Dental Implants Rationale

Modern dentistry aims to restore patients to normal function, comfort, esthetics, speech, and health.
Dental implants uniquely achieve this goal, regardless of atrophy, disease, or injury.
More than 1 million dental implants are placed annually in the United States; the industry is expected to reach $10 billion in 2020.
The number of implants used varies widely by country; Israel has the highest use at 230 per 10,000 people.
Only a small percentage of teeth replaced in the USA incorporate a dental implant.
Increased demand results from:
- Patients living longer.
- Age-related tooth loss.
- Socially active and esthetic consciousness.
- Higher incidence of partial and complete edentulism.
- Conventional prosthesis complications.
- Inherent advantages of implant-supported restorations.

Life expectancy has increased significantly; a 65-year-old can expect to live 20+ more years.
The population over 65 is projected to increase to over 20% by 2025.
Tooth loss is correlated with age; the need for implant dentistry will increase.
Over 69% of Americans between 35 and 44 have at least one missing tooth.

Aging affects the oral cavity, increasing vulnerability to tooth loss.
Medications cause xerostomia, weakening teeth and causing tissue loss.
Posterior regions mostly affected by single-tooth loss, particularly first molars.
First molars are often the first teeth lost due to decay, failed endodontic therapy, or fracture.
Loss of molars can compromise arch form and occlusion.
Crowns have varying lifespans, with failure often due to caries, periodontal disease, or endodontic issues.
Tooth loss in the elderly is linked to physical and mental decline.
Individuals lacking natural teeth performed approximately 10% worse in memory and mobility tests.

Elderly patients are living longer, maintaining social activities like dining and dating, increasing the importance of comprehensive dental services.

Prevalence of partial edentulism increases the need for dental implants; molar loss is common.
Mandibular free-end edentulism is more frequent than its maxillary counterpart.
Partial free-end edentulism is often managed with removable partial prostheses.
Complete edentulism is decreasing, but the total number of edentulous patients needing treatment will rise in future.
Full mouth extractions are sometimes done in anticipation of future implant placement.
Edentulism rates vary widely; the rate increases approximately 4% per 10 years in early adulthood.
Education and income are inversely proportional to edentulism in the United States.
Approximately 12 million individuals in the United States have edentulism in one arch.
The number of edentulous people is projected to be approximately 8.6 million by 2050.

Bone requires stimulation to maintain form; tooth loss leads to decreased bone density.
Loss of teeth causes remodeling and resorption of alveolar bone.
There is a 25% decrease in the width of bone during the first year after tooth loss and an overall 4-mm decrease in height during the first year after extractions for an immediate denture.
Mandibular bone loss is fourfold greater than in the maxilla.
Removable dentures do not stimulate bone and accelerate bone loss.

Facial changes include a decrease in facial height and loss of the labiomental angle.
The chin rotates forward, creating a prognathic appearance.
Thinning of the vermilion border occurs.
Deepening of nasolabial groove and lengthening of maxillary lip are seen.
Mentalis and buccinator muscles sag, producing jowls or a "witch’s chin."

Fixed Partial Denture Morbidity
- A three-unit fixed partial denture (FPD) also presents survival limitations to the restoration and, more importantly, to the abutment teeth.
- Caries and endodontic failure of the abutment teeth are the most common causes of prostheses failure.
Removable Partial Denture Morbidity
- Removable soft tissue–borne partial dentures (RPD’s) have one of the lowest patient acceptance rates in dentistry
- Those patients wearing the partial dentures often exhibit greater mobility of the abutment teeth, greater plaque retention, increased bleeding on probing, higher incidence of caries, speech inhibition, taste inhibition, and noncompliance of use.
- Complete Denture Morbidity
- Masticatory function is an important factor when discussing com- plete denture function. The difference in maximum occlusal forces recorded in a person with natural teeth and one who is completely edentulous is dramatic. In, the first molar region of a dentate person, the average force has been measured at $150$ to $250$ pounds per square inch (psi).
- A patient who grinds or clenches the teeth may exert a force that approaches $1000$ psi. The maximum occlusal force in the edentulous patient has been shown to be reduced to less than 50 psi
- Patients wearing complete dentures for more than 15 years may have a maximum occlusal force of $5.6$ psi

Bone Maintenance: Implants help maintain alveolar bone by providing stimulation.
Reduced horizontal forces preserve underlying tissues.
A mandibular denture often moves when the mylohyoid and buccinator muscles contract during speech or mastication.
Implants allow teeth to be positioned for esthetics and phonetics, not just stability.
Implants allow vertical dimension to be restored.
Occlusion
- Implants helps the stability of restorations and it is more likely for a patient to return to centric-relation occlusion
Occlusal Awareness
- Implants helps patients function in a more consistent range of occlusion and to control the direction of the occlusal loads by the restoring dentist. , This preserves the underlying soft and hard tissues.
Greater biting force
Improves health
Improves Psychological Health

The future of oral implantology is very positive and is expected to continue as one of the fastest and largest growth areas in medicine.