Implant :- Any 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
Dental implant :- A prosthetic device of alloplastic
material Implanted into the oral the oral tissues
beneath the mucosa, periosteal layer and or within
the bone to provide retention and support for a
removal or fixed prosthesis.
Implantology :- The study or science of placing
and restoring dental implants.
Implant surgery :- The phase of implant dentistry
concerning the selection, planning, and
placement of the implant body and abutment.
Implant prosthodontics :- The phase of
prosthodontics concerning the replacement of
missing teeth and/or associated structures by
restorations that are attached to dental implants
Implant dentistry:- The
selection, planning, development, placement, and
maintenance of restoration(s) using dental
Implant abutment :- The portion of the dental
implant that serves to support and or retain any
Implant prosthesis:- Dental prosthesis such as
crown and other fixed dental
prostheses, removable dental prostheses as well
as maxillofacial prostheses supported and
retained in part or whole by dental implants.
1.Based on implant design
2.Based on attachment mechanism
3.Based on macroscopic body design
4.Based on the surface of the implant
5.Based on the type of the material
Inserted into the jaw bone after
mucoperiosteal flap elevation.
Tapped in place in a narrow trench made with
a rotary bur.
One or more posts pierced through the
mucoperiosteum after suturing of the flaps.
After a few week healing, a FPD is fabricated
by a classic method and cemented on top of
Three diverging pins were inserted either
transgingivally or after reflection of
mucoperiosteal flaps in holes drilled by spiral
At the point of convergence, the pins were
interconnected with cement to ensure the
proper stability because of their divergence.
◦ Straumann and co workers introduced hollow
cylinders in mid1970s.
◦ Implant stability would benefit from the large bone
to implant surfaces provided by means of the
◦ Holes ( vents ) favour the ingrowth of bone to offer
Full cylindrical implants were used by Kirsch
and became available under the name of IMZ .
The long term survival rates were
unacceptable, leading to the limited use of
this implant type currently.
They are rarely used at present.
The concept was developed by Scortecci. It is
based on the lateral introduction into the jaw
bone of a pin with a disk on top.
Once introduced into the bone volume, the
implant has strong retention against
The most common type of implant is the
screw shaped, threaded implant.
A decrease in the interthread distance at the
coronal end of the implant has been
proposed to enhance the marginal bone level
1. Minimize apical bone fenestration
2. Allow for implant placement in narrow
3. Amenable to immediate placement into
anterior extraction socket
They are customized according to plaster
model derived from an impression of the
exposed jawbone, prior to the surgery
planned for implant insertion.
They are designed to
retain the overdenture.
They are rarely used.
They were developed to retain the dentures in
the edentulous lower jaw.
The implant was applied through
submandibular skin incision.
“staple bone” implant
developed by Small,
consisted of a splint
adapted to the
of the mandible.
Biomechanics involved in Implantology
The nature of the biting
forces on the implants
Transferring of the biting
forces to the interfacial
The interfacial tissue
A successfully osseointegrated implant
provides a direct and relatively rigid
connection of the implant to the bone.
A critical aspect affecting the success or
failure of an implant is the manner in which
mechanical stresses are transferred from the
implant to bone smoothly.
Surface plays an important role in biological
Surface modifications have been applied to
metallic biomaterials in order to improve the
◦ Wear resistance
◦ Corrosion resistance
◦ Biocompatibility and surface energy, etc.
Micro rough surfaces
◦ Better bone apposition
◦ Higher percentage of bone in contact with the
◦ Influence the mechanical properties of the interface
◦ Stress distribution
◦ Bone remodelling
◦ Bone resorption
◦ Fibrous connective tissue layer
functional surface of
The surface of titanium has been modified by ion
beam mixing a thin carbon film.
The corrosion resistance and other surface and
biological properties were enhanced using
carbon plasma immersion ion implantation and
Reactive plasma spray produces a feasible BAG-
coating for Ti-6Al-4V dental implants.
The coating withstands, without any damage , an
externally generated tensile stress of 47MPa,and
was adequate for load bearing applications.
