Common Types of

Dental Implant Materials

in Dentoalveolar Trauma
Management

Dr. Nina Djustiana, drg. M.Kes.

Senior Lecturer of Dental Material Science and Technology Faculty of
Dentistry Universitas Padjadjaran, Indonesia
 DENTOALVEOLAR TRAUMA

Injuries affecting the teeth and /or their supporting

tissues and can be sub divided in to:
• Dental hard tissues and pulp
• Periodontal tissues
• Supporting bone
• Gingivae and oral mucosa
• Combination of above
 DENTOALVEOLAR TRAUMATIC INJURIES
(DAI)

• Injury resulting from an External Force, involving teeth,

alveolar portion of maxilla or mandible, & adjacent soft
tissues.

• Fractured, displaced, or lost anterior teeth have a

significant functional, aesthetic, and psychological effects
thus affecting quality of life
DENTOALVEOLAR INJURIES CONSTITUTES OF

• Alveolar bone Fracture 6%

• Soft tissue injury 47– 58%
• Uncomplicated crown fracture 26 -76%
• Complicated crown fracture 15.5%
• Root fractures 7.7%
• Avulsion 4–22%
• Improper management can lead to tooth and alveolar
bone loss leaving defective alveolus in the post
traumatic state.
 MANAGEMENT OF POST DENTOALVEOLAR
TRAUMATIC INJURY

• Localized alveolar defects are challenging from

conventional prosthodontic treatment point of view.

• Alveolar bone is lost due to late complications of injury. ;

if replanted tooth during growth becomes ankylosed
and submerged, prevents normal growth of the alveolar
crest .
 TO RESTORE BONE DEFECTS, VARIOUS
MATERIALS & METHODS ARE USED

• Augmentation with onlay bone grafts, membrane

techniques, bone distraction, bone splitting, and
implant treatment, resorbable plate.
 IMPLANT TREATMENT
• Selection of the right material for dentoalveolar recovery treatment will enhance
tissue reconstruction, both in the function and shape of the maxillofacial region.

• A definitive treatment plan can start to be formulated based on the following

questions:
WHAT:
- Determine what implant to place. Most important factors are
the implant width and length.
- Material type (Metal/non metal; Biodegradable materials/Non
Biodegradable materials)
- Surface characteristics (machined/smooth or rough implant
surface)
- Shape of the implant (parallel or tapered)
- Presence or absence of a collar (also referred to as ‘tissue level’ or a ‘bone
level implant’)
 IMPLANT TREATMENT
• WHEN:
The timing of the surgery relative to the removal of the
tooth.

• WHERE:
Clinician should always aim for ideal 3-dimensional
placement which will allow the creation of a
harmonious restoration without compromising the
longevity of the implant.
 IMPLANT TREATMENT
• Advances in biotechnology and biomedical
fields that provide material innovations on
maxillofacial region reconstruction.

• Dental implant materials evolved from iron,

stainless steel, titanium, vitallium, and most
recently, the resorbable material, namely
polylactide.
IMPLANT MATERIAL SELECTION
• Metal
1) Titanium, Tantalum;
2) Titanium, Vanadium, Alumunium alloy (common used);
3) Ferum, Chromium, Nickel;
4) Cobalt, Chromium, Molybdenum.
• Non-Metal
1) Plastic materials: Polymeric; Polymethyl Methacrilate (PMMA);
Polymethyl Methacrilate-Vitreous Carbon (PMMA-VC);
Polymethyl Methacrilate mixed with silica sol (PMMA/Silica).
2) Carbon materials: Vitreous Carbon; Pyrolic Carbon/Low
Temperature Isotropic (LTI); Vapour Deposited Carbon/Ultra
Low Temperature Isotropic (ULTI).
3) Ceramic materials: Porous Ceramic, Non Porous Ceramic;
Biodegradable materials (Tricalcium Phosphate, etc.); Non-
Biodegradable materials.
 METAL DENTAL IMPLANT
• Specific characteristic and biomechanical properties, including
tensile strength, shear stress, modulus elasticity, and yield
strength.

• Proper tensile strength is needed to maintain fracture

reduction and resists from physiological pressure; while
proper elasticity is needed to be easily formed as in situ plate.

• Metals used in dentoalveolar trauma treatment in the form of

plates, screw, and mesh for comminuted fracture treatment.

