DENTAL IMPLANTS

INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com
www.indiandental...
Classification of Implant
According to Leonard. R.Rubin
Classified according to the tissue into which they are
embedded or...
According to Charles. A.Babbush
There are five main types:
• Mucosal Inserts
• Subperiosteal Implants
• Endodontic Implant...
Endodontic Stabilizers: Metal rods cemented into
root canal of a natural tooth and extends beyond apex
into the bone
Non-m...
Classification of Implant
Biomaterials

According to Charles A.Babbush, Carl. E. Misch
• Metals and Alloys
• Ceramics and ...
 Tantalum
 Platinum
 Iridium
 Gold

 Palladium
 Zirconium
 Hafnium

 Tungsten

Ceramics: Bioactive and Biodegradab...
 Calcium Aluminates

 Zirconium Oxide (Zirconia)
 Titanium Oxide (Titania)

Synthetic Crystalline Structures like
Hydro...
 Ultra-high Molecular weight polyethylene

(UHMW-PE)
 Polypropylene
 Polysulfone
 Polydimethyl siloxane or silicone ru...
According to Stephen.D.Cook; Jeanette. E.Dalton
(Based on Tissue Response and Systemic
Toxicity)
Biotolerant
Bioactive
Bio...
Implant Systems
 IMZ Dental Implant Systems
 Innova Endopore Implant System
 Nobel Biocare and 3i Systems
 Sulzer-Calc...
IMZ Dental Implant Systems

www.indiandentalacademy.com
 It consists of a cylindrical, endosseous

implant; a highly polished transmucosal
implant extension (TIE), and a viscoel...
 They are available in 3.3, 4.0 and 4.25 mm

diameter and in lengths of 8,11,13,15,17, and
19 mm
 The Transmucosal Impla...
4 mm implants in lengths 8,11,13
and 15 mm. placement head
assemble, titanium healing screw,
second-phase sealing screw an...
 They are developed by Interpore

International, Irvine
 Indicated in totally edentulous, partial
edentulous, class I an...
www.indiandentalacademy.com
Completely edentulous patient
rehabilitation


(1) custom tissue bar
and clip-on
overdenture

www.indiandentalacademy.com


(2) custom milled
tissue bar and
precision overdenture

www.indiandentalacademy.com


(3) implant supported,
electively retrievable
fixed prosthesis
(bone-anchorage
bridge)

www.indiandentalacademy.com
For partially edentulous patients
 Implant is rigidly connected to the natural

tooth using an extracoronal screwstabiliz...
www.indiandentalacademy.com
www.indiandentalacademy.com
 Single-tooth abutment has been designed

for use with IMZ implant
 In anterior regions of the mouth
 This titanium abu...
www.indiandentalacademy.com




Prefabricated
ceramicor post and
ring on the right
designed so that
when seated into
abutment on left, post
fits pre...
Noble Biocare and 3i Systems
 Both systems are similar
 Packaged differently: glass tube and blister

pack
 Various coa...
www.indiandentalacademy.com
 Counterbore to enlarge the coronal portion of

osteotomy in preparation for 3-mm twist drill
 3-mm twist drill
 Counte...
Seat Nobel Biocare implant so that
its cover screw is flush with crest of
bone

www.indiandentalacademy.com
Sulzer-Calcitek Implant System
 Available in 3.25, 4, and 5 mm diameters

 Principles applied can be used for other pres...
www.indiandentalacademy.com




Seat implant with its
plastic cap
Tap implant into
position
Seat calcitek implants
flush with crest of
bone

www.in...
Innova Endopore Implant
 It has a surface macrostructure of sintered

titanium beads
 This design greatly increases surf...
Pilot drill, implant bur, trial fit gauge,
implant placement

www.indiandentalacademy.com
Friatec and Frialit 2

 These are stepped screw or press-fit TPS-

coated implants designed to increase primary
stability...
www.indiandentalacademy.com
Omni-R
 Guide drill at potential implant site
 Pilot drill to full predetermined depth
 Intermediate drill
 R2 Hand au...
www.indiandentalacademy.com
Oratronics Spiral
 Guide drill used
 Pilot drill or spade drill to its final pre-

determined depth
 Spiral tap is atta...
SURGICAL PROCEDURES IN
IMPLANTOLOGY

 Stage I Surgery

also known as fixture installation stage, is the
procedure for ins...
High speed hand piece geared up
to run at high torque with a speed
of 1500 to 2000 RPMs, and the
slow speed hand piece at ...
Drills used for bone preparation
include: guide drill, 2 mm twist drill,
pilot drill, the 3 mm twist drill, and
countersin...
Irrigation unit is used to deliver an
even, steady flow of sterile water to
the surgical site at all times during
high and...
Surgical guide stent is placed in the
area to project the future position of
the fixture

