Different Implant

Component &
their function
-Yasmin Abou El-Enein
- Norhan Naief
- Noha Khaled
- Mahmoud Osama
- Mostafa Mahmoud
-Yehia Adel
- Nouran Mahmoud

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 Focus points :
1- Fixture
2-Cover Screw
3- Healing Collar
4- Different types of abutment
5- Ready-made & Custom-made implant concept
6- Implant & abutment analogues
7- Transfer copings
8- Waxing sleeves
9- Temporary abutment
10- Platform switching concept

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 One piece implant system Vs two piece implant system:

 No screw as screw lead to loosening or breakage

 No crestal bone loss
 Very strong – a 3mm single piece implant is stronger than 4
mm conventional implant
 No microleakage
 Designed specially for immediate loading
 Flapless, quick and simple
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Three different surgical approaches have been
used for the two pieces implant system:

 The two stage surgical process

 The one stage surgical approach

 The immediate restoration

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Fixture
1- Crest module:
Is that portion designed to
retain the prosthetic component
in a one piece or two piece
implant system.
 It also represents the transition
zoon from the implant body
design to the transosteal region
of the implant at the crest of the
ridge.
 Its smooth dimension varies
from 0.5 to 5 mm
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Functions:

a- It has a platform on which the abutment is seated,

which offers physical resistance to axial occlusal
loads.

b- An antirational feature is included on the platform

either external hex or internal hex.

c- Designed to reduce the bacterial invasion

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2- body:

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 a- press fit:
1- Depends on a coating or surface condition to
provide microscopic retention to the bone, most
often the surface is coated with rough material
e.g. (hydroxyapatite, titanium or plasma spray)
2- Macro retentive design as sintered ball
3- May be cylinder or tapered
4- Usually pushed or tapped into prepared bone site

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b- Screw root form
1- Are threaded in to a slightly smaller
prepared bone site.
2- Macroscopic retentive feature of a thread
for initial bone fixation.
3- May be parallel cylinder or tapered cylinder.
4- There are three basic screw geometries: V-
thread, buttress (or reverse buttress) and
power (square).

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c- Combination root form:

 Have macroscopic feature from both the

cylinder and screw root forms. It may also
benefit from microscopic retention to bone
through varied surface treatment.

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Apical Design Of Implant Body
 Antirotational feature:

1. Hole or vent.

2. Flat side or grooves.

 Apical end of each implant should be flat rather

than pointed
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Implant Length Implant Width
 Implant length varies from  Range from 3mm to 8mm
5-30mm  When the opposing landmark
 Length of the implant in limit the implant length
favorable bone quality and implant diameter is the logical
crown height may range method to increase functional
from 10 to 15mm and surface area
12mm is usually ideal  It should not be wider than
5mm in the ant. and 6mm in
the post

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 Cover screw
 At the time of insertion of a
two stage implant body
(stage 1 surgery), a first stage
cover screw is placed in to the
top of the implant to prevent
bone, soft tissue, or debris
from invading the abutment
connection area during
healing period

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The permucosal extension or healing
abutment
 Termed
a permucosal extension :
because it extends the implant
above the soft tissue and results
in the development of a
permucosal seal around the
implant.
a healing abutment
because stage 2 uncovery
surgery often uses this device
for initial soft tissue healing.
 It is available in multiple heights
and also can be straight, flared
or anatomical 14
In case of two stages In case of one stage In case of
surgery surgery immediate load

After a prescribed The surgeon may have The permucosal healing

healing period placed the permucosal abutment may not be
sufficient to allow a extension at the time used at all if a temporary
supporting bone of implant insertion prosthesis is delivered on
interface to develop : the day of surgery
a second stage or Or
procedure may be
performed to expose May have selected an May be used until the
the two stage implant implant body design
suture removal
or to attach a trans- with a cervical collar of
sufficient height to be appointment and the
epithelial portion
supra gingival. temporary teeth
delivery

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Abutments

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 Abutments
 The implant abutment is the portion of the
implant that supports or retains a prosthesis
or implant superstructure
 Walls are smooth & polished
 Length ranged from 1-10 mm

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Terminology
 Abutment screw
component which secures the dental
implant abutment to the dental implant
body
 Prosthetic or Attachment screw
component used to secure a fixed dental
prosthesis to the dental implant
abutment

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 Hygiene cover screw

It is placed over the abutment to prevent debris

and calculus from invading the internally
threaded portion of the abutment retention
during prosthesis fabrication between
prosthetic appointments

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 Classification
According to type of which the prosthesis or
superstructure is retained to the abutment

Screw retained Cement Attachment

retained

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1- Abutments for screw retention
 Uses a screw to retain the prosthesis or
superstructure
 Cannot use in case of inadequate inter-arch space
 Advantage : retrievability
 Diadvantage : screw emerge on occlusal surface
Less resistance to screw loosening & screw fracture

 In restoration for single unit implant these type not

preferred ????????

