Biological Aspects of Implants      INDIAN DENTAL ACADEMY   Leader in Continuing Dental Education   www.indiandentalacadem...
OverviewIntroductionDefinitionsHistoryClassificationImplant Materials, Surfaces, And FormsSurface modificationsResponse Of...
IntroductionOver years different clinical skills have been tried to help patients with the effects of partial or complete ...
DefinitionA dental implant is a device of biocompatible material(s) placed  within / against the mandibular / maxillary bo...
HistoryThe Mayan civilization has been shown earliest known examples to  have used endosseous implant, dating back over 1,...
ClassificationBased on relation to bone form                      Endosteal                     Subperiosteal             ...
Subperiosteal Implants (Eposteal implants): It is a framework specially fabricated to fit on top of supporting  areas in t...
Subperiosteal Implants (Eposteal implants):Types:          Interdental subperiosteal implants          Total subperiosteal...
Subperiosteal Implants :(Eposteal implants)The subperiosteal implantis retained by periostealintegration in which theouter...
Subperiosteal Implants (Eposteal implants): www.indiandentalacademy.com
Subperiosteal Implants (Eposteal implants):Preoperative                                 Postoperative   www.indiandentalac...
Subperiosteal Implants (Eposteal implants):                   Used only in the anterior mandible                     in th...
Endosteal ImplantsThey are surgically placed within alveolar and basal bone and aresubdivided into• Root form         impl...
Root FormAlvin Strock placed first successful   root form implant in 1938 in the   University of Harvard  Placed directly ...
Root FormCylindrical in shapeCan be threaded, smooth, stepped,  parallel/threaded, with /without  coating, with /without g...
Root FormThe Root form Implants are two  stage implantsStage I : is submersion / semi-   submersion to permit a functional...
Blade FormThe Endosteal Blade implant was  introduced in 1967 by Leonard  Linkow and also by Ralph &  Harold RobertsShape:...
Blade Formwww.indiandentalacademy.com
Ramus FormThe Ramus Frame implant was   developed in 1970 First fabricated from stainless   steel.In 1982, the fabrication...
Ramus FormThey are technique- sensitiveThey have an external attachment  bar that runs from ascending  ramus on one side t...
Endodontic StabilizerDiffer from other endosteal implants   in terms of functional applicationRather than providing additi...
Endodontic StabilizerShape:      have parallel / tapered sides      smooth / threadedIndication:          atleast 5mm of b...
Intermucosal Inserts Differ in form ,concept, function from   other modalitiesThey provide support for a prosthesis but   ...
Intermucosal InsertsDo not come into contact with boneMode of intergegration is not  osteointegrationReceptor sites in the...
IMPLANT COMPONENTS1. Implant body2. Sealing screw3. Healing cap4. Abutment5. Impression post6. Laboratory analogues7. Waxi...
IMPLANT COMPONENTS1.Implant body: Implant body is the endosteal dental     implant that is placed within the bone     duri...
IMPLANT COMPONENTS3.Healing cap:Healing cap is dome –shaped screw .They may range in length from 2 to 10mm   and projects ...
IMPLANT COMPONENTS5.Impression post:Facilitates transfer of intra oral   location of abutment to similar   position in lab...
IMPLANT COMPONENTS6.Laboratory analog:Component to represent either implant    or abutment in laboratory cast.It screws on...
IMPLANT MATERIALS, SURFACES,         AND FORMS www.indiandentalacademy.com
Implant Materials, Surfaces, And FormsThe composition and nature of the surface of an implant are  important characteristi...
Implant Materials, Surfaces, And FormsTo be successful, an implant must meet four conditions …2. Have an interface that st...
Implant Materials, Surfaces, And FormsTwo basic types of materials are used in implant dentistry:                Metals   ...
Implant Materials, Surfaces, And FormsCP titanium is available in 4 grades.             Titanium Alloys                Cp ...
Measuring Surface TopographyThe surface topography describes (1) the degree of roughness that the surface exhibits and (2)...
Surface modificationsTitanium implant surface   characteristics may be modified   by                                  Plas...
Surface modificationsPlasma sprayingInvolves heating the HA by a plasma flame at a temperature of   approximately 15,000° ...
Implant Surface ModificationsBlasted Surface              Blasted & Etched   Etched                  Hydroxyapatite Coated...
Advantages of increased surface roughness of Cp Ti implant• Increased surface area of the implant adjacent to bone.• Impro...
Disadvantages of Surface Coatings• Flaking, cracking, or scaling upon insertion• Increased plaque retention when placed ab...