Enhancement of the osteoconductivity of Ti
implants is potentially beneficial to patients
◦ shortens the treatment time and
◦ Increases the initial stability of the implant
Tri calcium phosphate
Ca-P coatings are applied to
◦ To combine the strength of the metals with the
bioactivity of Ca-P.
◦ Accelerates the bone formation around the implant and
effectively the osseointegration rate
◦ Ion beam dynamic mixing technique(IBDM)
◦ Radio frequency magnetron sputter
◦ Electrochemical deposition
◦ Plasma spraying
◦ Phosphate based glass
◦ Hydroxy apatite
TCP – tri calcium phosphate
CPP – calcium pyrophosphate
The cells on the coatings expressed higher
alkaline phosphatase activity than pure Ti.
◦ Suggesting the stimulation of the osteoblastic
activity on the coatings.
Titanium nitride is known for its high surface
hardness and mechanical strength.
◦ Increasing the corrosion resistance &surface
hardness of the implant surfaces exposed
Titanium nitriding - various methods
◦ Gas nitriding
◦ Plasma nitriding by plasma diffusion treatment
◦ Plasma assisted chemical vapour deposition
◦ Pulsed DC reactive magnetron sputtering
◦ Closed field unbalanced magnetron sputtering ion
Favour the osseointegration of the bone
because of the inherent roughness of such
An ion beam assisted sputtering deposition
technique has been used to deposit thick and
dense TiO2 films on titanium surfaces which
are not easily breached and hence improved
Similar to sand blasting but has more
controlled peening power, intensity, and
It is a cold process in which the surface of a
part is bombarded with small spherical media
The LASER peening technology is recently
◦ Non contact
◦ No media
◦ Contamination free peening method
High intensity (5 -15GW/cm2)nano second
(10-30ns) of LASER light beam (3-5mm
width)striking the ablative layer generate a
short lived plasma which causes a shock wave
to travel into the implant.
The shock waves induces the compressive
residual stress that penetrates beneath the
surface and strengthens the implant,
resulting in improvement in fatigue life and
retarding the stress corrosion cracking
Dual acid etched technique
◦ To produce microtexture rather than macrotexture
◦ Enhance the osteoconductive process through the
attachment of fibrin and osteogenic cells, resulting
in bone formation directly on the surface of the
◦ Higher adhesion and expression of platelet and
extracellular genes, which help in colonization of
osteoblasts at the site and promote
Sandblasted and acid etched (SLA) method
◦ SLA given by BUSER et al,
◦ Sand blasted, large grit, acid etched.
◦ The surface is produced by large grit blasting
process followed by acid etching using hydrochloric
A, Three-dimensional diagram of the tissue and titanium
interrelationship showing an overall view of the intact
interfacial zone around the osseointegrated implant.
B, Physiologic evolution of the biology of the interface
The term Osseointegration was first used by
Prof I-P Branemark. since then it has been
used to describe the procedure of bone
attachment with titanium. Though lately, the
Glossary of Prosthetic Terms (Sixth Edition)
lists the terms Osseointegration and
osteointegration but recommends the use of
the term osseous integration.
Osseointegration was originally defined as, a
direct structural and functional connection
between ordered living bone and the surface
of a load-carrying implant.
◦ Branemark in 1985
A direct on light microscopical level, contact
between living bone and implant.
◦ Albrektsson in 1981
A bony attachment with resistance to shear
and tensile forces.
◦ Steinemann in 1986
Branemark in 1990, then gave a modified
definition of his own –
◦ “A continuing structural and functional
coexistence, possibly in a symbolic manner,
between differentiated, adequately remodeling,
biologic tissues and strictly defined and controlled
synthetic components providing lasting specific
clinical functions without initiating rejection
Defined as direct bone deposition on the
Characterized by structural and functional
connection between ordered, living bone and
the surface of a load-bearing implant.
