The introduction of dental implants in the field of dentistry has revolutionized the way missing teeth in dental patients are restored, owing to their excellent biocompatibility, durability and esthetics. However, a major factor that determines their long term retention and success, is the extent of ossoeintegration they achieve with the surrounding jaw bone.

For this purpose, various techniques have been devised by to enhance the capability of the dental implants to form a retentive and long term bond with the jaw bone, a brief account of which is given in the preceding text.

Modification of Surface Topography at Macroscopic Levels

It has been known since long, that dental implants that have a rough surface, are able to achieve better ossoeintegration in comparison to the implants having a smoother surface. Several methods are used for creating roughness on the surface of implants:

• Acid Etching – in this technique, the implants are immersed into a solution of a heated acid, which results in the formation of pits on the implant’s surface.
• Anodization – in this method, strong acids are applied to the implant’s surface, thereby resulting in the formation of an approximately 1µm thick layer which results in the formation of an electric circuit, where the implant serves as an anode. The end result is formation of a thick oxide layer that improves osseointegration.
• Sandblasting – fine particles of sand are accelerated towards the implant’s surface, resulting in the deposition of these particles, and forming various pits on the surface of the implant.
• Grit-blasting – very small particles of ceramics of Titanium are projected towards the implant’s surface at very high speeds. This results in the deposition of these particles on the implant’s surface, thereby creating surface roughness.

Surface Modification of Implants at Nanoscale Levels

While macroscopic surface modifications are quite helpful in increasing ossoeintegration in dental implants, it has been shown that surface modifications at the nano-level provide even better results. Nano-sized modification of the surface texture in dental implants can be achieved in the following ways:

• Self-Assembly Monolayers (SAMs) – this includes the deposition of specific molecules that have a strong affinity for the implant’s surface, and expose various functional groups which prove helpful in the process of ossoeintegration.
• Deposition of Nanoparticles – this techniques involves the deposition of nanomaterials onto the implant’s surface, by using the sol-gel technique. This method is commonly used for the deposition of nano-hydroxyapatite (HA) on the implants to boos ossoeintegration and enhance its biocompatibility.

Modification of Implant’s Surface Energy

It has been theorize that by enhancing the surface energy of an implants, the wettability of the implant is increased, thereby leading to a boost in ossoeintegration caused by increased interaction between the implant’s surface and the biological environment. Following techniques can be used to modify an implant’s surface energy.

• Hydrophillization of the Implant’s Surface – by depositing hydrophilic groups on the implant’s surface, the wettability is increased, thereby directly enhancing the potential for ossoeintegration.
• Plasma Treatment – this technique can result in the formation of positively charged implant surfaces, thereby enhancing osteoblastic adhesion on the implant’s surface, which results in a direct increase in ossoeintegration potential of the implant.

Bio-functionalization of Dental implants

This approach involves the modification of the implants surface and behavior with the help of various biological molecules, which are able to modify the biological environment of the implant, in favor of ossoeintegration, osteoblastic adhesion and wound healing processes. For this purpose, cytokines, several growth factors and other biological proteins have been successfully employed, either by using direct adsorption, covalent bonding or by using various carrier systems.

This text provides a brief overview of the various techniques and methods that are being employed for the surface modification of dental implants. The main idea behind surface modification is to create an implant surface, which is not only more biocompatible, but also conducive to wound healing and ossoeintegration.

References

Bruschi, Michela, et al. “Composition and Modifications of Dental Implant Surfaces.” Journal of Oral Implants 2015 (2015).

SHIBATA, Yo. “Surface Modification of Dental Implants.” Dental Medicine Research 30.3 (2010): 269.

If you were to ask several dentists about what procedures they do recommend in case of tooth loss, most would probably tell you: dental implants. I guess we all agree about the multiple advantages of implants over bridges or removable prosthesis. We can say it is a no-brainer.

Yet, this tooth replacement therapy is somehow the most difficult to propose because most patients are quite scared of the whole implant procedure. To be honest, I perfectly understand the fears from a procedure that look like a really invasive and brutal process. But we know that our patients don’t need to worry, this procedure may look scary but with today’s tools, it is almost painless and easy as ABC.