• Most popular metal used as dental implant are vitallium,

stainless steel, and titanium.
 VITALLIUM
• Initial metal dental implant, since 1929.
• A trademark for an alloy of 65% cobalt, 30% chromium, 5%
molybdenum, and other substances).
• Advantages:
200% higher tensile strength and hardness (compared to other
metals);
50% stronger yield strength.
• Disadvantages:
Less biocompatibility (compared to titanium;)
Decreasing biomechanical fixation;
Increasing in intra- and extra-cellular accumulation of metal ions in
the immediate implant surrounding area;
Difficulties in radiographic scatter shape.
 STAINLESS STEEL
(IRON-CHROMIUM-NICKEL BASED ALLOYS)
• Also known as inox steel or inox from French inoxydable
(inoxidizable), is a steel alloy with a minimum of 10.5% chromium
content by mass and a maximum of 1.2% carbon by mass.
• Popular implant material in 1980s.
• Advantages:
Adequate strength, flexibility, ductility, and biocompatibility for most
maxillofacial implant applications;
Relatively cheap and easy to manufacture.
• Disadvantages:
Corrosion;
Late-onset implant failure;
Presence of radiographic scatter at MRI;
Subjected to allergic reactions in susceptible patients;
High galvanic potentials and corrosion resistance.
 TITANIUM
• Exhibits mechanical properties and biocompatibility desirable for internal
rigid fixation.
• Golden standard for reconstruction of the maxillofacial skeleton.
• Common choice in the repair of orbital floor fractures. In addition, the
development of hybrid materials (polyethylene with reinforced titanium
mesh) has further increased its use in such fractures.
• An inert, non corrosive and malleable metal.
• Titanium mesh cranioplasty has revealed to be an extremely safe and
reliable alternative to autografts and even more preferable to replacement
with natural bone autografts in case of large size cranial defects.
• Advantages:
Excellent biocompatibility by formation of stable oxide layer on its
surface;
Having mechanical properties similar to bone tissue;
Visibility on postoperative imaging with minimal distortion at MRI.
 TITANIUM
• Disadvantages:
Quite high cost;
Possible aesthetic issues related to the gray color of titanium which
becomes more pronounced when soft tissue situation is not optimal
and the dark color stands out through the thin mucosa.
 RESORBABLE PLATE
• Large permanent implants can lead to problems due to
migration, palpability, stress shielding, infection, thermal
sensitivity, and general discomfort.

• One possible solution to avoid these potential sequelae is to

use a bioabsorbable bone plate that can be eliminated from the
body in 8 months to 5 years.

• Bioabsorbable plates and screws often made of the polymers

polylactide and polyglycolide, as well as copolymers
polyglycolide-co-polylactide and poly(L-lactide-coD, L-lactide)
(P[L/DL]LA).
 RESORBABLE PLATE
• Resorbable bone plates do not provide enough fracture
stability to be safely used in the load-bearing regions of most
adult patients. Because the materials have low strength,
bioabsorbable bone plates tend to be bulky and cumbersome.
The materials are also associated with a significant amount of
swelling, discharge, and osteolysis.

• Osteolytic changes around self-reinforced polylactide screws

have been demonstrated to occur in 27% of cases. Furthermore,
many bioabsorbable materials need to be heated to a
temperature greater than the glass transition temperature to be
molded into the required shape.
 RESORBABLE PLATE
• Despite advances in self-reinforcement, absorbable plating has
not seen widespread use because bioabsorbable bone plates are
used mostly in the midface and skull, whereas thicker bone
plates are being proposed for fixation of fractures in the load-
bearing mandibular region.

• The major problem of existing bioabsorbable plate designs

stems from the thicker profiles required to combat the
materials’ low mechanical stability.

• Rudimentary design methods have resulted in larger and

thicker bone plate designs, which have traditionally served to
compensate for the lack of biomechanical understanding
pertaining to fractures of this region.
 RESORBABLE PLATE
• A longer amount of time is required to metabolically remove a
thicker bone plate thus the patient is subjected to a higher risk
of infection. Furthermore, the plates are cumbersome and
difficult to implant during surgery, leading to longer surgical
times.

• Ideally, the plates would be thinner and more pliable,

effectively making them less cumbersome, less palpable, and
capable of fast degradation. Modified plate designs are
necessary to use these materials safely in the mandible. Plate
design modification is a necessary step toward bringing these
materials into widespread use.
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