Tooth loss is very a very common problem; therefore, the use of dental implants is also a common practice. Although research on dental implant designs, materials and techniques has increased in the past few years and is expected to expand in the future, there is still a lot of work involved in the use of better biomaterials, implant design, surface modification and functionalization of surfaces to improve the long-term outcomes of the treatment. This article provides a brief history and evolution of dental implants.
Introduction to dental implants:
Tooth loss is very common and it can happen as a result of disease and trauma; therefore, the use of dental implants to provide support for replacement of missing teeth has a long and multifaceted history.
Statistics provided by the American Association of Oral and Maxillofacial Surgeons show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth6. Therefore, the use of dental implants reveals that about 100,000-300,000 dental implants are placed per year, which approximates the numbers of artificial hip and knee joints placed per year.
Research on dental implant designs, materials and techniques has increased in the past few years and is expected to expand in the future due to the recent growth of the global market for dental implants and the rising in the demand for cosmetic dentistry.
Evolution of Dental Implants:
The history of dental implants can be traced back to ancient Egypt, where carved seashells and/or stones were placed into the jaw bone to replace missing teeth. Other documented examples of early implants are those fabricated from noble metals and shaped to recreate natural roots.
Dental implants have a history of several centuries starting with the early civilizations more than 2,000 years ago in South and North America and regions of the Middle Asia and Mediterranean. Archeological findings have indicated that these civilizations replaced missing teeth using carved stone, shells, bones and gold.
Around 1930s, archaeological excavations in Honduras revealed that the Mayan civilization had the earliest known examples of dental implants, dating from about 600 AD, when a fragment of mandible with implants was found. The specimen had three pieces of shells carved into tooth shapes placed into the sockets of three missing lower incisor teeth. Later on, it was also observed that there was compact bone formation around two of the implants.
In the Middle Ages, dental implantation was performed by using allografts and xenografts. However, this practice didn’t become very popular, since it was identified as the reason for infectious diseases and even deaths.
Modern dental implant history starts during World War II when in the years of service in the army, Dr. Norman Goldberg thought about dental restoration using metals that were used to replace other parts of the body. Later on in 1948, in association with Dr. Aaron Gershkoff, they produced the first successful sub-periosteal implant. This success formed the foundation of implant dentistry in which they were pioneers in teaching techniques in dental schools and dental societies around the world.
One of the most important developments in dental implantology occurred in 1957, when a Swedish orthopaedic surgeon by the name of Per-Ingvar Brånemark began studying bone healing and regeneration and discovered that bone could grow in proximity with the titanium (Ti), and that it could effectively be adhered to the metal without being rejected13. Therefore, Brånemark called this phenomenon ‘osseointegration’, and he carried out many further studies using both animal and human subjects. In 1965, he placed the first Ti dental implants into a 34-year-old human patient with missing teeth due to severe chin and jaw deformities. Brånemark inserted four Ti fixtures into the patient’s mandible, and several months later he used the fixtures as the foundation for a fixed set of prosthetic teeth. The dental implants served for more than 40 years, until the end of the patient’s life.
Brånemark published many studies on the use of Ti implants, and between 1978 and 1981, he co-founded a company for the development and marketing of dental implants. Brånemark’s discovery had such a profound impact in dentistry that to the present day, over 7 million Brånemark System implants have now been placed and hundreds of other companies produce dental implants.
In May of 1982, Brånemark presented the results of his 15 years of human and animal research at the Toronto Conference on Osseointegration in Clinical Dentistry, and shortly after the conference, researchers from the United States were trained in Brånemark’s methods in Sweden.
In 1982, the US Food and Drug Administration approved the use of Ti dental implants, and in 1983, Dr. Matts Andersson developed the Procera (Nobel Biocare, Zurich, Switzerland) computer-aided design and computer-aided manufacturing (CAD/CAM) method of high precision, repeatable manufacturing of dental crowns15. Recent progress in the past century has focused on materials and techniques to improve quality and anchorage16; and after the mid-1980s, other important developments in dental implantology have been focused in the esthetic restorations.
The development of modern ceramics started in 1992; and from that time on, dental implant companies, have incorporated ceramic surface treatments and ceramic-like elements to implants with the purpose of further enhancing osseointegration.
Today, approximately 450,000 osseointegrated dental implants are being placed every year, with an expectation of 95% success rate (in the case of single tooth replacement with an implant supported crown), with minimum risks and associated complications.