VARIOUS IMPLANT SYSTEMS IN INDIA

ANISH AMIN

Contents

• Definition

• Classification

• Various implant systems

• Limitations

• Summary & Conclusion

• References

Introduction

Definition• Implant system (GPT, 1993): Dental implant

components that are designed mate together and implant system can represent a specific concept, inventor or patent. It consists of the necessary parts and instruments to complete the implant body placement and abutment components.

• Dental implant: is defined as a substance i.e., placed into the jaw to support a crown or fixed or removable denture.

Classification of Implants depending on

Implant placement within the tissues

Materials used

1.Epiosteal2.Endosteal

3.Transosteal

-Bioactive-Bioinert

-Biotolerated

Epiosteal Implant

• It is a dental implant structure that covers almost the entire crestal surface of the maxillary and mandibular residual alveolar bone under the soft tissue periosteum.

• It is a dental implant that receives its primary bone support by resting on the bone.

• So new bone will grow around the implant.• Example

– Subperiosteal implant

SUBPERIOSTEAL IMPLANTS

• An implant structure that covers the almost entire crestal surface of maxillary & mandibular RAR under the soft tissue to include the periosteum , with the four to six posts protruding out through gingiva and on it the complete denture will be attached.

• In 1930 Strock placed first endosteal implant.

• It is a dental implant that extends into the basal bone for support

• It transects only one cortical plate

• It can be further classified into – Root form

– Plate form

Endosteal Implant

Root form Plate form

- Used over a vertical column of bone

- Available in four forms cylindrical, press fit, screw root, combination.

They are used for horizontal column of bone which is flat and narrow facial lingual direction.

Transosteal implants

• A dental implant that

penetrates both cortical

plates and passes

through entire thickness

of the alveolar bone.

Parts of in implant

• Body or fixture

• Healing screw

• Healing caps

• Abutments

Various Implant Systems

Branemark system

• Developed from the

pioneering work of

Prof. Per-Ingvar

Branemark who

introduced the term

osteointegration

Indications & Types

Types of fixtures in Branemark system

Fixture standard

Fixture self tapping

Fixture Mk II

Fixture Mk III

Fixture Mk IV

Conical Mk III

UniversalSelf tappingUsed in type I, II, III, IV

bone

TaperedDouble thread

Uses soft trabecular

boneBone type III & IV

Self tapping Used in

bone type I, II, III, IV

BRANEMARK SYSTEM COMPONENTS• FIXTURE –

• pure titanium with machined threads

.

• The top of the fixture has hexagonal

design & threads ..

• The apical portion tapered with four

vertical notches.

• COVER SCREW- seals the

coronal potion of fixture during the

interim period.

• ABUTMENT- -made of titanium in a cylinder shape. the apical portion has hexagonal shape to fit the coronal portion of fixture.

• ABUTMENT SCREW – insert through the abutment & threads into the fixture to connect the two components .

• GOLD CYLINDER- made of lAu , Pl, Pd. It is machined to fit the coronal portion of the abutment. It becomes integral part of final prosthesis.

• GOLD SCREW –inserted through the gold cylinder & threads into the abutment screw to connect the gold cylinder & abutment.

Screw-retained restorations

Multiple Unit Restorations

• Abutment options

• Multiple unit abutment (NP, RP, WP):

Indications: Short span ridges, full jaw reconstructions, available in several heights therefore possible to place the prosthetic margin above, at or below the gingival margin - esthetics

• Gold cylinder to fixture – connects directly to head of the implant eliminating the use of an abutment.

• Advantages – – For sulcus depth of 3mm or less

– Limited space

– Good esthetics

• Limitations– Casting procedure

Types of fixtures in Branemark system

Fixture standard

Fixture self tapping

Fixture Mk II

Fixture Mk III

Fixture Mk IV

Conical Mk III

UniversalSelf tappingUsed in type I, II, III, IV

bone

TaperedDouble thread

Uses soft trabecular

boneBone type III & IV

Self tapping Used in

bone type I, II, III, IV

Replace Select Tapered Implant System

• It can be used where the anatomic condition

where limit the placement of standard root

implant.

Indications

• Maxillary sinus• Labial concavities in the premaxilla• Lingual undercuts in the mandible • Converging roots of the adjacent teeth• Immediate extraction site

• It has 2 surface treatments i.e.,

Ti Unite surface: combination of titanium oxide

texture + porosity = optimal osteointegration

HA coated surface:

• Accelerates the deposition of bone to the implant

FRIALIT Implant system

• 1n 1974 Dr. Willi Schulte

developed Frialit 1 also

known as Tubingen

Implants

• Worlds first root analog

system

• Implant concept: Root analog stepped cylinder, stepped screws and synchro-stepped screw.

