Implant Surgery

Dental Implant

•A substance that is
placed into the
jaw to support a
crown, fixed or
removable denture
Peri-implantation Biologic and Functional
Considerations
 Hard Tissue Interface

• Osseointegration- a direct structural and

functional connection between living bone and
the surface of a load-bearing implant without
intervening soft tissue between the implant and
bone.
- asymptomatic rigid fixation of
an alloplastic material in bone with the ability to
withstand occlusal forces.
 Important factors for osseointegration:

1. A biocompatible material
2. Atraumatic surgery to
minimize tissue damage
3. Implant placement in
intimate contact with bone
4. Immobility of the implant,
relative to bone, during
the healing phase
Implant Surgery

One-Stage Implant Two-Stage Implant

• Coronal portions stays • Top of the implant is
exposed through completely submerged
gingiva during the under gingiva
healing period
Soft Tissue to Implant Interface

• Zone of supracrestal connective

tissue is responsible for maintaining
a stable interface between soft
tissue and implant. It acts a seal or
barrier to the oral environment
• In a natural tooth there is a bone
support with a periodontal ligament
• In an Implant there is a direct
contact with bone without
intervening soft tissue.
Biomechanical Considerations

• Load-bearing capacity of implants > anticipated loads

during function

• If applied loads > load-bearing capacity

Failure: Mechanical or Biologic

 Implant Failure

• Mechanical Failure:
 Porcelain fracture
 Loosened or fractured prosthetic
screw
 Fracture of the implant fixture
• Biologic Failure:
 bone loss around the platform of the
implant progressive bone loss
around the entire implant complete

failure of implant
Implant vs. Tooth-retained restoration

• Osseointegrated dental • Teeth are suspended within

implants: direct contact with the supporting alveolar bone
alveolar bone by periodontal ligament

No periodontal ligament Physiologic movement

excessive forces
Teeth movement
Bone loss
Load-bearing Capacity

• Several factors influences load-bearing capacity:

Number and size of the Implant
Arrangement and angulation of the Implant
Volume and quality of the bone-implant interface
Arrangement and Angulation

• Angulation of the implants in relation to the occlusal

plane and the direction of the occlusal forces
• Loads directed through the long
axis are well tolerated
• Loads applied at an angle of 20 degrees
or more initiates bone loss
Partially edentulous patients

• MULTITOOTH EDENTULOUS SPANS

- The number of implants used will
influence the load-bearing capacity
of implanted prosthesis
- Implants should be placed in a
more curvilinear or staggered
fashion
PREOPERATIVE ASSESSMENT AND
TREATMENT PLANNING
• Chief Complaint
- statement in his or her own words that conveys the perceived problem,
concerns, expectations, and so on.

• Medical History and Medical Risk Assessment

- Metabolism diseases: - Mental conditions: - Habits and Behavioral

 Diabetes  Schizophrenia considerations:
 Paranoia  Smoking
 Osteoporosis
 Neurosis  Tabacco use
 Immune compromise (HIV,  Drugs
AIDS)  Hysteria
 Alcohol
 Bruxing and clinching