Good Morning

DENTAL IMPLANTSDR JEBIN,MDS.,D.ICOI

What is implant?

A dental implant is an artificial root that replaces the natural tooth root.

Crown

Gum

Implant

Tooth Root

Jawbone

Parts of implant

Cover screw 

Implant abutment interface

Implant collar

Fixture

The more teeth that are lost, the greater the impact to your patient’s appearance and psychological well-

Tooth loss leads to bone loss - Anterior

Why Dental Implants?

The average reduction in ridge height in the mandible during the first year after extraction is 4mm to 5mm.Note: Wear from clasp

on an otherwise healthy adjacent tooth

Tooth loss leads to bone loss - Posterior

Why Dental Implants?

Clinical Options

Restorative Option

This patient has healthy beautiful

teeth.

One option is to cut away the healthy

tooth structure and provide a three-unit

Or, preserve those two healthy teeth...

Place a single implant and

provide a restoration that looks, feels and

functions like

Restorative Option

Single‐Tooth Implant: Advantages

• High success rates • Decreased risk of caries of adjacent teeth.• Decreased risk of endodontic problems on adjacent 

teeth.• Decreased cold or contact sensitivity of adjacent teeth.• Psychological advantage.• Decreased abutment tooth loss.

Advantages of Implant‐supported Prostheses

• Bone maintenance.• Restoration and maintenance of Occlusal vertical dimension.• Maintenance of facial esthetics (muscle tone).• Esthetic improvement • Improved phonetics.• Improved occlusion.• Increased prosthesis success.

Types Of Implant System

1. Endosseous or root‐form Implants

– Screw or Thread type Implants

– Cylindric or Press fit type Implants

– Tapered Implants

2. Blade form Implants

3. Subperiosteal Implants

4. Transosseous Implants

– Mandibular staple Implant

– Transmandibulor Implants or Bosker Implant

Endosseous or root‐form Implants

1. Screw or Thread type Implants: 

• Uses threads for primary stabilization.

• For the placement of the Threaded Implant the osteotomy site is tapped or prethreaded with a thread‐former bur, to create the threads in the wall of the osteotomy site.

2. Cylindric or Press fit type Implants: 

• Uses friction for primary stabilization.• The placement of a Cylindric Implant 

depends on the friction between the Implant surface and the bone.

Thus no tapping is required.

3. Tapered Implants:

• Resemble a tooth root.

• design for both Threaded and Press fit type Implant. 

• Initially design for immediate placement into extraction socket.

• Dental Implants can be characterized by their macro andmicroscopic surface configuration.

• Macroscopically, we deal with two basic types ofimplants:

– Screws

– Cylinders

• Microscopically we deal with an assortment of surfacetreatments and coatings which are all designed topromote osseointegration.

Surfaces

Specific Micro‐Surface Design:

• Machined• Acid Etch• Shot Blasted• Titanium Plasma Spray• Hydroxyl Apetite (HA) Plasma Spray• Porous Sintered Surfaces     • TiUnite

Machined –

Surface morphology of a machined commercial pure (CP)Ti dental implant under low magnification

Surface morphology of a machined commercial pure (CP)Ti dental implant under high magnification

• Acid Etch –

Advantages:•increase in surface area.

Disadvantages:•possibility of contamination

• Short Blasted –

Advantages:•Increase in surface Roughness may promote ossteoblastic activity

Disadvantages:•Possibility of contamination

• Titanium Plasma Spray ‐

Shows the SEM image ofa Surface morphology ofan commercial pure(CP)Ti plasma-sprayedwith titanium dentalimplants surface

• Hydroxyl Apetite (HA) Plasma Spray ‐

Advantages:•Increases the surface provides an accelerated bio-integration. •HA is osteoconductive and promotes rapid and more complete osseointegration.

Disadvantages:HA is soluble in oral fluids and if the HA is exposed, it will cause implant failure with accelerated bone loss.

