The science of Osseointegration
Rationale for dental implants
Merits over Fixed partial dentures
Merits over removable prosthesis
Clinical implant component
Pre operative considerations
Various implant system
DENTAL IMPLANT – A dental implant is a
prosthetic device made of alloplastic material(s)
implanted into the oral tissue beneath the mucosal
or/and periosteal layer, and on/or within the bone to
provide retention and support for a fixed or removable
An apparent direct attachment
or connection of osseous tissue
to an inert, alloplastic material
without intervening connective
The graft material act as a
passive matrix like a trellis or
scaffolding for new bone to
DENTAL IMPLANT SYSTEM:-
dental implant components that are designed
to mate together.
• It consists of necessary parts and instrument
to complete the implant placement and
The science of osseointegration
In 1952 Dr. Per-Ingvar Branemark did extensive
experimental studies on the microscopic circulation of bone
marrow healing in rabbit. He found that hollow titanium
screw was irretrievable and he termed it as
OSSEOINTEGRATION (earlier called as bone
fusing/ankylosis) was defined by BRANEMARK as a direct
contact of living bone with the surface of implant at the
light microscopic level of magnification.
Rationale for dental implants
• Aging population living longer.
• Consequences of fixed prosthesis failures.
• Anatomical consequences of edentulism.
• Poor performance of removable prostheses.
• Psychological aspects of tooth loss.
• Predictable long term results of implant-supported
• Increased public awareness.
MERITS over fixed partial DENTURE
Reasons for the failure
Fracture of the
Periodontal health of
abutment tooth is
compromised leading to
additional tooth loss.
Caries & Endodontic
Single tooth implant
High success rates above
97% for 10 yrs.
Decreased risk of caries &
endodontic problems of
Improved esthetics of
Improved maintenance of
bone in edentulous site.
Merits over removable prosthesis
Accelerates bone loss.
Poorly fitting prosthesis
greater bone loss.
Requires relining every 5
Implant supported dentures
Less bone loss.
No Abutment loss.
Reduce the size of
Improves retention &
Uses of implants
• Individual tooth replacement.
• As abutment(s) for FPD with or without splinting to
natural teeth abutments.
• To construct either fixed(fully bone anchored)
complete dentures or removable complete dentures.
• Single complete denture.
• As Anchor in orthodontics.
• To retain maxillofacial prostheses.
• Poor retention of dentures due to anatomical factors.
• Poor oral muscular coordination.
• Low tolerance of mucosal tissues.
• Para functional habits leading to constant soreness and
• Active or hyperactive gag reflex.
• Psychological inability to wear conventional removable
• Unfavorable number and location of natural tooth
• Single tooth loss ( to avoid preparation of sound teeth
while constructing a fixed partial denture.
• Long span fixed partial denture.
• Depending on Anatomical site :
3.Endosteal- an endosteal implant is an alloplastic
material surgically inserted into residual bony ridge
primarily as a prosthodontic foundation.
a. Plate/blade form
b. Root form
c. Pin form
• Depending on the reactivity with bone :
• Depending on the implant
abutment interface :
1. External hex implant –
implant is connected to the
abutment by coupling which is
external about 2mm superior to
the coronal surface of the
2. Internal hex implant – the
abutment is internal to the
coronal surface of the implant
• Depending on the design :
1. Cylindrical shaped/ Press fit type- uses the
friction between the implant surface and the
2. Screw shaped/Threaded form- uses thread
to establish primary stabilization of the
implant allowing the process of osseo
intergration to occur without mobilization.
3. Tappered screw shaped.
CLINICAL implant component
• Implant body
• Sealing screw /
Cover Screw- this
is placed in the
implant during the
following stage 1
surgery. It prevents
the in growth of soft
tissue within the
• Healing Screw- it is
dome shaped screw
that is placed after the
stage 2 surgery done
placement. It allows for
the adaptation of the
around the implant.
• Abutment- it is that
component of the
implant system that
screws directly into the
implants and serves to
support &/or retain
any fixed or removable
• Impression Post- facilitates the transfer of
intra oral location of the fixture or the abutment
to a similar position in the lab cast.
• Laboratory Analogue- it is the component
machined to exactly represent either the implant
or the abutment in lab cast.(Not intended for
• Presurgical Implant Guide- Guides for proper
angulation and placement of implant.
