Introduction to Dental Implant

• The endosseous osseointegrated dental

implants are useful addition in the
management of patients who have missing
teeth.

• They are the nearest equivalent replacement

to the natural teeth.
Definition
• Endosseous dental implant is defined as “a
device inserted into the jaw bone to
support a dental prosthesis”.
Terminology
• Osseointegration: a direct structural &
functional connection between ordered,
living bone & the surface of a loaded-
carrying implant.

• Single Stage Implant Surgery: surgical

placement of a dental implant which is left
exposed to the oral cavity following
insertion.
• Two Stages Implant Surgery: initial
surgical placement a dental implant which
is inserted beneath the mucosa & then
subsequently exposed with a second
surgical procedure some months later.
Parts
• Implant Body (fixture): is the component
that is placed within the bone during the
first stage of surgery.

• Implant Abutment: the component which

attaches to the dental implant & support
the prosthesis.

• Abutment Screw: a screw used to

connect an abutment to the implant.
• Prosthesis Retaining Screws:
penetrates the fixed restoration & secures
it to the abutment.

• The Superstructure: is the prosthetic

component fabricated over the implant
after it’s placement.
• The crown, abutment, screw and bone of an implant, compared to natural tooth.
Classification
• Depending on the placement within
the tissues:
Epiosteal Implant: receives it’s primary
bone support by resting on it.
(e.g. sub-periosteal implants).

Transosteal Implant: passes through the

entire thickness of the alveolar bone.
 Endosteal Implant: extends into the
basal bone for support. It can be further
classified into root form & blade form.

• Depending on the material used:

Metallic implants: titanium, titanium alloy
& cobalt chromium alloy.

Non-metallic implants: ceramics,

polymers & carbons.
 Coated implants: e.g. hydroxyapatite
coating.

• Depending on their reaction with

bone:
Bioactive implants (hydroxyapatite).

Bio-inert implants (metals).

• Depending on the classification of
edentulous spaces:
The implant bone volume is classified on
the base of Kennedy- Applegate’s
classification of partially edentulous
spaces.
Each class of Kennedy classification
includes 4 divisions of varying bone
volume. (A, B, C & D).
• Depending on the treatment option:
Fixed prosthesis replaces only the crown.

Fixed prosthesis replaces the crown & a

portion of the root.

Fixed prosthesis replaces missing

crowns, gingival colour & portion of the
edentulous site.
Removable prosthesis; over denture
supported completely by implant.

Removable prosthesis: over denture

supported by both soft tissue & implant.
Success Criteria
• The minimum success criteria (proposed by
Albrektsson et al 1986) are:

An individual, unattached implant is

immobile when tested clinically.

Radiographic examination does not

reveal any peri-implant radiolucency.
After the first year in function,
radiographic vertical bone loss is less
than 0.2 mm/year.

The individual implant performance is

characterized by an absence of signs &
symptoms.
 As a minimum, the implant should fulfils
the above criteria with a success rate of
85% at the end of the 5 year
observation period & 80% at the end of
10 year period.

• The most obvious sign of implant failure is

mobility.
• Some of these criteria are applied to the
overall requirements of an implant system,
but are not as useful when judging the
success of individual implants.
Basic Guide to Osseointegration
• The biological process leading to &
maintaining osseointegration is dependant
upon a number of factors which include:

Biocompatibility & implant design.

Bone factors.
Loading conditions.
Prosthetic considerations.
Biocompatibility & Implant Design
• Successful clinical results are reported for
some titanium alloys & hydroxyapatite
coated implants.

• More recently resorbable coatings have

been developed.
• The implant design has a great influence
on initial stability & subsequent function.

• The main design parameters are:

Implant length: the most common

lengths employed are between 8 & 15
mm.
Implant diameter: at least 3.25 mm in
diameter is required to ensure adequate
implant strength.

Implant shape: hollow-cylinders, solid-

cylinders, hollow screws or solid screws
are commonly employed shapes which
are designed to maximize the potential
area for osseointegration & provide
good initial stability.
Surface characteristics: by increasing
the surface roughness there is the
potential to increase the surface contact
with bone (but this may be at the
expense of more ionic exchange &
surface corrosion).
Bone Factors
• The stability of the implant at the time of
placement is dependant upon bone quality
& quantity as well as implant design.

• The most favourable quality of jaw bone

for implant treatment is that which has well
 formed cortex & densely trabeculated
medullary spaces with good blood supply.

• Factors which compromise bone quality

are infection, irradiation & heavy smoking.
Loading Conditions
• It is important that the implant is not loaded
during the early healing phase.

• Some systems have advised leaving

implants unloaded for around 6 months in
the maxilla & 3 months in the mandible.
• Currently there is no accurate measure
which precisely determines the optimum
period of healing before loading can
commence.
Prosthetic Consideration
• Carefully planned functional occlusal
loading will result in maintenance of
osseointegration & possibly increased
bone to implant contact.

• In contrast, excessive loading may lead to

bone loss &\or component failure.
• Clinical loading conditions are largely
dependant upon:

 the type of prosthetic reconstruction:

vary from a single tooth replacement to a
full arch reconstruction.
The occlusal scheme:
the lack of mobility in implant supported
fixed prostheses requires provision of
shallow cuspal inclines & careful
distribution of loads in lateral excursions.

Loading will also depend upon the

opposing dentition.
The Number, Distribution, Orientation,
& Design of The Implant:
The distribution of load to the supporting
bone can be spread by increasing the
number & dimensions of the implants.
Spacing & 3 dimensional arrangement.
Tripod arrangement.
The Design & Properties of The
Implant Connectors:
a rigid connectors provides good splinting
& distribution of loads between implants.

Also the connectors should have a passive

fit on the implant abutments.
Dimension & Location of Cantilever
Extensions:
Cantilever extensions have the potential to
create high loads.

The extent of leverage of any cantilever

should not exceed the anteroposterior
distance between implants.
Patient Parafunctional Activities:
excessive loads may lead to loss of
marginal bone or component fracture.
Conclusion
• There are great many factors to take into
account to ensure predictable successful
implant treatment. There is no substitute
for meticulous attention to detail in all of
these areas. Failure to do so will result in
higher failure rates & unnecessary
complications.
THANKS