Laying the foundations

Kate Scheer talks about the need for advanced diagnostic tools in implant treatment

The latest dental implant systems offer various benefits, with being a stable, natural-looking replacement for missing teeth perhaps the most important.

Implants have consequently become a highly-accepted treatment for partial or complete edentulism, with many patients now choosing implants over traditional alternatives such as dentures or bridges.

However, the placement and restoration of an implant requires meticulous assessment and evaluation to ensure its long-term success. In particular, the condition of a patient’s jaw bone is key to achieving primary stability, which is vital to successful osseointegration (Javed et al, 2013).

Bone resorption and bone-grafting

One of the challenges of planning for dental implant treatment is the extent of bone resorption following tooth loss.

In the case of tooth loss or extraction, the bone that once surrounded the missing tooth gradually deteriorates due to a lack of stimulation. In fact, the rate of bone resorption is highest within the first six months following extraction, and proceeds at an average of 0.5% to 1.0% each year throughout an individual’s lifetime (Pagni et al, 2012).

Although the degree of bone resorption varies from patient to patient, it will always occur to some extent unless specific care is taken to avoid it. This is also an issue for denture wearers, whose appliance is not in direct contact with bone and therefore doesn’t stimulate it effectively (Knezović-Zlatarić et al, 2002).

In contrast, a dental implant is designed to mimic the function of natural tooth roots and remains stable following osseointegration with the jaw bone. Essentially, the longer a tooth is missing, the less bone is available to safely place an implant into.

In this case, bone grafting procedures may be required to ensure that the patient has adequate bone quality and quantity, which is crucial for the clinical success of implant treatment.

Bone grafts can be carried out at the same time or prior to placing an implant. While it is more convenient to place an implant and perform a bone graft simultaneously, not every clinical situation allows for this.

There are a variety of different bone-grafting procedures that practitioners can perform and selection will depend on each case. Ultimately, the time, effort, and additional expense of successfully performing a bone graft can greatly improve the aesthetic and functional outcome of an implant – particularly if a patient is suffering from extensive bone resorption.

A solid foundation for an implant

According to the website of the Association of Dental Implantology,, once an implant is placed, everyday masticatory forces will begin to stimulate the surrounding bone, which responds by becoming stronger and denser. Yet, there are a range of external factors that can influence the future preservation of the bone.

Slight bone loss over several years is considered normal and should not affect the patient’s implant directly. However, implant treatment is deemed a failure if there is bone loss of more than 1.5 mm following the first year of placement, and more than 0.2 mm every year after (Albrektsson et al, 1986).

Patients who suffer from diabetes, osteoporosis, or a poor immune system are at greater risk of bone loss as they already have weak bones (Chen et al, 2013).

Similarly, patients with a history of periodontal disease – typically as a result of poor oral hygiene – are more likely to contract peri-implantitis, which is a common cause of dental implant failure (Prathapachandran and Suresh, 2012). This inflammatory disease can damage the gingiva if left untreated, resulting in the deterioration of the bone structure supporting the implant.

Smokers, in particular, are in danger of developing peri-implantitis because nicotine is a vasoconstrictor that reduces blood flow, causing tissue ischemia and impaired healing of injured tissue (Kasat and Ladda, 2012). This can negatively impact the condition of the bone, especially in the initial stages of post-surgery healing and in the case of regeneration if a bone graft has been performed.

Essentially, without a solid foundation in which to place an implant, clinicians are unable to achieve primary stability. This emphasises the need for advanced diagnostic tools that can help guide practitioners to optimise implant treatment for both simple and complex cases.

As one of the industry’s leading manufacturers, W&H offers an innovative way to do this through the Osstell range of products, including the new Osstell Beacon. This intuitive handheld device facilitates a non-invasive way of measuring primary implant stability, observing osseointegration based on secondary stability readings, and aiding practitioners in determining the best possible time for implant loading.

For those seeking a complete system, the Implantmed surgical unit is available to purchase with the Osstell ISQ module already integrated. Consequently, clinicians are able to prevent implant failure, reduce healing time, and ensure the quality of treatment for highly effective, long-term results.

For a list of references, contact [email protected]

To find out more, visit, call 01727 874990 or email [email protected]

Become a Dentistry Online member

Become a member
Add to calendar