Dental implants are small titanium screws which can be used to replace a single tooth or multiple teeth. There is a vast amount of information available about the different types of implants available and the solutions that implants can provide. Whilst it is important to understand how implants work, one must not over look the importance that bone tissue plays in the process of osseo-integration. Osseo integration is the process whereby bone tissue bind and grown onto titanium dental implants. Once an implant is fused with the bone tissue we say that it has ‘osseo-integrated’.
The human skeleton serves as a support and protection for soft organs, it also regulates the mineral ion reservoir. To accomplish these functions we can recognize two structural tissues that form the bone, cortical (hard) and trabecular (soft). Both of them are distributed in different areas the body depending on the bones we are referring to.
The trabecular bone, known as soft or cancellous, is mostly organic with a high metabolic turnover rate. It is located in the interior part of the bones and is more sensitive to nutritional, biochemical and hormonal changes, experiencing greater losses of tissue and being more prone to fractures.
The cortical bone, known as hard or compact, is highly mineralised and is found mainly in larger bones.
To assess bone quality in radiographs and scans dental implantology follows a classification described by Misch (1993). Based on the thickness of cortical and trabecular bone in cross sections at different levels of the maxilla (upper jaw) and mandible (lower jaw) bone. The comparison with different types of materials shown in the table below represents its resistance when being drilled.
*Location where the different qualities of bone exist
CT Scan displaying transversal cuts to show the bone availability and quality along the maxilla
OPG (Panoramic radiograph) showing the availability of bone (red lines) in the anterior and posterior maxilla
This depends on several factors:
In healthy patients with good quality and quantity of bone, we usually recommend a 4 month healing period for implants to osseo-integrate. In those cases where bone grafting is required the healing process can take much longer.
Dr Mariana Cadorin is a dentist working at the Brighton Implant Clinic, she enjoys helping patients with solutions for missing teeth.