Comparision of tooth and implant/endodontic courses

INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMYLeader in continuing Dental EducationLeader in continuing Dental Education

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CONTENTSCONTENTS INTRODUCTIONINTRODUCTION STRUCTURE OF PERIODONTAL STRUCTURE OF PERIODONTAL

LIGAMENTLIGAMENT STRUCTURE OF PERI-IMPLANT TISSUESSTRUCTURE OF PERI-IMPLANT TISSUES CLINICAL PARAMETERS COMPARING CLINICAL PARAMETERS COMPARING

TEETH AND IMPLANTTEETH AND IMPLANT BIOMECHANICAL DIFFERENCE BIOMECHANICAL DIFFERENCE

BETWEEN TEETH AND IMPLANTBETWEEN TEETH AND IMPLANT CONCLUSION CONCLUSION BIBLIOGRAPHYBIBLIOGRAPHY


INTRODUCTIONINTRODUCTION The primary function of a dental implant is to The primary function of a dental implant is to

act as an abutment for a prosthetic device, act as an abutment for a prosthetic device, similar to a natural tooth root and crown. The similar to a natural tooth root and crown. The restoring dentist designs and fabricates a restoring dentist designs and fabricates a prosthesis similar to one supported by a tooth prosthesis similar to one supported by a tooth and as such also evaluates and treat the dental and as such also evaluates and treat the dental implant similarly to a natural tooth. Yet implant similarly to a natural tooth. Yet fundamental differences in the support system fundamental differences in the support system have to be recognized. have to be recognized.


PERIODONTAL LIGAMENTPERIODONTAL LIGAMENT

Synthetic cellsSynthetic cells Resorptive cellsResorptive cells Epithelial cellsEpithelial cells Extracellular matrixExtracellular matrix - fibers- fibers - ground substances- ground substances Other structuresOther structures Functions.Functions.


PERI-IMPLANT TISSUES PERI-IMPLANT TISSUES 3 mm tissue3 mm tissue 2 layers - epithelial 2 layers - epithelial - connective- connective Few epithelial layerFew epithelial layer lacks keratinizationlacks keratinization Increased susceptible.Increased susceptible. Sole vascular supply – Sole vascular supply –

alveolar supraperiosteal.alveolar supraperiosteal. Connective tissue rich in Connective tissue rich in

collagencollagen Acellular and avascular.Acellular and avascular.


CLINICAL PARAMETERSCLINICAL PARAMETERS Longevity Longevity PainPain Mobility Vs rigid fixationMobility Vs rigid fixation PercussionPercussion Crestal bone lossCrestal bone loss Radiographic evaluationRadiographic evaluation Keratinized tissueKeratinized tissue Probing depthsProbing depths Bleeding indexBleeding index Peri-implant diseasePeri-implant disease


LONGEVITYLONGEVITY

Criteria for implant success;[Albrektsson]Criteria for implant success;[Albrektsson]1.1. An individual unattached implant is An individual unattached implant is

immobile when tested clinically.immobile when tested clinically.2.2. The radiograph does not demonstrate any The radiograph does not demonstrate any

evidence of periimplant radiolucency.evidence of periimplant radiolucency.3.3. Vertical bone loss is less than 0.2mm Vertical bone loss is less than 0.2mm

annually after the first year of service of the annually after the first year of service of the implant.implant.


4.4. Individual implant performance is Individual implant performance is characterized by an absence of persistent or characterized by an absence of persistent or irreversible signs and symptoms such as irreversible signs and symptoms such as pain, infections, neuropathies, paresthesia, or pain, infections, neuropathies, paresthesia, or violation of the mandibular canal.violation of the mandibular canal.

5.5. Success rate is a minimum of 85% for 5 Success rate is a minimum of 85% for 5 years and 80% for 10 years.years and 80% for 10 years.


PAINPAIN Subjective findings of pain, tenderness and Subjective findings of pain, tenderness and

sensitivity are commonly seen in natural tooth. sensitivity are commonly seen in natural tooth. A natural tooth often becomes hyperemic and A natural tooth often becomes hyperemic and cold temperature sensitive as the first indicator cold temperature sensitive as the first indicator of the problem. Tooth becomes sensitive to of the problem. Tooth becomes sensitive to heat and painful to percussion, indicating heat and painful to percussion, indicating pulpitis. pulpitis.


The implants does not become hyperemic and is not The implants does not become hyperemic and is not temperature sensitive, and the early warning signs temperature sensitive, and the early warning signs and symptoms of a problems may not be present. and symptoms of a problems may not be present.

