Dental Implants Review : A detailed Review

A Comprehensive Review on Dental Implants
Abstract

Dental implants have revolutionized modern dentistry by providing a predictable and durable solution for the replacement of missing teeth. This review aims to provide an in-depth overview of dental implants, covering their history, classifications, biomaterials, surface modifications, surgical and prosthetic protocols, complications, and success rates. It also emphasizes clinical considerations and future innovations that are shaping implantology.

Introduction

Tooth loss is one of the most common oral health problems, caused by trauma, caries, periodontal disease, or congenital absence. Replacement of missing teeth is crucial not only for mastication and phonetics but also for aesthetics, psychological well-being, and overall quality of life.

Traditionally, removable dentures and fixed partial dentures (bridges) were the mainstay of treatment. However, these methods often caused bone resorption, compromised adjacent teeth, or failed to provide adequate stability. Dental implants emerged as a superior alternative, offering a more functional, aesthetic, and biologically favorable solution.

A dental implant is defined as an artificial fixture, usually made of titanium or other biocompatible materials, surgically placed into the alveolar bone to serve as a root analogue and provide support for prosthetic restorations. The predictability of osseointegration has made dental implants a cornerstone of modern prosthodontics and oral rehabilitation.

Historical Background

The concept of replacing missing teeth dates back thousands of years. Archaeological evidence suggests that ancient civilizations, including the Mayans and Egyptians, attempted to use shell, ivory, or carved stones as tooth substitutes.

1940s–50s: Vitallium implants were introduced but showed limited success.

1952: Per-Ingvar Brånemark discovered the principle of osseointegration while studying bone healing around titanium chambers. This laid the foundation of modern implantology.

1965: The first titanium dental implant was successfully placed in a human.

1980s onwards: Commercial dental implant systems became widely available, leading to their global adoption.

Today, implantology has evolved into a highly predictable discipline, with long-term success rates exceeding 90–95% in most clinical situations.

Biomaterials in Dental Implants
The choice of material plays a vital role in implant success. The most widely used materials include:

Titanium and Titanium Alloys

Gold standard due to excellent biocompatibility, corrosion resistance, and mechanical strength.
Available in commercially pure titanium (grades I–IV) and titanium alloys (e.g., Ti-6Al-4V).
Promotes osseointegration through the formation of a titanium oxide layer.
Zirconia (Yttria-stabilized zirconium dioxide)
Metal-free, highly aesthetic alternative.
Biocompatible with reduced plaque accumulation.
More brittle than titanium

1. Dental
Implants
Presented By :
DR. ABHISHEK ASHOK SHARMA
BDS, MDS, Ph.D., MHA, FAGE, FICOI
Member of Indian Society of Periodontology (ISP)
Member of World Congress of Oral Implantology (WCOI)
Member of International Board of Oral Implantology (IBOI)
Member of Indian Society of Oral Implantologists (ISOI)
Member of International Congress of Oral Implantologists (ICOI)

2. INTRODUCTION
•A dental implant isa medical device, typically a titanium
screw, that is surgically inserted into the jawbone to
replace the root of a missing tooth.
•Dental implants have been used to replace missing teeth
for more than half a century.
•They are considered to be an important contribution to
dentistry as they have revolutionized the way by which
missing teeth are replaced with a high success rate.
•This success depends on the ability of the implant
material to integrate with the surrounding tissue.

3. CLASSIFICATION

4. Conventional Dental Implants
Basal Implants
Zygomatic Implants
Pterygoid Dental Implants

5. Classification Based On : Nature of Implants
•Long Implants / One-Piece
•Integral Implants
•Cortical Platform Implants
•Cortical Implants
•Ball attachment Implant
•Screw-Type Implants
•Only Integral Implants
•Narrow Conical Implants
•Conical Implants
•Narrow Trapeze Implants
•Trapeze Implants

6. BROAD CLASSIFICATION OF DENTAL
IMPLANTS
•Based on Position in Bone
•Based on Implant Design
•Based on Surface Characteristics
•Based on Materials Used
•Based on Surgical Technique
•Based on Loading Protocol

