Dental implant

Group one
Introduction:
• Dental implant is a device inserted into the jaw bone to support a
dental prostheses which penetrate oral mucosa to replace the natural
tooth.
• Also defined as a substance that is placed into the jaw to support a
crown or fixed or removable denture.
history of dental implant :
• in 500 BC the Etruscans , living in what is now modern Italy , replaced
missing teeth with artifical teeth carved from the bones of oxen
• The first evidence of the use of implants dates back to 600 AD in the
mayan population which was found in 1931 by an archeological team
• Ancient Egyption used tooth shaped shells and ivory to replace teeth
• Modern implant dentistry began in the early 19th century , much
experimentation was being done about what material would work best as
the replacement tooth.
• Attempts were first made at implanting natural teeth from another persons
mouth, but these implants suffered much infection and were rejected by
the host
• in the early 1880s alot of materials were used to fabricated a dental
implants such as gold which was placed into fresh extraction sockets ,
platinum disc ( into which a porcelain crown was fixed ) and a
porcelain with platinum post
• in the early 1990s lambotte fabricated implants of aluminum, silver ,
brass, red copper and magnesium
• Strock was one of the early pioneers on this field who suggested
using vitallium , and cobalt chromium molybdenum alloy in dental
implantology in 1939
• The breakthrough :
• In 1952 , a startling discovery was made which has the great implication for
tooth replacement Dr. Per-Ingvar Branemark an orthopedic Surgeon

he discovered that the animals bone had directly attached to the titanium
surface and this phenomenon was called osseointegration
the first practical application of osseointegration was the implantation of new
titanium roots in an edentulous patient in the 1965
osseointegration : ''the fusion of the surface of the dental implant to the
surrounding bone, so that it is secured tightly in the bone and ready to be
used as an anchor for a tooth or prosthesis'' . (GTP-7)
osseointegration : defined by the american academy of implant
dentistry as '' the firm , direct and lasting biological attachment of
metallic implant to vital bone with no intervening connective tisse''
By 1964 pure titanium was commercially accepted as the material of
choice for dental implant
Branemark devoted 13 years conducting animal studies to determine
the parameters under which osseointegration would occur . Based on
his study titanium was the material of choice
 ADVANTAGES:

• 1 .Preservation of bone
• 2 .Improved function
• 3 .Aesthetics
• 4 .Stability and support
 Disadvantages:

• 1 .Can't be used in medically compromised patients who can't

undergo surgery
• 2 .Longer duration of treatment
• 3 .Need of patient cooperation
• 4 .expensive
Indication:

• Severe morphologic compromised of denture supporting areas

• Poor oral muscular coordination
• Low tolerance of mucosal tissues
• Parafunctional habits
• Active o r hyperactive g a g reflexes
• Psychological inability to wear removable prosthesis
• Singletoothloss
• Unfavorable number and location of abutments in a residual dentition
 Contraindications for Dental Implant:
• 1 .Acuteillness.
• 2 .Terminalillness.
• 3 .Pregnancy.
• 4 .Uncontrolled metabolic disease.
• 5.Tumoricidal radiation to the implant site.
• 6.Unrealistic expectation.
• 7.Improper motivation.
• 8 .Lake of operator experience.
• 9 .Unable to prosthodotically restore.
Dental Implant Supported Prosthesis:
• 1- Single Crown

• 2- Fixed Bridge

• 3- Full Arch Implant

1- Replacing a Single Missing Tooth

• A crown is used to replace one missing tooth, each crown attaches to

it’s own implant
If a patient is missing single tooth
• 1- Fixed Supported Bridge

• 2- Implant Supported Crown

1- Fixed Supported Bridge
• This method of tooth replacement is very esthetic and functional for a
period of time

• But?
Advantage of replacing a single missing tooth
with an implant supported crown:
• 1- It looks, feels and functions like a natural tooth.
• 2- Its much more esthetic long term.
• 3- It does not decay.
• 4- There is no need to grind down natural adjacent tooth.
• 5- The bone is preserved, preventing visible bone loss.
• 6- It’s more hygienic than tooth-supported bridge.
Indication of Single-tooth restorations
supported by implants :
• 1. An otherwise intact dentition.
• 2. A dentition with spaces that would be more difficult to treat with
conventional fixed prosthodontics.
• 3. Distally missing teeth when cantilevers or partial removable dental
prostheses are not indicated.
• 4. A prosthesis that needs to closely mimic the missing natural tooth.
The requirements for single-tooth implant
crowns are as follows:
• 1. Esthetics.
• 2. Antirotation, to avoid prosthetic component loosening.
• 3. Simplicity, to minimize the amount of components used.
• 4. Accessibility, to maintain optimum oral health.
2- Replacing Multiple Missing teeth
• Three common treatment option:
• 1- the traditional tooth supported bridge
• 2- a removable partial denture
• 3- an implant supported bridge
• In this condition the benefits of implant supported bridge are even
more obivious because comfort and stability are also concerns
The advantage of replacing multiple missing
teeth by implant supported bridge:
• 1- they look, feel and function like natural teeth.
• 2- they much more comfortable and stable than partial denture
• 3- natural biting and chewing capacity is restored
• 4- they virtually stop bone resorption ( deterioration) process.
• 5- the integrity of the facial structure is maintained.
• 6- adjacent natural teeth are not compromised by grinding them into
peg shapes or slowing loosening them with pressure
• 1-multiple implants placed between the remaining natural teeth,
fabricate a fully implant-supported restoration
• 2-one or two implants can be placed in the long edentulous span and
the final restoration connected to natural teeth (protecting the teeth
with telescopic copings is recommended to maintain prosthesis
retrievability).
• 3- long edentulous span reconstruction of soft and hard tissue as well as
teeth, use of resin teeth processed to a metal substructure. complete
metal-resin fixed dental prosthesis or hybrid prosthesis
• For smaller defects, pink porcelain can be used to compensate for
missing soft tissue
Fixed restoration in completely edentulous
arch :
• There are 2 implant options:
• a complete metal-resin fixed dental prosthesis
• a metal-ceramic fixed dental prosthesis
complete metal-resin fixed dental prosthesis:
• is a cast alloy framework with processed denture resin and teeth.
• The mandible is supported by a minimum of 5 implants whereas the
maxilla is supported by 6 implants.
• It can be made esthetically pleasing only if bone loss is minimal and is
best suited for patients who have recently (within 5 years) lost their
natural teeth, or they will need to restore the bone and soft tissue if
the loss is within minimum range
• Patients with sever bone loss will need removable partial denture
only.
• The advantage of full denture implant is that the patient will
psychologically feel as if they have their natural teeth and the implant
component doesn’t wear out quickly.
• But sometimes implants placed in embrasure spaces can lead to
disastrous esthetic results and can impede access for hygiene.
• With a metal-resin prosthesis, the clinician must decide between
leaving enough space for hygiene access and minimizing space for
optimum esthetics.
• Esthetic and phonetic problems in the maxillary arch can often be
avoided by not placing implants near the midline and restoring the
incisor teeth with pontics.
• Metal-ceramic implant restoration may be indicated if adequate bone and
soft tissue contours are available.
Metal-resin restorations are the treatment of choice for edentulous
patients with moderate bone resorption.
Distal-extension implant-supported
restoration:
• There are two distal-extension restorative options:
• 1. place an implant distal to the most posterior natural abutment and
fabricate a fixed prosthesis connecting the implant with the natural
tooth
• 2. The other option is to place two or more implants posterior to the
most distal natural tooth and fabricate a completely implant-
supported restoration