RESPONSE OF BONE TO     IMPLANTSwww.indiandentalacademy.com
Branemark (1952)       Described the relationship between titanium  and bone for which they coined the term osseointegrati...
The Glossary of Prosthodontic Terms(GPT) refers to the term  “osseous integration”which is defined as “the apparent direct...
Bone to Implant InterfaceTwo basic theories   1.Fibro-osseous integration by Linkow, James & Weis   2 Osseointegration by ...
www.indiandentalacademy.com
Mechanism of Osseointegration     Blood clot (between fixture & bone)    Clot transformed by phagocytic cell              ...
EVENTS AFTER IMPLANT PLACEMENTBone Necrosis• About 1 mm of cortical bone adjacent to the osseous wound (osteotomy site) un...
2.The Strength Phase• The implant is stabilized• The process of resorption begins• Stronger, weight bearing bone is formed...
• The fibers are arranged irregularly, parallel to the implantbody, when forces are applied they are not transmittedthroug...
Factors influencing Osseointegration   – Biomaterial for dental implant   – Surface composition and structure   – Implant ...
Bone resorption can be caused by 12 months following fixture insertion vertical bone loss is observed due to traumatic sur...
The main contributing factor to bone resorption are1. Local inflammation from plaqueDirect action of plaque products induc...
3. Heat•     Heating of bone to a temperature in excess of 47°C during    implant surgery can result in cell death and den...
4. Primary stability or Initial stability   – where an implant fits tightly into its osteotomy site then   osseointegratio...
7.BONE QUALITY & QUANTITY• Areas of jaws – More cortical bone (anterior mandible)                   Anchor implant success...
• Vertical dimension of bone - Minimal for endosteal implant  is 8mm.   It is important to leave at least 2mm of bone betw...
• Vertical dimension of bone - Minimal for endosteal implant  is 8mm. It is important to leave at least 2mm of bone betwee...
Bone Density Classification (Misch)www.indiandentalacademy.com
6. Contamination  – Contamination of the implant site    by organic and inorganic debris    can prejudice the achievement ...
7. Loading schemesDelayed loading:        The prosthesis is attached at the second procedure after        a conventional h...
Biomechanical Overload             BIOMECHANICAL OVER LOAD      Biomechanical Over Load    Bone Loss At Coronal Aspect    ...
Revised criteria for implant success– Individual unattached implant is immobile when tested  clinically.– No evidence of p...
References1. Caranza’s Clinical Periodontology 10th Edition2. Jan Lindhe Clinical Periodontology and Implant Dentistry 4th...
Thank youwww.indiandentalacademy.com
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Biological aspects of implants /certified fixed orthodontic courses by Indian dental academy

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Biological aspects of implants /certified fixed orthodontic courses by Indian dental academy

  1. 1. Biological Aspects of Implants INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com
  2. 2. OverviewIntroductionDefinitionsHistoryClassificationImplant Materials, Surfaces, And FormsSurface modificationsResponse Of Bone To ImplantsOsseointegrationEvents After Implant PlacementFactors influencing OsseointegrationReferences www.indiandentalacademy.com
  3. 3. IntroductionOver years different clinical skills have been tried to help patients with the effects of partial or complete edentulism. Dental problems that were historically the most difficult can be solved today with assistance of dental implants www.indiandentalacademy.com
  4. 4. DefinitionA dental implant is a device of biocompatible material(s) placed within / against the mandibular / maxillary bone to provide additional / enhanced support for prosthesis / toothThe Glossary of Prosthodontic Terms (GPT) defines an implant as “a prosthetic device or alloplastic material implanted into the oral tissues beneath the mucosal and/or periosteal layer, and /or within the bone to provide retention and support for a fixed or removable prosthesis.” www.indiandentalacademy.com
  5. 5. HistoryThe Mayan civilization has been shown earliest known examples to have used endosseous implant, dating back over 1,350yrs before Per Branemark started with titaniumArcheologists found a fragment of mandible dating about 600AD. which is considered to be that of a woman in her 20s had three tooth shaped pieces of shell placed into sockets of three missing lower incisor.• The tooth-shaped shell implants and the jaw were examined radiographically and it was determined that compact bone had formed around 2 of the implants and the bone was radio graphically similar to that which forms around blade implants. This may be the earliest example of any endosseous implant. www.indiandentalacademy.com