• Surgical indications: Immediate implant placement, delayed implant placement, late implant placement.

• Material: Medically pure titanium • Implant surface: TPS coating, HA coating (stepped

cylinder), DPS (stepped screw, Synchro stepped screw)

• Implant diameter: 3.4mm, 3.8mm, 4.5mm, 5.5mm, 6.5mm

• Implant length: 8 to 15mm• Anti-rotation: Internal hex

• Instruments: Drills, Bone Condenser, Bone Expander, Cortical Drill, Bone Profiler.

• Indications: Missing single teeth, free-end cases, tooth bound gapes, edentulous jaws

• Forming of soft tissue: Gingival formersGingiva formers: D 3.4 to 6.5, GH 1,2,3, and 5mm

• Abutments: Straight, customized crown abutments, telescopic abutments, screw retained, or cemented, CeraBase, AuraBase

Design

FRIALIT®-2 stepped cylinder :

• Stepped screw

• Synchro stepped screw

• The optimum implant for every situation

Stepped cylinder• Apex diameter in 3 to 5 steps by

0.4 to 0.6mm / step.• Coronal section of the implant

body has 1.5mm collar. • 3 longitudinal grooves • Deep internal implant abutment

connectionAdvantages of the FRIALIT®-2

stepped• Improvement of the implant site in

the event of low bone density• Atraumatic insertion in extremely

cortical bone• High stability, strong bone

adhesion at the titanium surface

The FRIALIT®-2 stepped screw

• First step – no threads, 1.5mm machine polished collar

• Self tapping thread from second step.

• Deep profile surface

• Cover screw in the silicon stopper

Advantages

• Implant can be inserted by finger pressure alone.

• Final position with ratchet implant driver.

• Increased osteointegration (DPS)

• Only 3 revolutions for complete seating

The FRIALIT®-2 Synchro stepped screw

• Crestal implant cervix – machine polished 0.4mm.

• Threaded deep profile surface has DPS.

• Cover screw in silicon stopper

Advantages• Applicable for all one

classes I to IV.• Atraumatic insertion• Increase self tapping in

cortical bone

Advantages

Implant abutment connection

• Tube-in-tube mechanism.• The rotation stop is secure by 1.5mm tall

and 2.5mm wide hex residual rotation less than 1°

• Highest mechanical stability by internal 3.4mm long parallel walled implant abutment connection for a secure occlusal load transfer

• Crown abutments have a groove at their base for sealing ring

• 3mm in diameter, biodegradable silicon – Bacteria proof sealing.

Color coding

FRIALIT®-2 colors provide

• Clear identification of the implant diameter

• Easy assignment of implant components

• Safe documentation

• Biocompatibility and resistance to the oral environment

Drills

Twist drill D

2.0

Round drill

Stepped Drill

D 3.4

Stepped Drill

D 3.8

Stepped Drill

D 4.5

Stepped Drill

D 5.5

Stepped Drill

D 6.5

8, 10, 11, 13 and 15mm

Advantages

• Optimum stabilization of the implant abutment interface

• Anti-rotational connection between the abutment and the implant

• Clear and secure positioning of the abutment on the implant

• No possibility of screw breaking or loosening

• Minimization of the risk of soft tissue perforation

ITI Implant System

• International team of implantology

• Types – – Hollow cylinder, – Hollow screw– Solid screw

• Single stage and 2 stage versions

• Consists of pilot drills, hollow traphine drills, depth gauges and twist drills.

Advantages

• The microgap between the primary and secondary components is supragingival – good peri-implant hygiene.

• The construction of the implant body is such that no second stage surgery for uncovering it is required.

Types

• TPS screw

• TPS hollow

Indications

• Symphyseal region between the mental foramen

• Single tooth replacement

• Bridge abutments

Design • Length 9,11,14,17 & 20mm• Width 3.5 to 4.2mm• 8 to 12 degree conical head with 4 slots – Prevents rotation.• Head: is internally threaded with 5mm deep socket which will accept 4-8mm

long, 2mm wide occlusal screws.• Neck: highly polished, slightly concave allows good oral hygiene and

gingival adaptation• Body: Ti plasma sprayed increases the surface area• Screw threaded with edges rounded - Causes the compression of cortical and

medullary bone. • Apex: Fluted, angled to 120° - permits self tapping

• The Standard Implant:one-stage or transgingival healing, mainly indicated for the posterior region.

