Today All-on-4 represents an optimal treatment plan for many people who are not candidates for traditional dental implant procedures, but want to avoid the discomfort and inconvenience of loose dentures. But it’s been a long struggle to get here.
The Prehistory of Implants
There are a few examples of early implants placed by people who didn’t record their techniques or technology. Perhaps the earliest examples of true dental implants come from a recent discovery in La Chene, France, southeast of Paris. Dated to about 2300 years ago, researchers found the remains of a woman whose skull had been crushed. The remains included 31 teeth and an iron bar, which images taken at the site show was sitting in the place of the missing tooth. This is strong evidence, but it’s not conclusive. We don’t know for sure that the implant was placed in life.
The first definitive dental implants known is the use of shells implanted in place of lost teeth by the Maya around 600 AD. X-rays taken of the jaws that hold the implants show that the shells achieved osseointegration: they had been incorporated into the jawbone. We know these were implanted during life and stayed in place long enough for this healing to take place.
Implant Renaissance: High Hopes and Inflammation
During the Renaissance people tried to replace teeth with many different structures, most often tubes or screws that could serve as a tooth root. They topped the implant with a cosmetic dental crown, similar in principle to modern dental implants. But the materials used for these implants (gold, platinum, chromium, molybdenum, and others) did not integrate well and often caused significant inflammation, leading to discomfort and implant failure.
Giving Up on Integration
The failure to achieve consistent osseointegration led to frustration among many researchers, and they began to look for other ways to secure replacement teeth. People looked for alternatives that didn’t integrate into the jawbone, developing subperiosteal and transosteal implants.
Subperiosteal implants sit directly under the gums on top of the jawbone. A metal superstructure connects the implants together to secure a denture without actually attaching to the bone.
Transosteal implants operate like a mechanical bolt. The implant has two parts: one that fits under the jawbone and passes through the jawbone up to the top. Nuts secure the implant on the top and become anchor points for dental crowns.
Both of these types of implants could provide functional results, but they often resulted in high rates of complications and failure.
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