LCC RK667.I45 (print) | LCC RK667.I45 (ebook) | NLM WU 640 | DDC 617.6/93–dc23 LC record available at https://lccn.loc.gov/2021007918 LC ebook record available at https://lccn.loc.gov/2021007919
Cover Design: Wiley
Cover Images: © Luigi O. Massa
Preface
Dentistry has a venerable history. Although prosthodontics has been practiced for several thousand years, the science of dentistry and dental care have made their greatest advances over the past 100+ years. What started out with the ground‐breaking work of Greene Vardiman Black (1836–1915), reached its current extraordinary achievements and capabilities with a variety of innovations in the basic sciences, biomaterials science, radiography, dental armamentaria… and the dental implant.
The modern dental implant is based on the pioneering work of the Swedish orthopedic surgeon, Per‐Ingvar Brånemark, in 1952.
Basically, a dental implant is a surgical fixture placed into the jawbone where it fuses with bone or osseointegrates over the span of a few months. Thus, the dental implant becomes a replacement for the root of a missing tooth such that it can support a replacement tooth or bridge. In fact, dental implants are now considered the standard of care for most prosthetic replacements of missing teeth.
The great advantage of an osseointegrated dental implant is that it is remarkably stable, mimics a natural tooth and will function independently of adjacent teeth. The success rate for dental implantology is now close to 98%, making dental implants the most successful of any restorative dental treatment.
This book was written in response to numerous requests to make available a practical guide to dental implants that functions as a virtual “how‐to” manual for the dentist. What we have tried to do is discuss the many different aspects of dental implantology, even that difficult subject of economics, and give examples of each treatment modality covered in the text. We have also provided literature references so that the interested reader can delve more deeply into any subject that catches their interest.
We hope we have succeeded in our efforts and that this book will prove to be a useful guide and help to dentists as they embark upon the exciting task of placing and restoring dental implants for their patients.
Luigi O. Massa
New Braunfels, TX
J. Anthony von Fraunhofer
Boerne, TX
1 Why Dental Implants?
Why dental implants? There is one simple answer: there is an overwhelming need. Within the last one to two generations, there have been vast societal changes, including the fact that people are now living longer with greater motivation to maintain the function and esthetics of their natural teeth. It was common for people just 60 or so years ago to lose most, if not all, of their teeth well before retirement age. As a result, dentistry prior to the 1960s was largely focused on providing restorations for carious teeth and fabricating removable appliances such as removable partial dentures (RPDs) and complete dentures (CDs) as the final dental solutions for missing teeth.
Partial and Complete Edentulism in the Twenty‐First Century
The population is aging and, by 2030, more that 20% of the U. S. population will be aged 65 years or older, Fig. 1.1 [1].
These projected data indicate that within 10–12 years, about 20% of the population will be “senior citizens,” namely 65 years or older [1]. Although advances in medicine and pharmacology, together with improved nutrition, dietary awareness and exercise, have significantly improved the average life expectancy, the outlook for maintained and even improved dental hygiene as well as overall oral health still looks bleak. In fact, partial or complete edentulism is increasing. Whereas fluoridation has markedly reduced dental caries [2, 3], the prevalence of tooth loss through periodontal disease, enamel erosion, wear, trauma and disease (e.g., cancer) is growing [4–7].
Figure 1.1 Projected aging of the United States.
(Source: Based on United States Census Bureau. Release Number CB20‐99: 65 and Older Population Grows Rapidly as Baby Boomers Age. Washington, DC, June 25, 2020).
Figure 1.2 Prevalence of edentulism by race and ethnicity in adults ≥65 years [9].
(Source: Based on Centers for Disease Control and Prevention. Edentulism and tooth retention. Atlanta, Ga., September 10, 2019).
According to the American College of Prosthodontics, more than 35 million Americans are edentulous, and 178 million people are missing at least one tooth and these numbers are expected to grow over the next two decades [8].
What is distressing about these statistics is that edentulism affects our most vulnerable populations – the aging and the economically disadvantaged, Fig. 1.2. In the geriatric population, for example, the ratio of edentulous to dentate individuals is 2 : 1, with about 23 million being completely edentulous and some 12 million are edentulous in one arch. About 90% of edentulous patients have dentures and some 15% of edentulous patients will have dentures made each year [8].
The consequences of partial or complete edentulism are well‐known and include many facets of the quality of life (QoL) as well as facial appearance, self‐image and self‐confidence. Overall, health consequences of edentulism encompass significant nutritional changes, digestive issues, obesity, diabetes, and coronary artery disease to name but a few.
The Reality of Dental Implants
Although there have been minor variations over the past few years, the current life expectancy for the U.S. population in 2020 is 78.93 years [10], and we can anticipate increases in tooth failures. Vertical root fractures, endodontic failures, restorative failures, and periodontal disease may result in tooth loss. In contrast to the practice of dentistry in the nineteenth and twentieth centuries, modern dentistry focuses on the replacement of lost teeth utilizing implants, combined with comprehensive analysis of function and esthetics.
In modern dentistry, the dental implant is the best tooth replacement option for nearly all situations where a tooth is missing or is failing. The primary reason for this is the extremely high success rate achieved with dental implants. Saving teeth at all costs is no longer the norm because of the unpredictability of the longevity of heroic dentistry. In other words, preserving bone and tissue regeneration are now considered to be more important than trying to prolong tooth retention. This approach not only promotes bone healing and preservation but ensures that implants are placed
