Some Information about Dental Implant Surface

Dental root form implants are manufactured from a highgrade titanium alloy, the surface of which consists of a micro layer of titanium oxide. The implant surface can also be treated by plasma spraying, acid etching, sandblasting or coated with HA. The removal of plaque and calculus deposits from these implant surfaces with Dental Instruments designed originally for cleaning natural tooth surfaces can result in major alterations to the delicate titanium oxide layer. Altering the surface topography by roughening the surface may enhance calculus and bacterial plaque accumulation.

Resulting scratches, cuts or gouges may also reduce the corrosion resistancy of titanium, and corrosion and mechanical debris can accumulate in the surrounding tissue. The aim of procedures for debriding dental implants should be to remove microbial and other soft deposits, without altering the implant surface, and thereby adversely affect biocompatibility. Increased surface roughness can lead to an increase in bacterial accumulation and resultant soft tissue inflammation. Because of the critical nature of the implant/soft tissue relationship, metal ultrasonic scaler tips, hand scalers or curettes should not be used as they have been shown to significantly alter the titanium surface.

Current methods for professional cleaning of implant or titanium transmucosal elements include the set of plastic ultrasonic tips( ultrasonic scaler ) or hand instruments followed by the prophy cup polishing method or various types of floss and buffing strips. The design of the permanently cemented super structure often does not allow adequate access for the prophy cup, especially in interproximal areas, and plastic instruments are not very efficient for the removal of plaque or mineralized deposits. In addition, the prophy cup and paste method may leave residual paste at the implant/soft tissue interface area.

Airpolishing consists of directing, water, air and sodium bicarbonate towards the tooth or implant surface, resulting in efficient removal of bacterial plaque and soft mineralized deposits. The residual powder is biocompatible and being soluble is not retained at the implant/soft tissue interface( dental implant machine ).

Two airpolishing systems are currently available. One system, typically available on the Dentsply Prophyjet? and Cavijet,? the EMS Airflow, and the Satelec units, delivers the air and powder, typically at 60-80 psi pressure through one nozzel and the water through a separate concentric nozzel. Some mixing of the streams takes place at the interface of the streams, but the centre of the stream consists essentially of dry powder. This “Biphasic” stream is directed at the tooth or implant surface. Several studies have investigated this system, and its effects on implant surfaces, and conclude that this system can result in significant changes to the implant surface.

How to Use a Dental Curing Light Correctly

According to the American Dental Association, nearly 150 million resin-based restorations and sealants are placed every year. Almost all of these use light-cured resin-based composites. Thus, a light-curing device is now commonly found in dental practices across the country. Some assume that a “point and shoot” technique is sufficient. However, in order to achieve optimal results, dental curing lights must be used correctly.

In the dental field, a curing light can use ultraviolet or visible light, depending on what it is designed for. Both dentist and patient need to wear eye protection to limit damage to the retina for even the 20 seconds to a minute that the light is in use during rapid curing, and the light needs to be well maintained so that it will work properly and effectively. It’s also important to use the right curing light for the right resin product; many lights are designed to handle a range of resins safety.

Using a curing light accomplishes two things. In the first place, it makes sure that the resin cures properly and adheres evenly. When applying fillings, this is critical to keep the filling in place in the mouth. For sealants, the curing light limits the risk of cracks and other problems with the sealant. With adhesives for implants( dental implant motor ) and braces, the rapid, even cure is also designed to limit problems in the future.

How a dentist uses a light-curing unit makes a large difference in the amount of energy a restoration receives. Even when the device is handled correctly, if the energy level is insufficient, then the resulting restoration may not attain expected longevity; this may explain why resin-based restorations last only five to seven years when actual life expectancy should be 15 years or more.

Both light intensity – or irradiance – and the dental application should factor into a dentist’s decision regarding his or her choice of curing light. For instance, irradiance is measured by calculating power output, or milliwatts (mW), of a curing light across the surface area of the curing light guide. A curing light must deliver a minimum irradiance of 400mW/cm2 for a time interval to adequately polymerize a 1.5-2mm thick resin composite.

Clinicians also should consider the clinical application at hand. It has been documented that irradiance of curing lights attenuate/decrease significantly when it passes through restorative materials, such as ceramic restorations or resin composites. The percentage of decrease in irradiance depends on filler type, filler loading, shades, refractive index, opacity, translucency and thickness of restorative materials. Curing lights with high irradiance compensate for the decrease in the loss of total energy and allow dentists to cure resin composites completely. In general, an irradiance of 1000mW/cm2 or higher is considered ideal to cure resin-based materials through indirect restorations.


Treatment Planning Always Poses a Challenge to the Clinicians

An expectation of a beautiful smile at the end of treatment is a primary concern for all patients, but most are also concerned with appearance while undergoing treatment. The anterior maxilla is often referred to as the aesthetic zone. Missing maxillary lateral incisors creates an aesthetic problem with specific orthodontic and prosthetic considerations, therefore treatment planning always poses a challenge to the clinicians.

Treatment alternatives for missing teeth include removable partial dentures, conventional fixed bridges, resin bonded fixed bridges, autotransplantation and dental implants. Treatment of tooth loss or agenesis in the anterior maxilla with single-tooth implant supported crowns is well documented. Depending on the type of final restoration that is chosen, interdisciplinary management of these patients often plays a vital role in the facilitation of treatment. One of the most common treatment alternatives for the replacement of congenitally missing teeth is a single-tooth implant. The main advantage of this type of restoration is that it leaves the adjacent teeth intact.

The healing period after implant placement by dental implant equipment is generally 3-4 months and the appearance of a gap from a missing tooth can be a concern during healing phase, especially if it is in the display zone of a patient’s smile. If the treatment plan includes prosthetic replacement of the missing tooth rather than space closure, then space maintenance is also an issue. In an appearance conscious patient, use of riding pontics as space maintainers is a good option during treatment.

Implant was loaded in the region of missing tooth under anaesthesia and post operative instructions were given. The healing period after implant placement was 3-4 months and the appearance of a gap from a missing tooth was a concern during healing phase, especially because patient had high aesthetic demands. So, an interim restoration was planned along with an Essix retainer.

Mesiodistal width determination – When a single anterior tooth is missing, mesiodistal width of the pontic should be determined by considering the width of the contralateral natural tooth. When teeth are missing bilaterally, the mesiodistal width of the pontic should be determined by analyzing the space available and the dimensions of the remaining natural teeth. So in this case, the mesiodistal width of the contralateral natural tooth was considered.

Height determination- The cervical end of the pontic should touch the gingiva with a smooth contour. If the cervical end of the pontic does not touch to the gingiva, then the negative space between the pontic and the gingiva can affect the aesthetics, especially in high smile line patients. The incisal edge or cusp tip of the pontic should be in harmony with the adjacent natural tooth for maximum esthetics.

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