PRE OPERATIVE CONSIDERATIONS
• Patient’s selection
• Treatment planning for success- a well prepared
treatment plan is critical for the success of the
• General examination:- general health of the
Patient psychology and
Etiology of edentulism.
• Extra Oral Examination –
Smile line should be considered at the first
• Intra Oral Examinations-
1. Jaw opening
2. Oral hygiene
3. Inter-arch relation
4. Presence of any pathology
• Radiographic Examination-
Pre prosthetic imaging objectives
1. To identify disease
2. Determine bone quality
3. Determine bone quantity
4. Determine implant position
5. Determine implant orientation
Density of the available bone (MISCH in 1988)
D1- Dense cortical bone (anterior mandible).
D2- Thick dense to porous cortical bone on the crest and
coarse trabecular bone within (anterior maxilla)
D3- Thin porous cortical bone on the crest and fine
trabecular bone within (anterior maxilla & posterior
D4- Fine trabecular bone (posterior maxilla)
*Bone density assist by radiographic technique by CT
scan and also by tactile sensation by drilling through
ANATOMICAL LIMITATION OF IMPLANT
• Buccal plate
• Lingual plate
• Maxillary sinus
• Inter implant distance
• Inferior alveolar canal
• Inter arch distance
Minimum distance between
implant and indicated structure
• 3mm between outer edge
of the implants
• 2mm from the superior
aspect of the canal
STEPS IN IMPLANT PLACEMENT
• Step 1- Create a full thickness crestal incision
& select the final implant location with a pre
surgical prosthetic guide so the site can be
marked with a round bur (1800-2000 rpm).
• Step 2-Use the pilot drill to appropriate
depth(700-1000 rpm)with copious irrigation.
• Step 3-A parallel pin is used to determine the
appropriate alignment with adjacent teeth
opposing occlusion or other implant.
A radiographic image is recommended.
• Step 4-When the final depth is reached with a
pilot drill the site is expanded with appropriately
sized implant bur at drill speed of 1000 rpm with
• Step 5-Irrigation is done to remove bone chip or
residue. The site is checked with appropriate trial
fit guage shoulder of the cone shaped position of
the guage should be flushed or just below the
• Step 6-Impalnt is aseptically delivered directly to
the site using the delivery tooth. Implant is
pressed into the prepared site with manual
pressure & delivery tooth disconnected using
gentle rocking motion. Wrench torque (10-45N-
• Step 7- Cover screw is placed over the implant
to prevent gingival growth into the implant.
• Step 8-Flap margins are repositioned &
• Conventional loading:- 1st stage surgery
patient is made to wait for 6 months for
• Healing period:- 12-16 weeks.
• Impression for loading:- 7-17 days are
required for the formation of gingival cuff
around the future abutment.
Immediate Implant Placement
• Occurs at the time of extraction.
Reduction in healing time.
Healing occurs similar as in case of extraction
which enhance bone to implant contact.
Need for subsequent mucogingival surgery to
correct tissues moved by repositioned flap.
Used of bone graft material to fill the socket.
Increase chance of infection and implant
Primary stability achieved
restoration has full
placed with 48 hrs
post surgery >
restoration not in
load & prosthetic
functions within 2
months > early
Delayed Implant Placement
• Is performed 2 months after extraction.
Share same as immediate implant placement
Allow soft tissue healing.
More ossteogenesis adjacent to implant.
No mucogingival flap advancement to correct
Lack of primary stability and limitation of bone
POST OPERATIVE FOLLOWUP
Implant loading(minimum integration
Region of implant placement
• Anterior mandible
• Posterior mandible
• Anterior maxilla
• Posterior maxilla
• Implant into bone graft
Minimum integration time
• 3 months
• 6 months
• 6 months
• 6-9 months
SECOND STAGE SURGERY:
• Implant cover screw is exposed by the use of
tissue punch by conservative incision & then
• Healing abutment is placed with a finger
pressure on each implant & gingival
Implant success criteria
• Immobile when tested clinically.
• No evidence of peri-implantitis.
• Mean vertical bone loss is < than 0.02mm
annually after the 1st year.
• No persistent pain, discomfort or infection is
attributable to implant.
Various implant systems
• Differ mainly in biomaterial, design and surgical
• NOBLE BIOCARE
ITI STRAUMANN INTEGRAL
BIO HORIZON LIFE CORE
BIOTEK ADIN Implant
ENDOPORE Implant system