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 2-Abutments for cement retention
 Uses dental cement to retain the
prosthesis or superstructure
 Better to use provisional cement
not permenant one
Retrievability
 Mainly used in posterior teeth
where screwdrivers is difficult
 Contraindication : When Inter-arch
distance , a minimum of 5-7 mm of
the abutment should be exposed
into the oral cavity to ensure a
retentive restoration
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 Abutments for attachments

 Uses an attachment device to retain the

prosthesis (O-ring attachment)
 used for removable prosthesis that are implant
retained
 These may be used for complete dentures and
partial dentures

 The abutment for cement/screw/attachment

may be screwed or cemented into the implant
body

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According to the material of
construction, abutments can be
further classified into:

 Titanium abutments
 Gold abutments
 PEEK abutments
 Ceramic abutments
 Zirconium abutments
 TiN-coated abutments

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 Abutments for overdentures

Locator implant abutment

Abutment w/
O-ring attachment Ball Abutments
Delrin Collar

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 According to the type of implant to which
they are attached :

Abutments for flat-surfaced implants

Implants that do not have anti-rotational elements

are flat-surfaced and usually require attachment
of one-piece abutments

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Abutments for implants with ant rotational
features

used anti-rotational features : the external hex,

the internal hex, the spline-type interface and
the morse taper

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 Temporary & permenant
abutments
 Temporary abutments:
PEEK temporary abutment
 Individual soft tissue
management for esthetic cases
 Screw- or cement-retained
temporary crowns
Do not use in the mouth for longer
than 6 months
Place temporary restoration out of
occlusion
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According to axial relation between
abutment and implant body
1- straight abutment:
-Narrow
-Regular
-Wide

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2-Angled abutments:
- It is used when dental implants are not placed
parallel to adjacent teeth to achieve proper
restorative contour.

- Angulation range: 10-30

- Advantages:

1) Facilitates paralleling of non aligned implants

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2)Help clinician in avoiding anatomical
structures when placing implants.

3)Decrease treatment time , fees ,

and need to perform guided bone
regeneration procedures.

- Disadvantages:
1) Increase stresses on implant and bone.
2) Not recommended in single units
restorations .

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3-Tapered abutment:
- It is mainly used for esthetic and
functional reasons.

- Transition to restoration is more gradual

allowing teeth with larger cross section to
restore with better emergence profile.

- It improve stability and emergence profile .

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- Indication:
1)Large diameter implants.
2) Multiple restorations .

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Abutments may be classified
to:
 1 piece implant & abutment
 2 pieces:
-Composed of angled body
And fixation screw
3 pieces:
-composed of connector ,
Head and screw

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 Custom-Made
implant components
1-Implant body 2-Abutments
 1-Implant body(fixture)

a-Technique
Pirker etal,in the International Journal of Periodontics & Restorative Dentistry
b- Material

Zirconia
 Advantages:

1-Decrease bone & soft tissue trauma

2-Decrease time
3-Prevent dark discoloration of gingiva in case of
gingival recession
4-Increase surface area for biointegration or
Osseointegration
Disadvantages:

1-High modulus of elasticity of zirconia

2-Cost
 2-Abutments

 Several Ready-Made abutments have been

reported with:
abutment misfit and microgaps, including screw
loosening,micro-bacterial,abrasion and wear of
components

Hamilton etal in Int J Prosthodont 2013

A-UCLA

 It is prefabricated abutments.
They offer the possibility to design a
customized abutment for various prosthetic
solutions using the traditional wax-up and
casting technique.
Before After
2-Cad/Cam system

A-zirconia
Advantages:

1-Highly esthetic
2-Easier in milling than Ti
3-Biocompatible material
Disadvantages:

1-Possibility of fracture
2-Cost
b-Titanium
The most common use abutment
Advantages:

1-High strengh
2-Biocompatibe

Disadvantages:

Esthetic
 Gold Hue milled titanium abutments
c-Hybrid abutment
Designing and fabrication of Hybrid
abutment

Ti-base

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How to select your abutment?
From mechanical view: The Ti abutments did
not exhibit any failures below 900 N , while the
Zr abutment failure zone is in the range of 250
to 400 N when fatigue.
From biological view:
No differences in soft tissue health were seen in
peri-implant mucosa adjacent to zirconia and
titanium abutment surfaces.

