IMPLANT DIAGNOSIS

Under the supervision of dr. Rewaa

 1. INTRODUCTION

• Dental implants are one of the options available to replace missing teeth in the
recent years, dental implant design has improved to such an extent that mere
integration with the bone is no longer considered as the only success criteria
for the implants.
• It is expected that successful implant treatment restores normal function,
esthetics, comfort and speech in a patient.(misch ce. 1999)

Huda, Irfanul & Singh, Rohit & Nabi, Aaysha & Singh, Supriya & Anand, Kumar. (2020). Diagnosis for dental implant. IP Annals of Prosthodontics and Restorative
Dentistry. 6. 135-139. 10.18231/j.aprd.2020.028.
 1. INTRODUCTION

• A good dental and medical history is the beginning of any dental treatment
planning.
• . The dental history will help in identifying the cause of tooth loss and the
reasons why the patient is seeking replacement.
• The procedures of patient selection, treatment planning, implant selection,
placement and prosthetic management are technically demanding Meticulous
attention to detail is needed for optimal success.

Huda, Irfanul & Singh, Rohit & Nabi, Aaysha & Singh, Supriya & Anand, Kumar. (2020). Diagnosis for dental implant. IP Annals of Prosthodontics and Restorative
Dentistry. 6. 135-139. 10.18231/j.aprd.2020.028.
 THE SUCCESS OF ANY SURGICAL IMPLANT
PROCEDURE DEPENDS ON CAREFUL SELECTION
AND PREPARATION OF THE PATIENT.

• Imaging is an irrefutable part of preoperative implant assessment to determine feasibility of fixture

installment.
• It is one of the most accurate means by which the clinician can assess the morphologic features of the
proposed fixture site, select implant of appropriate size and evaluate the fixture periodically after its
placement. The assessment includes
• 1. Appraisal of proposed implant site,
• 2. Determination of bone quantity and quality,
• 3. Assessing inclination of alveolar process,
• 4. Location of adjacent anatomic structures,
• 5. Detect existing pathology

Huda, Irfanul & Singh, Rohit & Nabi, Aaysha & Singh, Supriya & Anand, Kumar. (2020). Diagnosis for dental implant. IP Annals of Prosthodontics and Restorative
Dentistry. 6. 135-139. 10.18231/j.aprd.2020.028.
 2.INITIAL CONSULTATION

• Gathering the patient’s history in which the patient’s profile is recorded in which age, sex, occupation status
is noted down.
• Then the chief complaint is recorded in the patient’s words.
• Past dental condition with a history of periodontal disease, caries, trauma, change in occlusion or smile, any
oral pathology or smoking habits should be noted down
• Medical history; usually completed in the first visit
• Health information; anatomical abnormalities this may include severly resorbed alveolar ridges, congenital
deformities like diminutive maxilla or mandible, undercut, tori, exoestosis, enlarge tongue and salivary
gland.
• Age patient under 18 may not be candidates for implant replacement because their dental arches are not
fully developed.

• Systemic illness; these may reflected in poor tissue tone, low pain threshold, slow healing, sensivity to
pressure, tissue fragility and xerostomia.
Huda, Irfanul & Singh, Rohit & Nabi, Aaysha & Singh, Supriya & Anand, Kumar. (2020). Diagnosis for dental implant. IP Annals of Prosthodontics and Restorative
Dentistry. 6. 135-139. 10.18231/j.aprd.2020.028.
 2. INITIAL CONSULTATION

• 2.1. Extraoral examination :allows for evaluation of facial symmetry, skeleton profile,
facial contours, and patient’s speech, etc.
• 2.2. Intraoral examination: Intraoral soft tissue is examined for any pathology.
• 2.2.1. Bone evaluation and Intraoral palpation can be used
• 2.3 Periodontal evaluation : includes periodontal charting, periodontal disease,
classification and documentation of the location of quantity of keratinized attached gingiva.
Bone loss, i.e. Vertical or horizontal defect should be carefully mapped
• 2.4. Bony anatomy of implant site and its evaluation is done with visual inspection
mounted study models and by cephalometric radiographs. Mounted study models can assist
in properly evaluating the arch form as well as inter arch relationship
• 2.5. Smile analysis All aspects of patient’s smile should be analyzed and the patient’s
esthetics, expectations should be documented preoperated digital photographs can be utilized
to evaluate and document the pretreatment smile.

