Reviewer by: Sophia Divinagracia
Original Branemark Protocol
DENTAL IMPLANTS
- A prosthetic device alloplastic
material implanted into the oral
tissues beneath periosteal layer
- Provide retention and support
for fixed or removable patient
HISTORY
600 AD- first evidence of dental
implant
Per-ingvar Branemark
- Father of modern dental
implants
- Swedish physician and research
professor
- Titanium screws could not be
remove after bone healing
- “fixture”
- Development of different types
of titanium
Per-ingvar and Gosta Larsson of
Gothenburg
- 1965: first ossoeintegrated
dental implant
- Mandibular 4 implant supported
Ossoeintegration
- Rigid fixation if implant the host
bone site no intervening tissue
(Branemark, 1977)
- “bone to titanium”
- A process in which clinically
asymptomatic rigid fixation of
alloplastic material is achieved
and maintained in the bone
during functional loading (Zarb
and Albrektsson)
- Dapat yung ossoeintegration no
swelling, pain, etc.
Side note:
Every 6 months pabalikin yung patient
National Institute of Health Conference
1988 (NIH)
- Officially approved the
ossoeintegrated implant as a
regular dental treatment method
1. Gentle traumatic placement of
the implant
2. Initial stabilization of the
implant
3. Two stage protocol
4. A period of unloaded healing
5. Use of commercially pure
titanium
Side notes: 6 months -even a year to
achieve ossoeintegration
2. Loading
- 4 months- lower
- 6 months- upper
- less density yung bone sa maxillary
bone more ideal sa mandible
3. Stage
- implant placement
- uncover after??? Idk
- period na wala pang crown until hindi
pa nag hheal
Temporary Anchorage Devices-TADS
NIH-Harvard concencus of implant
success rate (1978)
1. Bone loss no greater than one
third of the vertical height of
the implant
2. Good occlusal balance and
vertical dimension
3. Gingival inflammation amenable
to treatment
4. Mobility of less than 1mm in any
direction
5. Absence of symptoms and
inflammation
6. Absence of damage to adjacent
teeth
7. Absence of paresthesia or
anesthesia or violation of the
mandibular canal, max. sinus, or
floor of the nasal passage
8. Healthy collagenous tissue
without polymorphonuclear
infiltration
Side notes:
Mucositis=gingivitis
Implantitis=periodontitis
 Reviewer by: Sophia Divinagracia
Signs of failure
- Inflammation Bioactive
- Redness - Interaction
- Bleeding - Osseointegration

Paresthesia Implantology=materials
- Mandibular premolar
- Inferior Alveolar Nerve
- Posterior Molar Mechanical properties

Side note:
Biotolerant PMMA, Stainless
Cone beam computed tomography steel, Co-cr alloy
(CBCT)- is a must Bioinert Titanium
Partially stable
A 15 year study of osseointegrated zirconia
implant in the treatment of the Bioactive Glass ceramic,
edentulous implants tetra-calcium
phosphate
Success rate ceramic,
hydroxyapatite
Maxillary Mandibular cement
5 years 96.5%
5 years 81% 91%

Biological properties
Factors of implant success and failure

a. Biomechanical Titanium
- Implant materials - Biocompatible
- Implant design - Light weight
- Highly corrosion resistant due to
b. Biology stable oxide
- Implant surface quality - High mechanical resistance high
- Status of the bone (density) strength
- Low price
c. Clinical Application - Grade 1-5
- Surgical procedure
- Implant loading conditions Titanium alloy (Ti6Al4v)
- Aluminum increases the strength
Biocompatibility and decrease the weight of the
- Acceptable by the body without alloy
rejection - Vanadium acts as a beta-phase
stabilizer and increase the
Biomaterials strength
- A non-drug substance suitable
for incision in systems which Types of Titanium in Dental Implants

