History and development of Dental implants / dental courses


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History and development of Dental implants / dental courses

  1. 1. HISTORY, TERMINOLOGY AND DEVELOPMENT OF IMPLANTOLOGY INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Introduction Oral or Dental Implants have opened the door to the 21st century in dentistry and oral rehabilitation. They have increased the treatment possibilities for patients and improved the functional results of their treatment. Patients who had to compromise their esthetic appearance, chewing functionality and nutritional intake due to complete or partial tooth loss can now be restored back to various degrees of normal esthetics and function. www.indiandentalacademy.com
  3. 3. Since the commercial distribution of Dental Implants, the field of Oral Implantology has undergone a rapid and progressive development. Many professionals have branched off and specialized in this particular field. Their continuing research efforts reward this field with new concepts and developments almost on a daily basis. www.indiandentalacademy.com
  4. 4. Research efforts from many different disciplines such as material science, physics, medicine, biochemistry and others form the foundation for continued improvements in the field of Oral Implantology as well as the hardware being used. What several years ago was considered to be an alternative or experimental treatment in dentistry is often today considered as the Standard protocol now. www.indiandentalacademy.com
  5. 5. HISTORY AND DEVELOPMENT OF INTRA- ORAL IMPLANTS www.indiandentalacademy.com
  6. 6. Early Historical Developments: In 500 BC, The Etruscans, living in what is now modern Italy, replaced missing teeth with artificial teeth carved from the bones of oxen. www.indiandentalacademy.com
  7. 7. Man has been searching for ways to replace missing teeth for thousands of years. The first evidence of the use of implants dates back to 600AD in the Mayan population, which was found in 1931 by Dr. and Mrs. Wilson Popenoe, an archeological team, who were excavating in Honduras. www.indiandentalacademy.com
  8. 8. Ancient Egyptians used tooth shaped shells and ivory to replace teeth. In the 1700s John Linter suggested the possibility of transplanting teeth of one human into another www.indiandentalacademy.com
  9. 9. Modern implant dentistry began in the early 19th century. Much experimentation was being done about what material would work best as the replacement tooth. Attempts were first made at implanting natural teeth from another person's mouth, but these implants suffered much infection and were rejected by the host. www.indiandentalacademy.com
  10. 10. In 1809, Maggiolo fabricated a gold implant which was placed into fresh extraction sockets to which he attached a tooth after a certain healing period. www.indiandentalacademy.com
  11. 11. In 1886 Edmunds was the first in the US to implant a platinum disc into the jawbone, to which a porcelain crown was fixed. In 1887, a physician named Harris use of teeth made of porcelain with a platinum post, instead of a gold post. www.indiandentalacademy.com
  12. 12. In the early 1990s Lambotte fabricated implants of aluminum, silver,brass,red copper, magnesium,gold and soft steel plated with gold and nickel. Greenfield in 1909 made a lattice cage design of iridoplatinum and made the first root form design. www.indiandentalacademy.com
  13. 13. Modern Historical Developments: Early pioneers in this field include Dr. Strock AE, who, in 1931 suggested using Vitallium r, a metal alloy, for dental implants. Surgical cobalt chromium molybdenum alloy was introduced to oral implantology in 1938 by Strock. In 1940, Boths first reported bone fusing to titanium www.indiandentalacademy.com
  14. 14. In 1941, Dr. Gustav Dahl of Sweden provided a retentive mechanism for jaws that were completely edentulous. This was the introduction of the subperiosteal implant. www.indiandentalacademy.com
  15. 15. In 1946, Strock designed a two-stage screw implant that was inserted without permucosal post. In 1947, Manlio Formiggini of Italy developed an implant made of tantalum. In 1947, Raphael Chercheve designed a double delinked spiral implant made of chrome-cobalt alloy. www.indiandentalacademy.com
  16. 16. THE BREAKTHROUGH In 1952, a startling discovery was made which had great implications for Tooth Replacement Therapy. Dr. Per-Ingvar Branemark , an Orthopedic Surgeon, discovered that the hollow titanium rod used in the study was not retrievable when the experiment was complete. Further studies showed that the animal's bone had directly attached to the titanium surface. This phenomenon was called osseointegration. www.indiandentalacademy.com
  17. 17. The first practical application of osseointegration was the implantation of new titanium roots in an edentulous patient in 1965. More than thirty years later, the non-removable teeth attached to these roots were still functioning perfectly. www.indiandentalacademy.com
  18. 18. In the mid 1950’s,LEE introduced the use of an endosseous implant with a central post and circumferential extensions. www.indiandentalacademy.com
  19. 19. In the 1960s, emphasis was placed on making the biomaterials more inert and chemically stable within biologic environments. By 1964, commercially pure titanium was accepted as the material of choice for dental implants, and since that time, almost all dental implants are made of titanium. www.indiandentalacademy.com
  20. 20. In 1967, Dr. Leonard Linkow of New York introduced the blade form implant. These blades came in a variety of sizes and forms and were the most widely used type of implant until the 1980s. www.indiandentalacademy.com
  21. 21. In 1970, the ramus endosseous implant was developed by ROBERTS AND ROBERTS. In 1975 the first synthodont aluminium oxide implant was placed in a human www.indiandentalacademy.com