7. Classification : Based on Position in Bone
1.Endosteal Implants (within bone)
1.Screw type
2.Cylinder type
3.Blade type
2.Subperiosteal Implants (above bone, beneath
periosteum)
3.Trans-osteal Implants (through the jawbone)

8. Classification : Based on Implant
Design
•Root Form Implants
•Plate Form Implants
•Ramus Frame Implants
•Intramucosal Inserts

9. Classification: Based on Surface
Characteristics
•Machined Surface
•Roughened Surface (sandblasted, acid-etched)
•Plasma-sprayed Coatings (titanium, hydroxyapatite)
•Anodized Surfaces
•Nano-textured Surfaces

10. Classification : Based on Materials Used
•Titanium and Titanium Alloys
•Zirconia (Ceramic Implants)
•Stainless Steel (historical)
•Polymers (experimental)
•Composites

11. Classification Based : On Nature of
Implants Loading
•Aggressive Implants
•Semi-Aggressive Implants
•Pre-Post Dental Implants
•Cortical Placing Dental Implants

12. Classification : Based on
Surgical Technique
•One-stage Implants
•Two-stage Implants
•Immediate Implants (post-
extraction)
•Delayed Implants

13. Classification : Based on
Loading Protocol
•Immediate Loading Implants
•Early Loading Implants
•Delayed Loading Implants

14. IMPLANT-BONE
INTERFACE
&
OSSEOINTEGRATION

15. •For dental implants to succeed, intimate contact
between the peri-implant bone and the implant surface
should be achieved and maintained.
•Therefore, an integration between the implant surface
and the bone is required for the success of any implant
system.
•This integration is known as osseointegration, and is
defined as “a direct structural and functional connection
between ordered living bone and the surface of a load-
carrying implant”.

16. POINT
2
NOTICE

17. As a result of the absence of periodontal
ligaments between the implant and its
surrounding bone, when the implants are
loaded, they move within the bone due to
bone elastic deformation.
Furthermore, osseointegrated implants
cannot be moved orthodontically.

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21. 21
PART
-

II

22. SHAPE
&
STRUCTURE
22

23. SHAPE
•Cylinder Dental Implant
•Straight Screw Dental Implant
•Conical Dental Implant
23

24. •Polished
•Roughened
•Hydroxyapatite
•Rough & Polished Combination
•3D Texture Innova Implant
Design
24

25. PRINCIPAL COMPONENTS
OF
DENTAL IMPLANT
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26. 26

27. Endosseous Fixture
(Implant Body / Fixture Screw)
Scientific Term: Endosseous implant fixture
•This is the root-form structure fabricated typically from
commercially pure titanium (cpTi, Grades I–IV) or titanium
alloys (Ti-6Al-4V ELI).
•It is surgically anchored within the alveolar or basal bone and
serves as the osseointegrated foundation for the prosthesis.
•Surface Modifications may include:
•Sandblasted, Large-grit, Acid-etched (SLA) surfaces
•Plasma-sprayed titanium or hydroxyapatite coatings
•Anodized surfaces for enhanced osseointegration
27

28. IMPLANT COLLAR
(CERVICAL REGION / TRANSMUCOSAL PORTION)
Scientific Term : Implant collar or transmucosal zone
•The superior segment of the fixture adjacent to the crestal bone
and peri-implant soft tissue.
•May be designed as machined-smooth or micro-threaded to
minimize crestal bone loss.
28

29. IMPLANT–ABUTMENT CONNECTION
Scientific Term: Implant–prosthetic junction
•The precision interface ensuring the mechanical
stability and bacterial seal between the fixture and the
abutment.
•Connection types include:
•External Hex Connection
•Internal Hex/Octagon Connection
•Conical/ Morse Taper Connection
29