www.indiandentalacademy.com
Guide drill is the first drill used in
the bone preparation process. It is
designed to penetrate the cortical
layer of the...
Initial penetration using surgical
guide stent, is initiated using high
speed guide drill at 1500 RPM.
Copious saline irri...
2 mm twist drill is used second in
the sequence to prepare the site to
2mm in diameter

www.indiandentalacademy.com
Site is progressively enlarged to
2mm with a 2mm twist drill at 1500
RPM

www.indiandentalacademy.com
Pilot drill is used next. Inferior
portion of the drill is to engage the
2mm prepared site and superior
portion begins the...
Final orientation and inclination of
the fixture is by using the pilot drill
at high speed, high torque. It has
an 2mm non...
3 mm twist drill is fourth drill in bone
preparation. Its used to prepare
bone to its final destination

www.indiandentala...
Implant site is prepared to final
length and width utilizing a 3mm
twist drill operating at high speed

www.indiandentalac...
Countersink is the final drill used in
the high speed drilling process. It is
used to create a shelf in the
prepared bony ...
Crestal bone carefully prepared
using countersink. Allows superior
aspect of fixture to be placed
crestally or sub-crestal...
Bone tap is the first in the series of
slow speed bone preparation.
Made of titanium and used to
thread the bone prior to ...
Receptor site is tapped utilizing a
titanium tap operating at 15 to 20
RPMs along with copious irrigation

www.indiandenta...
Fixtures are composed of
commercially pure titanium and
range in length from 7 to 20 mm
and width of range 3.75 and 4.0
mm...
Fixture mount is connected to the
fixture

www.indiandentalacademy.com
Connection to handpiece is used to
connect the fixture mount to the
handpiece

www.indiandentalacademy.com
Fixture is connected to the
handpiece, and inserted to the pretapped site at 15 to 20 RPMs

www.indiandentalacademy.com
Fixture is in position with
connection t handpiece still
connected

www.indiandentalacademy.com
Cylinder wrench used for final
tightening of fixture

www.indiandentalacademy.com
Open end wrench to stabilize the
fixture during removal of fixture
mount

www.indiandentalacademy.com
Machine screwdriver used to
unscrew the fixture mount from
fixture

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Subcrestal position of the fixture

www.indiandentalacademy.com
Screwdriver, either hexagonal or
slotted used to place cover screw
into fixture

www.indiandentalacademy.com
Cover screws are available either a
hexagonal or slotted configuration

www.indiandentalacademy.com
Coverscrew picked up in slow
handpiece and placed into the
fixture

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Appearance of fixture after insertion
of cover screw

www.indiandentalacademy.com
Sutures placed

www.indiandentalacademy.com
Osseointegration
Osseointegration implies that “it is a contact
established without interposition of non bony
tissue betwe...
Osseointegration can also be defined as “a
direct structural and functional connection
between ordered, living bone and th...
Mechanism of osseointegration
 Similar to primary bone healing

 Initially, blood present between fixture and

bone
 Bl...
Photomicroradiographs showing
bone ingrowths after 12 weeks

www.indiandentalacademy.com
 This connective tissue is callus
 Osteoblasts form osteogenic fibers which can

calcify
 New bone matrix is formed and...
Photomicroradiographs showing
bone ingrowths in HA coated and
non-coated implants

www.indiandentalacademy.com
Stage II surgery


Uncovering of
implants may be after
3 to 4 months of
healing in mandible
and 5 to 6 months in
case of ...
Cover screw is exposed after
removal of overlying bone or soft
tissue

www.indiandentalacademy.com
Hexagon cover screw driver used
to remove cover screw from implant
from abutment connection

www.indiandentalacademy.com
After 4 months of healing, cover
screw removed

www.indiandentalacademy.com
Selection of proper sized abutment
for transmucosal connection

www.indiandentalacademy.com
Abutment placed into fixture and
secured with abutment screw

www.indiandentalacademy.com
Small or large healing caps used to
prevent debris collection in
threaded portion of abutment screw

www.indiandentalacade...
Surgical dressing during healing
phase

www.indiandentalacademy.com
Tissue response after two weeks

www.indiandentalacademy.com
Hex abutment screwdriver to screw
abutment screw into fixture

www.indiandentalacademy.com
Abutment placed with help from
screwdriver

www.indiandentalacademy.com
Abutment clamp used to prevent
transfer of torque to implant while
connecting abutment screw

www.indiandentalacademy.com
Abutment clamp in use

www.indiandentalacademy.com
In case of multiple implants, same
procedure is followed

