Presented by: Manal Moh Al-Hajri

Ass.Professor of Oral Medicine, Oral Diagnosis and Periodontology

B.D.S (Sana'a University)
M. D. Sc, PhD (Cairo University)
Dental Implants
 A Dental Implant is defined as “ is a
surgical component that interfaces with
the bone of the jaw or skull to support
a dental prosthesis such as
a crown, bridge, denture, facial prosthesis
or to act as an orthodontic anchor.

 The fundamental work of Branemark and

associates in the 1960s demonstrated that
commercially pure titanium implants can be
anchored to the jawbone and used
successfully for tooth replacement in
edentulous arches.

 The relationship between the bone and the

implant was called osseointegration
•Branemark presented his research for the first time in North America
at the conference held in Toronto, Ontario, Canada, in 1982, and his
findings were unanimously considered a breakthrough in dental
prosthetics and oral rehabilitation and the opening of a new era in
clinical dentistry.

•Since the mid-1980s, clinical and laboratory research in dental

implantology has resulted in the development of numerous implant
systems and different techniques for surgical placement and
subsequent prosthetic reconstruction.
 IMPLANT BONE INTERFACE

 Osseointegration: Brånemark introduced the term

osseointegration and defined it “as a direct structural and functional
connection between ordered, living bone and the surface of a load-
carrying implant.”

 Fibrosseous Intigration: Collagen fibers run parallel to implant

surface.
 Bone Density

 Bone quality at the recipient site influences the interface between

bone and implant.

 Compact bone offers a much greater surface area for mineralized

tissue-to-implant contact than cancellous bone.
Lekholm and Zarb (1985) also classifi ed the “quality” of the bone in the
edentulous site:
•Class 1 and class 2: Characterized a location in which the walls – the
cortical plates – of the site are thick and the volume of bone marrow is
small.
•Class 3 and class 4: Are bordered by relatively thin walls of cortical
bone, while the amount of cancellous bone (spongiosa), including trabeculae
of lamellar bone and marrow, is large.
 Indications:

 For completely edentulous patients with advanced residual ridge

resorption.

 For partially edentulous arches where RPD may weaken the abutment
teeth.

 In patients with maxillofacial deformities’.

 For single tooth replacement where fixed partial dentures cannot be

placed .

 Patients who are unable to wear RPD.

 Patients desire .

 Patients who have adequate bone for the placement of implants.

 CONTRAINDICATION

 Presence of non treated or unsuccessfully treated

periodontal disease .

 Poor oral hygiene .

 Uncontrolled diabetes.

 Chronic steroid therapy .

 High dose irradiation.

 Heavy Smokers and alcohol abuse.

ADVANTAGES:

 Preservation of bone

 Improved function

 Aesthetics

 Stability and support.

 Comfort.
Disadvantages:

 Can not be used in medically compromised patients who

cannot undergo surgery.

 Longer duration of treatment.

 Need of a lot of patients cooperation

 Expenssive.
 CLASSIFICATION

(A) Depending on the placement with in the tissue:

 Subperiosteal implants:
These implants receive their primary
bone support by resting on it.

 Transosteal Implants:
These implants penetrate both cortical
plates and passes through the entire
thickness of alveolar bone.
 Endosteal implants:
This kind of implants extends into basal bone for
support. It transect only one cortical plate.

(B) Depending on materials used :

Metallic Implants: Non metallic Implants:

 Ceramic
 Pure Ti
 Carbon
 Ti alloy  Alumina
 Polymer
 Co,Cr,Mo alloy
 Composite
 Titanium:
 Used as almost pure metal
 Corrosion resistant
 Strong & lightweight
 Great biocompatibility

 Ceramics:
 Most biocompatible
 Formation of hydroxyapatite at surface
 Potential for chemical bond between bone
& implant

 Coated Metals:
 Combines strength of metal with good
interface potential of ceramic
(C) Depending on Design:

 Screw shaped
 Cylinder shaped
 Tapered screw shaped.
Other classification of endosteal implants into four groups
according to the surface coating were:
• Hydroxyapatite
•Titanium plasma sprayed surface (TPS)
•Uncoated titanium alloy
•Uncoated commerciall pure titanium

Accotding to the time of installation endosteal implants were

classified into:
•Immediate
•Delayed immediate (2 weeks -3 months after extraction).
• Delayed Implantation (6 months after extraction).
Endosteal imlant also classified according to the surgical
technique into:

• Single stage implants (non-sub.merged)

•Two stage implants (submerged).

