Dental News

By Dr. Dheeraj Kumar Koli

Dental implants are screw shape devices used for anchorage for dental prosthesis i.e. crown, dentures inside the mouth. They are made of titanium alloy and serves as a replacement for the root of missing tooth. They are used in adults of all ages for the replacement of teeth missing due to trauma, decay, or if an individual born without teeth. An abutment is connected to the implant fixture and over the abutment; a tooth cap or denture was fixed to provide the functions. Once they are placed in the jaw bone, they form a bond with the bone and provide rigid base support for artificial teeth replacement.  They are indicated in adolescents once the facial growth is completed i.e. 16year for girls and 18 years for boys. Dental implants result in the restoration of the masticatory and cosmetic function of the individual so that the individual can enjoy his life confidently.

Q. How much time it takes to replace the teeth with the help of a dental implant?

A. Every patient depending on their need, medical and dental history and the health of supporting jawbones requires a customized treatment strategy. It can be 4 to 6 months for simple cases and up to 1 year for complex cases.

Q. Is dental implant treatment is safe.

A. Dental implants are a safe and effective procedure for the last 30 plus years. The implant dentist should educate the patient regarding the effect of certain medical conditions and habits like smoking which affect the success and prognosis of dental implants. Qualified dentists with highly competent skills will be able to manage the complications if any arises.

Q. Does dental implant is a painful procedure.

A. With the help of good anaesthesia the implant placement is relatively painless and the use of analgesic postoperatively reduces the discomfort and pain associated symptoms. Usually, patients return to their day to day activity from the next day post-implant placement.

Q. What are the steps for dental implant treatment?

A.  Dental implant requires following steps –

• Pre-treatment examination involving oral cavity examination, X-rays, and 3-dimensional evaluation of bone quantity and quality. Design a treatment plan specific to the situation.
• Dental implant placement under anaesthesia and management of post-operative symptoms like pain, mild swelling, and discomfort by the use of medicine.
• It will take few months (3 to 6months) so, that firm bond formation between implant and bone. During the healing phase, soft biting is allowed to prevent premature implant loading.
• After implant healing and abutment connected to the implant fixture and a dental crown will be attached to it.
• Maintenance of good oral hygiene and periodic check-up is required for the long term health of the implants.

Q. Dental Implants VS Fixed Bridge

A.  Dental fixed bridge requires grinding of two adjacent teeth to provide support for the bridge for the missing tooth while a Dental Implant will be placed in the site of missing teeth without grinding the adjacent teeth. The ground teeth underneath the bridge have also become prone to decay and bone loss. So dental implants will be an effective way of restoring the natural smile.

Q. What are the different types of implants and techniques?

A. Dental implants are available in different sizes, shapes, and designs. The treating implant dentist will select the suitable implant type and the treatment for the clinical situations.

Q. What is the longevity of implants?

A. Dental implant longevity is good if the patients are following a good oral hygiene regime and regular follow-ups after dental implant therapy. The dental implant has a good survival rate of 15plus years if all the factors related to implant health like gums and bone health are controlled.

The writer is Dr. Dheeraj Kumar Koli who Associate Professor, Prosthodontics and Oral Implantology. Diplomate of World Congress of Oral Implantology, Japan Division, All India Institute of Medical Sciences New Delhi.

By Dr Anil Chandna & Dr Anmol Kalha

The unprecedented pandemic brings with it a huge weight of fear and suffering. Now after lockdown, almost all aspects of human existence are challenged, institutions as we know them, stumble and leadership struggles to give direction to find a way through uncharted waters. Healthcare reassembles itself as all elective procedures are on hold and only OPDS are on and the entire focus is on containing and responding to the challenges of the virus.