Mitsias etal in2009 studied reliability and fatigue Damage Modes of Zirconia and
Titanium Abutments
From Aesthetically view:

Sailer etal, in 2007 studied : Esthetic Factors

Influencing the Decision Between
Titanium and Zirconia Abutments
in Anterior Regions
Case
Difference between readymade &
custom made
Types of bond:
-Osseointegration
-Biointegration
IMPLANT , ABUTMENT ANALOGUE
AND TRANSFER COPING
The object of making an impression in implant
dentistry is to accurately relate an analogue
of the implant or implant abutment to the
other structures in the dental arch.
Analogue:

represent implant body or abutment in the

laboratory cast.
- implant analogue.
- abutment analogue.
Selection of impression coping
Select diameter of coping
1- match color of implant plateform
2-match EP of healing abutment
Materials
Titanium, plastic, and anodized aluminium
Types of impression techniques:

I)Conventional crown and bridge technique

( not utilizing analoques).

II)Impression techniques using analogues:

1-Indirect technique (closed tray) .
2-Direct technique (opened tray) .
either implant or abutment level.
Implant Level Impression
Transfers the position of the implant from the
patient’s mouth to a master model so that an
appropriate abutment can be selected for the
case. which is more accurate
Abutment Level Impression
An abutment is pre-selected by the dentist,
placed and torqued onto the implant. An
appropriate abutment impression coping is used
to transfer the position of the abutment from
the patient’s mouth to a model. The restoration
is fabricated to fit on top of the abutment.
conventional crown and bridge
technique not utilizing
analogue:
the abutment is reduced outside patient
mouth and returned to patient mouth to be
readjusted.

Impression poured into stone.

Disadvantage of conventional
technique.
 Titanium reduction is tough.
 Heat generation lead to damage of
osseointegration.
 Overreduction may lead to screw exposure.
 Thin abutment of stone may be broken easily.
 Impression techniques using
analogues
Indirect technique ( closed tray):
Transfer type impression coping.
Transfer copings are attached to the implants by
screws , custom tray is loaded with impression
and seated in pt mouth , remove the impression .
the transfer coping remain screwed to the implants
not removed
inside impression.
The transfer copings are unscrew from the
implant , replaced in their positions in the
impression , attached to their implant
analogues then pour the impression
→ we will obtain a model containing implant
analogues in similar positions as in patient
mouth.
Closed Tray (Indirect) Procedure
indications to use of the transfer type impression
coping.
- limited mouth opening they can be used as
there may not be sufficient space for access to
the screws retaining pick up type impression
copings .
- patients with an exaggerated gag reflex( when
the impression has to be removed as quickly as
possible).
Direct technique ( opened tray):
(pick-up type impression coping)
● Coping are attached to the implant by screws , custom
tray is fabricated but with an occlussal window
corresponding to the transfers site.
●The transfer should be long enough to pass occlusally
through the window of the custom tray , wax is placed
between the transfers and the opening to avoid
impression material escaping occlusally.
after impression , the visible transfers are
unscrewed and the impression tray is removed
with the transfers sill in the impression→ implant
analogues are then screwed to the transfers then
pour the impression with stone.
Open Tray (Direct) Procedure
 It has been shown that the pick up type impression
coping(open tray) is the more accurate type of
impression , as error occur on removal and
replacement of the transfer type impression
coping(closed tray).
Splinted technique:-

 In the direct technique in which the transfers

are splinted together with duralay .
Plastic coping.
 The waxing sleeve
simplifies the work of the laboratory technician. It is designed
to be easily modified, shaped, and waxed-to to create an ideal
metal support for a fixed prosthesis.

(Design the desired abutment shape with respect to the soft

tissue and gingival margins.)

Selection:
Select the correct wax-up sleeve based upon the corresponding
implant platform

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Fabricate the master cast using Select the correct wax-up sleeve

Friction-fit the wax-up sleeve mark the approximate height to

inside the master cast model guide the trim.

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 Remove the wax-up sleeve from the
Trim the wax-up sleeve
master cast to futher modify height
within the contours of the
for accuracy and tooth shape
teeth

Reduce the projecting part of the

Friction-fit the wax-up sleeve into the
wax-up sleeve prior to applying
master cast once complete.
any wax.
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Build wax around the wax- Design the desired abutment shape with
up sleeve from the bottom- respect to the soft tissue and gingival margins.
up. Wax up the ideal tooth preparation.