Design of dental implants could be available in
either:

•Two-piece (implant which required the attachment of

abutments to the implant body at a visit subsequent to the
placement visit , a load-free period of three to six months
after fixture installation is required ).

• One-piece
 PARTS OF IMPLANT

1.Implant body or fixture:

It is the component that is placed with in the
bone during first stage of surgery

2.Healing screw:
During the healing phase this screw is normally
placed in the superior surface of body

Function:

- Facilitates the suturing soft tissues.

- Prevents the growth of the tissue over the

edge of the implant.
3. Healing caps:
Are dome shaped screws placed

over the sealing screw after the

second stage of surgery &
before insertion of prosthesis.

4.Abutments:
Part of implant which resembles a
prepared tooth & is inserted to
be screwed into the implant body

5. Impression posts
 IDEAL REQUIESETS

To achieve an osseointigrated dental implant with a high

degree of predictibility the implant must be:

 Sterile

 made of a highly biocompetible material

 Inserted with an atraumatic surgical techinique that avoids

overheating of the bone.

 Placed with initial stability

 Not functionally loaded during the healing period

Note:
After an initial remodeling in the first year that results in
1.0 to 1.5 mm of bone reduction,' the bone level around
healthy functioning implants remains stable for many
years, allowing implants to be a predictable means for
tooth replacement.
 Prosthetics & attachments
 Crowns
 PFM’s most common
 Could be gold, ceramic,
composite
 Attached by screws or
cemented

 Dentures
 “Traditional” materials - acrylic
 Attached by various fasteners:
clips, balls, screws, etc.
Surgical Protocol of endosseous implant
placement
 The soft tissue is removed,
exposing the implant, and a
“healing cap” is placed

 Healing: several weeks

 Healing cap is removed and an

abutment is placed

 Abutment is prepared
(“post”/cylinder added) &
impressed for prosthetic
Abutment
 Sent to lab for fabrication Implant analog
 Crown (or other prosthetic) is seated with
cement or screw (or other fastener)
 COMPARISON OF PERI-IMPLANT TISSUES
AND GINGIVA

 The free marginal gingiva around

teeth and the peri-implant mucosa
around implants have many clinical
and histological features in common.

 Color and Consistency:The clinical

healthy soft tissues facing teeth
and implants are pink and have a
firm consistency
 Regarding the vascular topography of the periodontium and the peri-
implant tissues, it has been observed that the periodontium around
teeth is supported by supraperiosteal vessels lateral to the alveolar
process and vessels from the periodontal ligament.

 In contrast, the peri-implant mucosal blood supply was provided by

terminal branches of larger vessels originating from the periosteum of
the bone associated with the implant site.
 The vascular supply to the peri-implant mucosa is not as extensive and
complete as that present around teeth.

 Fewer vessels in the supracrestal soft tissue zone immediately

lateral to the implant surface suggest that the peri-implant soft
tissues might have an impaired defense capacity against irritation.
Probing Depth:
 The probing depth around healthy gingival tissues and peri-implant
mucosa has been compared both in animal models and in and found to
be more advanced at implants than at teeth.

 Around implants the probe displaces the junctional epithelium as well as

the connective tissue and stops close to the bone. Around teeth, the
probe tip stops coronal to the apical portion of the junctional
epithelium
Gingivitis on teeth
Mucositis on implant

Periodontitis on teeth
Peri-implantitis on implants
Soft tissue evaluation:

 The soft tissue around implants should be evaluated for changes in

color and consistency.

 The tissue should be palpated for exudate and pain.

 The conditions most frequently seen during recall appointments are

peri-implant mucositis, hyperplasia, small fistulas, and increased oral
exposure of the implant components.

 The soft tissue can be evaluated for its tendency to bleed by bringing a
probe into gentle contact with the marginal soft tissue and rubbing it
across the tissue.
Probing:
 Some clinicians/researchers feel
the probing depth should be
regularly evaluated.

 Others feel that probing should only be performed when significant

radiographic bone loss or pathology are noted.

 There are others who feel probing is not necessary and does not
provide valuable information.

 When using a probe, it should be made of plastic to protect the metal

components from being scratched
 Maintenance of Implants

 Great OH by patient:

 Toothbrushes, floss, interdental

aids, etc.

 Caution during prophylaxis:

 Scaling with conventional

instruments may damage the
titanium surface

 Sonic instruments are

contraindicated

 Use a very mild abrasive with

rubber-cup prophy
Thank You