The thing is we need to educate our patients and present dental implants in layman terms so that they can make an informed decision.

So, to make the discussion with the patient easier, I usually follow some predetermined guidelines that help me to be concise, focused and to get the most of my patients’ attention, which is the case for almost any procedures I need to explain.

Our goal is to make sure we have the full attention of our patients, that’s why I like to follow 4 simple steps.

Once it is obvious dental implants are the way to go for a patient, I explain what this option is about in 4 steps.

1) Definition

In my opinion, the best way to explain a dental implant is to use the analogy of a natural tooth.
A natural tooth has 2 parts: the crown which is visible above the gum line and the root which anchors the tooth through the gum. When you lose a tooth, you lose those 2 elements. To fill the gap, you have the option to either replace only the crown part or both (crown and root). Dental implants enable to replace both because it has a root and a crown. The root, usually made of titanium, is screwed into the jawbone. After 2-4 months, the bone around the root will fuse to it: this will ensure your new tooth is tightly fixed to your jawbone. After this process called integration, an abutment will be placed into the root and will protrude up trough the gum line, and then a crown will be placed on this abutment in the final phase.

I like to keep things simple and don’t go into details about the immediate loading, the titanium vs zirconia etc, my aim is to let the patient have a general understanding of the procedure to start with. Note that I often suggest my patients to get more information on some other websites that deal with dental implants. There are tons of it. One that I like is beautysetter. It is a new general website about plastic surgery and dentistry, run by a friend of mine so I am a bit biased. For those who prefer tumblr, beautysetter.com also has one.
The reason why I kept asking my patients to check information on other websites is simple; I want my patients to know that there is nothing to hide and that they can then get back to me to ask any questions they want. this a good way to build trust. Of course, there is always the risk that your patient might pick another dentist, but if they do, it simply means I need to work on some other parts of my “package”.

2) Pain

Right after the definition/ procedure, I know the pain is a concern I want to deal with quickly so I can keep my patient focused on the following parts of my mini “presentation” because this pain issue can create a mental block that can prevent the patient from being totally focused on me.

Dental implant surgery is a quick, outpatient procedure that can be performed under local anaesthesia so, it will be as painless and comfortable as possible. If you are really stressed, just keep in mind we have several additional conscious sedation techniques.

Once the pain issue is resolved and your patient is all ears, you can list the 4 main benefits that make implants such a perfect choice.

3) Benefits/cons

– Dental implants totally replace the root and the crown of the tooth you lost.
– It avoids premature bone loss by keeping your jawbone stimulated in the missing tooth area, and also maintains the integrity of the surrounding teeth.
– You don’t need to change your dental care routine, as implants behaves exactly like normal tooth
– Implants will often last a lifetime which is not always the case with bridges or partials etc….

Once you gave those 4 main benefits, you can talk about the cost which is the main con.. but you can do it with confidence because the cost will be better accepted owing to those advantages.

4) Cost

I don’t talk about prices in the beginning because if I do, the patient won’t even listen to you any longer, the price should not be a focal point that will shut your patient’s ears…. That’s why, in my opinion, prices should be given at the end.

Here again, we know patients will check prices elsewhere, so I show patients articles about what dental implants costs, that give the range of implant prices. Here again, you can show a chart you made but I prefer a document or a website made by a third party.

This range of prices enables me to explain to my patients why I am not the cheapest dentist (I prefer to discuss the price issue right form the start so that the patient won’t be surprised if he or she gets cheaper quotations with other fellow dentists… If you don’t, chances are the patient won’t come back…)
Here comes your pitch about your years of experience, the material you use, your services etc…. you can also propose the payment options you can offer, the packages etc….

The secret is in my humble opinion to anticipate the patient’s issues or questions and make sure your patient is always in relaxed state of mind, which fosters full understanding.

I strongly believe in direct, honest and clear communication, this is the best way to establish excellent relationships with your patients and create loyalty.

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