Implant types

dental implants

1. Types of implant & Implant Components Presented by Mujtaba Ashraf MDS III Department of Prosthodontics 14-12-2017 Mujtaba Ashraf 1

2. Introduction 14-12-2017 Mujtaba Ashraf 2

3. Dental implants are designed to provide a foundation for replacement of teeth that look, feel, and function like natural teeth. Reconstruction with dental implants has changed considerably. Rather than merely focusing on the tooth/teeth to be replaced, today’s implant practitioners considers a broad and complex set of interwoven factors before formulating an implant treatment plan. 14-12-2017 Mujtaba Ashraf 3

4. Implant: A biocompatible alloplastic material or device that is surgically placed into oro -facial tissues and used for anchorage, functional , therapeutic, and/or aesthetic purposes . -Glossary of Implant Dentistry I mplant : A ny object or material, such as an alloplastic substance or other tissue, which is partially or completely inserted or grafted into the body for therapeutic, diagnostic, prosthetic, or experimental purposes. –GPT 9 Definition 14-12-2017 Mujtaba Ashraf 4

5. •The first two decades of 20 th century predominated by the clinicians namely R.E Payne & E.J. Greenfield . •R.E. Payne presented his technique of capsule implantation at the clinics of Third international Dental Congress, reported in the Dental Cosmos in 1901 . •Technique- Extracting the root, enlarging the socket with trephine, trial fitting of the capsule. He then placed grooves on both sides of the socket & filled 2/3 rd with rubber, fitted the porcelain root into the capsule & set it, with gutta-percha . 14-12-2017 Mujtaba Ashraf 5

6. In 1913 Dr. Edward J. Greenfield came up with the surgical method to prepare osteotomy in the healed bone using trephine. He fabricated the hollow cylindrical basket root of 20 gauge iridioplatinum soldered with 24 carat gold . F irst two-piece implant, which separated the abutment from the endosteal implant body at the initial placement. 14-12-2017 Mujtaba Ashraf 6

7. GREENFIELD emphasized on the importance of intimate contact between bone & implant . Hollow implants facilitated growth of bone into implant body & secure it. 3 months period of unloading. Implants failures because of infection. His techniques were similar to present concepts of osteotomy preparation, restoring after healing time. 14-12-2017 Mujtaba Ashraf 7

8. The modern era of implant dentistry most definitely began in the late 1930s with the work of Venable, Strock , Dahl, Gershkoff & Goldberg. Venable in 1937 developed the cast Co- Cr- Mo alloy known as Vitallium . 1937 Adams- Introduced submerged implants with ball head screws. In 1939 Alvin & Strock used the Venable screw type implant . THE DAWN OF THE MODERN ERA 1935-1978 A.D. 14-12-2017 Mujtaba Ashraf 8

9. In 1938 Stock placed the threaded vitallium implant into the extraction socket, the first long term endosseous implant. It remained firm & asymptomatic for nearly 17 years.  In 1947, Formiggini developed a single helix wire spiral implants made of stainless steel or tantalum. Two ends of the wire were soldered together to form a post or neck . 14-12-2017 Mujtaba Ashraf 9

10. In 1950 Lee’s - design i.e central narrow post with extensions . In 1943 Dahl in Germany developed Intramucosal or button implants – Mucosal inserts 14-12-2017 Mujtaba Ashraf 10

11. While conducting research into the healing patterns of bone tissue, accidentally discovered that when pure titanium comes into direct contact with the living bone tissue, together to form a permanent biological adhesion . He named this phenomenon " osseointegration ". Professor Per-Ingvar Brånemark began extensive experimental studies in 1952 on the microscopic circulation of bone marrow healing. These studies led to a dental implant application in the early 1960s . 14-12-2017 Mujtaba Ashraf 11

12. Brånemark System Component Fixture Pure titanium with machined thread Top of the fixture has hexagonal design and thread The apical portion tapered with four vertical notches Cover screw Seals the coronal portion of the fixture during the interim period Abutment Made of titanium is the cylinder shape. The apical portion has hexagonal shape to fit the coronal portion 14-12-2017 Mujtaba Ashraf 12

13. Abutment Screw – insert through the abutment & threads into the fixture to connect the two components . Gold Cylinder- made of Au , Pt, Pd. It is machined to fit the coronal portion of the abutment. It becomes integral part of final prosthesis. Gold Screw – inserted through the gold cylinder & threads into the abutment screw to connect the gold cylinder & abutment. 14-12-2017 Mujtaba Ashraf 13

14. This concept was propagated by   Dr. Charles Weiss . According to him there is a fibro-osseous ligament formed between the implant and the bone and this ligament can be considered as equivalent of the periodontal ligament found around natural teeth . The collagen fibers are present at the bone-implant interface and have an osteogenic effect. He advocated early loading of the implants. Concept Of Fibrointegration : 14-12-2017 Mujtaba Ashraf 14