  22. 22. In 1975 the first synthodont aluminium oxide implant was placed in a human Vitreous carbon implants were first placed in early 1970 by Grenoble In early 1980s Tatum introduced Omni R implant made of titanium alloy root form implant with horizontal fins. www.indiandentalacademy.com
  23. 23. Niznick in 1980 introduced Core-vent, an endosseous screw implant manufactured with a hydroxyapatite coating. Calcitek corporation began manufacturing and marketing its synthetic polycrystalline ceramic hydroxyapatite coated cylindrical post titanium alloy implant. www.indiandentalacademy.com
  24. 24. In 1985, Straumann Company designed plasma sprayed cylinders and screws to be inserted in a one stage operation. In 1988, a National Institute of Health (nih) consensus development conference on osseointegration in dental implants catalyzed the acceptance and defined the criteria for success. www.indiandentalacademy.com
  25. 25. In 1988, National Institutes of Health (NIH) Consensus and American academy of implant dentistry recognize the term “root form” . Branemark devoted 13 years conducting animal studies to determine the parameters under which osseointegration would occur. Based on his study titanium was the made the material of choice. www.indiandentalacademy.com
  26. 26. INTRAORAL IMPLANT TERMINOLOGY www.indiandentalacademy.com
  27. 27. Implant:- “A graft or insert set firmly or deeply into or onto the alveolar process that may be prepared for its insertion”. (GPT-7) Abutment:- “A tooth or portion of an implant which protrudes through the mucosa into the oral cavity for the retention or support of a crown or a fixed or removable denture prosthesis”.( GPT-7) www.indiandentalacademy.com
  28. 28. Implant denture:- “A denture which receives its ability and retention from the substructure which is partially or wholly implanted under the soft tissue of the denture base seat”. (GPT-7) Dental substructure:- “ The metal framework which is beneath the soft tissues and in contact with bone for the purpose of supporting an implant denture superstructure”. (GPT-7) www.indiandentalacademy.com
  29. 29. Dental superstructure:- “The metal framework which is retained and stabilized by the implant denture substructure”. (GPT-7)  Edentulous (fully and partially) :- “Simply stated, fully edentulous refers to an individual that has no teeth at all in either the upper or lower jaw. Partially edentulous refers to missing one or more teeth”. www.indiandentalacademy.com
  30. 30. Implant hygiene :- “In as much as good oral hygiene habits are important; in implant dentistry they are even more important. The design of the teeth that are fixed to the implant is critical to allow the patient easy access to cleaning”. www.indiandentalacademy.com
  31. 31. Implant prosthodontics :- “This is a branch of implant dentistry that is concerned directly with the restorative phase following implant placement and the overall treatment plan before and after the placement of dental implants”. www.indiandentalacademy.com
  32. 32. Protocol :- “Implant protocol is the regimen and discipline that is strictly followed by the general dentist, the implant surgeon, the implant dental technician and any other team member”. One of the most critical aspects of implant dentistry is proper pre-treatment planning within a team approach. prosthodontist :- In Implantology, his/her responsibilities are to diagnose, evaluate and to plan the treatment of the patient. The steps to follow in having implants should be personally suited to the patient by the prosthodontist. www.indiandentalacademy.com
  33. 33. Surgeon:- Implantology is not considered a specialty branch of dentistry. Surgical procedures can be performed by an oral surgeon, a periodontist. The surgeon's responsibility is to select the appropriate shape and size of implant to be placed precisely where the dentist has requested. The qualified surgeon also performs other implant related surgeries, such as bone grafting, sinus lifts, etc. www.indiandentalacademy.com
  34. 34. Team approach :- In conventional dentistry, a dentist works alone. His/her practice revolves primarily around their skills and experience. Implant dentistry is a multi-skilled field. The prosthodontist works closely with the oral surgeon or periodontist who will be performing the surgical aspects. The implant dental technician will also be involved with making of the teeth. Also involved on the implant team are the x-ray technicians, dental assistants, surgical assistants, implant manufacturers and, of course, the patient's positive attitude. www.indiandentalacademy.com
  35. 35. Membrane: – In the field of dental implant surgery it is referred to as a little sheet made up of different materials (GoreTex, Collagen etc.) and designed to protect a grafted bone site from influx of soft tissue cells. Soft tissue cells would compromise bone healing, since they proliferate at a faster rate than bone cells. Oral Implantology: – “A specialized field of dentistry, dealing with the placement and restoration of dental implants”. www.indiandentalacademy.com
  36. 36.  Titanium: – Although by some considered an exotic metal it is actually one of the most abundant elements on earth. However, it took scientific advances of modern metallurgy to turn this black sand into useful metal. Commercially pure titanium currently comes in four different grades (1-4), grade 4 being the finest. Most dental implants are either machined out of commercially pure titanium or an alloy thereof. The most frequently used alloy is Ti Al6V4. This alloy improves the fracture resistance of titanium and does not compromise the osseointegration into bone. www.indiandentalacademy.com
  37. 37. Osseointegration: - “The fusion of the surface of a dental implant to the surrounding bone, so that it is secured tightly in the bone and ready to be used as an anchor for a tooth or prosthesis”.(GTP-7) Osseointegration:- “A condition that exists when a titanium implant is inserted, screwed or pressed into living bone. The result is a biological bond of living bone to the titanium implant. In essence, the two become one”. www.indiandentalacademy.com
