Dental Implant | Balaji Dental and Craniofacial Hospital, Chennai, India

Dental Implant Procedures for Oral Rehabilitation

by smbalaji | Aug 4, 2021 | Dental Implant

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Dental implant surgery is performed to place root-shaped titanium posts at the site of missing teeth. This titanium implant fuses with a surrounding bone through a process known as osseointegration. This then provides the perfect foundation for fixing ceramic crowns. They fulfill every criterion for being a perfect replacement for lost teeth.

Dental implant procedures have become one of the most common procedures performed in dental clinics today. A high percentage of patients with missing teeth choose to undergo dental implant procedures. Most single-tooth procedures are performed at the chairside under local anesthesia.

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Chairside dental implant procedures are relatively simple surgeries. It is performed under local anesthesia. Conscious sedation is used in patients who are apprehensive of undergoing dental implant surgery. Patients are advised to not consume anything orally for four hours before the scheduled surgery.

Conscious sedation is easily administered to the patient. A patient who is scheduled to undergo conscious sedation has to bring an attendant with them. The effect of conscious sedation wears off within a few hours following the procedure. Conscious sedation is completely safe and the patient is monitored throughout the procedure.

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Anyone who is healthy can undergo dental implant procedures. Patients first undergo a full mouth examination including diagnostic imaging studies. A thorough medical history is also obtained. This will ensure complete patient safety for undergoing the procedure.

Blood pressure and blood sugar status are determined through tests. Overall oral health is assessed. Any sign of minor bleeding from gums is tested. The health of the gum tissue is also assessed. Any residual tooth roots need to be removed. A thorough check is conducted for every type of dental condition.

Dental implant surgery is straightforward when there is an adequate bony foundation for the fixation of the implants. This is performed as a procedure in the dental clinic under local anesthesia. A period of 4-6 months is allowed to elapse to allow for osseointegration of the implant.

Abutments are connectors that are used to connect the crowns to the dental implants. Ceramic crowns are attached to the abutments, thus providing a permanent replacement for the missing teeth. Patients need to maintain good oral hygiene to enjoy a lifetime of trouble-free service from their dental implants.

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Patients sometimes do not have enough bone in their jaws for the fixation of dental implants. This could either be due to tooth loss a long time ago or surgery for jaw diseases. Modern surgical techniques overcome these obstacles and enable dental implant procedures for these patients.

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Bone grafting is commonly used to improve the bony foundation in the jaws to enable the placement of the titanium posts. This is harvested from the patient at the time of placement of implants. Results from this surgery are very good and there is complete normalization of function after placement of dental implants.

This procedure is performed in the operating theatre under general anesthesia. Patients need to be admitted to the hospital the day before surgery. They also should not consume anything orally for at least eight hours prior to surgery. This requires hospitalization for approximately three days.

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Bone is lost quickly in the posterior region of the upper jaw after loss of the molar teeth. The size of the maxillary sinus also increases when teeth are lost in the upper molar region. This results in the inadequate bony foundation for the placement of the titanium implants.

Sinus lift surgery is performed in patients with such a presentation. A bony window is made in the posterior region of the upper jaw. The membrane lining the maxillary sinus is first gently lifted. Bone graft or bone substitute is placed in the space created between the lining and the bone. Dental implants are then placed in this region.

This results in good bony consolidation in the region with adequate support for the implants. Results are very good for patients who undergo this procedure.

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Zygoma implants are the ideal implants for patients who do not wish to undergo bone graft surgery. These are extra long implants, which are placed directly in the zygomatic bone. This is a very strong bone, which enables these implants to withstand high biting forces.

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Dental implant procedures can either involve the placement of implants to replace one to all teeth. It can range from a few missing teeth to full mouth replacement. Crowns that are cemented in place are the treatment of choice for single teeth implants or replacement of short spans.

Complete dentures placed over implants can either be removable or fixed. Removable dentures mimic normal gum and teeth structure and can be snapped into place. Fixed dentures again are cemented into place and cannot be removed by the patient

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As with all surgical procedures, these procedures are followed by side effects like swelling and pain at the site of the procedure. The dental specialist addresses these issues. This is easily controlled with analgesics and quickly subsides in a few days. The patient can resume normal activity in a very short period of time.