www.indiandentalacademy.com
Prosthetic rehabilitation in
Implantology
Components mainly
used in fabricating
prosthesis and
making impression
include t...
Impression coping is designed with a
machined surface to to fit precisely to
the abutment replica. The central
portion is ...
Index pins are available in 10,15
and 20 mm lengths. These are
used to secure the impression
coping to the fixture in the ...
Impression coping is placed on top
of fixture and is secured by the
index pin

www.indiandentalacademy.com
Hole created in the tray for access
to retrieve guide pin after
impressioning

www.indiandentalacademy.com
Impression made with an
elastomeric impression material

www.indiandentalacademy.com
Abutment replica is an brass
analog of the abutment. Top
surface is identical in shape and
form to the abutment in the mou...
Abutment replica in position in the
impression, secured by the guide
pin

www.indiandentalacademy.com
The gold cylinder is secured to the
abutment replica with a slotted gold
screw

www.indiandentalacademy.com
Coping has been cast and
resecured to the cast with a gold
screw

www.indiandentalacademy.com
A case of failing partially
edentulous situation. Restored
using 3 fixtures as anchorage

www.indiandentalacademy.com
Impression made with a suitable
impression material

www.indiandentalacademy.com
Impression copings are in position

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Wax-up is sprued and cast

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Completed fixed prosthesis

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The inferior surface of the
prosthesis

www.indiandentalacademy.com
Patient restored with mandibular
and maxillary fixed prosthesis

www.indiandentalacademy.com
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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Dental Implantology / /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

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Dental Implantology / /certified fixed orthodontic courses by Indian dental academy

