Bone zero dental implant for risky cases of severe bone resorption

this is a lecture conducted by Dr Islam Kassem and prof A shaban

1. Copy Right 2024
Bone zero
Implant concept

2. BDS,MSc,PhD
Senior Consultant Prothodontics
Professor of Prothodontic future university
Head of Egyptian Academy of Prtothodontics
Former of TMJ focus course
Prof Ahmed Shaban

3. BDS,MSc,MFDS RCS Ed, MOMS RCPS Glasd,
FFD RCSI,FDS RCPS GLasg,FDS RCS Ed
FFD GDent London
Senior Consultant OMFS
Head of OMFS Agamy Hospital
IMAXFAX center
Mr.Islam Kassem

4. •There is no conflict of interest in this lecture
•I have no monetary benefit from this lecture.
•No implied sponsorship by any company to the
speaker
•all photographed patients were treated by the
speaker and consented for photographing and
public publishing

5. In the memory of
prof Abdelhady
Nassif

6. This is lecture is
dedicated to Dr
Hassan Negm

10. Details please

11. E-log book
M implant Diploma

12. [email protected]
Diagnosis first
2006

14. WHAT IS GRAFT ?
A viable tissue that after removal from
a donor site is implanted with in a
recipient tissue is then restored
repaired & regenerated.

15. WHAT IS GRAFTING ?
Procedure used to replace /
restore missing bone or gum
tissue.

16. WHAT ARE BONE GRAFTS?
Bone grafts are the materials used for
replacement or augmentation of the
bone.
Food and Drug Administration (FDA)
regulates bone grafting materials

17. OSTEOINDUCTION
•  A chemical process by which molecules
contained in the graft(bmp)convert the
neighbouring cells into osteoblasts which
in turn form bone.
•  Process by which graft material is
capable of promoting
- osteogenesis

- cementogenesis - new PDL
(Urist & McLean)

18. A graft, a biomaterial or a
substance is osteo inductive when
implanted in a non osseous
environment called as an ectopic site,
bone formation occurs.

19. OSTEOGENESIS
represents all the steps & processes leading to bone
formation. This term has been used by some authors to
define bone grafts capable of forming bone through
osteoblastic cells contained in the transplanted graft
OR
the process of bone formation, which begins with either
osteoblasts in the patient's natural bone or from surviving
cells in the bone graft that is placed.

20. OSTEOCONDUCTION
• A physical effect by which the matrix of
the graft forms a scafold that favours
outside cells to penetrate the graft and
form new bone.
• The Graft material acts as a passive
matrix like a trellis or scaffolding for new
bone to cover over itself. 

( Urist & colleagues ) 

•

21. •  Process also known as Trell's effect
• occurs with the ingrowth of capillaries in
the new connective tissue.
• A material is osteoconductive when its
structure & its chemical composition
facilitate new bone formation from existing
bone. 


22. OSTEOSTIMULATION - “The
stimulation of osteoblast proliferation
and differentiation as evidenced
during in vitro osteoblast cell culture
studies by increased DNA content and
elevated osteocalcin and
alkalinephosphatase levels”
FDA 2005

23. CONTACT INHIBITION
The process by which the graft
material prevents apical proliferation
of epithelium
(Ellegaard & colleagues 1972)

24. INDICATIONS FOR GRAFTS
 Deep Intraosseous Defects 

Tooth Retention 

Support for Critical Teeth 

Bone Defects Associated With Aggressive
Periodontitis 

Esthetics (Shallow Intraosseous Defects) 

Furcation Defects 


25. technology can help?

27. Bone substitutes
Xenogeneic grafts (xenografts)
Bovine-derived hydroxyapatite
Coralline calcium carbonate Alloplastic grafts
(alloplasts)
Polymers Bioceramics
- Tricalcium phosphate
- Hydroxyapatite Bioactive glasses

28. IDEAL CHARACTERISTIC OF BONE
GRAFT
• Nontoxic
• Nonantigenic
• Resistant to infection
• No root resorption or ankylosis
• Strong and resilient
• Easily adaptable
• Readily and sufficiently available
• Minimal surgical procedure 

Stimulates new attachment 


29. AUTOGRAFTS
•  first bone replacement grafts reported for
periodontal applications
•  ‘‘Gold Standard’’ for bone grafting procedures
• Rich source of bone & marrow cells
•  osteogenic potential 

•

31. BASED ON INDUCTIVE POTENTIAL
Extraoral—hip marrow
Fresh
Frozen Intraoral
Osseous coagulum—bone blend Tuberosity

Extraction sites

Osseous coagulum Continguous autograft

32. Go Digital Equal
more safety
www.mrread.ca

33. EXTRAORAL SITES
• Schallorn (1967/ 1968) introduced use of autogenous” HIP
MARROW “Grafts (illiac crest marrow) in t/t of periodontal
defects.
• highest inductive potential
• Obtained using a Turkell bone trephine 


34. Advantages:
Greatest induction potential for osseous
regeneration
Sufficient quantities for extensive defects.
May be stored for future use.

35. Disadvantages:
Additional surgical insult to the patient.

additional expense i.e. orthopedic surgeon or
hematologist.

Potential for root resorption with fresh material.

36. Calverial
Bone

37. ANTIBIOTIC COVERAGE
Tetracycline-type drugs are the antibiotics of choice for immediate
postsurgical plaque suppression due to their broad spectrum of activity,
attraction to healing wound sites and concentration in GCF.
They are administered in therapeutic doses for the first 10 days following
surgery or until the patient can practice proper plaque control in the area

38. FATE OF BONE GRAFT
Once the material is placed in the bony defect it may act in
a number of ways which may decide the fate of the graft
material.
The various possibilities include:
• Bone graft material may have no effect at all.
•  The bone graft material may act as a scaffolding
material for the host site to lay new bone.
•  The bone graft material may itself deposit new bone
because of its own viability. 


39. •Vitamin deficiency in adolescent ,
review article ,
•Europtian J of pediatric 2014 Kassem
et at 

•

40. Subperiosteal implants are a type of dental
implant used to support prosthetic teeth or
dentures. They are placed under the periosteum,
which is the tissue covering the bone

41. They are generally considered for patients
with severe bone loss or deformity where
other implant types are not feasible

43. It’s an old story
Friction support implant

44. •Surgically driven
•

45. Pre-Surgical Assessment: A comprehensive evaluation,
including imaging (such as CT scans), is performed to
assess bone structure and determine the feasibility of
.the implant
Surgical Planning: The implant is custom-designed
based on the anatomical details obtained from imaging
studies

47. •Workflow
•

48. Minute in planning save hour
In surgery
•

49. Teeth driven

50. Facial assessment

51. Surgical Placement: An incision is made to expose the
bone, and the subperiosteal implant framework is placed
directly onto the bone. The periosteum is then
.repositioned over the implant
Healing Period: The implant is allowed to integrate with
the bone and soft tissue over several months before the
.prosthetic teeth or dentures are attached

64. :Advantages :
- Bone Preservation: Avoids the need for extensive bone
grafting procedures
-Reduced Need for Bone Augmentation: Suitable for
.patients with significant bone resorption

65. :Disadvantages:
Complexity: The procedure is more complex compared to
other types of implants.
Longer Healing Time: The healing period can be longer.
Potential for Complications: Includes risks of infection,
implant failure, and peri-implantitis.

66. Take home massage

Egyptians create the standards,
The world follows

67. •Islam Kassem
•[email protected]
•00201559900333
•Slide share
•Pub med
•Researchgate