Introduction to Dental

Implantology
Dr. Nigam Sattar Khan

BDS , FCPS OMFS (PAK) , CHPE

FFD RCS (Oral surgery/ Oral Medicine) Ireland

WHY C-IMPLANTOLOGY
Session 1

 Introduction to dental implantology

 Indications and contraindications
 Basic surgical skills
 Instrumentation of dental implant and implant kit
 Biomechanics of dental implants and its components
 Preferred method of choice to replace single ,multiple or completely
edentulous sites

 Dental Implant, 3D Illustration A dental implant (also known as an end osseous

implant or fixture) is a surgical component that interfaces with the bone of
the jaw or skull to support a dental prosthesis such as a crown, bridge,
denture, or facial prosthesis
HISTORY OF DENTAL IMPLANTS

 During the time of the Phoenicians and Chinese, Egyptian and Mayan in 600
AD, some of the first dental implants of the world were created. For reasons
of masticatory or aesthetic necessity, there is evidence that, through
material such as Sea shells , ceramics, metal, ivory, shells and bones, these
civilisations found the first solutions for tooth loss

 1965 Branemark had his first human volunteer for dental implants
Requirement of a successful dental
implant treatment
 Careful implant treatment planning
 Meticulous surgical technique
 Precise prosthetic restoration

An ideal dental implant team consist of

-Surgeon
-Restorative dentist
-Periodontist
-Trained Radiologist
-Lab technician

Implant system is complex so we have to get familiar with one system and use it
Increasing Demand for Dental implants

(1) Patients living longer

(2) Age-related tooth loss
3) Patients are more socially active and esthetic conscious
(4) A higher incidence of partial and complete edentulism
(5) Conventional prosthesis complications, and
(6) The inherent advantages of implant-supported restorations.
 ADVANTAGES OF IMPLANT SUPPORTED PROSTHESIS

 • Maintain bone
 • Restore and maintain occlusal vertical dimension
 • Maintain facial esthetics (muscle tone)
 • Improve esthetics
 • Improve phonetics
 • Improve occlusion
 • Improve/regain oral proprioception (occlusal awareness)
 • Increase prosthesis success
 Improve masticatory performance/maintain muscles of mastication and facial
expression
 Reduce size of prosthesis (eliminate palate, flanges)
 No need to alter adjacent teeth
 More permanent replacement
 Improve psychological health
 Overall health improved
CRITERIA FOR IMPLANT SUCCESS

Albrektsson and colleagues proposed the following

criteria for an implant to be regarded as clinically successful :
1. The unattached implant exhibits no clinical mobility.
2. Radiography demonstrates no evidence of radiolucency
between implant and bone.
3. Marginal bone loss is less than 0.2 mm annually after the first
year of service.
 4) . Absence of persistent pain, discomfort, or infection.

 Albrektsson and colleagues proposed that these criteria (with a success rate
of 85% at the end of a 5-year observation period and 80% at the end of a 10-
year period) should be the minimum acceptable levels for a treatment
method to be considered Successful.
DIFFERENT TYPES OF IMPLANTS
 SUBPERIOSTEAL
 ENDOSTEAL
 TRANSOSTEAL
 ZYGOMATIC IMPLANTS
ENDOSSEOUS
INDICATIONS OF IMPLANT PLACEMENT
 REPLACE ONE OR MORE TEETH AS SINGLE UNITS
 SUPPORT A BRIDGE AND ELIMINATE THE NEED FOR A PARTIAL DENTURE
 PROVIDE SUPPORT FOR A DENTURE ,MAKING IT MORE COMFORTABLE
 PREVENT BONE AND GUM RECESSION
 IMPROVE ESTHETIC APPEARANCE OF TEETH AND MOUTH
IMPLANT COMPONENTS
IMPLANT COMPONENTS
IMPLANT BODY

 AXISYMMETRIC
 Sequentially enlarge the osteotomy
Abutment

 1 piece or
 2 piece abutments
Implant crown

 Screw retained
-Screw through crown into implant
-Screw Access hole through crown
-better for restricted restorative space

 Cement retained
-Abutment is attached separately to implant
-Cement may be trapped subgingivally and cause periimplantitis
 A screw-retained restoration is one in which the crown and abutment
are fixed and directly screwed to the implant. It should be noted that a
minimum height of 4 mm is required between the implant head and the
opposite occlusal surface.
TERMINOLOGY

 Osseointegration
Direct contact between an implant and
living bone at the light microscope level.
Osseointegration is also referred to as
Secondary stability
 According to Branemark, Zarb, and Albrektsson (1985) Osseointegration is the
direct structural and functional connection between ordered, living bone and
the surface of a load–carrying implant.