• The Standard Plus Implant:for subgingival implant placement in the esthetic region.

• The Tapered Effect Implant:for immediate and early implantation in extraction alveoli.

Three prosthetic diameters are available:

• Narrow Neck:

Implants with the 3.5 mm Narrow Neck (NN) restorative platform

(Standard Plus Implant with a built-in octa abutment with external

connection, for single-tooth restorations).

• Regular Neck:

Implants with the 4.8 mm Regular Neck (RN), restorative platform.

• Wide Neck:

Implants with the 6.5 mm Wide Neck (WN), restorative platform

Immediate loading of edentulous arches.• The one-piece Monotype Implant with 8°

cone (endosteal diameter 4.1 mm) is specially designed for immediate loading with a bar denture.

• Because of the self-tapping thread, tapping is not necessary with this implant type.

Indications• Immediate loading in the mandible with a

bar denture supported by four implants

The solution for narrow gaps• The Narrow Neck prosthetic system is specially designed for situations

where space is limited in the lower incisor region and the upper lateral incisors.

• The NN prosthetic system offers cast-on gold copings and individually modifiable titanium copings (also available in an angulated version) for the 3.5 mm shoulder diameter so that a safe and esthetic restoration is ensured for both screw-retained and cement-retained solutions.

• Only screwdriver and ratchet with torque control device are needed to place the prosthesis.

Indications• Single-tooth replacement of the upper lateral incisors and the lower

lateral and central incisors

Cementing on a solid basis.• The Solid Abutment system for Regular Neck and Wide

Neck implants with its reliable Morse taper connection, ensures a secure and exceptionally stable abutment-to-implant connection to prevent loosening.

• The abutments are available in different heights. The abutments and corresponding transfer components are color-coded for accurate and simple prosthesis fabrication.

Indications• Cement-retained restorations with the crown and bridge

technique

Indications• Standard Implant Ø 3.3 mm

RN:used in limited alveolar ridge width

• Standard Implant Ø 4.1 mm and Ø 4.8 mm RN:All indications

• Standard Implant Ø 4.8 mm WN:Crowns and bridges in the molar region

synOcta for Regular and Wide Neck

Indications• All indications for crown and bridge

techniques

Advantages• All indications in the area of immediate and early

implantation

Core vent system

• Developed by Dr. Gerald Niznick in 1986

• Screw type designs with perforation or hollow basket

• Types– Core vent

– Screw vent

– Micro vent

– Bio vent

Core vent

• Made up of Ti alloy 90% Ti-6Al-4V

• Diameters – 3.5,4.5mm

• Threaded or beveled hex threaded

• Length –8, 10.5, 13 and 16mm

• Fixture having threaded screw design as a horizontal and vertical vent at the apex made up of CP Ti.

Screw vent• Smooth neck – offers the option

of placing the implant level with bone or 1mm above it.

• Screw vent is narrower than core vent

• Diameter 3.75mm• Length: 7,10,13,16mm• Made up of CP titanium threaded

at the apex – self-tapping easier.• Surface is acid etched.

Micro vent • Root form shape

• Made up of Ti alloy, Ha coating

• Diameters: 3.25, 4.25mm

• Length: 7, 10,13, 16mm

Bio-vent• Bullet shaped implant

• Hydroxyapatite coated has vertical slot and an apical hole offered in length 7,10,13,16mm.

• Main indicated in maxilla

Advantages

• Screw type helps in easy insertion

• Hollow cylinder type – good bone to implant contact.

• 8 different widths are provided for different types of bone.

Integral Implant System

• It’s a 2 stage implantation process

Indications

• Totally edentulous mandible or maxilla

• Fixed and removable bridge work

Design• Cylindrical shape

• Coated with dense HA

• Diameter: 3.25 to 4mm

• Length: 8,10,13, & 15mm

• The central core is a Ti alloy healing screw and gingival cuff

• Consists of drills : Pilot drill, rosette bur, intermediate spade drill and spade drill.

• Length: 8,10,13,15mm

Advantages

• Different diameters so wide selection for the dentist

• Cylindrical shape

• More favourable stress distribution

Pitt-Easy• The System The two-phase

• Cylindrical screw implant

• Made of pure titanium, with two different surfaces

• VTPS coating

• The vacuum titanium plasma spray coating

• Safe osseointegration.

