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Differences between implant and nature tooth

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(a) teeth (b) around implants typical of the Branemarksystem (c) the non-submerged ITI implant system

Natural: On enamel

Implant: on titanium(abutment/implant)

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Frontal view ofgingival fiber groups(A) Circular(B) Dentogingival(C) Dentoperiostal(D) Alveologingival

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PDL

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PDL

0.1 to 0.2 mm in widthsupport the teeth in a viscoelastic manner

Cellsosteoblasts, osteoclasts,cementoblasts ancementoclasts, fibroblasts, epithelial rests ofMalassez,undifferentiated mesenchymal cells,

neurovascular elements...extracellular constituents

Fibers (collagen fibers, oxytalan fibers)

Ground substance

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collagen fiber

type I collagen fiberSharpey's fibres

in the root cementumand the alveolar bone

principal fibersAC: alveolar crest fibersH: horizontal fibersOBL: oblique fibersPA: periapical fibersIR: interradicular fibers

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Blood supply-natural tooth

Natural toothFrom the PDL to theconnective tissue

from the alveolarprocess to the PDLand then to theconnective tissue

from the alveolarprocess directly to theconnective tissue

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Blood supply-implant

timeAfter extraction

After implant placement

reasonDue to the absence of aPDL

dynamic process of boneremodeling

Increase in corticalbone, decrease in

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Recession of buccal gingiva tissue is a commonoccurrence→ implant exposure (estheticproblem)

Evaluation of the patient’s (soft) tissue biotypeand bone thickness should be conducted at thetime of Tx planning

The thicker the native hard and soft tissue, themore abundant the blood supply that can beexpected after implant placement

complication

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tooth loss → resorption in a palatal direction →ridge thinning

The thin bone remaining on the facial aspect ofthe implant tends to be cortical, withsignificantly less vascularity

After implant placement, the biological width

must be reestablishedBone loss to 1 st implant thread

Blood supply(bone remodeling)

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Branemark/submerge/ two stage

bone margin: located at thefirst thread

The JE: on the abutmentThe join between abutment andimplant head : is located withina zone of non-arrangedconnective tissue of about 1mmto 2 mm in width

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ITI Straumann type / non-

submerged/single stage roughened surface

within bone

smooth neckan integral part of the implanttransmucosal collar

JE

located on the implantthe implant/abutment join islocated coronal to this level

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Bone

two-stage implantvertical and horizontal bone loss occurring afterabutment connection

Platform-switchingshifting the implant abutment junction inward andaway from the peri- implant bone → preservation of crestal bone → (increase blood supply)→ supportsoft tissue

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Probing depth

natural teethhealth : probe penetrates the JE to somedegreeInflammation: probe is stopped by the mostcoronal intact gingival connective tissue fibres,about 2 mm from the bone

Implantsulcus depth is very much dependent upon thethickness of the soft tissue cuffgenerally deeper than around teeththe probe tip finishing short of the bonemargin by about 2 mm

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Probing depth

natural teethimportant part of dental examination

Implantinformation questionabledo not recommend probingradiographic assessment of bone levelsdigital pressure on soft tissue: bleeding orsuppuration

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> 10 Years:a. Keep tooth and restore as indicated.

5-10 Years:a. Make independent implant restoration.

b. If abutment must be included, make coping andretrievable prosthesis.

c. Make tooth a "living pontic" by adding moreimplants or splinting to additional teeth.

< 5 Years:

a. Extract and graft.