Huda, Irfanul & Singh, Rohit & Nabi, Aaysha & Singh, Supriya & Anand, Kumar. (2020). Diagnosis for dental implant. IP Annals of Prosthodontics and Restorative
Dentistry. 6. 135-139. 10.18231/j.aprd.2020.028.
 3. OCCLUSION

• The patient should be examined for the changes in occlusion due to the missing teeth.
There may be premature contacts or major occlusal discrepancies due to trauma to
occlusion.
• It is also necessary to create a diagnostic wax-up to determine spatial relationship (mesial,
distal, buccal, and lingual) as well as the alignment and parallelism of the implants to be
placed.
• 3.1. Temporomandibular joint
• 3.2. Plain film radiography
• 3.3. Periapical radiograph
• 3.4. Occlusal radiograph
• 3.5. Panoramic radiograph
• 3.6.Computed tomography
 OSSEOINTEGRATION,

• Osseointegration, defined as a direct structural and functional connection

between ordered, living bone and the surface of a load-carrying implant, is
critical for implant stability, and is considered a prerequisite for implant
loading and long-term clinical success of end osseous dental implants

The successful outcome of any implant procedure is mainly dependent on the interrelationship of the

various components of an equation that includes the following :

1.Biocompatibility of the implant material

2.Macroscopic and microscopic nature of the implant surface & designs

3.The status of the implant bed in both a health and a morphologic (bone quality) context

4.The surgical technique

5.The undisturbed healing phase

6.Loading conditions
 STAGES OF OSSEOINTEGRATION

• Direct bone healing, as it occurs in defects, primary fracture healing and in

Osseointegration is activated by any lesion of the pre-existing bone matrix.

• When the matrix is exposed to extra cellular fluid, noncollagenous proteins

and growth factors are set free and activate bone repair . Once activated;
osseointegration follows a common, biologically determined program that is
subdivided into 3 stages:

• Incorporation by woven bone formation;

• Adaptation of bone mass to load (lamellar and parallel-fibered bone

deposition);
 C L I N I C A L AS S E S S M E N T S F O R O S S E O I N T E G R AT I O N

• Many methods have been tried to clinically demonstrate osseointegration of an implanted alloplastic material.

• .1.Performing a clinical mobility test and finding that the implant is mobile is definite evidence that it is nonintegrated

• 2.Radiographs demonstrating a apparently direct contact between bone and implant have been cited as evidence of

osseointegration

• Radiolucent zones around the implant are a clear indication of its being anchored in fibrous tissue, Whereas the lack

of such zones is not evidence for osseointegration. The reason for this is that the optimal resolution capacity of

radiography is in the range of 0.1 mm whereas the size of a soft tissue cell is in the range of 0.01 mm; thus a narrow

zone of fibrous tissue may be undetectable by radiography

• 3.The use of a metal instrument to tap the implant and analyze the transmitted sound may, in theory, be used to

indicate a proper osseointegration. However, there is no typical “sound diagram” defined for the osseointegrated
 OSSEOINTEGRATION IS ALSO A MEASURE
OF IMPLANT STABILITY, WHICH CAN
OCCUR AT 2 DIFFERENT STAGES:

• Primary stability of an implant mainly comes from mechanical engagement with

compact bone.
• Secondary stability, on other hand, offer biological stability through bone
regeneration and remodeling. The former is a requirement for secondary stability.
The latter, however dictates the time of functional loading.
• Currently; various diagnostic analyses have been suggested to define implant
stability standardized radiographs, cutting torque resistance test, modal analysis
and, Resonance frequency analysis (RFA).
• The evaluation of implant stability using RFA machines such as Osstell and
Implomates still has some uncertain issues.
 FACTORS THAT DETERMINE SUCCESS AND FAILURE OF
OSSEOINTEGRATED IMPLANTS
• Bone-Implant Interface

• Osseointegration is a striking phenomenon in which bone directly opposes the implant surface without any
interposing collagen or fibroblastic matrix. Also, the strength of the interface between bone and implant increases
soon after implant placement (0–12 weeks)..

• Implant Biocompatibility

• Commercially pure titanium is widely used as an implant material as it is highly biocompatible, it has good
resistance to corrosion, and no toxicity on macrophages or fibroblasts, lack of inflammatory response in peri-
implant tissues

• Titanium Oxide

• When Ti (Titanium) or Ti alloys are exposed to air or normal physiologic environments, there is a reaction with
the oxygen that causes and oxide layer to be formed. Usually the oxide is in the form of TiO 2. The oxide layer
protects against corrosion.

• HA coatings have the advantage of increasing surface area, decreasing corrosion rates, and accelerating bone
formation via faster osteoblast differentiation.
 Recent Innovations in Dental Implant
Technology to Enhance Osseointegration

1.Use of computer aided radiographic treatment planning & surgical guide fabrication using advanced

computer aided design/computer aided manufacturing software

2.Implant surfaces with hydrophilic properties that promote osteoconduction of new bone growth

3.Use of recombinant human growth factors on the implant surface or as a part of the placement

4.Surface chemistry modifications to accelerate bone growth (fluoride modified titanium oxide surface)