• Fast bone regeneration surface .

Prof.Dr. h.c. Hans L. Grafelmann

Design• Different colours• Green code 3.25mm from 8

to 24 mm length• Yellow code 3.75mm from

8 to 20mm length• Red code 4mm from 8 to

16 mm length

Indications

• Freshly extracted sockets

• Extremely atrophied ridge.

• Mainly in frontal and pre-antral area.

• Seldom below the sinus and rarely in the tuber area

Advantages• Ensure precise and most atraumatic bone preparation• Due to the design, shape and dimension• Minimum alveolar bone resorption Good osteointegration• Tight cervical to apical adaptation of surrounding bone• Polished cervical portion • Establishes and immediate close friction fit at the marginal

bone entrance.• 5 months healing period

Bi-cortical Implants System

• Bi cortical screw is a screw type implant which finds

optimal support in bone i.e., bicortical support.

• One phase implant

• Self tapping• Pure Ti implant• Design

– Square– Universal round head

• Diameter: 2.5, 3.5, 4.5, 5.5mm• Length: 13, 14, 16, 19, 21, 23, 25mm• Smaller length: 21 to 26mm used in children (Standard length is 30mm)• Threads: 3, 4, 5• More effective self tapping helix with cutting segments each displaced by

30°.• Helix design has deeper arching with a progressive diameter upwards from

the apical tip.

Indication• Single tooth replacement• Bridge or bar abutments in anterior regions (Maxilla or mandible)Contraindication• Bone as little as 8mm • Insertion possibilities in maxilla are limited distally to the sinus. Advantages• Easy to handle • Simple insertion technique• Immediate and lasting stability• The bone particles cut during insertion are utilized for closer bone contact. • No post operative swelling• Little or no bone resorption

Osteoplate 2000 (Blade implant)

• Linkow blade implants invented in 1967.

• Long thin blade that will be surgically inserted into the

groove in the bone .

• Abutment projecting out from the blade to this crown or

attachment for denture can be placed.

• Osteoplate 2000 is developed by prof.dr.h.c.hans

l.Grafelmann

INDICATIONSIn the maxilla & mandible• Less than 4mm crest width (subnasal, labial atrophies or concavities - vertical

blade plate shapes• Presinus region (<3.5mm crest width) = asymmetric shapes• Subsinus region with insertion depths of <8mm and <4mm crest width (without

sinus lift surgery) = Horizontal maxillary shapes• In tuber area (rich marrow and prominent palatal undercuts) reduced or asymmetric

residual bone = tuber shapes• With posterior crest width of <4mm and available bone height atleast 6 to 8mm

above the mandible canal = shallow horizontal shapes.• With bone height 1 to 5mm above the mandible canal but >6mm in the ramus area =

ramus shapes.

Designs• Made up of pure Titanium

• Implant body use

• TPF coated

• Available in vertical implant & horizontal implant type with type B neck (trapezoid shape)

• Type A round neck

• Each implant is supplied with temporary post, cover screw and final post

Advantages

• Can be used in severely resolved ridges.

• Osteointegration is predictable (after 36 weeks)

• Shoulder thickness and neck design of Type B – helps in small atrophied alveolar ridges

BioHorizons Implant SystemIndications• Single tooth replacement (mandibular central lateral incisor, maxillary

lateral incisor)• Design: Square thread design – imparts 10 times less destructive

stresses, maximize compressive low transfer, Excellent primary stability• 3 different thread forms – for different bone density. • Square thread• Conventional V thread• Coronal 2/3rd parallel walls – initial stability, surgical simplicity. • Apical taper• Self tapping apex – simulates convergent roots

• Diameter: 3.5, 4, 5, 6mm. • Length: 9, 12, 15mm • Threads: D2, D3, D4• 6mm diameter implant – used in posterior extraction sites• 3mm implant – missing laterals mandibular incisors • Surface treatment – RBM (Resorbable blast media, Pure titanium oxide)• Hydroxyapatite – used in soft bone.• D4 type bone• D4 implant

Advantages

• Less marginal bone loss because of 0.5mm length

polished collar = better esthetics.

• Spiralock technology reduces the chances of screw

loosening.

IMTEC (Endure implant system)

• Has one stage and two stage implantation processDesign:• Diameter: 3.5, 4.3mm• Length: 11,14,17mm• Triple micro threading - Microthreads preserve

cortical bone at the crestal ridge – reduces bone stress

• 1mm polished collar • Abutment implant junction - Internal Hex plat

form • Natural anatomic tooth form

Innova Implant System

Endopore implants• Unique, truncated cone shaped

design, multilayout porous surface – 3 dimensional bone ingrowth.