Dentistry came to a sudden stop from 22 March 2020, as lockdown after lockdown brought the realisation that there was a serious issue at hand. All clinics were shut, institutions closed and advisories were abound high- lighting the risks of dental care, the virus being a silent passenger of aerosols, salivary glands, the mouth and the very air that was breathed in the close proximity of the patient. Since then, a slew of discussions have only served to highlight the fears and the new challenges of perhaps returning to the analog era from a rapidly advancing digital era of dentistry. The massive influx of technology, newer materials and techniques helped to build a business in India which was valued at roughly $1.36 billion, employing almost 20 lakh people directly or indirectly. 313 recognised institutions with almost 15,000 faculty and staff would add another annual dimension of Rs 1,800 crore and the stakes are high.

Before the pandemic hit and alarm bells rang regarding the lack of job opportunities, less than 50% of the graduating dentists were register- ing with dental councils for clinical practices. Rising costs of infrastructure and equipment, concentration of dental practices in metros had begun to create a negative aura to this profession, which was at one hand being grudgingly accepted as a part of mainstream healthcare. It continued to be the privilege of the wealthy and the elite as all spending was from private incomes, practically no insurance and very little in- vestment by the government to employ dentists or create opportunities in the rural sec- tor. The lack of direction even at the height of the pandemic is very obvious as no clear directions have emerged from the Ministry of Health and Family Welfare on resumption of dental practices. Advisories are there from the Dental Council and the professional associations but at the end of the day, executive directions can only be issued by the administration. A proposal to create DGDS in the Health Ministry was tabled to handle direct responsibility and regulate the dental profession but it languishes at the lack of interest and intent.

The road ahead

1. The lack of financial support will seriously impact the young dentists who entered into practice carrying a huge burden of rentals and loans. This has a huge impact as earnings dropped to zero at the beginning of the lockdown and after and the return will be slow with additional costs of PPEs, masks, trained assistants, limited appointments and the inherent fears that abound in the minds of doctors and patients both on the virulence of the virus. Add to this, the fear of quarantines and health issues in the event of a possible infection and the ripple effects begin to gather furious momentum. Is there a bail out? No one knows.

2. The practices and clinics were unregulated and not really meeting the baseline norms of asepsis and infection control before the pandemic. The first attempt to regulate was made by the government in the form of the ‘Clinical Establishments Act’ which defined the minimum requirements for both rural and urban practices. This was to be implemented in full measure and will need to be done if dentistry has to return to its position in mainstream health care.

3. Dental institutions will have to transform to provide departments of bio-safety, create adequate processes in the clinics as the fears and threats are real. Students will need training in infection control protocols, standards drill beyond the webinars and luminaries who espouse unreal wisdom. The positive aspect is that as international travel and living overseas un- veils the threats to students, there will be a return to In- dian institutions and those who transform and adapt will not only survive but flourish, after all a population of 1.3 billion people will always have oral healthcare needs.

4. Dental treatment will have to return to realism and efficiency with minimal contacts, greater reliance on diagnostics and skills rather than a massive influx of apparent technology and advertising. The whole concept of cost of care will need to be redefined. It will be about value and not just availability.

5. Investment in training of dental assistants and para- dental staff will be worth the while as the new dentistry will need a set of people with skills in infection control and assisting. This could open up an entire new field for dental institutions with excess capacity as it is and certificate courses would be very much in demand.

6. Investment in manufacture of dental materials and equipment with an export focus is very much a possibility. As global supply chains are suspended, China-centric manufacture will shift and could go in favour of intrinsic manufacture and marketing. If we are the pharmacy to the world, so could it be for dental materials and equipment.

7.We are in the midst of a population shift from urban to rural. It’s time for the government and private players to look at dental setups in rural India.

The virus is here and while there is a hushed silence, it has not solved all the issues of oral health. The world is rebooting and so should dentistry in India. There may be a lull but all is not lost. It may be a slow re- turn but return we will; after all, India has shown tenacity and resilience in the face of all adversity. Dental Council of India is putting all efforts under the Health Ministry for better outcomes.

Dr Anil Chandna is the executive member of Dental Council of India and Dr Anmol Kalha is a senior dentist.