 A prosthetic device or alloplastic material

implanted into the oral tissue beneath the

mucosal or/and periosteal layer and/ or in the
bone to provide retention and support for the
fixed and removable prosthesis. - GPT
 Edentulous patient
 Partially edentulous patient with history of difficulty in
wearingR.P.D.
 Patient requiring long span F.P.D.treatment
 Patient who refuses wearing a removable prosthesis
 Patient with severe changes in C.D.bearing tissues
 Poor oral muscular coordination
 Parafunctional habits that compromise prosthesis stability
 Unrealistic patient expectation for complete denture
 Hyperactive gag reflex
 Patient psycologically against removable prosthesis
 Unfavourable number and location of abutments
 Single tooth loss, avoid preparation of sound teeth
Absolute Contraindications
 Recent myocardial infarction
 Valvular prosthesis
 Severe renal disorder
 Uncontrolled diabetes
 Uncontrolled hypertension
 Generalized osteoporosis
 Chronic severe alcoholism
 Radiotherapy in progress
 Heavy smoking
RELATIVE CONTRA INDICATIONS
 Cardiovascular problems
 Congestive heart failure
 Coronary artery disease
 Prosthetic heart valves
 Rheumatic heart disease
 Endocrine disorders (e.g., calcium, iron, avitaminosis, low
estrogen in females)
 Hyperactive involuntary muscle movements (e.g., Parkinson’s,
Huntington’s)
 Bone disorders (e.g., osteomyelitis, osteopetrosis, osteoporosis)
 Benign/malignant bone neoplasms or cysts and fibro-osseous
disease
 pregnancy
 Preservation of bone
 Improved function
 Aesthetics
 Stability and retention
 comfort
 Expensive
 Cannot be used in medically compromised pt.
 Who cannot undergo surgery.
 Many patients do not accept longer duration of
treatment and tedious fabrication procedures.
 Requires lot of patient cooperation
 Cannot be universally placed due to presence
of anatomical limitation.
1) Depending on the placement within the
tissues
Epiosteal / Subperiosteal implants
Endosteal implants
Transosteal implants
i) METALLIC IMPLANTS
• titanium
• cobalt chromium molybdenum alloy- Titanium
aluminum vandium
• Cobalt chromium molybdenum
• Stainless steel
• Zirconium
• Tantalum
• Gold
• Platinum

ii. NON – METALLIC IMPLANTS - ceramics

- carbon
3)Depending On Their Reaction With Bone:
a.Bio-active
• Hydroxyapatite
• Tri Calcium Phosphate
• Calcium Phosphate
b. Bio inert -metals
Commercially used -pure titanium
– Titanium-aluminum-vanadium alloy (Ti-6Al-4V) -
stronger & used with smaller diameter implants

Titanium
•Lightweight
•biocompatible
•corrosion resistant (dynamic inert oxide layer) •strong &
low-priced
•It is 6 times stronger than compact bone
•Its modulus of elasticity is 5 times greater than that of
compact bone (thus equal mechanical stress transfer)
Misch 1989 reported five prosthetic options of
implants.
 FP1- fixed prosthesis replaces only crown; looks
like a natural teeth.
 FP2- fixed prosthesis; replaces crown and portion
of root.
 FP3- fixed prosthesis replaces missing crowns and
gingival colour and portion of edentulous sites.
 RP4- removal prosthesis ; overdenture supported
completely by implant.
 RP5-removal prosthesis ; overdenture supported
by soft tissue and implant.
1. Implant body or fixture
2. Healing screw
3. Healing caps
4. Abutments –resembles a prepared tooth and is
designed to be screw into the implant body.
5. Impression posts-small stem used to transfer the
intraoral location. They are placed over implant
body during impression making.
 Superstructure metal framework that attaches
to the implant abutment and provides either
retention for removable prosthesis or
framework for fixed prosthesis.
 Commonly used superstructures include
overdentures , fixed bridges ,fixed detachable
bridges and single crown.
 This includes medical , dental and diagnostic
evaluation.
Medical history
– vascular disease
– immunodeficiency
– diabetes mellitus
– tobacco use
– bisphosphonate use
History of Implant Site
• Factors regarding loss of tooth being replaced.
• Factors that may affect hard and soft tissues:
– Traumatic injuries
– Failed endodontic procedures
– Periodontal disease
• Clinical exam may identify ridge deficiencies
Dental evaluation
Dense cortical (D1) bone
 Highest bone implant contact (BIC) > 80%

