Implant anatomy, materials and the digital world

1. Implant anatomy, materials and the digital world

2. Block I
Part I – Implant parameters
Part II - Materials
Part III – Hard- and Software

3. Part I – Implant parameters, type and
size planning

4. Suprastruktur
General Geometry
Surface
Roughness
Threads
Surface doping
Etc.
Implant body

5. Externe Verbindungen Interne Verbindungen
Konische
Verbindungen
Nicht-Konische
Verbindungen
Connections

6. Externe Verbindungen Interne Verbindungen
Übersicht Verbindungsarten
Konische
Verbindungen
Nicht-Konische
Verbindungen

7. Implant-Abutment-Interface:
• Discontinuing the form
• Discontinuing the mechanical stability
• Can discontinue the material
• Connection to intra implant cavity
• This concerns conical and parallel connections alike!

8. What do we want?
A long term stable and aesthetical result
Stable soft and hard tissue

9. Bone remodelling
Horizontal 1,3 – 1,4 mm
Vertical 1,5 – 2 mm
Tarnow et al.
J Periodontol. 2000;71: 546-549
Calvo Guirado et al.
Implant Dent. 2007;16: 155-164 24 months post-op

10. Which parameters influence this stability?

11. • Micro-gap
• Geometry
• Biomechanical aspects

12. Mikrospalt

13. Mikrospalt: Quantifizierung
>1 / << 4 µm 4 µm 11 µm 15 – 22 µm
Rack et al.
In vitro synchrotron-based radiography of micro-gap formation at the implant-abutment
interface of two-piece dental implants.
J Synchrotron Radiat;17: 289-294.

14. Mikrospalt: Mikroflora
• Smallest oral mikroorganism:
1 µm

15. Mikrospalt: Mikroflora
• Proof of intra implant
microbiological life
Persson et al. (1996) Clin Oral Implants Res 7:90-95
Quirynen et al. (1993) Clin Oral Implants Res 4:158-61

16. Mikrospalt: Molekulares Leakage
Gram negative
Bacteria
Bacteria Cell Wall Lipopolysaccharide
(LPS)
MW 10-20 KDa

17. Micro-gap: LPS – induced activation of Osetoclasts
LPS
TLR
Il-1ß
ß
1
2
3
Osteoclast
activation

18. Harder et al.
Molecular leakage at implant-abutment
connection
Clin Oral Investig. 2010;14: 427-432.
• Proof of bacterial
settlement in conical
connections

19. • Micro-gap
• Geometry
• Biomechanical aspects

20. Geometry: Platform Switch
3,8 3,8
3,8
3,8
3,8 4,3 5,5
4,8
Canullo et al.
Platform switching and marginal bone-level alterations: the results of a randomized-controlled trial.
Clin Oral Implants Res. 2010;21: 115-121.

21. Platform Switch
3,8 3,8
3,8
3,8
3,8 4,3 5,5
4,8
- Umgekehrtes Platform-Switch / Knochen-Remodelling Verhältnis
Platform-Switch
Bone-Remodelling
Canullo et al.
Clin Oral Implants Res. 2010;21: 115-121.
1,49 mm 0,99 mm 0,82 mm 0,56 mm

22. Platform Switch: Horizontal distance with a positive
effect on the periimplant bon
Autor Jahr Ausmaß Platform
Switch [mm]
Clinical study Cochetto 2010 1,7
Clinical study Canullo 2010 1,7
Clinical study Capiello 2008 1,0
Clinical study Vigolo 2009 0,9
Animal Study Jung 2008 0,8
Animal study Weng 2010 0,5
Clinical study Hürzeler 2007 0,45
1.7 mm
0.45 mm
Size of horizontal distance

23. • Micro-gap
• Geometry
• Biomechanical aspects

24. Biomechanik: Stressverteilung im periimplantären
Knochen/ Finite – Element – Analysen
Compression
-Stress
Tensile
-Stress
Tabata et al.
Platform switching: biomechanical evaluation using three-dimensional finite element
analysis.
Int J Oral Maxillofac Implants. 2011;26: 482-491.

25. Stressverteilung im periimplantären Knochen
Compression
-Stress
Tensile
-Stress
Regular Platform Switch Wide Platform
Tabata et al.
Platform switching: biomechanical evaluation using three-dimensional finite element
analysis.
Int J Oral Maxillofac Implants. 2011;26: 482-491.

