosteum - are collectively referreced to as the Schneiderian membrane.

Indications and Contraindications for Sinus Augmentation

Prior to tooth loss, the sinus membrane maintains its position above the roots of the posterior maxillary teeth. Upon extraction, the sinus pneumatizes or expands unimpeded, reducing the over-all bone volume in the area. If less than 10mm of bone height remains after tooth loss, sinus augmentation should be considered to prevent implant placement from extending through the Schneiderian membrane. Contraindications may include uncontolled medical conditions, sinus pathology, acute or chronic sinusitis, heavy smoking, history of radiation therapy, and blood disorders. These patients may be at high risk of complication such as delayed wound healing or graft infection.

When used appropriately, sinus augmentation is an important tool for implant planning in the posterior maxilla. Predictable implant placement and restoration is possible for patients with minimal bone height, allowing for ideal treatment.

Interested in learning more about sinus augmentation? Contact the author of this article, Southfield Periodontist and Dental Implant Specialist, Dr. Amar Katranji at 248.357.3100 or visit Joseph R. Nemeth, DDS & Associates on the web at http://www.drnemeth.com/.

If you are a dentist and would like information about the Michigan Implant Study Club or any upcoming continuing education courses sponsored by Joseph R. Nemeth, DDS & Associates, visit the for dental professionals page of the website at http://www.drnemeth.com/forprofessionals.html.

Michigan Dental Implant Patient Seeks Guidance From Southfield Periodontist

Patient Question: I have been missing a tooth in the back upper right area for quite a while and would like to have it replaced. I would prefer not to have to cap the teeth on either side so an implant seems like the way to go. I was told I would need to "grow bone" in that area. How is that possible?

Anonymous, Farmington Hills, MI

Answer: It sounds like what your doctor is concerned about is getting enough bone in the area requiring the implant. Sometimes when an implant is needed in the posterior areas of the maxilla (upper jaw bone), the sinus cavities get in the way. The sinus is nothing more than a space for air, but if the sinus is very large, it minimizes the amount of bone available to secure an implant; therefore, we need to grow bone.

The procedure, called a sinus augmentation or sinus lift, involves raising a small amount of the membrane lining the sinus (like the membrane inside an egg shell) and filling the empty space with a bone grafting material. We then let this bone grow or mature for approximately six months. At that point the patient will most likely have grown enough bone to support the implant.

Have a similar question? Contact the Michigan Dental Implant Specialists at Joseph R. Nemeth, DDS & Associates at 248.357.3100. Our team of Doctors, Hygienists, Assistants and Business staff are all highly knowledgable in the fields of Periodontics and Dental Implants and will be pleased to answer any and all of your questions or address any concerns. Submit your question online at http://www.drnemeth.com/patientinfo_asktheperiodontist.html.