Implantology

Dr.Irakli Chachua
Prosthodontist, oral surger
Dental clinic ZEPPELIN
Dental implants
 Dental implants
companies
• 1) Straumann.
• 2) Nobel Biocare (Danaher)
• 3) Dentsply Sirona (Previously Astra Tech)
• 4) Zimmer Biomet.
• 5) BioHorizons
• 6)SGS impalnts
• 7)MIS implants
Dental impalnts
 Types of abutments
• Straight
• Angled
• Ball type

• Materials: metal and

zirconia
Prosthetics on implants
Surgical kit
Implant bors
physiodispenser
 Selection of implants
• Documented clinical success
• Commercially pure titanium
• Cylindrical threaded implant design
• Protocol
• A modified roughened surface
• Universal implant for al bone
• Universal protocol for immediate and early loading
• Various lenghts and diameters
• Internal implant conncetions
• Low start up cost
• Ability to cement or screw retained final prosthesis
• Affordable cost to patient
• Training,education and ongoing support
 Planning of implantation
• Anamnesis
• General health condition
• Oral cavity examination (external, internal)
• Panoramic Xray
• CT scan
 Extra Oral examination
• TMJ and muscles
• Smile line
 Intraoral examination
• General :
• Primery disease
• Parafuntion
• Prognosis of the remaining teeth
• Occlusal support and control
• Specific on site:
• Space-interdental and interocclusal
• Ridge thickness and shape
• Nature, thickness and condition of the soft tissue
• Availability of bone
Important
Radiographic examinations
X-RAY
 Radiographic examinations
• Maxilla:
• Maxillary sinus
• Nasal floor
• Incisive canal
• Labial concavities
 Radiographic examinations
• Mandible:
• Inferior dental canal
• Mental foramen
• Lingual concavities
 Bone types
• Type I bone is comparable to oak wood, which is very hard and dense. This type of bone has less
blood supply than all of the rest of the types of bone. The blood supply is required for the bone to
harden or calcify the bone next to the implant. Therefore, it takes approximately 5 months for this
type to integrate with an implant as opposed to 4 months for type II bone.
• Type II bone is comparable to pine wood, which isn’t as hard as type I. This type of bone usually
takes 4 months to integrate with an implant.
• Type III bone is like balsa wood, which isn’t as dense as type II. Since the density isn’t as great as
type II, it takes more time to “fill in” and integrate with an implant. 6 months time is suggested
before loading an implant placed in this type of bone. Extended gradual loading of the implant can,
however, improve the bone density.
• Type IV bone is comparable to styrofoam, which is the least dense of all of the bone types. This
type takes the longest length of time to integrate with the implant after placement, which is usually
8 months. Additional implants should be placed to improve implant/bone loading distribution..
Bone grafting or augmentation of bone are often required. Bone expansion and or bone
manipulation can improve initial implant fixation.
 Bone types
• Type I: homogeneous cortical bone;
• Type II: thick cortical bone with marrow
cavity;
• Type III: thin cortical bone with dense
trabecular bone of good strength;
• Type IV: very thin cortical bone with low
density trabecular bone of poor strength
 Delayed placement
Potential benefits
• Initial remodelling of sot and hard tissues
has occurred. This allows for predictable
placement of implants in relation the these
tissues
• There is more soft tissue avaialable to
modify gingival aesthetics
• It is easier to place the implant after bone
healing
 Delayed placement
Potential problems
• Delay completion of treatment and, if
present, prolonged use of removable
denture
• If the bone ridge is just wide enough for
implant palcement at the time of extraction
then further resorption may occur if
placement is delayed making subsequebt
implant placement difficult without tissue
augmentation
 Immediate placement
potential benefits
• Reduces time between removal of teeth amd
restoring the implant
• May preserve bone

• potential problems:
• The depth to place an implant, this may result in
either placing an implant deeper or exposure of
implant that has been placed superficially
• Limits the possibility for Modification of tissue,
which is important for aesthetics
• Technically Difficult procedure
 Number of implants
• Full maxillary fixed bridge on implants (6-8
implants)
denture on implants
4-6 implants
 Distances

• Distance between
implants is 1.5-3mm
• If 4mm diameter is
used than 7mm
• Distanc between
adjacent tooth and
implant is at least
2mm
Flap design
 Bone preparation
• Bone is prepared with gradually widening
the diameter of bors.
• The objective is to produce a site as
atraumatically as possible into which a
slightly wider-sized implant is threated
• The primary goal is to produce rigid
fixation of the implant in the bone to
ensure its stabiliyu during osteointegration.
• The torque should be at least 30ncm
 Direction
• Implant direction guider is
placed, after pilot bor is
used, to identify the
direction of implant.
• This is essential if
multiple implants are
placed. Especially on
edentulous jaw
• Direction Indicator
diameter: Ø2/Ø2.4-2.8
mm
 Single stage surgery
• In this case long-healing
abutment is placed on
implant, that protudes
through the soft tissues it
fitted.
• Not in all situation
• If there is a risk of a
denture pressing on the
integrating implant
• If the implant is short or
located in less than ideal
bone.
 Second-stage surgey
• It is required to uncover a bnuried implant
following osteointegration.
• “Punch” flap or mucoperiostal flap is done
• The soft tissue healing abutment is placed
• The impreison is taken several weeks
later
 suturing
• The implant must be
placed into the previously
drilled bone, full with
blood.
• Luck of blood may cause
the problem with
osteointegration
• Implant must be sutured
hermetically
• For suturing is used
nonresorbable poliamid
cords, size 4.0
 Types of suturing technique
• In case of 1 to 2
implants placement a
single suturing
technique is used

• Continouse suturing
technique is used In
case of multiple
implant placement.