• With threaded implants the fixation which occurs allow for rotation movement of the implant with endopore resistance to vertical, horizontal, and rotational movement.

• Implant abutment junction – Internal hex

– External hex

• Abutment platform 4.8mm

• Diameter 3.5, 4.1, 5mm

• Length: 5, 7 ,9, 12mm

• Collar height: 1.8-2.8mm -Smooth coronal region

• Abutment types are UCLA, UMA, Dalla Bona, Over denture system.

• Surface treatment – Acid wash surface, hydroxyapatite surface, TPS surface, Machine surface

Advantages• A secure, three-dimensional interlocking interface

with bone

• Predictable and minimal crestal bone remodelling

• Greater surgical options with shorter implant lengths

• An uncomplicated surgical sequence

• Minimal instrumentation and inventory

UNITI Implant System • Single or two stage surgical protocol.• Consists of straight abutment (4.3mm).• Tapered abutments • Ball abutmentsDesign• Diameter: 3.3, 3.7, 4.3, 5.3, 6mm – Based on every cervical

diameters of natural teeth.• Length: 10, 13, 15mm • Anatomic root shape• Upper 1/3rd – Cortical component of implant body is parallel sided

with shallow threads one continuous pitch of 0.9mm – ideal atraumatic placement in dense cortical bone – optimal load transfer.

• Lower 2/3rd – cancellous component – anatomic

taper and sharper, deeper threads (0.35mm) are

nearly horizontal – high degree of stability in

cancellous bone.

• Self cutting slots in the apical portion –

accommodates displaced bone volume during

implant insertion - prevents bone chips being

packed at the base of the osteotomy site.

• Implant tip is rounded

• Microgrip surface – osteoconductive high porosity

surface 1-5 micron.

• 1mm highly polished collar – better soft tissue

integration.

• Implant abutment connection – twin hexagon internal connection.

• The twin hexagon is sandwiched between two solid cylindrical guides above and below the hexagon – high degree of stability and stress distribution

• Microgap free and bacteria proof joint

• The deep internal connection with a abutment extending 3.3mm into the implant body – offers strength and stability.

Indications

• Single tooth replacement

• Single tooth replacement

• Multiple teeth replaceemnt

Advantages

• Biological root form suited for immediate extraction cases.

• Wide diameter neck + tapered form = ideal for peri-implant defect size in sockets (obviates additional augmentation materials)

• Wide platform – esthetic emergence profile.

• Tapered root – minimizes risk of damaging adjusting teeth and structures.

Astra Tech Implant System

• Two stage implant – manufactured from pure titanium

• Submerged implant

• Got unique conical seal design

• Surface treatment

• Grit blasting – Ti oxide particles

• Conical head

• Taper is 11°

Implant components • Fixture (length 8-19mm; Diameter 3.5 to 4mm)

– Self tapping– Parallel sided

• Cover screw• Abutments

– Healing abutment– Straight and angled abutment (20-30°)– Uni abutment (20° & 45°)

• Drills– Twisted drill– Tiger drill – Ti N coated with laser etched bands.

Advantages• Implant abutment junction is conical junction – prevents microbial contamination

IMZ IMPLANT SYSTEM

• Kirsch developed the IMZ implant system in 1974. Since 1978 it is in clinical use.

• Intramobile cylinder endosseous two stage osseointegrated implant.

• IME i.e., intramobile element is made up of polyoxymethylene was used as a shock absorbing element simulating PDL

• Available in 3.5 to 4mm diameter and 8,10,13,15mm length.

• Surface coating may be titanium plasma spray or plasma sprayed HA coated surface.

Indications

• Single tooth replacement

• Unilateral free end

• Bilateral free end

• Wide edentulous span

• Fully edentulous arch

Summary & Conclusion

References• Block & Kent’s Endosseous Implants For Maxillofacial

Reconstruction.• Elaine Mc Clarence ’s Close to the edge.• Hubertus Spikerman’s Color atlas of Dental medicine

(Implantology).• Malvin E. Ring’s Dentistry An Illustrated History.• Sumiya Hobo’s oseointegration and occlusal rehabilitation.• Ralph V. McKinney, Jr’s endosteal dental implants.• ADA council on scientific affairs Dental endosseous implants. An

update. JADA, Vol. 135, January 2004.

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