 Anterior region of mandible very dense

compact bone
Dense to thick porous cortical and coarse
trabecular bone (D2)
 BIC = 70% 5.
 Dense to porous compact bone on the outside
and coarse trabecular bone on the inside .
 Anterior and posterior mandible
Thin porus cortical and fine trabecular bone (d3) BIC =
50 %
 Thinner porous compact bone and fine trabecular
bone
 Anterior or posterior maxilla and posterior
mandible
Fine trabecular bone (d4)
 BIC = < 25 % 5

 No cortical crestal bone

 posterior maxilla in long term edentulous patients
 Diagnostic evaluation
 Iopa
 Occlussal radiographs
 Lateral cephalometric radiographs
 OPG
 CBCT
STEP 1: INITIAL SURGERY STEP
2: OSSEOINTEGRATION PERIOD STEP
3: ABUTMENT CONNECTION STEP
4: FINAL PROSTHETIC RESTORATION
Surgical placements of implants
• Success Rates >90%
• Histologic definition –“direct connection between
living bone and loadbearing endosseous implants at
the light microscopic level.”
factors affecting:
 Biocompatibility of implant material

 Implant design

 Surface conditions

 Status of host bed

 Surgical technikque

 Implant loading
• Fibroosseous integration – “tissue to implant
contact with dense collagenous tissue between the
implant and bone”
• Seen in earlier implant systems.
• Initially good success rates but extremely poor
long term success.
• Considered a “failure” by todays standards
Maxillary anterior region
 Low quality and quantity As bone height
decreases the remaining bone narrows to close
approximation with nasal cavity, maxillary
sinus, incisive canal.
 It is limited to canine eminence areas.

 CANINE EMINENCE AREA MUCH

SUITABLE FOR IMPLANT PLACEMENT IN
MAXILLARY ARCH
MAXILLARY POSTERIOR REGION
 Due to resorption pattern, proximity of sinuses
and quality of bone implants are rarely placed
here. Severe bone resorption and low palatal
vault creates a difficult situation for implant
procedure.
MANDIBULAR ANTERIOR REGION
 This region between mental foramina has
adequate bone for 4-6 implants. Minimum of 7
mm from inferior border of mandible to the
crestal ridge is needed .
 In resorbed ridge mental foramina located on
top of the ridge;care is necessary to prevent
damage to it and possible paresthesia.
MANDIBULAR POSTERIOR REGION
 Implant placement is difficult in this region
because of presence of inferior alveolar nerve.
 There should be minimum 1mm clearance
between the implant apex and the canal.
 Pattern of bone resorption is almost same on
buccal and lingual side.
 Pattern of resorption in crestal region creates
variety of shapes from sharp edge to flat and
wide. Shorter length implants are necessary.
 MAXILLARY SINUS AND INFERIOR
ALVEOLAR CANAL ARE THE PRINCIPAL
ANATOMICAL SITES LIMITING THE
IMPLANT PLACEMENT
Complications
 Membrane perforation.
 Presence of bony septae which divide sinus
into separate compartments.
 Postoperative infection.

 Wound dehiscence.
 Barrier Membrane exposure.

 Transient sinusitis.
 Surgical Complications:
Inoperative Complications
1.Oversize Osteotomy.
2.Perforation of cortical plates.
3.Inadequate soft tissue flaps for Implant coverage.
4.Broken burs.
5.Improper Instrumentation
6.Hemorrhage.
7.Poor angulations & Position of Implant.
 PROSTHETIC COMPLICATIONS: Component
& framework breakage
1.Fractured Frameworks & Mesostructure bars
2.Partial loosening of cemented bars and
prostheses
3.Inaccurate fit of castings
4.Inadequate Torque application 5.
In accurate frame work abutment interface 6.
Occlusal factors
7.Implant Fracture
Ailing Implant
 The ailing implant is the least seriously affected
Implants.
 Nothing more than a radiographic evidence of
diminishing but static bone loss may direct the
implantologist to be suspicious
Failing Implant
 The failing implants are firm. Osseointegration
develops apically and is responsible for the
implants stability. Routine radiography reveals
progressive bone loss around the cervical areas
of the implant.
 Failing implants - Actinobacillus
actinomycetemcomitans
-Porphyromonas gingivalis
Failed Implant
The simplest definition of a failed implant is
mobility.
This can be diagnosed by:
… Tapping and receiving a dull sound.
… Manipulating by two mirror handles and
detecting movement.
… By the use of the Periotest and eliciting a
response of +9 or higher