Biotolerant Fixtures: titanium grade 4 consider

- No interaction with bone or biocompatible and fracture strength
surrounding structures
- Rejection Abutment: Titanium grade 5 consider
the protection and fixture connection
Bioinert
- Neutral Screw: titanium grade 5 consider
- Minimal interaction with fracture strength
surrounding tissues
 Reviewer by: Sophia Divinagracia
Tool: stainless steel (consider corrosion
and durability)
Design
Classification of implant system??
1. Surgical technique
- 2 types
a. One-stage: exposed in
gingiva.
b. Two-stage: embedded;
incised
One-Stage technique’
- Exposed
- Implant/implant healing abutment Internal connection
through the periosteum or gingival
tissue at the time of implant
placement
Advantages:
- Easier gingival management
- Patient management
Two stage technique (submerge type)
- Implant with implant cover screw are
completely submerged with flap
closure
- Implants are allowed to heal, free of
loading, and micromovement for a
period of time to allow
osseointegration
- 2-4 months mandible (healing)
- 4-6 months maxillary (healing)
- 2nd surgery/operation is needed
- Placement of healing abutment
- Allow emergence of implant/abutment
though the soft tissues
Advantages:
- Simultaneously bone augmentationNon-submerged implants
procedure at the time of implant
placement, the primary flap closureAdvantages:
will minimize post-op exposure of the
grafty materials
- Prevents implant movement during
healing
- ??
Implant abutment connection
- 3 major implant system function
a. Branemark 1965: two stage
external
b. Straumann 1986: one stage
internal
c. Astra: one stage internal
(submerged)
External connection
- Facilitate implant insertion
- Provide with an anti rotational
device (external)
Disadvantage
- Limited effectiveness when
subject to axis??? Or horizontal
forces
- May allow for micromovement of
the abutment, thus causing
inability of the joint
- Abutment screw loosening
- Inside the implant body
- Higher stability and improved
force distribution
- Has ability to ?? lateral leads
deeply within the implant
- Less movement between
abutment and implant walls.
- Less prone to screw loosening
and screw fracture
Fractures in implant
- Tx: surgery =remove implany
Side notes:
- 8 degrees maxillary taper:
Straumann implants
- 11 degrees taper: astra
- 15 degrees taper: Straumann
- Simplified protocol
- Simplified?? Protocol due to solid
abutment
- Improved primary stability due
to cervical countersite
- Reduce number of surgical
stages
- Reduce??
- ??
- ??
Limitations
a. Esthetic risk
b. Bacteria r.
 Reviewer by: Sophia Divinagracia
c. Surgical r.
d. Mechanical r. Shear

R???
Indication:
- Posterior edentulous
- Good oral hygiene
- Law esthetic??
- Simple cases

One-step submerged implants

- Good short-term results reported
using submerged implant place Forces distribution
in surgical U
F
N
A. surgical protocol: conventional A
F
surgery; healing abutment V
A
before suturing Tensile & O
V
B. preliminary result?? Compressive R
O
Shear A
R
B
A
Physiologic constraints on design B
L
E
3 Utypes of forces L
N
F 1. compressive
A 2. tension
V 3. shear IMPLANT PLACEMENT
O - implant should be place
R perpendicular to the occlusal
Bone
A is stronget in compression plane
B weaker in tensive forces
30%
65% weaker in shear forfves
L Consider the ff:
Tension stress 1. adjacent teeth
2. curve of spee
3. Curve of Wilson

- Allows more axial load the

implant body
- Reduces the amount of crestal
stress
- Reduces the shear forces the
Compressive implant bone interface

Influence of implant body design

- Smooth cylinder implant body
- Result to a shear type force at
the implant-to-bone interface
- Microscopic retention: plasma
spray and hydroxyapatite coating
(reestablish osseointegration)

Threaded implant
 Reviewer by: Sophia Divinagracia
- Reduces shear forces at the
implant to bone interface
- Thread geometry

Thread shapes in dental implant

Unit length
Pitch=
Number of thread

Square
- Provides an optimized surface
area for intrusive compressive
load transmission
- Generating least shear forces

V-shape
- 10 times greater shear force
than square
- Reduces shear load provide more - The broader the better
compressive load - If implant is the same, a smaller
- Transmit axial force through a pitch means there are hreater
combination of compression, amount of thread
tensive, and shear
-  amount of threads= implant
surface area
Buttress
- Increase the amount of bone to
- 10 times greater shear forces
implant contact
than square
- Increase resistance to vertical
forces
Thread Pitch
- Thread design maxillary implant
Thread depth
a better spreading?? And primary
- The distance from the tip of the
stability
thread to the implant body
- Refers to the distance from the
- Shallow thread will be easier to
center of the thread to the
insert into dense bone
center of the next thread
- A deep thread will allow for
much primary stability
specifically for situations such as
soft bone of immediate implant
size
 Reviewer by: Sophia Divinagracia
bacterial plaque adhesion ad
incidence of peri-implantitis
Thread width - Newest generation has surface
-is the distance is the same axial plane treatment to top of implant no
between coronal most part and the polished collar
apical most part at the tip of the single
thread

Face angle
- Is the angle between the face of
the thread and a plane
perpendicular to the long axis of
the implant
- Small forces angle will increase
tensile and compressive type
forces
- Increase face angle will increase
shear forces

-
Implant collar
- Superior part of the fixture
- Collar height
a. Submerged implant: 0.5 to 1
mm in height
b. Non-submerged implant: 3-
5mm

- Purpose
1. Allows functional remodeling
of bone
2. Improve abutment fixture
interface
3. Prevents exposure of surface
coating

- Polished implant collar smooth

titanium surface decrease