15. Although fibro-osseous dental implants showed initial promise , they have been a disappointment in the long term . Implants that are fixed in the bone socket by the growth of connective tissue initially perform fine. But they tend to fail over time. When these failed implants are removed and inspected, the collagen fibers are seen growing parallel to the implant rather than directly into contact with it like natural periodontal ligament. Detractors of the fibro-osseous method of implantation believe this simply isn’t a strong enough connection to stand up to the forces of biting and chewing that teeth are subjected to through the years 14-12-2017 Mujtaba Ashraf 15

16. Classification of Implants depending on Implant placement within the tissues Materials used Epiosteal Endosteal Transosteal Metallic implants Non – metallic implants 14-12-2017 Mujtaba Ashraf 16

17. Epiosteal Implant It is a dental implant that receives its primary bone support by resting on the bone. So new bone will grow around the implant. Example Subperiosteal implant It is a dental implant structure that covers almost the entire crestal surface of the maxillary and mandibular residual alveolar bone under the soft tissue periosteum . 14-12-2017 Mujtaba Ashraf 17

18. SUBPERIOSTEAL IMPLANTS An implant structure that covers the almost entire crestal surface of maxillary & mandibular RAR under the soft tissue to include the periosteum , with the four to six posts protruding out through gingiva and on it the complete denture will be attached. 14-12-2017 Mujtaba Ashraf 18

19. In 1939, Strock placed first endosteal implant. It is a dental implant that extends into the basal bone for support It transects only one cortical plate. Endosteal Implant 14-12-2017 Mujtaba Ashraf 19

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21. Root form Plate form Used over a vertical column of bone Available in 3 forms cylindrical,, screw root, combination. They are used for horizontal column of bone which is flat and narrow facial lingual direction. 14-12-2017 Mujtaba Ashraf 21

22. Cylinder root form implants depend on a coating or surface condition to provide microscopic retention to the bone. Most often the surface is either coated with a rough material (e.g ., hydroxyapatite, titanium plasma spray) or a macro retentive design (e.g., sintered balls ). Usually pushed or tapped into a prepared bone site. They can be a paralleled wall cylinder or a tapered implant design 14-12-2017 Mujtaba Ashraf 22

23. Screw root forms are threaded into a slightly smaller prepared bone site and have the macroscopic retentive elements of a thread for initial bone fixation. They may be machined, textured, or coated. There are three basic screw-thread geometries : V-thread, buttress ( or reverse buttress) thread, and power (square ) thread designs. P rimarily available in a parallel cylinder or tapered design. 14-12-2017 Mujtaba Ashraf 23

24. Combination root forms have macroscopic features from both the cylinder and screw root forms. As a general rule, the combination implant designs have a press-fit surgical approach (as the cylinder implants) and a macroscopic implant design for occlusal loads. 14-12-2017 Mujtaba Ashraf 24

25. Transosteal implants A dental implant that penetrates both cortical plates and passes through entire thickness of the alveolar bone. 14-12-2017 Mujtaba Ashraf 25

26. Metallic implants T itanium C obalt chromium molybdenum alloy Titanium aluminium vanadium Cobalt chromium molybdenum Stainless steel Zirconium Tantalum Gold Platinum 14-12-2017 Mujtaba Ashraf 26

27. NON – METALLIC IMPLANTS Ceramics Carbon 14-12-2017 Mujtaba Ashraf 27

28. Depending On Their Reaction With Bone • Based on the ability of implant to stimulate bone formation Bio active • Hydroxyapatite • Tri Calcium Phosphate • Calcium Phosphate Bio inert M etals 14-12-2017 Mujtaba Ashraf 28

29. Implant components 14-12-2017 Mujtaba Ashraf 29

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32. 1. Implant fixture 2. Implant mount 3. Cover screw 4. Gingival former/healing screw/healing abutment/ permucosal extension 5. Impression post/impression transfer abutment 6. Implant analogue 7. Abutment 8. Fixation screw Implant Components 14-12-2017 Mujtaba Ashraf 32

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34. Implant Fixture The term fixture is used synonymously for the implant itself which is inserted and gets osseointegrated with the bone. It works as the tooth root , and various kinds of components are used to cover it, make its impression, and retain or fix the prosthesis on top of it. 14-12-2017 Mujtaba Ashraf 34

35. Crest Module The crest module of an implant body is that portion designed to retain the prosthetic component in a two-piece implant system. It also represents the transition zone from the implant body design to the transosteal region of the implant at the crest of the ridge. 14-12-2017 Mujtaba Ashraf 35

36. The abutment connection area usually has a platform on which the abutment is seated ; the platform offers physical resistance to axial occlusal load. An antirotation feature also is included on the platform (external hex) or extends within the implant body (internal hex) 14-12-2017 Mujtaba Ashraf 36

37. The crest module often is designed to reduce bacterial invasion. Its smoother dimension varies greatly from one system to another (0.5–5 mm). When the crest module is smooth, polished metal, it is often called a cervical collar . 14-12-2017 Mujtaba Ashraf 37