Pain is rarely associated with the implant after Pain is rarely associated with the implant after primary healing.primary healing.

Forces upto 500g are used clinically to evaluate tooth Forces upto 500g are used clinically to evaluate tooth or implant pain or discomfort.or implant pain or discomfort.

The persistent pain during percussion or function on The persistent pain during percussion or function on implant- removal even in the absence of mobility.implant- removal even in the absence of mobility.


Pain in implant occurs due to ;Pain in implant occurs due to ;1.1. Soft tissue entrapment between implant and Soft tissue entrapment between implant and

abutment- elimination of soft tissue.abutment- elimination of soft tissue.2.2. Implant placed proximity to nerve – unthread Implant placed proximity to nerve – unthread

the implant and reevaluate.the implant and reevaluate.3.3. Bone stress beyond physiologic limits – Bone stress beyond physiologic limits –

address occlusion and parafunctional habits, address occlusion and parafunctional habits, prosthesis should be modified, or additional prosthesis should be modified, or additional implants placed to dessipate the forces.implants placed to dessipate the forces.


MOBILITYMOBILITY Natural tooth, usually anteriors moves around Natural tooth, usually anteriors moves around

0.1mm and molars around 56 to 73microns.0.1mm and molars around 56 to 73microns. Implant moves less than 73 microns.Implant moves less than 73 microns. Mobility can be tested using two rigid Mobility can be tested using two rigid

instruments apply a labiolingual force of instruments apply a labiolingual force of approximately 500g.approximately 500g.


Clinical implant mobility scaleClinical implant mobility scale

Scale descriptionScale description0 absence of clinical mobility0 absence of clinical mobility1 Slight detectable horizontal mobility 1 Slight detectable horizontal mobility 2 Moderate horizontal mobility upto 2 Moderate horizontal mobility upto

0.5mm 0.5mm 3 Severe horizontal movement greater 3 Severe horizontal movement greater

than 0.5mmthan 0.5mm4 Visible moderate to severe horizontal 4 Visible moderate to severe horizontal

and any visible vertical movement. and any visible vertical movement. www.indiandentalacademy.comwww.indiandentalacademy.com

Natural tooth with primary occlusal trauma exhibits Natural tooth with primary occlusal trauma exhibits an increase in mobility and radiographic periodontal an increase in mobility and radiographic periodontal ligament space. Once the cause of trauma is ligament space. Once the cause of trauma is eliminated, the tooth return to zero mobility and a eliminated, the tooth return to zero mobility and a normal radiographic appearance. normal radiographic appearance.

In implant, with 0.1mm horizontal mobility, on In implant, with 0.1mm horizontal mobility, on occasion may return to rigid fixation. To achieve this, occasion may return to rigid fixation. To achieve this, implant should be completely out of occlusion for implant should be completely out of occlusion for several months.several months.


Periotest – is a computed mechanical device Periotest – is a computed mechanical device developed by developed by Schulte Schulte that measures the that measures the damping effect of an object.damping effect of an object.

The recording ranges from -8 to +50. teeth The recording ranges from -8 to +50. teeth with zero clinical mobility have typical ranges with zero clinical mobility have typical ranges from +5 to +9. implant corresponds to values from +5 to +9. implant corresponds to values ranging from -8 to +9.ranging from -8 to +9.


PERCUSSIONPERCUSSION

It is used on teeth to It is used on teeth to determine which tooth determine which tooth is sensitive to function is sensitive to function or is beginning to or is beginning to abscess.abscess.

The ringing sound that The ringing sound that occurs on percussion occurs on percussion corresponds to the corresponds to the presence of bone presence of bone implant interface.implant interface.


CRESTAL BONE LOSSCRESTAL BONE LOSS

Under ideal conditions a tooth or implant should lose Under ideal conditions a tooth or implant should lose minimal bone.minimal bone.

AdellAdell et al, determined that successful implants after et al, determined that successful implants after first year loading had an average 0.1mm bone loss for first year loading had an average 0.1mm bone loss for each year.each year.

Early loss of crestal bone beyond 1mm after prosthsis Early loss of crestal bone beyond 1mm after prosthsis delivery is usually a result of excessive stress at the delivery is usually a result of excessive stress at the crestal implant-interface.crestal implant-interface.

the dentist should evaluate and reduce stress factors the dentist should evaluate and reduce stress factors such as occlusal forces, cantilever length, and such as occlusal forces, cantilever length, and especially parafunction on observation of initial bone especially parafunction on observation of initial bone loss.loss.