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Dental implants require the same level of care that is provided to natural teeth. Meticulous oral hygiene has to be maintained to ensure the long-term success of dental implants. The patient should schedule a dental checkup every six months for follow-up care. This will ensure that the patient has trouble-free service from their dental implants all their life.

Best Dental Implant Clinic in India

by smbalaji | Jun 2, 2021 | Dental Implant

Best Dental Implant Clinic in India

Difficulties Arising from Premature Loss of Teeth

Premature loss of teeth has always plagued mankind since the ages past with the most common cause being dental caries. Other causes include trauma, congenital absence, etc. When it is an anterior tooth, it leads to compromise in esthetics while a posterior tooth like a molar always leads to compromised ability to chew food.

Mankind has always sought ways to replace these lost teeth. Various methods have been utilized by modern dentistry. They included removable partial dentures, crowns, full dentures, etc. However, all of these have their inherent disadvantages and can never be considered to be actual replacements for the lost tooth/teeth.

Disadvantages Associated with Conventional Modalities of Tooth Replacement

They lack the tactile feel afforded by natural teeth, are structurally weaker, can be dislodged while talking or eating or lead to secondary caries of adjacent teeth. The advent of dental implants opened up new horizons in dentistry.

Rehabilitation with dental implants is like creating a replica of natural teeth and this provides optimal esthetic and functional replacement for the patient.

Dr. Per-Ingvar Branemark was involved in scientific research, which included the placement of titanium implants in the femur of rabbits. He noticed that the titanium implants completely fused with the bone over a period of several months and became indistinguishable from the bone. This observation led to the development of dental implants by Dr. Branemark.

What is Dental Implant and what are its Advantages?

Dental implants are titanium posts that are fixed in the alveolar bone at the site of lost teeth. They mimic the structure of the roots inside the alveolar bone. The titanium completely fuses with the surrounding bone in a process known as osseointegration. This imparts them with strength that is equal to that of natural teeth.

Dental implants require the same kind of care that is given to natural teeth. Patients who have received dental implants should maintain scrupulous oral hygiene. Dental implants last a lifetime when the patient meticulously follows all the instructions provided by the surgeon.

The Field of Dental Implantology in India

Our hospital is a pioneering center for dental implant surgery in India. We are considered to be the best dental implant clinic in India by various organizations that are associated with the field of Implantology. We have placed over 50000 dental implants over a period of 25 years with satisfied patients from all around the world.

A center has to offer complete rehabilitation using dental implants to be considered as the best dental implant clinic in India. We are a certified specialty center for dental implant surgery in India. Every step of rehabilitation with dental implants is addressed in-house for complete patient satisfaction. Dr. SM Balaji is considered to be the best dental implant surgeon in India in view of his extensive experience of over 25 years with dental implants.

We offer placement of implants both under local anesthesia as well as extensive full mouth rehabilitation with dental implants under general anesthesia. Loading protocols are optimum for the premium dental implants used in our hospital.

Preoperative Preparations Required for Placement of Dental Implants

A thorough medical history is obtained before the placement of dental implants. Patients with diabetes and hypertension should have normal blood sugar levels and blood pressure readings before undergoing dental implant surgery. Preoperative antibiotics are prescribed for patients with artificial heart valves and prosthetic joints.

In the case of patients undergoing dental implant surgery under general anesthesia, they need to be admitted to the hospital and should abstain from food intake for eight hours prior to surgery.

Placement of Dental Implants under General Anesthesia

We offer full mouth rehabilitation with dental implants, utilizing general anesthesia for the placement of multiple implants in both jaws in a single surgical procedure. Patients who have been edentulous for a long duration usually lack a good bony foundation due to resorption of the alveolar bone.

Various surgical procedures are performed for increasing the height of the jawbone where there is excessive resorption due to long-standing absence of teeth.

