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Dental Implants

Dental implant is an artificial

alloplastic material placed
surgically into the jaw to
support a dental prosthesis.

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The titanium has been selected due to the

following proven characteristic:

1- strength.
2- light weight.
3- biocompatibility.
4- history of success in
the field of medical joints
replacement.

Parts
of the dental implant

1- the crown
2- abutment
3- fixture

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Parts of the dental implant

• 1- the crown: a replacement tooth, custom
made to match the color of adjacent teeth.
• 2- abutment : a devise that support and
connect the crown to the implant fixture.
• 3- fixture : is a titanium device imbedded in
the jaw bone to replace the original root of
the tooth.

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Indications for dental implants.

1. Intolerance to removable dental prosthesis.

2. Need for long span fixed prosthesis with
questionable prognosis.
3. Single tooth loss that will make it necessary
to prepare sound adjacent teeth for a fixed
prosthesis.
4. Unfavourable condition, location and
number of abutment teeth.

Contraindications for dental

implants
1- the mandible is severely atrophic as there is a
high risk of fracture.
2- there is an alveolar bone deficiency and the
patient declines bone grafting.
3- The patient is emotionally and psychologically
unstable (eg, bruxism, poor home care).
4- underlying disease or disorders of the bone
are present ( eg, osteoporosis)

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Advantages of implant over conventional

treatment
Advantages:

• 1- Implants do not involve preparation of

the adjacent teeth,
• 2- they preserve the residual bone, and
• 3- excellent aesthetics can be achieved.

1. Preservation of tooth structure.

Fixed bridge Implant

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Bone resorption after extraction

loss of teeth →
Lack of stimulation to the residual bone →
Decrease in bone density, height and width.

osseointegration
•A direct structural and functional
connection between living alveolar bone
and the load carrying surface of the
dental implant .

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Brånemark (May 3, 1929 –

December 20, 2014)
a Swedish physician
"father of modern dental implantology".

Factors affecting osseointegration

1. Implant biocompatibility
2. Implant design
3. Implant surface area
4. Implant bed ( type of bone),
5. Surgical technique.
6. Loading condition

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Misch classification
Bone quality (according to MISCH)

Classification Density Location

D1 Dense cortical bone more than Anterior lower jaw

70%
D2 The compact bone 50-75 % Ant./post. lower jaw
ant. upper jaw

D3 The dense cortical bone 25- Ant./post. upper jaw

50% post lower jaw

D4 Spongeous bone, large Posterior upper jaw

structure. The dense bone less
than 25%

Types of dental implant

1. Mucosal Insert

2. Endodontic Implant (Stabilizer)

3. Sub-periosteal implant

4. Transosseous implant

5. Endosteal or Endosseous implant

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Primary stability
• Primary stability is the initial mechanical lock
between the screw implant and the bone , it
depend on :
1- the length and diameter of the implant .
2- the thread design
3- the quality of the bone site : cortical versus
spongy bone .
4- the preparation of the surgical site, heat
generation, torque, and speed of the handpiece.

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2nd lecture

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PRE – SURGICAL PLANNING

Selection of implant dimension and length

In order to determine if there is sufficient

mesio – distal space and vertical height of
the bone it is necessary to perform
tomographic, panoramic, and periapical
radiographies.

surgical stent

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1- at least 1mm of excess bone should be present

on both the lingual and buccal side after taking
the width of the planned implant type into
consideration.
2- At least 2 mm of bone should be present on
either mesial or distal side of the implant and any
adjacent tooth or adjacent implant.
3- vertical ridge height must ideally provide a 1 or 2
mm margin of safety from the inferior alveolar
canal , maxillary sinus and other adjacent vital
structures.

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1mm
2 mm

1mm
2 mm

Surgical procedure for

endosseous implants

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Anesthesia
• Local anesthesia is usually used.
• General anesthesia rarely used for patients
who are anxious and apprehensive or when
multiple implant used.

Flap design
1- There is a trend towards flapless surgery .
Using punch drill.
2- An incision is made slightly buccal on the
mandible
3- palatal to the maxillary crest ( with or with
out a vertical releasing incision ).
4- mid crestal incision

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Crestal Incision

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Ø3.4 Final Drill

(1,000rpm with irrigation)

parallel pins

3810 Fixture 4310 Fixture

[D.-Ø3.8, L.-10mm] [D.-Ø4.3, L.-10mm]

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Ø3.4 Final Drill

(1,000rpm with irrigation)

3810 Fixture 4310 Fixture

[D.-Ø3.8, L.-10mm] [D.-Ø4.3, L.-10mm]

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Healing abutment(Ø5.5M) installation with Hex Driver

3810 Fixture 4310 Fixture

[D.-Ø3.8, L.-10mm] [D.-Ø4.3, L.-10mm]

Healing abutment(Ø5.5M) installation with Hex Driver

3810 Fixture 4310 Fixture

[D.-Ø3.8, L.-10mm] [D.-Ø4.3, L.-10mm]

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Healing abutment(Ø5.5M) installation with Hex Driver

3810 Fixture 4310 Fixture

[D.-Ø3.8, L.-10mm] [D.-Ø4.3, L.-10mm]

Suture

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