Make sure there are no Remove the wax-up sleeve from

undercuts and the screw the master cast to finish the surface
access hole is completely
filled.

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The surface should be smooth Send the wax-up sleeve and the
and free of any chips or burrs master model to lab

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 Temporary Abutment
Definition: Temporary Abutment is a temporary component
for provisinal screw- and cement-retained restoration
Indications
.
Temporary Abutment is used in single tooth, partially and
totally edentulous situations for temporary cement- and screw-
retained restorations
Material
Commercially pure titanium or plastic

Clinical procedures
Temporary Abutment and processing the temporary
restoration in the dental laboratory. The procedure
can also be done chair-side
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According to provisinal resoration:

Choose temp abutment

Cemented provisionaL restoration use plastic temp
abutment
Cemented use plastic or tit
Multi implant unit use ( conical
abutment /tit coping / plastic cap)

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Remove the Healing Abutment Place a Temporary Abutment
and hand-tighten using the
Abutment Screw

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 Modify the preparation and margins as
Mark the areas which require modifications
needed using a carbide or a diamond bur.
(height, margins,

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Place undercuts around the surface to create a
Try-in the appropriate poly-carbonate
mechanical retention for acrylic.
Place

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Place the Direct Coping Screw and put a
Block-out any undercuts on the adjacent teeth
screw-access hole into the shell crown.

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Place acrylic inside the crown. Remove the excess acrylic and
Properly position the crown polish.
over Abutment

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Place a cotton pellet over the screw Make any other final occlusal adjustments and
followed by composite to fill in the screw- polish
access-hole

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PLATFORM SWITCHING

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 Patient’s expectations

 Restore masticatory function.

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 Patient’s expectations

 Esthetically pleasing.

 Easy to clean.

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 Patient’s expectations

 Permenant restoration.

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Main factors affecting bone
loss
1. Implant crest module:

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Main factors affecting bone
loss
2. Occlusal overload

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Main factors affecting bone
loss
3. Micro gap

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Main factors affecting bone
loss
4. Biological width formation.

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Platform switching (PLS)

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 Platform switching

 History.

104
 Platform switching

 Bone
preservation

 Soft tissue
preservation.

 Eshtetic effect.

 Mechanical
Effect.

105
 Evidence based assessment
Peri implant bone level

N=14

N=7

Hürzeler M, Fickl S, Zuhr O, Wachtel HC. Peri-implant bone level around implants with
platform-switched abutments: preliminary data from a prospective study. Journal of
oral and maxillofacial surgery : official journal of the American Association of Oral and
Maxillofacial Surgeons. 2007;65(7 Suppl 1):33–9.
106
 Evidence based assessment
Peri implant bone level

 Aim.

 Findings.

López-Marí L, Calvo-Guirado JL, Martín-Castellote B, Gomez-Moreno G, López-Marí M.

Implant platform switching concept: an updated review. Medicina oral, patología oral y
cirugía bucal. 2009;14(9):e450–4.
107
 Evidence based assessment
Peri implant bone level

 Aim.

 Findings.

Fickl S, Zuhr O, Stein JM, Hürzeler MB. Peri-implant bone level around implants with
platform-switched abutments. The International journal of oral & maxillofacial implants.
2010;25(3):577–81..
108
 Evidence based assessment
Inter implant distance

 Aim.

 Findings.

Rodríguez-Ciurana X, Vela-Nebot X, Segalà-Torres M, et al. The effect of interimplant

distance on the height of the interimplant bone crest when using platform-switched
implants. The International journal of periodontics & restorative dentistry.
2009;29(2):141–51. 109
 Evidence based assessment
Effect of difference in diameter

Canullo L, Fedele GR, Iannello G, Jepsen S. Platform switching and marginal bone-level
alterations: the results of a randomized-controlled trial. Clinical oral implants research.
2010;21(1):115–21.
110
 Evidence based assessment
Effect of difference in diameter

Canullo L, Fedele GR, Iannello G, Jepsen S. Platform switching and marginal bone-level
alterations: the results of a randomized-controlled trial. Clinical oral implants research.
2010;21(1):115–21. 111
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 To summarize

 Main advantages of PLS:

1. Reduce bone destruction in vertical and
horizontal directions
2. Preserve soft tissue support thus giving
better esthetics.
3. Provide better load distribution

113
 Main indications

1. In reduced available ridge height.

2. Thin ridges.
3. Implants need to be placed less than 3 mm
apart.
4. Short implants in atrophic areas.
5. Achieving good eshetics in anterior maxilla

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THANK YOU