RADIOGRAPHIC EVALUATIONRADIOGRAPHIC EVALUATION

The radiographic assessment of natural teeth assists in The radiographic assessment of natural teeth assists in determining the presence of decay, lesions of endodontic determining the presence of decay, lesions of endodontic origin and periodontal bone loss.origin and periodontal bone loss.

Implants do not decay and do not develop endodontic related Implants do not decay and do not develop endodontic related conditions.conditions.

Crestal bone loss around the implant can be evaluated but Crestal bone loss around the implant can be evaluated but radiograph only illustrates clearly the mesial and distal crestal radiograph only illustrates clearly the mesial and distal crestal levels of bone , but early bone loss often occurs on the facial levels of bone , but early bone loss often occurs on the facial aspect.aspect.

An absence of radiolucency does not mean presence of bone at An absence of radiolucency does not mean presence of bone at the implant interface, since 40% decrease in density is the implant interface, since 40% decrease in density is necessary to produce a traditional radiographic difference.necessary to produce a traditional radiographic difference.


Parallel periapical radiographs are more difficult to Parallel periapical radiographs are more difficult to obtain for implants than for tooth, obtain for implants than for tooth,

Radiographs are taken and reviewed every 6 to 8 Radiographs are taken and reviewed every 6 to 8 months until stable for two consecutive periods. If months until stable for two consecutive periods. If bone loss greater than 2mm is observed from the bone loss greater than 2mm is observed from the bonelevels noted from stage II uncovery to the bonelevels noted from stage II uncovery to the prosthesis delivery, parafunction on the transitional prosthesis delivery, parafunction on the transitional prosthesis should be suspected. Night guards and prosthesis should be suspected. Night guards and stress reduction on the affected implants are stress reduction on the affected implants are indicated.indicated.


KERATINIZED TISSUE CONCERNSKERATINIZED TISSUE CONCERNS

Minimum of 2mm keratinized tissue and 1mm Minimum of 2mm keratinized tissue and 1mm attached gingiva.attached gingiva.

Least amount of keratinized tissue is in I PMLeast amount of keratinized tissue is in I PM If other periodontal index are normal, If other periodontal index are normal,

keratinized gingiva plays minimal rolekeratinized gingiva plays minimal role Its not mandatory but benefit if present.Its not mandatory but benefit if present.


PROBING DEPTHSPROBING DEPTHS The correct pressure The correct pressure

recommended for probing is 20 recommended for probing is 20 g, g,

Sulcus depths greater than 5 to Sulcus depths greater than 5 to 6 mm have a greater incidence 6 mm have a greater incidence of anaerobic bacteria of anaerobic bacteria

the probing depth next to a the probing depth next to a healthy implant is typically healthy implant is typically greater than that of a healthy greater than that of a healthy natural tooth natural tooth

material from which the probe material from which the probe should be fabricatedshould be fabricated


BLEEDING INDEX BLEEDING INDEX Gingival bleeding when probing correlates Gingival bleeding when probing correlates

with Inflammation and the plaque Index with Inflammation and the plaque Index inflammation is typically less around implants inflammation is typically less around implants

than around teeth than around teeth Loe and Silness gingival index Loe and Silness gingival index


PERI-IMPLANT DISEASE PERI-IMPLANT DISEASE Initial pellicle composition is similarInitial pellicle composition is similar They contain gram +ve bacilli and cocci.They contain gram +ve bacilli and cocci. Supra gingival calculus is seen in implant but Supra gingival calculus is seen in implant but

not subgingival .not subgingival . Calulus around the implant is less tenaciousCalulus around the implant is less tenacious Gingivitis is a bacteria-induced inflammation Gingivitis is a bacteria-induced inflammation

involving the region of the marginal gingiva involving the region of the marginal gingiva above the crest of bone and is similar in both above the crest of bone and is similar in both teeth and implant- peri mucositis.teeth and implant- peri mucositis.


The bacteria in gingivitis around a tooth may affect The bacteria in gingivitis around a tooth may affect the epithelial attachment but without loss of the epithelial attachment but without loss of connective tissue attachment. Because the connective connective tissue attachment. Because the connective tissue attachment of a tooth extends an average of tissue attachment of a tooth extends an average of 1.07 mm above the crestal bone, at least 1 mm of 1.07 mm above the crestal bone, at least 1 mm of protective barrier above the bone is left. protective barrier above the bone is left.

