Introduction to Dental Implants

Introductory class on dental implants for final year BDS students

1. Dr. Ritam Kundu.
MDS PGT. Final Year
Dept. Periodontics, Dr. RADCH

2. Introduction to Implant
dentistry

Brief history

 Osseointegration

Classification of Implant

Different Components of
Implant


Advantages of Implant over
conventional crown, bridge

Complications associated
with dental implants

3. What is an Implant ?

Implants are devices or tissues that are placed inside or on the surface of the body,
intended to replace missing body parts or to serve other purposes, such as deliver
medication, monitor body functions, or provide support to organs and tissues.


Dental Implant: A permucosal device that is
biocompatible and biofunctional and is placed on or
within the bone associated with the oral cavity to
provide support for fixed and removable prosthesis.

4. 600 AD – Maya Civilisation – Three shells in shape of teeth were placed
in place of missing teeth in mandibular anterior region

Similar instances in Inca, Chinese and Egyptian ancient civilisation

1809 – Maggiolo – implanted 18 Karat Gold alloy, with porcelain crown
into jaw bone.

Mid 1800’s – Harris – Porcelain implant into jaw bone

1909 – Greenfield used iridoplatinum implant

5. Per- Ingvar Branemark , a Swedish orthopaedic surgeon, during his
experiments with microscopic circulation of bone marrow, discovered
titanium implants gets integrated into the bone without any adverse
bone or soft tissue reactions.

7. The primary goal of implant installation is to achieve and maintain a stable
bone to implant conection. This BIC is termed as- Osseointegration.

- Clinically, osseointegration is the asymptomatic rigid fixation of an alloplastic
material (implant) in bone with the ability to withstand occlusal forces.

- Histologically, osseointegration is defined as the direct structural and
functional connection between ordered, living bone and the surface of a load
bearing implant without intervening soft tissues. (PI Branemark et al in 1986)

8. Clinical evidence of successful Osseointegration:

• Implant should not be mobile when tested clinically
• Implant should be asymptomatic – absence of persistent signs
and symptoms, such as pain, infections, etc.
• Stable crestal bone levels – annual rate of bone loss should be
less than 0.2 mm after the first year in function
• Radiographic evidence of increasing mineralization of the newly-
formed bone at the implant surface
• Healthy soft tissues
• Absence of peri-implant radiolucency.
Concept of Fibro integration:
- Propagated by Weiss (1986)
- Formation of fibro-osseous ligament, which is equivalent to
PDL , between alveolar bone & implant

9. Phases
Of
Osseointegration

13. Cement Retained Restoratoin Screw Retained Restoratoin




 SCRP is possible
Direct-Casting
Screw Abutment & Cylinder
Temporary (Ti / Plastic)
Combi
Dual
Dual Milling
Angled (15° / 25°)

14. Two stage
(Healing submerged,
then uncovery surgery)
One stage
(Implant with permucosal
healing, no uncovery surgery)
Early restoration
(Restoration placed
in 3 months after surgery)

16. Implant Surface Chemical Composition:

- Unsuccessful trials with implants made of Carbon or Hydroxyapatite due to lack of
resistance, under Occlusal load, they fractured
- Different noble metal or their alloys also were inefficacious.
- Today, vast majority of dental implants is made up of CP Titanium or their alloys
- Ti6AlV4 – Titanium-Aluminium: 6%, Vanadium 4% - are known to provoke bone resorption
as the result of leakage of some toxic components.
Titanium:
 Biocompatible
 No allergic reaction
 High ultimate strength and low modulus of elasticity
 Pure titanium is highly reactive, when exposed to atmosphere within microseconds an
oxide layer is formed (TiO2).
- Zirconium implants
Advantage:
 Osseointegrates with bone like titanium.
 High aesthetics
 Used in patients with titanium allergy.

 Disadvantage :
Zirconium implant is that it is made in a single body,
because zirconium components which can be screwed to
the zirconium body have not yet been developed

17. Benefits of dental implants:

1.It prevents bone loss because the implant anchors (osseointegrates) the jawbone
and thus prevents further bone loss .
2. It restores the function and aesthetics of the overall maxillofacial prosthesis.
3. It offers best and most preferred option for stabilizing loose dentures .
4. It is thought to be the only option to deliver the fixed prosthesis where the
conventional bridge is not possible.
5. It is the strongest and long-lasting treatment for the replacement of missing teeth.

6. The deep flanges and palatal extension of complete dentures, which cause
substantial discomfort to patients, can be avoided once the denture is retained over
the implants.
7.No need to prepare healthy tooth in order to replace missing tooth
8.Repeated use of removable denture periodontally weakens remaining teeth.

18. Indication:

1.Generally any edentulous area can be an indication for dental implants.
2.Severely compromised denture bearing area
3.Poor oral muscular coordination
4.Parafunctional habits leading to recurrent soreness and instability of
prostheses
5.Hyperactive gag reflex in patients, caused by RPD or CD
6.Unfavourable number of potential abutment teeth
7.Single tooth loss
Contraindication:

1.Acute illness
2.Terminal illness
3.History of IV bisphosphonates
therapy
4.Pregnancy
5.Severe uncontrolled metabolic
diseases
6.Poor oral hygiene status

19. Case Done at DEPT OF PERIODONTICS, RADCH
By Dr. R. Kundu & Dr. D. Mondal

20. Dental Implant: A permucosal device that is biocompatible and biofunctional
and is placed on or within the bone associated with the oral cavity to provide
support for fixed and removable prosthesis.
Sleeping Implants

21. Bleeding

Cortical plate perforation

Devitalisation of adjacent tooth

Implant or component Ingestion or Aspiration

Nerve injury

Mandible fracture

Dislodgement into the sinus

Peri-implantitis & Peri-implant-mucositis

22. Progressive bone loss present but clinically
immobile implant