 Osseointegration is a time-dependent healing process whereby clinically

asymptomatic rigid fixation of alloplastic materials is achieved, and
maintained, in bone during functional loading.
 6 WEEKS TO SIX MONTHS DEPENDING ON LOCATION OF IMPLANTS AND HEALTH
OF JAW BONE
 ANTERIOR MANDIBLE : 3 MONTHS
 POSTERIOR MANDIBLE : 4 MONTHS
 ANTERIOR MAXILLA: 6 MONTHS
 POSTERIOR MAXILLA: 6 MONTHS
 BONE GRAFT: 6-9 MONTHS
FACTORS AFFECTING
OSSEOINTEGRATION
 BIOMATERIALS- TITANIUM
 ATRAUMATIC SURGICAL TECHNIQUE WITH SPECIALLY DESIGNED DRILLS
 IMPLANT DESIGN
 HEALTH AND BONE QUALITY
 BIOMECHANICAL FACTORS
 IMMOBILITY OF IMPLANT
 LOAD BEARING CAPACITY OF IMPLANT HAS TO BE MORE THAN ANTICIPITATED
LOADS DURING FUNCTION.IF APPLIED LOADS ARE GREATER, THERE IS
LIKELYTO BE A MECHANICAL FAILURE

 NUMBER AND SIZE OF IMPLANT

 AVOID LINEAR ARRANGEMENT OF IMPLANTS
PRE OPERATIVE ASSESMENT AND
TREATMENT PLANNING
 INITIAL OBSERVATION AND PATIENT INTRODUCTION
 CHIEF COMPLAINT
 MEDICAL HISTORY AND MEDICAL RISK ASSESMENT
 DENTAL HISTORY
 INTRAORAL EXAMINATION
 RADIOGRAPHIC EXAMINATION
1 piece vs 2 piece dental implants

 1 piece Implant
 Implant and abutment are attached together
 Drilled into bone as one unit
 Cannot correct angle between the two components

 2 piece Implant:
 Implant and abutment are separate components
- Implant drilled into bone , then abutment attached next.
PRIMARY STABILITY

 Primary stability is an important factor in implant survival. With-out primary stability,

the implant may experience micromotion during the healing process, which may
compromise the osseointegration process.
 Two methods are commonly used to determine primary stability.
 Insertion torque is the rotational force recorded during the surgical insertion of a
dental implant into the prepared site, and it is expressed in Newton centimeters.
 Resonance Frequency Analysis
IMPLANT MACROSTRUCTURE

 Parallel sided screw and tapered screw

 Implant threads
 Crest and outer diameter
 Root and inner diameter
 Helix angle and pitch
 SURGICAL INSTRUMENTATION

 IMPLANT DRILLS
 WRENCHES
 DRIVERS
 IMPLANT MOUNTS
 IMPLANT COMPONENTS
IMPLANT DRILLS
IMPLANT WRENCHES
IMPLANT DRIVERS
One Stage vs Two Stage Dental Implant
Placement
 A One stage Dental implant means that the implant and healing abutment
are placed at the same time.
 A two stage dental implant involves placing a cover screw on the implant and
closing the gums tissue over it during the healing process
 Load : Any external mechanical force applied to a prosthesis, dental implant,
abutment, tooth, skeletal organ, or tissue.
 Loading: Application of a force directly or indirectly onto a dental implant, tooth, or
prosthesis.
 Immediate occlusal loading: A clinical protocol for the placement and applying force
on dental implants, with a fixed or removable restoration, at the same clinical visit.
 Early loading Refers to the time of applying occlusal forces to a dental implant after its
initial placement. A prosthesis is attached to the implant(s), earlier than a more
conventional healing period.
 Delayed loading Refers to the time of applying occlusal forces to a dental implant after
its initial placement. A prosthesis is attached or secured after a conventional healing
period.