PERIIMPLANT

ANATOMY, BIOLOGY
AND FUNCTION
BY.
DR. MUHAMMAD AMIN
ASSOCIATE PROFESSOR

HOF
PERIODONTOLOGY DEPARTMENT (DIDC)
CONTENTS:

• Introduction
• Implant Geometry (Macrodesign)
• Hard Tissue interface
• Soft tissue interface
• Clinical comparison of teeth and implants
Introduction
What is a dental implant?
A dental implant is an artificial tooth root that interfaces with the
bone of the jaw to support dental prosthesis such as a crown,
bridge or denture.
 Implant Geometry (Macrodesign)
1. Endosseous implants
• Bladelike
• Pins
• Cylindrical (Hollow and full)
• Disklike
• Screwshaped
• Tapered and screw shaped

2. Subperiosteal framelike implants

3. Transmandibular implants
Hard Tissue interface
Primary goal of implant installation is to achieve and maintain a stable bone-to-implant connection which
is known as osseointegration.

Histologically, osseointegration is defined

as direct structural and functional connection
between the bone and the load-bearing
implant surface without soft tissue
intervention.

Clinically, osseointegration is defined as the

rigid fixation of alloplastic material (implant)
in the bone with the ability to withstand
occlusal forces.
Hard tissue interface

Initial bone healing

• Implant site osteotomy initiates a sequence of events

which involved inflammatory reaction, bone resorption,
release of growth factors and attraction of
osteoprogenitor cells by chemotaxis.
• Osteoprogenitor cells differentiate into osteoblasts
leading to bone formation
• Immobility of the implant must be maintained, mild
inflammatory response enhances healing.
 Initial bone healing

• Proper vascular supply and oxygen tension are

important for pre-osteoblasts, if they are poor stems
cells differentiate into fibroblast leading to scar
formation.
• During preparation, if the bone is heated it leads to
necrotic bone and scar formation. The temperature
should not be exceeded beyond 47 degrees
centigrade.
• Woven bone is immediately formed between
implant and the bone, which after several months is
replaced by lamellar bone.
• After 18 months, a steady state of lamellar bone is
reached.
Hard Tissue Interface
Bone remodeling and Function
1. Primary stability (achieved at the time of surgical placement) depends on:

• Implant Geometry (macrodesign)

• Quantity and quality of the bone available for the implant

2. Secondary stability (achieved with healing) depends on:

• Implant surface (microdesign)

• Quantity and quality of the adjacent bone which determines

the percentage of contact

Soft tissue interface

Epithelium
• Like the natural dentition, oral epithelium surrounds the
implant.
• Sulcular epithelium lines the inner surface of the gingival
sulcus
• The apical part of the gingival sulcus is lined with
junctional epithelium.
• Sulcular epithelium is 0.5mm and epithelium attachment is
2mm.
Soft Tissue Interface
Connective Tissue
• Periimplant connective tissue resembles natural
dentition, however it lacks periodontal ligaments,
cementum and fibres,
• Periimplant connective tissue is of about 1-2 mm.
 Soft Tissue Interface
Keratinized Tissue
• Implants surrounded by (non-
keratinized) mucosa only are said to
encounter more periimplant problems
than implants surrounded by
keratinized mucosa.
• Keratinized mucosa is firmly
anchored by the collagen fibres to
the underlying periosteum unlike
nonkeratinized mucosa which has
elastic fibres, which tend to move.
• Due to lack of keratinized tissue
patients often complain of pain and
discomfort while performing oral
hygiene procedures.
Vascular supply and
Inflammation
• The vascular supply of
periimplant gingiva or mucosa
is limited due to lack of
periodontal ligament
• Periimplant gingiva has the
same morphology and reacts
the same way to plaque
accumulation.
• Inflammatory response to
plaque is similar.
 Clinical comparison of Teeth and Implants

• Lack of periodontal ligament in the

implant is the most striking feature.
• No resilient connection between the
implant and the bone, due to which
implants cannot adjust to compensate for
the presence of premature occlusal
contacts.
• Implants cannot move, thus an occlusal
disharmony has repercussions.
• The absence of periodontal ligament
further reduces tactile sensitivity and reflex
function.
• Natural teeth continue to erupt and migrate where
implants do not.
• It is problematic to place an implant adjacent
to a mobile tooth because as teeth move in response
to or away from the occlusal forces the implants bear
entire load.
• Occlusal overload and parafunction habits may cause
microstains or microfractures in the bone, leading to
bone loss and fibrous inflammatory tissue at the
implant surface.