Sinus Lift Surgery for Increasing Height of Alveolar Bone in Upper Jaw

The jaw bone is lost to the greatest degree in the posterior region of the upper jaw. Our hospital is a specialty center for sinus lift surgery. This procedure involves creating a bony window in the side of the upper jaw. Access is gained into the sinus floor region.

The Schneiderian sinus membrane lining the maxillary sinus is gently lifted and the resultant space is filled with a suitable bone graft material. The amount of bone lost is clearly accessed at this stage. A larger bony foundation increases the number of masticatory forces that can be withstood by the implants.

This is followed by the placement of a single tooth or multiple dental implants, which successfully undergo osseointegration in four months. Dental crowns that are perfectly shade-matched to the patient’s natural teeth are then fixed to the dental implants. We are considered to be the best dental clinic in India for this specialty procedure.

Utilization of Bone Grafts to Augment Alveolar Bone

Bone grafts harvested from the patient are also used to augment atrophic maxillary bone that has undergone resorption. This is usually harvested from the patient’s rib region. They are fixed to the alveolar bone using titanium screws.

A period of 4-6 months is allowed to elapse for consolidation of the bone grafts with the underlying alveolar bone. Dental implants are then placed on this consolidated bone followed by crowns in four months after osseointegration of the implants.

All-on-4 and All-on-6 Dental Implants

Only four implants are used in each jaw to rehabilitate completely edentulous patients in the All-on-4 implant system. Six implants are used in each jaw for the All-on-6 implant system. The implants that are placed in the anterior jaw are placed vertically while the posterior implants are placed in a tilted position.

Placement of Zygoma Implants directly in the Zygomatic Bone

This is a highly specialized complex implant surgery. It involves the placement of an extra-long posterior implant directly into the zygomatic bone when upper posterior alveolar bone height is greatly reduced. Zygoma implants are the perfect method to rehabilitate patients who have suffered extreme bone loss in the maxillary posterior region due to early tooth loss.

Patients who do not want to undergo the additional surgery of bone grafting opt for this procedure. Our hospital is considered to be the best dental implant clinic in India for the placement of zygoma implants. These implants are able to withstand high occlusal forces and last a lifetime.

Complete Patient Satisfaction with Treatment with Dental Implants

We are the best dental implant clinic in India and offer a wide variety of treatments with dental implants. Patients are advised regarding the best treatment plan for optimal results and a lifetime of service from their dental implant surgery.

Broken Front Tooth Removal and Dental Implant Surgery

by smbalaji | Mar 30, 2021 | Dental Implant

The patient undergoes root canal therapy for left upper central and lateral incisors

The patient is a 20-year college-going male from Chennai in Tamil Nadu, India. He is an avid sportsman and has been involved in sports from a young age. Around five years ago, while playing football, an opponent’s head had crashed against his upper left central and lateral incisor teeth.

Since it had been around the time of his tenth board exams, he had self-medicated with analgesics without visiting the dentist and the pain had subsided. A few months later, he noticed that the crowns of both teeth had turned slightly darker. There was also a dull ache in the region. He had rushed to his family dentist who had informed him that the two incisors had turned nonvital due to the injury.

Nonvital tooth root canal treatment successfully completed on the two upper incisors

Root canal therapy had been advised for the two teeth and had been successfully completed. The pain subsided completely. Ceramic crowns had been advised by the dentist for the two teeth. The patient had however completely forgotten about that and had got on with the business of daily living.

Reinjury to the same two teeth while playing competitive cricket with friends

A few days ago, the patient had been playing cricket with his friends. There was a repeat of the previous accident when he collided with another fielder while trying to complete a difficult catch. This had ended badly for him with the lower half of his lateral incisor cleanly breaking off.

There was a lot of pain in the region following the collision. It was only after he got back home that he noticed that the central incisor was mobile.

His parents immediately rushed him to their dentist. He obtained radiographic images of the two teeth and explained to them that there was a horizontal root fracture of his central incisor. Explaining further, he said that the tooth had to be extracted. Realizing that the tooth would be lost, the patient wanted a dental implant to replace the missing tooth.