In contrast, no connective tissue attachment zone In contrast, no connective tissue attachment zone exists around an implant because no connective fibers exists around an implant because no connective fibers extend into the implant. Hence no connective tissue extend into the implant. Hence no connective tissue barrier exists to protect the crestal bone around an barrier exists to protect the crestal bone around an implant. implant.


Periodontitis around teeth is caused by bacteria, Periodontitis around teeth is caused by bacteria, characterized by apical proliferation and ulceration of characterized by apical proliferation and ulceration of the junctional epithelium, progressive loss of the the junctional epithelium, progressive loss of the connective tissue attachment, and loss of alveolar connective tissue attachment, and loss of alveolar bone.bone.

After prosthesis delivery, early crestal bone loss After prosthesis delivery, early crestal bone loss around an implant usually is not caused by bacteria. around an implant usually is not caused by bacteria.

However, bacteria on occasion may be the primary However, bacteria on occasion may be the primary factor. Anaerobic bacteria have been observed factor. Anaerobic bacteria have been observed especially when sulcus depths are greater than 5 mm.especially when sulcus depths are greater than 5 mm.


BIOMECHANICAL DIFFERENCESBIOMECHANICAL DIFFERENCES

TOOTHTOOTH Shock absorberShock absorber Decreased stressDecreased stress Mobility to occlusalMobility to occlusal trauma, returns aftertrauma, returns after elimination.elimination. MovementMovement 8-28 microns vertical8-28 microns vertical 56-108 horizontal 56-108 horizontal Pivot movement present which Pivot movement present which

minimizes crestal bone loss minimizes crestal bone loss

IMPLANTIMPLANT no resilient interfaceno resilient interface no force dissipationno force dissipation irreversible bone lossirreversible bone loss 0-5 microns, 10-50microns.0-5 microns, 10-50microns. No pivot movement, stress No pivot movement, stress

concentration at bone crest. concentration at bone crest.


Biomechanical designBiomechanical design

Greater width of Greater width of occlusal surface hence occlusal surface hence lesser magnitude of lesser magnitude of stress.stress.

Cross section shape Cross section shape resists bucco-lingual or resists bucco-lingual or lateral load.lateral load.

Similar elastic modulus Similar elastic modulus of tooth and implant.of tooth and implant.

Lesser widthLesser width

Round cross sectionRound cross section

Difference in elastic Difference in elastic modulusmodulus


Sensory nerve complexSensory nerve complex

Premature contact – Premature contact – orthodontic migration.orthodontic migration.

Excess tongue/oral habits Excess tongue/oral habits can cause migrationcan cause migration

Early detection of Early detection of occlusal load. Hence bite occlusal load. Hence bite force is of less magnitudeforce is of less magnitude

Increased occlusal Increased occlusal awareness.awareness.

No orthodontic movementNo orthodontic movement

Biting force is 4 folds Biting force is 4 folds greater due to lack of greater due to lack of propioception.propioception.

Decreased occlusal Decreased occlusal awareness.awareness.


Clinical evidence of Clinical evidence of occlusal trauma – wear occlusal trauma – wear facets, stress lines, lines facets, stress lines, lines of luder, cervical of luder, cervical abfraction.abfraction.

Fatigue fracture.Fatigue fracture.


CONCLUSIONCONCLUSION Devan stated that preservation of that which Devan stated that preservation of that which

remains and not the meticulous replacement of remains and not the meticulous replacement of what is lost. Even though the implant has got what is lost. Even though the implant has got more advantages compared to other prosthesis, more advantages compared to other prosthesis, ultimately, it is the natural tooth which ultimately, it is the natural tooth which remains the best.remains the best.


BIBLIOGRAPHYBIBLIOGRAPHY Contemporary Implant Dentistry – Carl E.Misch Contemporary Implant Dentistry – Carl E.Misch Endosseous implants for Maxillofacial Endosseous implants for Maxillofacial

reconstruction – Block and Kent reconstruction – Block and Kent ORBANS “Oral histology & embroyology”ORBANS “Oral histology & embroyology” Dental Clinic of North America.-Implantology-Dental Clinic of North America.-Implantology-

July 2006;50;3.July 2006;50;3. Dental implants- the art and science- Charles Dental implants- the art and science- Charles

A.Babbush.A.Babbush. Implants and restorative dentistry- Gerard Implants and restorative dentistry- Gerard

M.Scortecci.M.Scortecci. www.indiandentalacademy.comwww.indiandentalacademy.com

Comparision of tooth and implant/endodontic courses

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Transcript of Comparision of tooth and implant/endodontic courses