30. ABUTMENT
(Prosthetic Abutment / Transmucosal Connector)
Scientific Term : Prosthetic abutment
•The intermediate component that emerges through the oral
mucosa and supports the prosthetic crown, bridge, or
overdenture.
•Types of abutments :
1.Healing Abutment (Gingival Former / Healing Cap): Temporarily
placed to shape peri-implant mucosa.
2.Temporary Abutment: For provisional restorations.
3.Definitive Abutment: For final prosthesis (straight, angled, or custom
CAD-CAM fabricated).
4.Multi-unit Abutment (MUA): For multiple implant-supported
prostheses and All-on-4/All-on-6 concepts. 30

31. ABUTMENT SCREW
(Fixation Screw)
Scientific Term: Prosthetic fixation screw
•A bio-mechanically critical titanium or titanium-alloy screw
securing the abutment to the implant body.
•Requires precise torque application (using a torque wrench,
typically 20–35 N-cm) to maintain preload and screw joint
stability.
31

32. PROSTHESIS
(Suprastructure / Superstructure)
Scientific Term: Implant-supported prosthetic restoration
•The visible, functional replacement of the tooth/teeth
fabricated from ceramics, metal-ceramics, or zirconia.
•Retention modalities:
•Cement-retained prosthesis
•Screw-retained prosthesis
•Telescopic or attachment-retained prosthesis
32

33. COVER SCREW
Scientific Term : Fixture cover screw
•A flat-topped titanium disc-like screw used during the healing
phase (submerged protocol) to protect the inner threads of the
implant until second-stage surgery.
OTHER ACCESSORY COMPONENTS
•Transfer Coping (Impression Post) : Used to capture the 3D
position of the implant in the impression for laboratory
fabrication.
•Laboratory Analog: Replica of the implant fixture used in the
working cast.
•Waxing Sleeve / Plastic Coping: For laboratory procedures to
fabricate custom abutments or frameworks.
33

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35. SURGICAL GUIDELINES
FOR
DENTAL IMPLANT
PLACEMENT
35

36. INITIAL EVALUATION :
•Medical history & systemic conditions
•Radiographs, CBCT scans
•Bone quality and quantity assessment
SURGICAL STEPS :
•Incision and flap reflection
•Osteotomy preparation (drilling sequence)
•Placement of implant fixture
•Suturing and healing phase (osseointegration)
PROSTHETIC PHASE :
•Placement of healing abutment
•Impression making
•Crown/bridge/denture attachment
36

37. •The patient’s tissue bio-type is classified according to how
thick or thin the supporting bone and gingival soft tissues
are defined.
•Becker and Oschenbein classified 3 distinct types :
1.Pro-nounced Scalloped
2.Scalloped
3.Flat
•A thin periodontium will be pro-nounced scalloped or
scalloped.
•A thick periodontium will present with flat gingival
architecture, usually supported by thick buccal and lingual
plates of alveolar bone.
•The normal crest is defined as 2 mm from the CEJ and the
low crest is present in patients with recession.
•Sounding to bone is the best clinical parameter to help
identify the attachment level.
37

38. BONE SOUNDING
•"Bone sounding" isa technique where a periodontal
probe is gently pressed through the gum tissue to the
level of the bone.
•This procedure helps a Periodontologist to assess the
location of the underlying bone, identify any
discrepancies with the gingival lining, and evaluate the
health of the gingival tissues.
•It is a pre-operative assessment to ensure there's
sufficient bone height for an implant and can also be
used to check for proper anesthesia during extractions
or to ensure adequate space for a pontic in a bridge.
38

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40. 40

41. SURGICAL STEPS
•The original Brånemark protocol required a vestibular flap with a
two-stage approach.
•The implant was placed and buried under the soft tissue and
after an adequate period of healing (three months mandible, six
months maxilla), a second stage surgery was performed with
crestal incisions to expose the fixtures and connect a trans-
epithelial abutment.
•Using the one stage technique requires a crestal incision or even
a flapless approach, drilling directly through the soft tissues.
41