Necessity for atraumatic extraction of fractured tooth fragments for implant success

The dentist explained to them that the broken root fragment had to be removed atraumatically to ensure that the socket structure was preserved. This would have to be done very skillfully as a root canal treated tooth would be brittle and prone to crumbling. He said that this was imperative for successful dental implant surgery.

The American Association of Endodontists advocates this treatment protocol for horizontal fractures of anterior teeth. Artificial teeth in the form of porcelain crowns are fitted onto the implants. Gum tissue modification or bone grafting is not necessary per this protocol. There are also other types of crowns including zirconium used for this treatment.

The dentist had informed parents that they needed to get this done at a specialty dental implant hospital. He had then referred the patient to us for further management.

Our hospital is a specialty center for dental implant placement. We are amongst the first centers in the city to offer successful graftless implant rehabilitation using zygoma implant surgery. Over 25000 patients have been successfully rehabilitated in our hospital with premium quality dental implants in the last decade.

Implant-supported dental crowns are fabricated in our state of art in-house dental laboratory. Dental professionals trained in quality control procedures oversee the entire process. These permanent crowns are fixed over dental implants to offer permanent rehabilitation. Dental cement and luting agents used are of the highest quality thus ensuring very high long-term survival rates.

We also place temporary crowns over the dental implants during the fabrication process of the permanent crowns.

Initial presentation for fractured tooth extraction and dental implant placement

Dr. SM Balaji, dental implant surgeon, examined the patient and obtained imaging studies. These revealed the horizontal root fracture in the middle third region of the tooth. He explained the treatment plan to the patient and his parents who readily consented to the procedure.

After administration of local anesthetic, the coronal portion of the fractured tooth was extracted with the extruding root canal obturation material. An endodontic file was then carefully threaded through the broken apical fragment, which was carefully removed without any trauma to the socket.

Following the successful removal of the fractured tooth, a Nobel Biocare implant was carefully placed into the extraction socket. The flap was then closed with sutures. Dental implant osseointegration to the socket would take approximately four months. The patient was instructed to return in four months for placement of a ceramic crown on the implant.

The patient and his parents expressed understanding of the instructions and will return for ceramic crown fixation.

Video – Dental Implant Surgery

Dental Implant vs Bridge

by smbalaji | Mar 15, 2021 | Dental Implant

Missing teeth may lead to additional dental issues, but implants and bridges can restore your smile and enhance your dental and overall health.

What is Dental implant?

The dental implant is a surgical fixture that is inserted in the jawbone and allowed to attach with the bone for a few months. The dental implant is a substitute for the root of the missing tooth. In exchange, this “artificial tooth root” is used to carry a replacement tooth or bridge. Having a dental implant fused to the jawbone is the closest thing to imitating a natural tooth since it stands on its own without damaging the nearby teeth and has great stability.

The process of fusion between the dental implant and the jawbone is called osseointegration. Most dental implants are made of titanium, which helps them to blend into the bone without being known as a foreign object in our body. Technology and research have evolved over time to significantly enhance the results of dental implant placement. Today, the success rate for dental implants is close to 98%.

Dental implant Procedure

An implant is normally the preferred choice for the replacement of a single tooth. Placing an implant requires careful planning to determine the amount of bone in which the implant is inserted to ensure that sufficient support for the implanted tooth is provided.

We may take Cone Beam CT scan(CBCT) of your teeth to see the amount and shape of the bone available for the implant and to take impressions of your teeth. If your jawbone is sufficient, the dentist can use a computer to make models of your jaw to simulate the implant prior to the actual procedure. This will increase the precision of the insertion and minimise the amount of tissue disrupted during the implant process.

If your jawbone does not accommodate an implant, we will increase it with bone or bone-like material during surgery. You’ll need to wait a few months for the bone to heal before you get an implant.

The next move is to place the titanium screw which replaces the root of the tooth in your jaw. The screw is fitted with a cap that looks like a little stud in your gum. In the next few weeks, your jawbone will expand around the screw to anchor it securely in place, and your gum will heal.