  6. 6. ClassificationBased on relation to bone form Endosteal Subperiosteal TransosseousBased on shape Blade form Root formBased on material used Metallic Ceramic www.indiandentalacademy.com
  7. 7. Subperiosteal Implants (Eposteal implants): It is a framework specially fabricated to fit on top of supporting areas in the mandible or maxilla under the mucoperiosteum with perimucosal extension for support and attachment of a prosthesis.Indications: In cases of advanced alveolar resorption in which volume of residual bone is insufficient for insertion of endosteal implant. Used in atrophied bone and where jaw structure is limited www.indiandentalacademy.com
  8. 8. Subperiosteal Implants (Eposteal implants):Types: Interdental subperiosteal implants Total subperiosteal implants Circumferential subperiosteal implantsAdvantages: light weight individually designed metal framework fits over remaining bone www.indiandentalacademy.com
  9. 9. Subperiosteal Implants :(Eposteal implants)The subperiosteal implantis retained by periostealintegration in which theouter layer of periosteumprovides dense fibrousenvelope & anchors theimplant to bone throughsharpeys` fibers www.indiandentalacademy.com
  10. 10. Subperiosteal Implants (Eposteal implants): www.indiandentalacademy.com
  11. 11. Subperiosteal Implants (Eposteal implants):Preoperative Postoperative www.indiandentalacademy.com
  12. 12. Subperiosteal Implants (Eposteal implants): Used only in the anterior mandible in the very atrophic mandible Due to the complex nature of the surgical approach this implant is not used frequently. www.indiandentalacademy.com
  13. 13. Endosteal ImplantsThey are surgically placed within alveolar and basal bone and aresubdivided into• Root form implants include those that approximate the shape and dimensions of tooth roots (called root form implants)• Blade form those that are plates of metal (called blade implants)• Ramus form those that are metal frameworks where only a portion of the metal is implanted into bone (ramus frame implants). www.indiandentalacademy.com
  14. 14. Root FormAlvin Strock placed first successful root form implant in 1938 in the University of Harvard Placed directly into bone, like natural tooth forms Designed to resemble the shape of natural tooth Can be placed anywhere in mandible / maxilla where there is sufficient available bone www.indiandentalacademy.com
  15. 15. Root FormCylindrical in shapeCan be threaded, smooth, stepped, parallel/threaded, with /without coating, with /without grooves / vent 3 to 5mm in diameter 7 to 20mm in lengthAs a rule root forms must achieve osteointegration to succeed. So they are placed in an afunctional state during healing until they are osteointegrated www.indiandentalacademy.com
  16. 16. Root FormThe Root form Implants are two stage implantsStage I : is submersion / semi- submersion to permit a functional healing.Stage II : is attachment of an abutment / retention mechanism www.indiandentalacademy.com
  17. 17. Blade FormThe Endosteal Blade implant was introduced in 1967 by Leonard Linkow and also by Ralph & Harold RobertsShape: as the name suggests a metal / blade in cross-sectionAvailable in 1 stage / 2 stage forms 2.5mm in widthCan be placed anywhere in 8 to 15mm in depth mandible / maxilla 15 to 30mm in length www.indiandentalacademy.com
  18. 18. Blade Formwww.indiandentalacademy.com
  19. 19. Ramus FormThe Ramus Frame implant was developed in 1970 First fabricated from stainless steel.In 1982, the fabrication process was changed to titantiumINDICATION: Total mandibular edentulism with severe alveolar ridge resoption www.indiandentalacademy.com
  20. 20. Ramus FormThey are technique- sensitiveThey have an external attachment bar that runs from ascending ramus on one side to ascending ramus on the other side.Posteriorly on each side they have endosteal extensions, inserts into available bone within ascending ramusAnteriorly it has plate / blade extension which is inserted into symphysis www.indiandentalacademy.com
  21. 21. Endodontic StabilizerDiffer from other endosteal implants in terms of functional applicationRather than providing additional abutment support for restorative dentistry , they are used to extend the functional length of an existing tooth root to improve its prognosis www.indiandentalacademy.com
  22. 22. Endodontic StabilizerShape: have parallel / tapered sides smooth / threadedIndication: atleast 5mm of bone should be available beyond apex of tooth being treated2nd premolars & molars are not good candidates in mandible as they are over inferior alveolar canal in maxilla as they are over maxillary sinus www.indiandentalacademy.com