42. •Langer introduced the sub-epithelial connective tissue
graft as a predictable technique for augmenting thin
tissue and it is especially useful when minor ridge
resorption is present.
•The most common donor site is the palatal tissue mesial
to the first molar.
•Another popular donor site is the tuberosity tissue. This
area is especially desirable when a thicker graft is
needed for ridge augmentation procedures (inlay or
pouch technique) in the anterior aesthetic zone.
42

43. POSITION & ANGULATION OF IMPLANT
•The initial drilling (round bur) starting point can be moved and
the angulation of the implant tipped to avoid bone dehiscence
or fenestration.
•The more palatal the movement, the deeper sub-gingivally the
implant platform must be positioned to accommodate for the
emergence of the restorative components through the soft
tissue.
•Dense bone (Type D-1 & D-2) requires careful attention to
drilling with adequate irrigation in order not to overheat the
bone.
•Placing the implant into too tight a site can lead to failure due
to pressure necrosis. The shape of the implant, parallel walled
vs. tapered will also greatly affect the tightness (primary
stability).
43

44. 44

45. •Type 3 and 4 bone requires modification of the drilling
protocol.
•Tapered implants have an advantage in softer bone due
to the wedging effect at the time of placement.
•The tapered implant is more challenging at the time of
placement, because the depth of the prepared site
needs to be exactly at the level of where the desired
final position of the implant needs to be placed.
•As opposed to a parallel wall implant that can be
placed deeper if desired, due to the ability to sink the
implant into the prepared site.
45

46. TIMING OPTIONS
•Extract and wait several months prior to implant placement.
•Orthodontic forced eruption to move the gingival complex
and crestal bone into a more favorable position prior to
extraction.
•Extract and bone graft the socket to help preserve soft
tissue contours and minimize collapse of the ridge, if the
buccal plate is thin or has a slight dehiscence.
•Extract and place implant immediately into socket (single rooted
teeth and buccal plate is thick and intact).
•Two stage buried.
•One stage with healing abutment or customised healing
abutment.
•Immediate load implant with provisional restoration.
46

47. TIMING OPTIONS
•Extract and wait several months prior to implant placement.
•Orthodontic forced eruption to move the gingival complex
and crestal bone into a more favorable position prior to
extraction.
•Extract and bone graft the socket to help preserve soft
tissue contours and minimize collapse of the ridge, if the
buccal plate is thin or has a slight dehiscence.
•Extract and place implant immediately into socket (single rooted
teeth and buccal plate is thick and intact).
•Two stage buried.
•One stage with healing abutment or customised healing
abutment.
•Immediate load implant with provisional restoration.
47

48. •Extract and wait two to three months, then bone graft
(Intra-oral block or GBR).
•After five to six months healing, place the implant.
•Single anterior teeth are best for immediate loading as
compared posterior teeth where the occlusal forces are
far greater.
•In the fully edentulous cases, immediate loading with a
rigid splinted interim prosthesis is advised.
48

49. SOCKET SHIELDING TECHNIQUE
•In the socket-shield technique (SST) the root
is bisected, and the buccal two-third of the
root is preserved in the socket so that the
periodontium along with the bundle bone and
the buccal bone remains intact.
•The SST provides a promising treatment
modality to manage these risks and preserve
the post-extraction tissues in esthetically
challenging cases. The principle is to prepare
the root of a tooth, which is indicated for
extraction, in such a manner that the
buccal/facial root section remains in place.
49

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51. 51

52. SURGICAL
COMPLICATIONS
•In order to minimize post-surgical complications, careful
planning of the flap design, and gentle soft tissue manipulation
is required.
•Control of bleeding, along with releasing incisions that allow for
flap advancement and closure without tension are mandatory.
•Failure to maintain flap coverage due to sloughing or opening of
the incision line will lead to delayed healing with compromised
results.
•Smoking affects both hard and soft tissue healing and has been
shown to be the greatest risk factor.
52

53. •The medically compromised patient (e.g.
Diabetes Mellitus, Autoimmune disease, patients on long term
steroids, radiation treatment etc.) needs special
attention, but is not contra-indicated to
receiving treatment.
•Logical and ethical decisions need to be
made with the patient and their
physicians.
53

