Stability With Implant Dentistry

We have in implant dentistry, this concept of mechanical stability versus biologic stability. For an implant that’s placed initially, the implant pilot hole, or the hole that we drill, will always be a little smaller than the implant itself. An implant is like a screw. So, if you imagine drilling a pilot hole in some wood or something, it’s about the same. 

Unlike the wood, though, the bone changes after you’ve placed this implant in. In the initial placement of the implant, we have some implied mechanical stability, meaning it’s in there tight, and we want to get the implant in tight enough so that it can be used in whatever way that we need to use it under those circumstances. That tightness is measured in Newton centimeters. 

So, we do have tools that we use chairside to determine how these implants go in- a certain amount of tightness, per say. If it’s tight enough, it can be used right away. You can think of it like that.  

Now, over time, that stability decreases because bone ends up healing. In order for the bone to heal to the implant, it has to resorb a little bit and make room for new bone to form into it. 

So, it loosens up a little bit, and these curves cross in a certain way to the healing curve and the initial mechanical stability curve and the point in which they cross where the initial stability has gone, and now we’re dealing more with the biologic stability or the healing stability, the actual number or whatever we decide that number is doesn’t matter. 

The real question is, is it tight enough not to get impacted by that initial use so that it loosens up on itself? It’s a really important question in making decisions and determinations as to what we’re doing with this implant. Will it be a good idea for us to use it right away? Should we decide to let it sleep or heal below the gum line? Should we even use a mini-implant versus a standard implant?  

A mini-implant is always one piece, so there’s always a piece sticking up from the gums. Whereas a standard implant has these pieces that we can screw, these attachments, we can screw on and off to allow for it to heal without being disturbed. A really important question and kind of a long-winded answer, but a lot of those decisions that we make surrounding what type of implants should be used here, how we should use, how we should determine what strategy to use, whether it be immediately placed or delayed placement should we do bone grafting or should we put the implant in right away after the extraction?  

Those are all the things that go through my head and go through the heads of dentists that understand these types of things and trying to achieve the patient’s goals, right? Everybody wants to have something done really quickly. Single-stage surgery, if possible, doesn’t have to come back very often. All those things are really exciting. 

Sometimes, it’s just not practical because the risk of having an implant problem is too great under the circumstances that are presented. Now, that’s also why oftentimes when you call our office or maybe another dental office, we say, “We’d like to see you for that consultation”, because some of these measurements and some of these tolerances needs to be evaluated with the 3D image or a 3D X-ray so that we can actually answer that question. 

So if the question becomes, “How much is an implant?” we need to know what process to take meaning. We need to ask you what we’re trying to achieve first. Then, we need to take X-rays and evaluate what type of strategy we should use. And then thirdly, what we want to know is what type of timeline and what type of implant, all those things. 

It all wraps all into one. So that’s why we offer free consultation so that we can have an opportunity to give you all these answers. How much is it going to cost? How much time is it going to take? It all wraps into this question, so it’s a very good one.