Compared to as direct fracture healing, in
which the fragment ends become united by
bone, without intermediate fibrous tissue or
Material and surface properties
◦ Bio inert materials
◦ Rough surfaces
Improve adhesive strength
Favors bone deposition
Degree of mechanical interlock
Primary stability and adequate load
◦ Requires perfect stability
◦ Exact adaptation and compression of the fragments
incorporation by woven bone formation;
•4 to 6 weeks
adaptation of bone mass to load (lamellar and
parallel-fibered bone deposition); and
adaptation of bone structure to load (bone
The first bone tissue formed is woven bone.
characterized by a random, felt-like
orientation of its collagen fibrils, numerous,
irregularly shaped osteocytes and, at the
beginning, a relatively low mineral density.
it grows by forming a scaffold of rods and
plates and thus is able to spread out into the
surrounding tissue at a relatively rapid rate
(deposition of parallel-fibered and lamellar
lamellar bone, or towards an equally
important but less known modification called
parallel- fibered bone
◦ Three surfaces qualified for deposition of fibered
and lamellar bone
Woven bone formed in the first period of OG
Pre-existing or pristine bone surface
The implant surface
◦ Deposition of more mature bone on the initially
formed scaffold results in reinforcement and often
concentrates on the areas where major forces are
transferred from the implant to the surrounding
Pre – existing or pristine bone
◦ The trabeculae become necrotic due to the temporary
interruption of the blood supply at surgery.
Reinforcement by a coating with new, viable bone
compensates for the loss in bone quality (fatigue), and
again may reflect the preferential strain pattern
resulting from functional load.
The implant surface
◦ Bone deposition in this site increases the bone-
impIant interface and thus enlarges the load-
transmitting surface. Extension of the bone-
implant interface and reinforcement of pre-
existing and initially formed bone compartments
are considered to represent an adaptation of the
bone mass to load.
(bone remodeling and modeling)
Last stage of OG
It starts around the third month and, after
several weeks of increasingly high
activity, slows down again, but continues for
the rest of life.
Remodeling starts with osteoclastic
resorption, followed by lamellar bone
deposition. Resorption and formation are
coupled in space and time.
The cutting cone advances with a speed of about
50 pm per day, and is followed by a vascular
loop, accompanied by perivascular
Remodeling in the third stage of osseointegration
contributes; to an adaptation of bone structure to
load in two ways:
◦ It improves bone quality by replacing pre-existing,
necrotic bone and/or initially formed, more primitive
woven bone with mature, viable lamellar bone.
◦ It leads to a functional adaptation of the bone structure
to load by changing the dimension and orientation of the
six key factors for successful osseointegration:
◦ implant material;
◦ implant design;
◦ surface quality;
◦ prosthetic load;
◦ surgical technique;
◦ bone health.
The healthy soft, keratinized tissues facing
teeth and implants frequently have a pink
color and a firm consistency. The two tissues
have several microscopic features in
common. The gingiva as well as the
keratinized, peri-implant mucosa is lined by
a well-keratinized oral epithelium that is
continuous with a junctional epithelium that
is about 2 mm long.
The interface between epithelial cells and the
titanium surface is characterized by the
presence of hemi desmosomes and a basal
Capillary loops in the C/T under the
junctional and sulcular epithelium around
implant appear normal
The thickness of the epithelium is 0.5mm
The average direction of the collagen fiber
bundles of the gingiva is parallel with the
Even if perpendicular then they are never
embedded as in the case of dentogingival and
dentoperiosteal fibers around the teeth.
The fiber bundles also have cuff like
orientation – soft tissue seal around the
The vascular supply of the peri implant
gingival or oral alveolar mucosa is more
limited than that around natural teeth.
Schematic illustration of the blood supply in the connective tissue cuff
surrounding the implant/abutment is scarcer than in the gingival complex
around teeth because none originates from a periodontal ligament.
Newman, Takei, Klokkevold, Carranza.
Carranza’s Clinical Periodontology, 10th
Edition and 11th Edition
Lindhe, Lang, Karring. Clinical Periodontology
& Implant Dentistry, 5th Edition.
Carle E. Misch. Contemporary Implant
Dentistry. 3rd edition.
PHILLIP’S – SCIENCE OF DENTAL MATERIALS –
Kenneth J. Anusavice , Phd ,DMD
Robert K, Schenk & Daniel Buser. Osseointegration:
A reality. Perio 2000. Vol 17, 1998, 22-35.
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