From Volume 50, Issue 5, May 2023 | Pages 433-435
Dental implantology has revolutionized the dental profession by providing a practical and aesthetically pleasing replacement for lost or missing teeth. This article takes a comprehensive look at the history of dental implantology from the discovery of osseo-integration to the current practice of using conventional to zygomatic implants with bone grafts and soft tissue grafts.
CPD/Clinical Relevance: Knowledge regarding the current status of dental implants is of value to clinicians.
Dental implantology has revolutionized the dental profession by providing a practical and aesthetically pleasing replacement for lost or missing teeth. Today, implants are a routine therapeutic modality with a survival rate of over 95%.1 Dental implantology with titanium has come a long way since its inception in the 1960s when Professor Per-Ingvar Brånemark first reported the phenomenon of osseo-integration. This article takes a comprehensive look at the history of dental implantology from the discovery of osseo-integration to the current practice of using conventional to zygomatic implants with bone grafts and soft tissue grafts.
In the 1950s, Professor Per-Ingvar Brånemark, an orthopaedic surgeon from Sweden, was studying bone healing and regeneration using titanium. In one of his experiments, he inserted a titanium chamber inside a rabbit’s femur to understand how the bone regenerates. However, when he attempted to remove the chamber, he found that it had fused with the bone in such a way that it was impossible to remove. From this observation, he realized that titanium could be integrated into live bone tissue.2
This discovery led to years of research and experimentation with titanium in dental implantology. In 1965, Brånemark placed his first dental implant in a human volunteer, Gösta Larsson. Brånemark’s titanium implant was screw-shaped, with a rough surface, and allowed for osseo-integration with the surrounding bone.
Following the discovery of osseo-integration, the development of conventional dental implants progressed rapidly. A conventional implant is composed of three components: the implant body, an abutment, and a prosthesis. The implant body was screwed into the jawbone and traditionally left to osseo-integrate with the surrounding bone for a period of 3–6 months. Following osseo-integration, the abutment, which is a connector between the implant body and the prosthesis, is attached onto the implant, and the prosthesis, such as a dental crown, is secured onto the abutment (Figure 1). Due to advances in techniques and a greater understanding in biology we can now on occasions provide immediate placements of implants into extraction sockets and provide immediate loading of implants with functional teeth.3
The design of dental implants has evolved to improve osseo-integration, and the success of the implant. Today, implants are made from various materials, including titanium alloy, zirconium oxide, and ceramics. The surface of the implant is modified to enhance osseo-integration, with several surface treatments, such as sandblasting, acid-etching, and plasmaspraying.4 Implant sizes and shapes are also designed to match the varying anatomical structures of an individual’s teeth. For instance, there are implants that are specifically designed for molars or incisors.
Conventional dental implants have been the primary choice for oral rehabilitation for years, but not everyone is a candidate for them. Patients who have lost all their teeth, or those with an insufficient amount of bone volume may not be candidates for conventional implant placement. In such cases, extra-maxillary implants or subperiosteal implants have become a practical alternative.
Extra-maxillary implants are longer than conventional implants, and they are anchored in the bone outside the maxilla, such as the zygomatic, nasal and pterygoid bones.5 This anchorage provides the implant’s stability, allowing for successful prosthetic restoration despite a lack of adequate bone volume in the maxilla (Figure 2).
Subperiosteal jaw implants are also a type of implant used for patients who have a severe loss in upper or lower jaw bone. Subperiosteal implants are surgically placed beneath the gum tissue and on top of the jawbone, rather than inside the bone.6 They are held in place by screws or other fixation devices. The structure is usually made of metal or a metal framework that is shaped to fit the contours of the jawbone (Figure 3). The main advantage of subperiosteal implants is that they can be customized to fit the unique contours of each patient’s jawbone.
Bone augmentation techniques have come a long way to help patients with insufficient bone volume receive dental implants successfully. Bone grafting involves using bone tissue or bone substitutes to enhance bone volume in the jaw (Figure 4).
Bone grafting is also used to prepare sites for implant placement by augmenting areas with insufficient bone volume. Autogenous bone grafts, wherein the graft material is harvested from the patient’s own bone, are still the gold standard for bone grafting procedures. However, the bone can also be harvested from alternative sources, such as allogenic bone (tissue from a human donor) or xenogenic (animal bone) or from a completely synthetic source.7
Soft tissue grafting has evolved as an essential procedure in conjunction with dental implant placement, and it was previously not given much priority when compared to bone grafting. Research into the effects of soft tissue grafting procedures has led to increased knowledge of the procedures and their importance.
Soft tissue grafting is effective when the bone is thin immediately adjacent to the implant-supported crown. The implant ideally needs to be surrounded by a band of keratinized gum tissue for the implant and patient to function properly (Figure 5). A connective tissue graft can be used to thicken the peri-implant tissues via thickening the keratinized mucosa.8
The future of dental implantology will likely see the use of computer-assisted implantology, combining cone-beam computed tomography or magnetic resonance scans and virtual treatment planning along with 3D printing for implant manufacture.9 Computer-assisted implantology will ensure more precise placement of implants and a decreased likelihood of error.10 Advanced techniques such as growth factors and osteoconductive therapies might become more prominent options in bone grafting procedures. The introduction of artificial intelligence is close, but not here just yet!11
Dental implantology has come a long way since the discovery of osseo-integration by Professor Brånemark in the 1950s. Today, dental implants are a successful, aesthetically pleasing, and long-lasting dental restoration modality. In the past, conventional implants were the only possibility for treatment, but with the development of zygomatic implants, bone grafting, and soft tissue grafting, more patients are now candidates for successful implant-supported rehabilitation. The future of dental implantology looks exceptionally promising, with advancements that will improve the specificity and predictability of implant placement along with advancements in bone grafting procedures.
