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Single Piece Implants

Fixed Permanent Teeth on implants is a blessing for the mankind agonized with failing teeth and disagreeable removable dentures. Teeth can be fixed on conventional two piece implants or the single piece basal implants but, the main drawback with the conventional implants has been the time required for traditional protocols like the traumatic sinus lifts, nerve repositioning and expensive and unreliable bone augmentation procedures which take around 3 to 12 months during which the patients have to either remain edentulous or use removable intermediate dentures. Patients enduring two piece implant therapy have to stay for a prolonged spell before they can relish the benefits of fixed teeth.

Single piece implants have been a metamorphosis in the field of dentistry as a logical alternative to the conventional implants fabricated to overcome the disadvantages associated with the two piece implantology. The design of the implant plays a significant task in the success of the terminal restoration.

In the single piece implants the surgical part and the abutment are one indispensable piece. This was fabricated to conquer the structural weakness created into the two piece implants design as, in two piece implants the presence of multiple units led to interface problems and Peri-implantitis which ultimately led to bone loss and failure of the implant. Single piece implants are more reliable and strong as they are a single entity which are notably designed for immediate loading.

These are also called as basal implants as they are placed in the basal bone which is highly mineralised and is devoid of infection, The chewing load will be dispersed to the cortical bone region, which are resistant to resorption and this present through out the life and forms the stress bearing part of the skeleton. They dislodge upto 60% little bone in contrast to conventional implants there by preserving the blood supply and the integrity of the bone resulting in negligible post operative pain and discomfort. They are also affordable as the manufacturing cost is less.

Types of Single Piece Implants

KOS
Compression screw implants

Made of exceedingly break resistant titanium alloy and have apical compression threads which are best suited for immediate loading.

BCS
Bi - Cortical screw implants

These implants anchor the cortical bone thereby certifying secured load conveyance and osseointegration.

BOI
Basal Osseointegrated implants

Basal Osseointegrated implants, placed laterally into the bone and used where there is very less bone volume and where nerve by pass procedure is not attainable.

Indications

  • These implants can be placed in anybody with failing or missing teeth irrespective of bone height and volume.
  • Indicated in medically compromised patients like:

Diabetic mellitus - This problem is associated with added vulnerability to infection and diminished wound healing there by contraindicating the two piece implants, where as single piece implants being very polished do not allow colonization of bacteria on the implant surface there by making them suitable for such people.

Periodontitis - This effects the bone surrounding the tooth root. Basal implants are safe in these circumstances as the infected area is away from the basal bone, where the single piece implants are placed.

Smokers - Are suitable candidates as smoking cuts down the blood flow to the oral tissues like bone, gums and teeth resulting in impaired healing. Smokers have more incidence of gum recession which leads to peri-implantitis in case of two piece implants and ultimately to failure of the implants.

Smoking is not an issue for basal implants as the load bearing areas are far away from the affected site.

Advantages

  • The Basal implants phase out the danger of peri-implantitis as they are a single entity, highly polished and have a thin mucosal penetration.
  • Basal implants can be placed in anybody with missing or failing teeth irrespective of their bone and health status.
  • Better body design allows improved healing of the bone and osteonal remodeling.
  • The anchorage place, the basal bone provides supreme advantages to basal implants over conventional implants.
  • No waiting time as the durability rate of these implants depend on the activation of bone cells, which happens on chewing. Therefore they are called as immediate loading implants or "Implantation per protocol of immediate load".
 

Difference between Single Piece & Two Piece Implants

Dental Implant Single Piece Two Piece
Implant design Single entity, The implant and the abutment are fused The implant and the abutment are two separate bodies
Size and pattern Exist in various sizes and pattern, convenient for all bone types. Limited sizes and designs.
Implant Cost Reasonably priced as they are a single entity. They are also called affordable implants. Highly priced as it is a multiple component system and involves traditional protocols, extending upto 3 to 9 months
Place of insertion Installed in the basal bone which is highly mineralised and offers excellent and long lasting solution for implants because of the high load bearing capacity Arranged in the crestal bone which is sparsely mineralised and is prone to resorption and begins to recede once the tooth is lost
Implant placement procedure Painless single sitting technique and generally flapless.(Extraction of teeth if any and implant placement in a single sitting averts changes in bone contour of the neighbouring tissues like gums & bone). Two to there surgical sessions are imperature which contain complex procedures spread over a period of 3 to 6 months.
Bone Augmentation Not essential as the implants are placed in the basal bone which is present in everybody. Inherent in deficient bone cases. Unpredictable results with bone Augmentation.
Agonising surgical procedures Atraumatic, time taking surgical procedures like sinus lift and nerve repositioning are not required thanks to Pterygoid implants & nerve bypass procedure. Traumatic and unreliable procedures like sinus lift and nerve repositioning are mandatory as implants are placed in the crestal bone.
Bone Displacement Dislodges approximately 60% less bone, there by retaining the bone virtue. Significant amount of bone is displaced and it varies with size and length of the implant.
Screw loosening Not encountered as it is a single entity. Quite prevalent and subjected to increased mechanical stress under oblique loading.
Loading Ought to be loaded immediately as munching helps in stimulation of bone cells there by improoving the durability of the implant. Delayed loading, very often a period of 3 to 6 months is required, during which the patient is compelled to remain edentulous or put up with removable prosthesis.
Incidence of PeriImplantitis Not associated as they are highly polished and is a single unit. Primary handicap, occurs due to rough surface and microleakage at the implant abutment interface.
Long term Maintenance Effortless and identical to the of traditional bridges. Numerous trips to the implantologist might be required due to screw loosening, which has to be tightened periodically.
Patients Perspective Simple, Single sitting affordable procedure with immediate loading. Complex, multiple sitting, expensive procedure with delayed loading.