• Porous Sintered Surface –

• Groovy

These have thegrooves on the threadsof the implants

It has been shown inscientific studies thatthey increase stabilitycompared to implantswithout grooves.

• TiUnite–

SEM image of the TiUnitesurface, showing thepresence of pores withdimensions around 1-10micron-m and smaller poreswith diameter below 1micron-m

• What is TiUnite?

TiUnite is a highly crystalline and phosphate enriched titanium oxide.

TiUnite is a osseoconductive biomaterial, with its bone and soft tissue stimulating capacity

Case planning and preparation

Pre‐Surgical Planning

• Organized pre‐surgical team planning is key to the success of an implant restoration.

important considerations:• Implant placement

• Occlusal design

• Hygiene maintenance

need to be discussed.

Medical Contraindication

1…Absolute Contraindications– Recent myocardial infarction– Valvular prosthesis– Severe renal disorder– Uncontrolled diabetes– Uncontrolled hypertension– Generalized osteoporosis– Chronic severe alcoholism– Radiotherapy in progress– Heavy smoking(20 cig. a day)

Oral Contraindications:

• Ridge dimensions are insufficient to accommodate proper implant placement

• Lateral oral interferences are present• Habits such as‐

• Tobacco use• Alcohol consumption• Poor oral hygiene• Bruxism• Nail biting• Pencil biting• Tongue habits

• The placement of an endosseous implant is complicated by a initial bacterial load present at the time of surgery.

Survey the surgical site clinically and radiographically

to evaluate

1. Any residual infection is present in the bone2. Presence of a periapical lesion in adjacent

teeth

Before Placement Of an Implant

Propionibacterium acnesStaphylococcus epidermidisStreptococcus intermediusWolinella recta

PorphyromonasPrevotella

Mixed Flora

in endodontically

involved teeth

Hence

Any active endodontic lesions adjacent to the implant site should be treated before endosseous implant placement.

Any active endodontic lesions adjacent to the implant site should be treated before endosseous implant placement.

Overhanging restoration / localized periodontal diseases periostits

Patient’s Attitudes:

• Chief complaints

• Expectations

• Esthetic expectations

• Desired functional results

Patient’s dental history:

• Condition of soft tissue

• Condition of teeth

• Edentulous areas

• Current prosthesis and ability to provide esthetics, phonetis, and function

• Temporomandibular joint problems  

Diagnostic aids

• Panoramic Radiographs

• Lateral Cephalograms

• Tomograms and CT scans

• Mounted Study Cast and Diagnostic Wax‐up

Surgical guide/Template

The most important aim of a surgical guide is to guide the surgeon where to place the implant optimally. In addition, the surgical guide provides information about the tooth and supporting structures that have been lost.

A well‐designed surgical guide provides visual communication between the restorative dentist, implant surgeon and dental laboratory technician. 

Implant Selection

1). Greater the diameter of the dental implant less the crestal bone stress.2). Greater the length of the implant less the crestal bone stress.

Influence of implant diameter and length on 

crestal stress distribution

4 Screw Tap 5 Implantplacement

2 Tapered Drill ø 3.5 mm

3 Tapered Drill ø 4.3 mm

1 Twist Drill ø 2.0 mm

Implant Placement Procedure

•Make an incision for elevation of a fl

•Check orientation of the preparation sidirection indicator

•Drill to the appropriate depth

• Drill to the desired depth to enlarg

•Check orientation of the prepared site

• Drill to the desired depth to enlarg

• Implant placement with implant d

• Use the Surgical Torque Wrench to rotat

• Use the screwdriver to pick up the Cthread it into the implant

• Close and suture the tissue flap

Sinus Lift

Sinus Lift

Indirect sinus lift

Direct sinus lift

Complications 

• Membrane perforation.

• Presence of bony septae which divide sinus into separate compartments.

• Postoperative infection.

• Wound dehiscence.

• Barrier Membrane exposure.

• Transient sinusitis.