38. Implant Apex The implant apex portion is often tapered to permit ease of initial placement into the osteotomy. An antirotational feature of an implant may also be included, which has flat sides or grooves along the apical region of the implant body or an apical hole. 14-12-2017 Mujtaba Ashraf 38

39. The apical end of each implant should be flat rather than pointed . This allows for the entire length of the implant to incorporate design features that maximize desired strain profiles . 14-12-2017 Mujtaba Ashraf 39

40. implant mount The implant mount is a component which usually comes connected with the implant in its vial and it is used to carry the implant from its vial/packaging to the prepared osteotomy site either by hand or with a ratchet/hand piece adaptor. Implant Fixture Implant Mount 14-12-2017 Mujtaba Ashraf 40

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42. T he component that is used to cover the implant connection during the submerged healing of the implant. P revent bone, soft tissue, or debris from invading the abutment connection area during healing . Cover screw 14-12-2017 Mujtaba Ashraf 42

43. Gingival former/ healing screw/ healing abutment Used to form a healthy, aesthetic emergence profile of the soft tissue around the implant prosthesis . When the implant is re-exposed after it is osseointegrated with the bone , the cover screw is removed and replaced with a long gingival former and the site is left to heal for 2 to 3 weeks. 14-12-2017 Mujtaba Ashraf 43

44. P ermucosal extension A vailable in multiple heights to accommodate soft tissue variations. It also can be straight, flared, or anatomical to assist in the initial contour of the soft tissue healing . 14-12-2017 Mujtaba Ashraf 44

45. In the case of a one-stage surgical procedure, the surgeon may have placed the permucosal extension at the time of implant insertion or may have selected an implant body design with a cervical collar of sufficient height to be supragingival . 14-12-2017 Mujtaba Ashraf 45

46. Impression post/impression transfer abutment The impression post is the component that is used to transfer the implant Hex position and orientation from the mouth to the working cast . Once the soft tissue around the gingival former has healed, the gingival former is removed and impression post is inserted over the implant . An impression is made. 14-12-2017 Mujtaba Ashraf 46

47. Types of impression posts: Closed tray impression post Open tray impression post 14-12-2017 Mujtaba Ashraf 47

48. Closed tray impression post P oses shallow retention grooves along its body and a short connection screw. It is used in the closed tray impression transfer technique. The complete post remains under the impression and no part of it emerges out of the tray. After making the impression, this post is removed from the implant, assembled to the analogue, and inserted to the impression with the same orientation. 14-12-2017 Mujtaba Ashraf 48

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50. Open tray impression post P oses deep retention grooves along its body and a long connection screw. This post is used in the open tray impression transfer technique. A part of its long screw emerges out of the impression tray, and should be unscrewed before removing the impression from the mouth. 14-12-2017 Mujtaba Ashraf 50

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52. Implant analogue Implant analogue is a component which has a different body but its platform and connection are exactly similar to the implant. The analogue is used to replicate the implant platform and connection in the laboratory mode . 14-12-2017 Mujtaba Ashraf 52

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54. Prosthetic Attachments 14-12-2017 Mujtaba Ashraf 54

55. The abutment is the portion of the implant that supports or retains a prosthesis or implant superstructure A superstruc ture is defined as a metal framework that attaches to the implant abutment(s) and provides either retention for a removable prosthesis. 14-12-2017 Mujtaba Ashraf 55

56. Three main categories of implant abutments are described, according to the method by which the prosthesis or superstructure is retained to the abutment : ( 1) an abutment for screw retention uses a screw to retain the prosthesis or superstructure ( 2) an abutment for cement retention uses dental cement to retain the prosthesis or superstructure (3 ) an abutment for attachment uses an attachment device to retain a removable prosthesis 14-12-2017 Mujtaba Ashraf 56

57. Each of the three abutment types may be further classified as straight or angled abutments, describing the axial relationship between the implant body and the abutment. 14-12-2017 Mujtaba Ashraf 57

58. Summary 14-12-2017 Mujtaba Ashraf 58

59. The dental implant now has been established as one of the most preferred options for missing tooth replacement and many dentists are already practising this procedure or are willing to incorporate implants in their practise . Further, there are now several implant systems in the market with different implant designs and their specific components. This range and variety may often make it difficult for the novice dentist to understand and use implants and their components. Generic terminology has been developed to facilitate communication among implant team members. Regardless of the implant system used, the generic term is descriptive of the function of the component rather than its proprietary name . 14-12-2017 Mujtaba Ashraf 59

60. References Glossary of prosthodontic terms. Glossary of Implant dentistry. Dental Implant Prosthetics, 2 nd ed. Misch Misch CE, Misch CM. Generic terminology for endosseous implant prosthodontics. J Prosthet Dent 1992;68:809–12. 14-12-2017 Mujtaba Ashraf 60

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