The first successful implant in human dentistry was performed in 1965.1 Since that time, countless human dental patients have benefited from dental implantation, which has dramatically improved their health and quality of life.
Before the advent of implantation, teeth were saved at all costs, often to the local and systemic detriment of the patient. Now, diseased teeth are extracted and replaced with healthy implants.2 It has been shown that extracting infected teeth improves the overall jaw structure by maintaining as much of the original bone as possible.
Cosmetic dentistry is a growing business in human medicine, and its popularity in the veterinary field is sure to follow. I believe that many clients would currently choose implants for their pet if they knew the choice was available.
Contraindications for dental implantation are determined by ethical considerations and the local and systemic health of the patient. The health status of the patient should be considered above all else. Implants require multiple surgical events beyond the initial extraction. Implantation may not be suitable in geriatric or chronically ill patients.
Implantation also has a poorer prognosis in patients with diabetes mellitus or those receiving chronic therapy with corticosteroids because of the increased risk for infection.3 Implants should not be placed near sites of current oral infection, and the oral cavity must be treated with a complete dental prophylaxis and any additional therapies as directed by the oral examination and intraoral dental radiography.3
In addition, dental implants are subject to the periodontal bone loss seen with natural teeth. Reasonable assurance that the client will comply with at-home care and follow-up veterinary visits is critical.
Dental implants require an adequate amount of bone for support, which is often a concern because teeth are typically lost secondary to periodontal disease. If a patient has less than 2 mm of bone surrounding the site of implantation or if placement would encroach within 2 mm of the mandibular canal or sinus floor, implantation is not advised.
Ideally, implantation should be considered to replace lost teeth. It is an acceptable option if a patient is missing a tooth from birth but should not be considered to replace missing teeth in show or breeding patients unless a veterinarian has extracted the tooth or there is medical evidence that a tooth was previously present. A legal waiver is strongly advisable in such cases.
Implants in Practice
- Replacing a single tooth with an implant, the most common type of implantation, has the greatest long-term prognosis and cosmetic effect.
- Implants can be used without an artificial tooth (pontic) as a strengthening agent in the maxilla or mandible to avoid alveolar collapse.
- Implants can be placed as anchors or as support (pier) in a fixed bridge.
- One large implant can be used as an attachment for a multitooth span, but this is generally not recommended in veterinary patients, especially for teeth that will be subject to significant use or trauma.