Reconstruction of atrophic maxilla and mandible

Various grafting techniques

• Block grafts

• Interpositional Bone Graft

• Alveolar Distraction Osteogenesis

• Combination of bone graft and platelet rich plasma (PRP), decrease the healing time.   

• Soft tissue grafts:Used to increase the width of attached 

gingiva. Connective tissue grafts (most commonly 

used)

Healing

• The word osseointegration was defined as “a direct structural and functional connection between ordered, living bone and the surface of a load carrying implant.” 

Prosthetic phase

Abutments

Abutments are simply transmucosal extensions for the attachment of prostheses.

Abutments can be used to provide a restorative connection above soft tissues and to provide for the biologic width. 

Healing abutment/Gingival former

Esthetic abutment

Angled Esthetic Abutment

Multiunit abutment

Ball abutment

Bar supported over denture

Restorative solutions are the Goal

With the internal connection, three broad categories of restorations are possible: 

• Cement‐retained restorations

• Screw‐retained restorations

• Overdenture restoration 

Treatment Alternative

• One‐stage Immediate Function:

• One‐stage Delayed Function

• Two‐stage Delayed Function

One‐stage Immediate Function

Procedure overviewrestoring teeth with the implants and Immediate Function is similar to crown & bridge.

Requirements  for Immediate Function• High initial implant stability• Controlled loads• Osseoconductive implant surfaces

One‐stage Delayed Function

The one‐stage surgical procedure does not require a second surgical stage, abutments are left protruding through the soft tissue.

Two ‐stage Delayed Function

The two‐stage surgical procedure protects dental implants from functional loading by submerging the implants below the mucosa at the time of placement.

This requires a second surgical stage to uncover the implant.

1 Abutment connection 2 Impression abutment level

3 Laboratory procedures 4 Final restoration

The importance of the maintenance procedures should never be underestimated by either the patient or the therapist.

Maintenance phase

Implant Hygiene Products

Soft bristle toothbrushNon-abrasive toothpasteProxy brushDental flossElectric toothbrushesEnd-tuft brushAntimicrobial rinsesPlastic scalers

Implant Hygiene Products

Why the implants fail…. ?

Classification

• Surgical Complications:Inoperative Complications

1….Oversize Osteotomy.2….Perforation of cortical plates.3….Inadequate soft tissue flaps for

Implant coverage.4….Broken burs.5….Improper Instrumentation6….Hemorrhage.7….Poor angulations & Position of Implant.

• PROSTHETIC COMPLICATIONS:

Component & framework breakage

1….Fractured Frameworks & Mesostructure bars2….Partial loosening of  cemented bars and prostheses3….Inaccurate fit of castings4….Inadequate Torque application5….In accurate frame work abutment interface6….Occlusal factors7….Implant Fracture8….Implant loss

• Short term complications:(six months post operative)

… Postoperative infection… Dehiscent Implants.… Radiolucencies.… Antral complications.… Implant mobility.

• LONG TERM COMPLICATIONS

1…Ailing Implants.2…Failing implants.3…Failed implants.

Ailing Implant

• The ailing implant is the least seriously affected Implants.

• Nothing more than a radiographic evidence of diminishing but static bone loss may direct the implantologist to be suspicious.

Failing Implant

• The failing implants are firm. Osseointegration develops apically and is responsible for the implants stability. Routine radiography reveals progressive bone loss around the cervical areas of the implant.

BONE RESORPTION……..

Failed Implant

• The simplest definition of a failed implant is mobility. This can be diagnosed by:

1… Tapping and receiving a dull sound.

2… Manipulating by two mirror handles and detecting movement.

3… By the use of the Periotest and eliciting a response of +9 or higher.

Keys to Success

1) Take in consideration maintenance liability and health of bone.

2) Give consideration to angiogenesis and blood supply.

3) Do plan the final prosthesis before starting the case.

Implants are the standard of care,

For you and your patient it’s as easy as

Crown & Bridge

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