  23. 23. Intermucosal Inserts Differ in form ,concept, function from other modalitiesThey provide support for a prosthesis but do not provide abutmentsMushroom shaped projections that are attached to the tissue surface of RPDs or CDs in maxilla & plug into prepared soft tissue receptor sites in the gingiva to provide additional retention & stabilityIndication: where endosteal & Subperiosteal implants are not practical www.indiandentalacademy.com
  24. 24. Intermucosal InsertsDo not come into contact with boneMode of intergegration is not osteointegrationReceptor sites in the tissue into which the inserts seat become lined with tough keritinised epitheliumOnly one appointment is required www.indiandentalacademy.com
  25. 25. IMPLANT COMPONENTS1. Implant body2. Sealing screw3. Healing cap4. Abutment5. Impression post6. Laboratory analogues7. Waxing sleeves8. Prosthesis www.indiandentalacademy.com retaining screw
  26. 26. IMPLANT COMPONENTS1.Implant body: Implant body is the endosteal dental implant that is placed within the bone during first stage surgery. It may be either a threaded or non threaded cylinderIt is either titanium alloy with or without hydroxyapatite coating.2.Sealing screw :• A screw is placed in the implant during the healing phase following stage –one surgery.Prevents the growth of the tissue over the edge of the implant. www.indiandentalacademy.com
  27. 27. IMPLANT COMPONENTS3.Healing cap:Healing cap is dome –shaped screw .They may range in length from 2 to 10mm and projects through the soft tissue into the oral cavity.Made up of resin such as polyoxymethyline or the titanium metals4.Abutment:Screws directly into implant support prosthesis.Primary component which provides retention to the prosthesis. www.indiandentalacademy.com
  28. 28. IMPLANT COMPONENTS5.Impression post:Facilitates transfer of intra oral location of abutment to similar position in laboratory cast.It screws directly into fixture / into abutment; once impression post is in place ,an impression is made. www.indiandentalacademy.com
  29. 29. IMPLANT COMPONENTS6.Laboratory analog:Component to represent either implant or abutment in laboratory cast.It screws onto the impression post after it has been removed from mouth & placed back into impression before pouring7. Waxing sleeve :Is attached to the abutment by the prosthesis retaining screw on a laboratory model.8. Prosthesis retaining screw :Penetrates the fixed restoration and secures to the abutment www.indiandentalacademy.com
  30. 30. IMPLANT MATERIALS, SURFACES, AND FORMS www.indiandentalacademy.com
  31. 31. Implant Materials, Surfaces, And FormsThe composition and nature of the surface of an implant are important characteristics because of their effect on the biologic development of an interfacial relationship between the bone and the implant.To be successful, an implant must meet 4 conditions:1. Be biocompatible so there is no undesirable reaction between the tissues and the implant (ie., corrosion, dissolution and/or resorption) www.indiandentalacademy.com
  32. 32. Implant Materials, Surfaces, And FormsTo be successful, an implant must meet four conditions …2. Have an interface that stabilizes postoperatively in as short a time as possible3. Be capable of carrying and transferring the occlusal stresses placed upon it4. Remain stable for a long period of time. www.indiandentalacademy.com
  33. 33. Implant Materials, Surfaces, And FormsTwo basic types of materials are used in implant dentistry: Metals Ceramics (either in a pure form or a hybrid type )Titanium Implants• Titanium’s biocompatibility, corrosion resistance, relatively light weight, low density, low modulus and high tensile strength make titanium based materials attractive for use in dentistry.• There are six different types of titanium based materials used to fabricate dental implants. These materials include Four types of commercially pure titanium (cpTi) Two titanium alloys www.indiandentalacademy.com
  34. 34. Implant Materials, Surfaces, And FormsCP titanium is available in 4 grades. Titanium Alloys Cp grade I Ti Ti-6Al-4V Cp grade II Ti Ti-6Al-4V Cp grade III Ti Cp grade IV Ti.The main difference between the 4 grades of titanium and the two alloys is the increasing ultimate tensile strength either in a pure form or a hybrid type www.indiandentalacademy.com
  35. 35. Measuring Surface TopographyThe surface topography describes (1) the degree of roughness that the surface exhibits and (2) the orientation of the irregularities on the surface.Surface roughness occurs in two principal planes: one perpendicularto the surface and one in the plane of thesurface (Thomas 1999)Currently 3 groups of instruments are available that mayprovide such information:1. Mechanical contact stylus instruments2. Optical instruments3. Scanning probe microscopes (SPM). www.indiandentalacademy.com
  36. 36. Surface modificationsTitanium implant surface characteristics may be modified by Plasma spraying & ion sputter coating• Additive methods (eg.Titanium Plasma Spray [TPS], Hydroxyapatite [HA]-coated)• Subtractive methods (eg.acid etched, particle blasted and combinations) www.indiandentalacademy.com
