The evolution of implant-retained prosthetics – Mr Luc Trevisan TBR Development ManagerFeatured Products Promotional Features
Posted by: The Probe 2nd August 2018
Dental implants are now widely recognised as a safe, effective alternative to traditional treatments for tooth loss. While the science and technology behind implantology is still relatively new to the profession, the prosthetic concepts employed to restore missing teeth are well known throughout history. This has helped shape practitioners’ understanding of their current applications in clinical practice.
The earliest known use of fixed crowns, for instance, dates back thousands of years in Southeast Asia, on the Philippine island of Luzon. Filipino natives had used gold to cap broken teeth or replace teeth that had been lost.[i]Researchers discovered that modifying teeth with gold was popular among native chiefs and the political ruling class of the period. Gold teeth were regarded as a symbol of wealth, power and social status among the elite – which is perhaps why the Spaniards took offence in the sixteenth century when they colonised the Philippines and found that the “uncivilised” local people were sporting gold teeth.[ii]
Prior to this, however, it was the Etruscans of 700 BC who used gold for dental crowns that were both functional and artistic. The Etruscans were an incredibly intelligent, ancient Italian civilisation which operated in what we know as Tuscany today. Like many other cultures around the world, luxury and wealth were highly valued to the Etruscans, and they used their basic knowledge of dentistry to experiment with gold, carved ivory and extracted human teeth in the production of rudimentary dental crowns and fixed bridges.[iii]
They began with the fabrication of a hollow gold tooth mounted on a thin gold band, which served as an anchor to the healthy teeth adjacent to the gap filled by the artificial tooth. The gold bands were wrapped around the teeth and cemented by soldering with heat. These provided a decorative replacement for one or more maxillary incisors that had been deliberately removed as a cultural tradition.[iv]The Etruscans’ solution to tooth loss may seem primitive but they are hailed as the first people in history that used a form of prosthetics in the mouth.
Modern advances have since given rise to a wide selection of prosthetic solutions which can be used effectively in implant restoration. The harmonious integration of the prosthesis within the oral cavity can have just as much influence over the success of an implant as its load-bearing capacity and ability to osseointegrate.ixSingle-unit crowns are common in implant dentistry but there is no one-size-fits-all solution. While gold has its advantages as a metal crown, it is not always the best material of choice for every implant or every patient.
Since the 1950s, porcelain-fused-to-metal (PFM) crowns have had a proven track record for being strong and durable, combining the strength of metal with the aesthetic benefits of ceramic.[v]The metal element of PFM crowns, however, can still become visible underneath the gingiva, thereby compromising the overall visual outcome.[vi],[vii]All-ceramic crowns may be preferable in this regard, as they provide an exceedingly life-like end result and are the ideal choice for upper anterior teeth where cosmetic appearance is a major concern. Zirconia-based restorations, for instance, have also exhibited high clinical survival rates.[viii]
Dental professionals have vast choice in the materials they can use to create implant-retained prosthetics, including connective components as well as crowns. Manufacturers offer titanium abutments, for instance, which retain excellent mechanical properties and biocompatibility, but often do not provide optimum aesthetics. Consequently, zirconia abutments are frequently used to overcome this issue.[ix]It is vital that practitioners select the most appropriate implant abutment for each case presented, in order to ensure that the proposed implant system can fully support a prosthesis. Otherwise, the abutment could fracture under the strain of occlusal forces, which could put the implant at risk of failure.[x]
Practitioners must also consider what implant system is best combined with the most appropriate prosthetic. The TBR Z1 implant system from Dental Express, for example, combines zirconia and titanium in one seamless component to ensure it provides excellent support to any prosthetic restoration – without compromising on aesthetics and function.
One of the main focuses of restorative dentistry is to achieve natural-looking restorations that can resist failure even after years of function in the oral cavity. Various solutions have been invented and discarded over the centuries but prosthetics such as dental crowns remain key – and continue to be relevant in dental implant applications. So long as appropriate materials are chosen, and practitioners follow the fundamental principles of preparation and delivery, implant-retained crowns can prove incredibly reliable.
For more information visit Dental Express at www.dental-express.co.uk, call 0800 707 6212 or learn more about the Z1 implant at http://z1implants.co.uk/and the full range of implants at http://dental.tbr-implants.com/en/
[i]Zumbroich, T. (Unknown) Gold Work, Filling and Blackened Teeth: Dental Modifications In Luzon. Link: http://www.academia.edu/7612056/Gold_work_filing_and_blackened_teeth_Dental_modifications_in_Luzon. [Last accessed: 23.02.18].
[ii]Schwartzberg, L. (2014) The Ancient History of Grills. Link: https://www.vice.com/en_us/article/znw9z4/the-ancient-history-of-grills-456. [Last accessed: 23.02.18].
[iii]Becker, M.J. (1999) Etruscan Gold Dental Appliances: Three Newly “Discovered” Examples. Link: https://digitalcommons.wcupa.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1007&context=anthrosoc_facpub. [Last accessed: 23.02.18].
[iv]Becker, M.J. (2003) Etruscan Gold Dental Appliances: Evidence for Early “Parting” of Gold in Italy Through The Study of Ancient Pontics. Link: https://link.springer.com/chapter/10.1007/978-94-010-0193-9_2#citeas. [Last accessed: 23.02.18].
[v]Animated-Teeth.com. (Unknown) 6 factors to consider when picking out the best kind of crown for your tooth. Link: https://www.animated-teeth.com/dental_crowns/s1-best-dental-crowns.htm. [Last accessed: 23.02.18].
[vi]Helvey, G. (2010) A History of Dental Ceramics. Link: https://www.aegisdentalnetwork.com/cced/2010/05/a-history-of-dental-ceramics. [Last accessed: 23.02.18].
[vii]Baker, B. and Reaney, D. (2014) Aesthetic failure of anterior crowns. Link: http://www.scdlab.co.uk/files/articles/ire/ADT_Nov14_Aesthetic_Failure_of_Anterior_Crowns.pdf. [Last accessed: 20.03.18].
[viii]Jung, R. E., Pjetursson, B. E., Glauser, R., Zembic, A., Zwahlen, M. and Lang, N. P. (2008) A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clinical Oral Implants Research. 19(2):119-130. Link: http://www.zora.uzh.ch/id/eprint/11795/1/Jung_Pejetursson_Clin_Oral_Impl_Res-2008_V.pdf. [Last accessed: 20.03.18].
[ix]El-S’adany, A. F., Masoud, G. E., Kamel, M. S. and Korsel, A. M. (2013) Fracture resistance of all ceramic crowns supported by zirconia and alumina versus titanium implant abutments. Tanta Dental Journal. 10(3):103-111. Link: https://www.sciencedirect.com/science/article/pii/S1687857413000206. [Last accessed: 20.03.18].
[x]Kahm, S. H., Kim, C. and Kim, S. (2013) Overcoming and Preventing Dental Implant Complications: Abutment Fracture Case Report. J Korean Dent Sci. 6(1):27-33. Link: https://pdfs.semanticscholar.org/fa1d/8c26bcf8ac7bab36743cb3dba70f1bc53933.pdf. [Last accessed: 20.03.18].