Introduction to Dental

Implants

Joseph V. Califano D.D.S., Ph.D.

Implants: The Numbers
>400,000 implants placed annually.
>90% success rate.
Mandible > maxilla.
$500-3500 per fixture.
$200-400 cost of fixture and drills.
6 months-? Amount of time from day of
placement to finished restoration.
Implants: Patient Selection
Relative contraindications:
 Uncontrolled diabetes
 Alcoholism
 Heavy smoking
 Post-irradiated jaws
 Poor oral hygiene
 General surgical contraindications
Implants: Presurgical Evaluation
Restorative requirements
Interarch space
Location of edentulous area
Bone quality and quantity
Radiographs
 Panoramic
 Periapical
 Lateral cephs
 Computerized tomograms
Implants: Treatment Planning
Single most important aspect of dental
implantology.
High success rates are almost always
accompanied by careful case selection.
The increased predictability of grafting
procedures allows for optimal esthetic
placement.
SimPlant®
Implants: Treatment Planning
Implants: Treatment Planning
Implants: Treatment Planning
Implants: Treatment Planning
Implants: Treatment Planning
Implants: Treatment Planning
Bone Quality
1. Type I (most dense) to Type IV
(least dense).
2. Impacts stability of fixture.
3. Determines length of healing
period.
4. Influences osteotomy
preparation.
5. Established at time of surgery.
Implants: Treatment Planning
Implants: Treatment Planning
Surgical Template
1. Provides a visual
communication between the
restorative dentist and implant
surgeon.
2. Indicates optimal site for
placement of fixtures.
3. Conveys critical esthetic
information.
4. May be used to fix index
copings at the time of fixture
placement.
Implants: Treatment Planning
Implants: Treatment Planning
Implants: Treatment Planning
Implants: Treatment Planning
Implants: Stage I - Placement
Implant Placement Step 1
Round bur
Implant Placement Step 2
2 mm twist
1. Apical portion of twist drills
are conical, which means that
this portion of the drill is
deeper than the actual implant
length.
2. The graduations on the twist
drills represent the height of
the fixture together with a
slotted cover screw.
3. Direction and parallelism
should be checked frequently
and by more than one person if
possible.
4. Use direction indicators.
Implant Placement Step 3
Pilot drill
1. Expands the entrance of the
osteotomy to 3 mm in
preparation for the 3 mm twist.
2. Limited reorientation may be
accomplished at this step.
3. The cutting portion of this drill
are the sides.
Implant Placement Step 4
3 mm twist drill
1. This is the terminal twist drill
for the standard platform
fixtures.
2. In very dense bone, a 3.15 mm
twist drill is recommended.
3. Reorientation may be
performed at this stage.
Implant Placement Step 5
Countersink
1. Used to widen osteotomy at
coronal position so that cover
screw may be placed at or
below the level of the bone.
2. Counersinking is NOT
typically performed.
Implant Placement Step 6
Fixture
1. Come in a variety of lengths
and widths.
2. Typically, wider is better.
3. A variety of surfaces and
thread configurations are
available.
4. One- and two-stage fixtures.
5. Type of fixture to be used is
often dictated by restorative
dentist’s preference.
Implant Placement Step 7
Cover screw
3-6 month healing period.
Implants: Stage I - Placement
Implants: Stage I - Placement
Implants: Stage I - Placement
Implants: Stage I - Placement
Implants: Stage I - Placement
Implants: Stage I - Placement
Implants: Stage I - Placement
Implants: Stage I - Placement
Implants: Stage II - Uncovering
Implants: Stage II - Uncovering
Implants: Stage II - Uncovering
Implants: Stage II - Uncovering
Implants: Stage II - Uncovering
Implants: Stage II - Uncovering
Implants: Stage II - Uncovering
Implants: Stage II - Uncovering
Implants: Restored
Implants: Complications
Early failure: lack of integration
Late failure: rarely occurs after first year
after restoration, can due to occlusal
considerations (heavy forces out of the
long axis), one loose screw in a multiunit
prosthesis, etc.
Periimplantitis
Implants: Maintenance
Regular recall schedule that is patient
specific
Titanium vs. steel vs. resin curettes
Implants are subject to the same
problems that the natural dentition is
with respect to periodontal status.