  37. 37. Surface modificationsPlasma sprayingInvolves heating the HA by a plasma flame at a temperature of approximately 15,000° C to 20,000°C.The HA is then propelled onto the implant body in an inert environment like argon, to a thickness of 50 to 100 μm.Ion-sputter coating• Process by which a thin, dense layer of HA can be coated onto an implant substrate.• Machined implants had a roughness of 5 micrometers while hydroxyapatite coated implants had a roughness of 30 to 50 micrometers www.indiandentalacademy.com
  38. 38. Implant Surface ModificationsBlasted Surface Blasted & Etched Etched Hydroxyapatite Coated www.indiandentalacademy.com
  39. 39. Advantages of increased surface roughness of Cp Ti implant• Increased surface area of the implant adjacent to bone.• Improved cell attachment to the implant surface.• Increased bone present at the implant surface.• Increased biomechanical interactions of the implant with bone.• Bone formation and maturation occurs at a faster rate in the initial phases on HA coated implants than on non-coated implants www.indiandentalacademy.com
  40. 40. Disadvantages of Surface Coatings• Flaking, cracking, or scaling upon insertion• Increased plaque retention when placed above the bone.• Increased bacterial adhesion and acts as a nidus for infection• Complications of treating the failing implants• Increased cost www.indiandentalacademy.com
  41. 41. RESPONSE OF BONE TO IMPLANTSwww.indiandentalacademy.com
  42. 42. Branemark (1952) Described the relationship between titanium and bone for which they coined the term osseointegration and defined it “as a direct structural and functional connection between ordered, living bone and the surface of a load- carrying implant.”The word osseointegration consists of “OS” the Latin word for bone and “integration” derived from Latin word meaning the state of being combined into a complete whole. www.indiandentalacademy.com
  43. 43. The Glossary of Prosthodontic Terms(GPT) refers to the term “osseous integration”which is defined as “the apparent direct attachment or connection of osseous tissue to an inert, alloplastic material without intervening connective tissue.” www.indiandentalacademy.com
  44. 44. Bone to Implant InterfaceTwo basic theories 1.Fibro-osseous integration by Linkow, James & Weis 2 Osseointegration by Branemark Meffert divided osseointegration Adaptive osseointegration Biointegration American Academy of implant dentistry defined fibrous integration as tissue to implant contact with healthy dense collagenous tissue between the implant and bone. www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46. Mechanism of Osseointegration Blood clot (between fixture & bone) Clot transformed by phagocytic cell (1st to 3rd day) Procallus formation (containing fibroblasts & phagocytes) Procallus becomes dense connective tissue (Differentiation of osteoblasts & fibroblasts) Callus (Osteoblasts on the fixture) Fibro cartilagenous callus (between fixture & bone) Bone callus (Penetrates & matures)Prosthesis attached to the fixtures stimulating www.indiandentalacademy.com bone remodeling
  47. 47. EVENTS AFTER IMPLANT PLACEMENTBone Necrosis• About 1 mm of cortical bone adjacent to the osseous wound (osteotomy site) undergoes post surgical necrosis in spite of careful surgical technique. Three phases have been described in the development of the bone-implant interface1.stabilization phase• Subendosteal and subperiosteal calluses form and adhere to the implant surface.• The bone is relatively low in density at this time (woven bone) www.indiandentalacademy.com
  48. 48. 2.The Strength Phase• The implant is stabilized• The process of resorption begins• Stronger, weight bearing bone is formed (lamellar bone)• Osteoclasts resorb nonvital bone and restore it with new lamellar bone3. The Durability Phase• Extensive remodeling occur and additional strength is developed.• With remodeling and proper prosthodontic function, the interface bone will tend to show very mature lamellated bone www.indiandentalacademy.com
  49. 49. • The fibers are arranged irregularly, parallel to the implantbody, when forces are applied they are not transmittedthrough the fibers. So no bone remodeling is expected in fibro-integration.• A direct bone implant interface occurs when an implant is allowed to heal in bone undisturbed.• Main factors affecting osseointegration include – Implant oxide layer contamination. – Poor temperature control during drilling. www.indiandentalacademy.com
  50. 50. Factors influencing Osseointegration – Biomaterial for dental implant – Surface composition and structure – Implant design – Heat during osteotomy – Contamination – Primary stability or initial stability – Bone quality – Epithelial down growth – Loading• A minimum of 3 month healing in mandible and 6 months in maxilla is necessary before load is applied www.indiandentalacademy.com