In the final step, the dentist will make sure that the implant is securely in place. He or she will remove the screw cap and replace it with a titanium abutment or a post. A porcelain crown designed to fit your surrounding teeth will be cemented or screwed onto the base.

What is Dental Bridge?

A bridge—which consists of artificial teeth fused to a metal frame—is a good way to replace a few teeth. The frame is cemented to support—either implants or healthy teeth protected by crowns. The more teeth are removed, the more natural teeth or implants are required to provide the bridge with the necessary support.

Dental Bridge Procedure

Having a bridge is a quicker procedure than getting an implant, but it also involves a number of visits; one for imaging and impressions, one for preparing crown teeth and fitting a temporary bridge, and another for fitting a permanent bridge.

Dental implant vs. bridge

Dental implants and bridges can theoretically produce natural-looking outcomes, but they do have their own advantages and disadvantages. Here’s a look at how these two tooth replacement choices are compared.

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The initial cost of treatment is lower for dental bridges when compared to dental implants; however, the cost of dental implants works out to be cheaper over the long term than dental bridges if you take the following factors into consideration

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Tooth preparation for bridge placement involves mutilation of teeth that will support the bridge (abutment teeth). Any mutilation of tooth structure leads to compromise in the structural integrity of the tooth. Dental implants are very similar to normal teeth to the extent of even mimicking their root structure. They do not require any form of preparation of adjacent teeth.

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Secondary dental caries in abutment teeth is possible after several years in the case of bridges if oral hygiene is not scrupulously maintained at the bridge-abutment tooth interface. This could lead to loss of abutment teeth with the need to fabricate new dental bridges. Dental implants are stand alone units and are completely immune to problems such as caries that plague natural teeth; however, dental implants also require maintenance of meticulous oral hygiene as gum disease can lead to loss of bony support for the dental implant.

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Abutment teeth can also become mobile over the years due to excessive occlusal loads. This could again lead to loss of these teeth thus requiring new dental bridges. Dental implants are immensely strong and can bear occlusal loads that are equal to loads borne by natural teeth.

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Bridges may have to be replaced several times over the lifetime of the patient while dental implants offer a permanent solution for lost teeth.

Alveolar Bone Grafting from Chin for Dental Implant Surgery

by smbalaji | Mar 23, 2020 | Dental Implant

Patient from consanguineous marriage born with unilateral cleft lip and palate

The patient is a 20-year-old male from Hazaribagh in Jharkhand, India. Firstborn to his parents, he had been born with a right-sided cleft lip, palate and a very minor alveolus deformity. This had caused a great deal of distress to his parents. His parents had been counseled at length about this condition.

Successful surgical management of cleft lip and palate deformity

The patient and his parents had been referred to our hospital for management of his deformities. He had first undergone cleft lip repair at three months of age. This had been followed by cleft palate repair at 8 months of age.

There were very good cosmetic and functional results from the cleft repair surgeries. He had been able to feed well and had met all his developmental milestones.

With the passage of time, as with all cleft patients, he had developed dental malocclusion. He also had a congenitally missing lateral incisor at the site of the alveolar cleft.

Some patients who have undergone cleft repair develop skeletal malocclusion due to a retruded maxilla. This is corrected by orthognathic surgery.

The dental malocclusion arising from his cleft deformity had not been addressed by his parents. About a year ago, he had expressed the wish to get this corrected to his parents. They contacted our hospital manager who gave them an appointment for consultation regarding his problem.

Parents and patient return to our hospital for management of his malocclusion

Dr SM Balaji, dental implant specialist, examined the patient. He then ordered imaging studies for the patient. The patient and his parents were then presented with the treatment plan.

Treatment planning presented to the patient and his parents

He had dental malocclusion with malalignment of his anterior teeth. There was a congenitally missing lateral incisor at the region of the minor alveolar cleft. It was explained to them that the first line of treatment would be presurgical fixed orthodontics. His malaligned teeth would be brought into perfect alignment.

