Dental implants are a mainstream part of patient care for replacing missing teeth and/or retaining other prosthetics. And implants are one of the fastest growing segments in patient care today.
When I was in dental school more than 15 years ago, dental implants were available, but more the exception than the norm, leaving me to learn about implants on my own. Fortunately for me, I saw that implants were not just a “trend,” but a viable treatment option for my patients. I completed 200+ hours in dental implant continuing education in less than a year and recognized that dental implants are still evolving.
Dental school education has adapted to this trend by incorporating dental implants into the current curriculum, but as I have talked to recent graduates, there is still a lot of confusion about implant basics and “fear” of even restoring dental implants. And to add to this problem, there are a lot of dental professionals who graduated before me that don’t know a lot about dental implants either – leaving recent graduates with few options to help them feel even comfortable restoring implants. Often times, patients are showing up from the surgeon’s office in the restorative dentist’s office with the implant in place and the needed supplies to “restore” or “finish” the implant.
So, in this series of articles, I plan to put together some basic information, or “cheat sheets” to help anyone, including your staff, to be able to feel a little better about dental implants.
In this first part, we are going to focus on the basic parts and pieces of dental implants, since this seems to create a lot of stress and confusion for many. I think that the biggest issue when it comes to dental implants is that when I first started with dental implants, there were only a handful of implant manufacturers. Today, there are several more companies producing implants, parts and pieces. And to add to the confusion, some of the implant companies have been “copying” other companies and offering interchangeable parts and pieces between companies. If that’s not bad enough, some companies have come and gone, leaving the patient with older implants that are still in service and the restorative dentist trying to restore them on a scavenger hunt trying to find parts.
Let’s start by looking at the basic parts of implants from bottom to top to get us started.
Dental implant or fixture: The part that is placed subgingivally into the bone (there are some of the older ones that do not, but are not used very often today). There are some that are one piece, meaning that they the implant fixture and abutment are one piece.
Healing/cover screw: This is placed in a two-stage surgery; it covers the opening of the implant and is covered by the gingival tissue/mucosa and fits within the dental implant.
Healing abutment/cuff: Placed in a single-stage surgery or used after the implant is uncovered; often times this is what is sticking through the gum/gingival tissue; can be color-coded for size and may be labeled for identification.
Impression coping: This is used after removing the healing cuff/abutment to take a tissue-level impression. There are open-tray and closed-tray types and various sizes and options depending on the clinical situation (I will review this in a future article).
Restorative abutment: There are temporary abutments; prefabricated abutments (straight, angled); custom abutments (zirconia, titanium, various other metals; milled, cast types); abutments to use for overdenture attachments (Ball attachments, ERA type, Locators, etc.).
Abutment screw: This is what helps keep the restorative abutment attached to the implant fixture; most overdenture attachments have the screw attached/is one piece.
Implant replica/abutment replica: This is what is used by the lab to develop a “working” model.
Manual screwdriver: Used simply to place and finger-tighten abutment screws, healing screws, healing cuffs.
Torque Wrench: Usually has an attachment to allow screwdriver to fit into it; allows to tighten or torque abutments, implants, etc. to company-specific specs. Can be used to remove tight screws/attachments as well.
As you can see, simply having knowledge of all of the parts and pieces (and this list is not all of them, but covers what most restorative dentists need to know and/or use), can be intimidating in itself. In the next article of this series, I will walk you through the basic process of restoring a simple single restoration which most, if not all, dentist have or will encounter in their practice.
(Click this link for more dentistry articles by Dr. Jeff Lineberry.)
Jeff Lineberry, DDS, FAGD, Visiting Faculty and Contributing Author; http://www.jefflineberrydds.com