26. Stressverteilung im periimplantären Knochen
Compression
-Stress reduction
Tensile
-Stress reduction
Regulär Platform Switch Wide Platform
Tabata et al.
Platform switching: biomechanical evaluation using three-dimensional finite element
analysis.
Int J Oral Maxillofac Implants. 2011;26: 482-491.
21,9 %
26,7 %

27. Stressverteilung am Implantat –Abutment -
Interface
Maeda et al.
Biomechanical analysis on platform
switching: is thereany biomechanical
rationale?
Clin Oral Implants Res.
2007;18: 581-584.
• If platform switch à stress is
diverted from implant bone
interface to implant-abutment
interface

28. Biomechanical stability - internal vs. external
Steinebrunner et al. (2008)
Implant-abutment interface design affects fatigue and fracture strength of implants,
Clin Oral Implants Res 19, 1276-84.
MATERIAL AND METHODS:
- Six implant systems
- Two systems with external connections (Branemark, Compress)
- Four systems with internal connections (Frialit-2, Replace-Select,
Camlog, Screw-Vent).
- one subgroup with (dynamic loading) and the other
- without prior dynamic loading (contr).
- 1,200,000 load cycles at 120 N.

29. External Internal
Branemark Screw-Vent Frialit 2 Camlog Replace Select
Compress
Biomechanical stability - internal vs. external

30. 1.200 000 Cycles
Biomechanical stability - internal vs. external

31. Überleben
der
Probekörper
Biomechanical stability - internal vs. external

32. Kraft
bis
zur
Fraktur
Biomechanical stability - internal vs. external

33. In the Zr group:
8 specimens survived
7 failed
Max. load of 400 N.
Biomechanical stability – zirconia abutments

34. Statische Belastung :
Titan: 1475 N
Zirkon: 690 N
Zyklische Belastung:
Titan: No damage at 400 N and 70.000 cycles
Zirkon: Accumulate damage at 175 N and 70.000 cycles
1475
690
175
625
430
0
500
1000
1500
2000
2500
Ti Zr Zr cyclic
Range
Mean
Biomechanical stability – zirconia abutments

35. Implant planning – average root diameter in mm
5.6
6.6
5.1
6
6.7
6.7
8
8
5
8-10
9-10 5
8
9
3-4 mm
2-4

36. Implant planning
3.3
-
4.3
3.3
-
(3.8)
3.8
-
4.3
3.8
-
4.3
3.8
-
4.3
5
-
6
5
-
6
3.3
3.8
-
4.3
5
-
6

37. Implant planning

38. Implant planning

39. Part II – materials

40. Part II – materials – 1. abutments

45. No statistical differrence between materials

46. Part II – materials – 2. supraconstruction

47. Choice of the restoration material

48. Choice of the restoration material
-
Metal ceramic crowns

64. Gold standard?
150 MPa flexural strength
Galvanic element
Metal ions in solution
Guindy, J. S., Schiel, H., Schmidli, F. & Wirz, J. (2004) Corrosion at the marginal gap of implant-supported suprastructures
and implant failure. Int J Oral Maxillofac Implants 19: 826-831.
Shirakura, A., Lee, H., Geminiani, A., Ercoli, C. & Feng, C. (2009) The influence of veneering porcelain thickness
of all-ceramic and metal ceramic crowns on failure resistance after cyclic loading. J Prosthet Dent 101: 119-127.

65. Choice of the restoration material
-
Veneered zirconia crowns

66. Veneered zirconia for posterior
single crowns
25 % chipping after 5 years
32 % chipping after 10 years
Sailer, I., Makarov, N. A., Thoma, D. S., Zwahlen, M. & Pjetursson, B. E. (2015) All-ceramic or metal-ceramic tooth-supported fixed
dental prostheses (fdps)? A systematic review of the survival and complication rates. Part i: Single crowns (scs). Dent Mater 31: 603-
623.
Sax, C., Hammerle, C. H. & Sailer, I. (2011) 10-year clinical outcomes of fixed dental prostheses with zirconia frameworks. Int J
Comput Dent 14: 183-202.

68. Inzidenz Verblendfrakturen implantatgetragener Einzelkronen nach 5 Jahren : 3.5%
Jung et al. Clin Oral Implants Res 2012;23 Suppl 6:2-21.