  51. 51. Bone resorption can be caused by 12 months following fixture insertion vertical bone loss is observed due to traumatic surgical procedure. – Vertical bone loss approximately 1 to 1.5 mm in first year – Marginal bone loss of 0.05 to 0.1 mm in first year – These measurements can be used a reference and in a bone loss condition should be evaluated to minimize failure. www.indiandentalacademy.com
  52. 52. The main contributing factor to bone resorption are1. Local inflammation from plaqueDirect action of plaque products induces formation ofosteoclasts, destroys bone through a non cellularmechanism2.Trauma from occlusionStimulate gingival cells, which release mediators forosteoclast formation. www.indiandentalacademy.com
  53. 53. 3. Heat• Heating of bone to a temperature in excess of 47°C during implant surgery can result in cell death and denaturation of collagen.• As a result, osseointegration may not occur• The implant becomes surrounded by a fibrous capsule• The shear strength of the implant-host interface is significantly reduced. www.indiandentalacademy.com
  54. 54. 4. Primary stability or Initial stability – where an implant fits tightly into its osteotomy site then osseointegration is more likely to occur. – This is often referred to as primary stability, and when this happens failure is less probable. – This property is related to the quality of fit of the implant, its shape, and bone morphology and density. www.indiandentalacademy.com
  55. 55. 7.BONE QUALITY & QUANTITY• Areas of jaws – More cortical bone (anterior mandible) Anchor implant successfully cancellous bone- Maxilla Difficulty to achieve initial stability for implant osteointegration requires a longer healing period.• www.indiandentalacademy.com
  56. 56. • Vertical dimension of bone - Minimal for endosteal implant is 8mm. It is important to leave at least 2mm of bone between the apical end of the implant and inf..alveolar canal .• Bone width – implants should be a minimum of 1mm of bone on the buccal and lingual aspects of dental implant. Ex -for a 4mm diameter implant 6mm of available bone width is necessary• ; www.indiandentalacademy.com
  57. 57. • Vertical dimension of bone - Minimal for endosteal implant is 8mm. It is important to leave at least 2mm of bone between the apical end of the implant and inferior alveolar canal .• Bone width – implants should have a minimum of 1mm of bone on the buccal and lingual aspects of dental implant. Ex -for a 4mm diameter implant 6mm of available bone width is necessary. www.indiandentalacademy.com
  58. 58. Bone Density Classification (Misch)www.indiandentalacademy.com
  59. 59. 6. Contamination – Contamination of the implant site by organic and inorganic debris can prejudice the achievement of osseointegration. – Material such as necrotic tissue, bacteria, chemical reagents and debris from drills can all be harmful in this respect. www.indiandentalacademy.com
  60. 60. 7. Loading schemesDelayed loading: The prosthesis is attached at the second procedure after a conventional healing period of 3 to 6 monthsEarly loading: The prosthesis is attached during a second procedure, earlier than the conventional healing period of 3 to 6 months. Time of loading should be stated in days to weeksImmediate / Direct loading: The prosthesis is attached to the implants the same day the www.indiandentalacademy.com implants are placed.
  61. 61. Biomechanical Overload BIOMECHANICAL OVER LOAD Biomechanical Over Load Bone Loss At Coronal Aspect Micro Fracture At Coronal Aspect Of Implant- Bone Interface Loss Of Ossteointegration Apicalgrowth Of Epitelium & C.TThe speed and degree of loss of implant-bone contact depends upon thefrequency and magnitude of the occlusal loading as well as superimposedbactrerial invasion www.indiandentalacademy.com
  62. 62. Revised criteria for implant success– Individual unattached implant is immobile when tested clinically.– No evidence of peri implant radiolucency is present as assessed on an undistorted radiograph.– Mean vertical bone loss is less than 0.2 mm after 1st year of service.– No persistent pain, discomfort or infection.– A success rate of 85% at the end of a 5-year observation period and 80% at the end of a 10-year period are minimum levels of success. www.indiandentalacademy.com
  63. 63. References1. Caranza’s Clinical Periodontology 10th Edition2. Jan Lindhe Clinical Periodontology and Implant Dentistry 4th edition3. Weiss Principles and Practice of Implants4. Carl Misch Contemporary Implant Dentistry www.indiandentalacademy.com
  64. 64. Thank youwww.indiandentalacademy.com

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