Next step of correction would be a corticocancellous bone graft to the region of his cleft alveolus defect. This would be through harvesting of a bone graft from his chin. This is indicated in patients with small cleft defects in the bone.

The bone graft would help close the bony defect at the alveolar cleft. Larger defects would require bone grafts harvested from the iliac crest.

A Nobel Biocare dental implant would then be fixed at that site after bone graft consolidation. This would be followed by placement of a ceramic crown after osseointegration of the implant. The patient and his parents were in complete agreement and consented to the treatment plan. Tooth replacement through implant dentistry is a specialty feature at our hospital.

Commencement of fixed orthodontic treatment for alignment of his teeth

Treatment was started for the patient using orthodontic ceramic tooth colored brackets and esthetic arch wire. Patient did not want metal brackets because of the esthetics involved. Once alignment had been obtained, the bony cleft defect at the site of the missing upper right lateral incisor was clearly delineated.

Successful placement of bone graft at the site of the cleft defect

Under general anesthesia, a flap was raised at the region of the missing lateral incisor. The bony cleft or fistula was exposed. A chin flap was raised next and corticocancellous bone grafts harvested from the patient’s chin region.

These bone grafts were then shaped and fixed with titanium screws at the site of the defect. The flaps were then closed with sutures after ensuring complete hemostasis.

Instructions were given to the patient and his parents that they will have to return in four months. There would be complete bony consolidation of the grafts at the site of the alveolar bony defect. A Nobel Biocare dental implant would be placed there followed in another four months by placement of a ceramic crown.

The patient and her parents expressed understanding of the instructions and will return in four months for dental implant surgery.

Surgery Video

Replacement of Missing Teeth with Dental Implants for a Dazzling Smile

by smbalaji | Mar 22, 2020 | Dental Implant

Replacement of Missing Teeth with Dental Implants for a Dazzling Smile

Case Report

An 18 year old female patient approached our dental hospital wanting to replace her missing upper front teeth. Patient gives a history of an accidental fall from a flight of stairs that occurred 2 weeks back at school, which has knocked out a couple of her upper front teeth right away injuring her gums and lips. Her lacerated gums and lips were treated at a local dental clinic nearby her residence. The young patient feels very odd and distressed to be without teeth. She grieved about her friends teasing her at school with funny names for her unpleasant smile without teeth. The patient’s parent demanded for a fixed option to replace her missing upper front teeth.

EXAMINATION OF THE PATIENT

On clinical examination, there was missing teeth in the upper front region. The surrounding gum tissues were fine with no pathological findings.

On radiological examination, OPG taken shows complete missing of upper anteriors with no remnants of teeth inside the bone. No abnormalities seen in the surrounding bone structure.

A thorough blood investigation revealed no systemic abnormalities.

TREATMENT PLAN

On view with the patients demand and considering her age, Dr. S.M. Balaji planned to fix dental implants at the involved site under local anesthesia. Later replacement of missing teeth with fixed ceramic prosthesis. Since the patient’s parent was also keen on fixed option, consent was obtained.

DENTAL IMPLANT PLACEMENT

Under local anesthesia, the gum tissue at the relative site was opened exposing the underlying jaw bone. Secondly, Dental implants of appropriate size and height were fixed in the bone with stability. Finally, the gum tissues were approximated with absorbable suture covering the implants.

POST-OPERATIVE FOLLOW UP

Instructions on oral care routine was briefed to the patient. She was asked to wait for a healing period of 3 months for the final prosthesis placement. During this interval of time, the dental implants completely osseointegrates with the surrounding jaw bone. In addition, an upper temporary prosthesis was given to replace the missing upper teeth for the time being.

THE FINAL PROSTHESIS

Post-operative OPG taken after 3 months shows well integrated dental implants in proper position with the bone. Hence after a few clinical sessions, a natural looking ceramic teeth were fixed onto the dental implants, enhancing the appearance of her smile and look. The shade of the final prosthesis was in perfect match with the color of her natural teeth, which instantly boosted her self confidence. The patient and her parents were extremely delighted and satisfied with the outcome.