69. Chipping of implant supported crowns: 3.5% after 5 years
Jung et al. Clin Oral Implants Res 2012;23 Suppl 6:2-21.

70. Clinical case
Maryland bridge

85. Choice of the restoration material
-
E.Max (lithiumdisilicate)

86. Simeone, P. & Gracis, S. (2015) Eleven-year retrospective survival study of 275 veneered lithium disilicate single crowns. Int J
Periodontics Restorative Dent 35: 685-694.
300-400 MPa flexural
strength milled
350-450 MPa
Biegefestigkeit pressed
98 % survival rate after
nach 11 years

87. Clinical case
Lithiumdisilicate fully anatomical

92. Clinical case
Lithiumdisilicate – „cut back“

106. 1. No chipping, but very rare fractures
2. Similar gaps at the margins as metal-ceramic
3. Great long term survival rate (11 y = 98%)
4. No fractures of the opposing dentition
5. Can be universally used
LiS2
Simeone, P. & Gracis, S. (2015) Eleven-year retrospective survival study of 275 veneered lithium disilicate single crowns. Int J
Periodontics Restorative Dent 35: 685-694.
Gehrt M, Wolfart S, Rafai N, Reich S and Edelhoff D. Clinical results of lithium-disilicate crowns after up to 9 years of service. Clin
Oral Investig. 2013;17:275-84.

107. Choice of the restoration material
-
Zirconia fully anatomical

108. Limmer, B., Sanders, A. E., Reside, G. & Cooper, L. F. (2014) Complications and patient-centered outcomes with an implant-
supported monolithic zirconia fixed dental prosthesis: 1 year results. J Prosthodont 23: 267-275.
700-1400 MPa flexural
strength
1-3 year data
50 % of complications in
opposing dentition

109. Clinical case – first case
FMR – zirconia fully anatomical

113. u n d A b f o r m u n g f ü r d i g i t a l e s W a x - u p

133. Clinical case
Implant and tooth supported hybrid bridge – zirconia full anatonmical

142. Clinical case
Simple bridge

156. 1. No chipping
2. Similar precision to metal ceramic or E.max
(beware of partial crowns)
3. Very good long term survival rates (2-7 y =
100%)
4. Fracture of opposing dentition
5. Can be used universally if high polished
1. Gehrt M, Wolfart S, Rafai N, Reich S and Edelhoff D. Clinical results of lithium-disilicate crowns after up to 9 years of service. Clin Oral Investig. 2013;17:275-84.
2. Lopez-Suarez C, Gonzalo E, Pelaez J, Serrano B and Suarez MJ. Marginal Vertical Discrepancies of Monolithic and Veneered Zirconia and Metal-Ceramic Three-Unit Posterior Fixed Dental
Prostheses. Int J Prosthodont. 2016;29:256-8.
3. Rojas Vizcaya F. Retrospective 2- to 7-Year Follow-Up Study of 20 Double Full-Arch Implant-Supported Monolithic Zirconia Fixed Prostheses: Measurements and Recommendations for Optimal
Design. J Prosthodont. 2016.
4. Zhang Y, Lee JJ, Srikanth R and Lawn BR. Edge chipping and flexural resistance of monolithic ceramics. Dent Mater. 2013;29:1201-8.
ZrO2

157. 1. Link abutment = titanium
2. Screw retained preferable to cemented
3. Adhesive cement and primer (24 hours at 37 degrees)
4. Supraconstruction 5-5 = cut back or fully anatomical
zirconia
5. All static or dynamic contacts in zirconia
6. Molar reconstructions fully anatomical
7. Other combinations with Lithiumdisilicate possible
8. Beware of functional problems before starting
treatment

158. Part III – what do I need for digital implantology

159. Part III – what do I need for digital implantology –
1. Clinic

163. Digitale Abformung – Funktionsprinzipien – konfokal und puderlos

165. watch every detail

169. Part III – what do I need for digital implantology –
1. Laboratory

170. 1 . S c a n n e r a n d S o f t w a r e
2 . M u l t i p l e m o d e l l i n g s o f t w a r e
3 . P r i n t e r a n d s o f t w a r e
4 . M i l l i n g m a c h i n e a n d s o f t w a r e
5 . G o o d s u p p o r t
6 . M o t i v a t e d s t a f f ! !

171. 1 . D e n t a l W i n g s / 3 S h a p e
2 . E x o c a d b a s e d s o f t w a r e
3 . e t c .

172. E x o c a d S o f t w a r e
1 . A m a n n G i r r b a c h , K a V o , S c h ü t z D e n t a l ,
Z f x , Z i r k o n z a h n

177. Kosten von 40.000 bis
120.000 Euro

178. SUCCESS IS THE ABILITY TO GO FROM FAILURE TO FAILURE
WITHOUT THE LOSS OF MOTIVATION.
Winston Churchill

179. thank you and see you tomorrow ...