54. 54

55. RISKS
&
COMPLICATIONS
55

56. 1.Age factor
2.Mesial Drift of teeth in Maxilla & Mandible
3.Oral Hygiene & Maintenance
4.Bruxism
5.Smoking
6.Peri-Implantitis
7.Bleeding Disorder
8.Osteoporotic Patients
9.Cardiovascular Disorders
56

57. AGE
•Older patients are more prone to altered systemic health
conditions, have poor local bone conditions and
potentially longer healing times.
•Patients older than 60 years have/had less implant
survival than usual.
•Implant submersion continues throughout adult life, and
its rate varies with age during the second and third
decades of life when compared with the fourth and fifth.
57

58. MESIAL DRIFT OF TEETH IN THE
MAXILLA AND MANDIBLE
•The spontaneous mesial drift of teeth in the step
dentition phase is well understood.
•There is about 5 mm mesial movement/drifting of teeth
in the lateral segment of jaw (canine to the first molar)
between 10 and 21 years of age.
•There is 2.5 mm buccal movement of incisors which may
result in a loss of space in arch leading to crowd.
•Dental implant does not take part in this mesial drift of
teeth.
58

59. ORAL HYGIENE & MAINTENANCE
•The accumulation of bacterial plaque leads to gingivitis,
periodontitis, and peri-implantitis.
•Furthermore, the presence of any symptoms of infection,
radiographic evidence of peri-implant bone loss, and/or
neuropathies reduced vascularity concomitant with
parallel-oriented collagen fibers may be indicative of an ailing
or failing implant.
•This can be managed by the use of interproximal brushes
penetrate 3 mm into the gingival sulcus or pocket.
•It also requires maintenance visit for the evaluation of
prosthetic component for plaque and calculus, stability of the
implant-abutment, peri-implant tissue margin, implant body,
and radiographs after every 12–18 months.
59

60. BRUXISM
•Glauser et al. 2001, evaluated 41 patients who received 127
immediately loaded implants. Their results showed that implants
in patients with bruxism were lost more frequently than those
placed in patients with no parafunction (41% vs. 12%).
•The higher failure rate among the bruxers is due to uncontrolled
functional loading of the implant, which leads to micro-motions
above the critical limit, resulting in fibrous encapsulation of the
implant instead of osseointegration.
•It was suggested that early or immediate loading is not
detrimental for osseointegration unless excessive micro-motions
occur at the bone-implant interface during the healing phase.
60

61. SMOKING
•Smoking reduces leukocyte activity and causes reduced
chemotactic migration rate and low phagocytic activity leading
to low infection resistance and delayed wound healing.
•Smoking affects osseointegration process by lowering blood
flow rate due to increased peripheral resistance and platelet
aggregation. Smoking residues are carbon monoxide and
cyanide, which delay wound healing capacity and along with
nicotine, inhibit cell proliferation rate.
61

62. PERI-IMPLANTITIS
•Peri-implantitis is a progressive inflammatory condition
which affects the tissues surrounding an osseointegrated
implant, leading to the loss of the supporting bone and
implant failure.
•It is characterized by bleeding, suppuration, increased
pocket probing depth, mobility of implant, and
radiographical bone loss.
•This inflammatory process is more intense and, goes
deeper and faster around the dental implant as compared
to the inflammation around the adjacent natural tooth.
62

63. BLEEDING DISORDER
•Bleeding disorders Uncontrolled hemorrhage can
be caused by platelet disorders, coagulant factors
deficiency, and using anticoagulant drugs such as
aspirin and warfarin.
•It is due to platelet deficiency.
•The most life-threatening adverse effect of dental
implant placement in these patients is upper
airway obstruction.
63

64. CARDIOVASCULAR DISEASE
•Cardiovascular diseases interfere with healing
and osseointegration process, resulting in
reduced fibroblast activity, impaired macrophage
function, and decreased collagen synthesis.
•Cardiovascular disease does not have a
significant influence on the long-term success
rate of dental implant treatment.
64

65. What a
Implantologist
Do
Now ?
65

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