  38. 38. Osseointegration:- defined by the American Academy of Implant Dentistry as "the firm, direct and lasting biological attachment of a metallic implant to vital bone with no intervening connective tissue." www.indiandentalacademy.com
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  41. 41.  A generic language for endosteal implants has been developed by MISCH & MISCH.  No single design is considered best for restoring all conditions. Each design type is useful in Tooth Replacement Therapy.  As a general rule, greater the functional surface area of the bone implant contact, the better the support the system for prosthesis. www.indiandentalacademy.com
  42. 42. Intra-oral Implants can be categorized into three main groups:  Endosseous Implants :-are implants that are surgically inserted into the jawbone. Root form. Blade (plate) form. Ramus frame. www.indiandentalacademy.com
  43. 43. Rootform Implant.  Nowadays, the most common implant used in the dental community.  The reason they are called Rootform Implants is because they closely resemble the shape of the original root of the lost tooth and design to use a vertical column of bone. www.indiandentalacademy.com
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  45. 45. Subperiosteal Implants :-are implants, which typically lie on top of the jawbone, but underneath the gum tissues. The important distinction is that they usually do not penetrate into the jawbone. www.indiandentalacademy.com
  46. 46. Transosseous Implants:- are surgically inserted into the jawbone. However, these implants actually penetrate the entire jaw so that they actually emerge opposite the entry site, usually at the bottom of the chin. www.indiandentalacademy.com
  47. 47. implant Implant body (fixture) Implant prosthetic componentsImplant body Implant prosthetic component Crest module A body An apex region # First stage cover screw # Second stage permucosal Extension OR healing abutment # Abutment # Hygiene screw # Transfer coping # Implant analog # Coping # Prosthesis screw www.indiandentalacademy.com
  48. 48.  Implant/Fixture is the actual part that is inserted into the bone.  Prosthesis:- the crown (tooth), and an attachment (abutment) with a screw.. www.indiandentalacademy.com
  49. 49. Implant body / fixture referred to surgically placed part which goes either into or set on the top of the jaw bone. crest module The crest module of an implant is that portion designed to retain the prosthetic component in a two piece system. It also represents the transition from the implant body design to the transosteal region of the implant at the crest of the ridge. This platform offers physical resistance to axial occlusal load, on which the abutment is set. www.indiandentalacademy.com
  50. 50. Following prosthetic component of implant placed in different phases of implant placement. First stage cover screw:- Placed at the time of insertion of implant body or stage I surgery. placed into the top of the implant to prevent bone, soft tissue or debris during healing. www.indiandentalacademy.com
  51. 51. Second stage healing abutment:- After a prescribed healing period , a second stage procedure is performed to exposed implant at transepithelial portion i.e. above the soft tissue. it is placed in place of cover screw to allow the pericircular area of mucous membrane heal properly and keratinized. www.indiandentalacademy.com
  52. 52. Abutment:- is the portion of the implant that support and retained a prosthesis or implant suprastucture and is then connected to the implant body. www.indiandentalacademy.com
  53. 53. Hygiene screw placed over the abutment to prevent debris and calculus from invading the internally threaded portion of the abutment during prosthesis fabrication between prosthetic appointments. www.indiandentalacademy.com
  54. 54. Transfer coping Use to transfer the design of implant to a master cast for prosthesis fabrication. Indirect transfer coping:- in which transfer coping screwed into the abutment in place when set impression Is removed from the mouth. Direct transfer coping:- after impression is set, transfer coping is transfer into the impression at the time of removal. www.indiandentalacademy.com
  55. 55. Implant analog Used in fabrication of the master cast to replicate the retentive portion of the implant body or abutment. After the master impression is obtained the corresponding analog is attached to the transfer coping and the assembly is poured in stone to fabricate the master cast. www.indiandentalacademy.com
  56. 56. Prosthetic coping:- is a thin covering, serve as the connection between the abutment and the prosthesis. Prefabricated coping:- metal component machined precisely to fit the abutment. Castable coping:- is a plastic pattern cast in the same metal as the prosthesis. Prosthetic screw:- a screw retained prosthesis is secured to the implant body or abutment. www.indiandentalacademy.com
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  59. 59. The Prosthesis The Abutment The Implant The Crown The Root- The Ligaments- www.indiandentalacademy.com
  60. 60. As the use of implants was finally endorsed by science, dental schools began to slowly inculcate the teaching of Implantology in their regular syllabus. Over the last 20 years we have witnessed the emergence of an entirely new scientific discipline which requires the integration of surgical, prosthetic and biomechanical concepts. Today, implants are recognized as the treatment of choice for tooth replacement in widely varying cases, including those where previously the prognosis used to be hopeless. CONCLUSION www.indiandentalacademy.com
  61. 61. For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com