  1. 1. DENTAL IMPLANTS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Classification of Implant According to Leonard. R.Rubin Classified according to the tissue into which they are embedded or on which they rest: Intraosseous implants: Receiving primary support from within bone Subperiosteal implants: resting on the bone beneath the periosteum Transosseous implants: stabilized by penetrating through both cortical plates Transcanal: support from an implant placed through the tooth root canal into the bone beyond the apex  www.indiandentalacademy.com
  3. 3. According to Charles. A.Babbush There are five main types: • Mucosal Inserts • Subperiosteal Implants • Endodontic Implants • Endosseous Implants • Transosteal Implants According to Dennis C. Smith, David.F.Williams • Buried: Metals Non-Metals Metals: Magnets placed in the superior aspect of the body of the mandible and another set placed in the www.indiandentalacademy.com lower denture 
  4. 4. Endodontic Stabilizers: Metal rods cemented into root canal of a natural tooth and extends beyond apex into the bone Non-metals: In ridge augmentation and facial recountouring procedures using proplast, ceramics and plastics Also in ridge maintenance efforts by placing implants made of carbon into recent extraction site root sockets • Semi-Buried: All true dental implants fall into this category Metals: Cobalt, Chromium, Molybdenum Non-metals: Ceramics, Bioglass, Carbons, Plastics www.indiandentalacademy.com
  5. 5. Classification of Implant Biomaterials According to Charles A.Babbush, Carl. E. Misch • Metals and Alloys • Ceramics and Carbon • Synthetic Polymers and Composites Metals and Alloys:  Titanium  Co-Cr-Mo based alloy  Iron-Chromium-Nickel based alloy  Other metals www.indiandentalacademy.com
  6. 6.  Tantalum  Platinum  Iridium  Gold  Palladium  Zirconium  Hafnium  Tungsten Ceramics: Bioactive and Biodegradable Ceramics based on Calcium Phosphates Metallic Oxide Ceramics:  Aluminium Oxides  Trocalcium Phosphates www.indiandentalacademy.com
  7. 7.  Calcium Aluminates  Zirconium Oxide (Zirconia)  Titanium Oxide (Titania) Synthetic Crystalline Structures like Hydroxyapatite Carbons :  Pyrolytic carbon  Polycrystalline Vitreous Carbon  Carbon-Silicone interstitial combination Synthetic Polymers:  Polyethylene Terepthalate (PET)  Polymethyl Methacrylate (PMMA) www.indiandentalacademy.com
  8. 8.  Ultra-high Molecular weight polyethylene (UHMW-PE)  Polypropylene  Polysulfone  Polydimethyl siloxane or silicone rubber  Polytetrafluoro ethylene Composites: Bioresorbable polymers like  Polyvinyl alcohol  Polyacids or glycosides  Cyanoacrylate www.indiandentalacademy.com
  9. 9. According to Stephen.D.Cook; Jeanette. E.Dalton (Based on Tissue Response and Systemic Toxicity) Biotolerant Bioactive Bioinert www.indiandentalacademy.com
  10. 10. Implant Systems  IMZ Dental Implant Systems  Innova Endopore Implant System  Nobel Biocare and 3i Systems  Sulzer-Calcitek Implant System  Friatec and Frialit  Oratronics Spiral  Implant Innovations incorporated www.indiandentalacademy.com
  11. 11. IMZ Dental Implant Systems www.indiandentalacademy.com
  12. 12.  It consists of a cylindrical, endosseous implant; a highly polished transmucosal implant extension (TIE), and a viscoelastic intramobile element (IME)  This has been in use since 1978  It is made of commercially pure titanium  The outer surface is titanium plasmasprayed with an electric arc, which gives rough texture and a large surface area  Apical end of implant contains vent for bone ingrowth www.indiandentalacademy.com
  13. 13.  They are available in 3.3, 4.0 and 4.25 mm diameter and in lengths of 8,11,13,15,17, and 19 mm  The Transmucosal Implant Extension (TIE) is an highly polished titanium sleeve that sits on top of the implant and extends up through the soft tissue  Designed to be easily cleaned in situ by patient and can be removed by dentist for extraoral cleaning  The Intramobile Element (IME) is made up of polyoxymethylene and provides a resilient connection between the implant and prosthesis www.indiandentalacademy.com
  14. 14. 4 mm implants in lengths 8,11,13 and 15 mm. placement head assemble, titanium healing screw, second-phase sealing screw and TIE, IME and TIE, www.indiandentalacademy.com
  15. 15.  They are developed by Interpore International, Irvine  Indicated in totally edentulous, partial edentulous, class I and II and single tooth edentulous space  IME is designed to minimize stress concentrations, by absorbing and distributing occlusal surfaces  Abutments systems are two: the conventional TIE and IME ; the intramobile connector (IMC) www.indiandentalacademy.com
  16. 16. www.indiandentalacademy.com
  17. 17. Completely edentulous patient rehabilitation  (1) custom tissue bar and clip-on overdenture www.indiandentalacademy.com
  18. 18.  (2) custom milled tissue bar and precision overdenture www.indiandentalacademy.com
  19. 19.  (3) implant supported, electively retrievable fixed prosthesis (bone-anchorage bridge) www.indiandentalacademy.com
  20. 20. For partially edentulous patients  Implant is rigidly connected to the natural tooth using an extracoronal screwstabilized attachment  Indicated for maxillary and mandibular posterior edentulous situations  It distributes load between the implant and the natural abutment  Possible if an semiprecision or telescopic attachment is used to connect teeth to implants www.indiandentalacademy.com
  21. 21. www.indiandentalacademy.com
  22. 22. www.indiandentalacademy.com
  23. 23.  Single-tooth abutment has been designed for use with IMZ implant  In anterior regions of the mouth  This titanium abutment is a two-piece insert  Transmucosal section tightened against top of the implant body www.indiandentalacademy.com
  24. 24. www.indiandentalacademy.com
  25. 25.   Prefabricated ceramicor post and ring on the right designed so that when seated into abutment on left, post fits precisely over coronal aspect of abutment crown secured by using cement www.indiandentalacademy.com
  26. 26. Noble Biocare and 3i Systems  Both systems are similar  Packaged differently: glass tube and blister pack  Various coating like hydroxylapatite and titanium plasma spray are available  Diameters– 3.75, 4, 4.5, 5, and 5.5 mm  Branemark instrument names are used  Procedure begins with guide drill to half its diameter at propos implant site  2-mm twist drill to final implant depth www.indiandentalacademy.com
  27. 27. www.indiandentalacademy.com
  28. 28.  Counterbore to enlarge the coronal portion of osteotomy in preparation for 3-mm twist drill  3-mm twist drill  Counter-sink drill  Depth gauge  Screw tap  Insert implant attached to fixture mount  Wrench stabilizes fixture mount while fixation screw is removed  Cover screw inserter  Cover screw placement with small hexagon screwdriver www.indiandentalacademy.com
  29. 29. Seat Nobel Biocare implant so that its cover screw is flush with crest of bone www.indiandentalacademy.com
  30. 30. Sulzer-Calcitek Implant System  Available in 3.25, 4, and 5 mm diameters  Principles applied can be used for other press- fit endosseous cylindrical implants  Pilot drill for a depth of 8 mm  Rosette bur to half its diameter over the pilot osteotomy  Intermediate spade drill to enlarge pilot osteotomy for final depth preparation  Counter bore drill to enlarge coronal portion  Final spade drill  Implant body try-in www.indiandentalacademy.com
  31. 31. www.indiandentalacademy.com
  32. 32.    Seat implant with its plastic cap Tap implant into position Seat calcitek implants flush with crest of bone www.indiandentalacademy.com
  33. 33. Innova Endopore Implant  It has a surface macrostructure of sintered titanium beads  This design greatly increases surface area and encourages high levels of intraosseous retention  Technique for seating uses the classic bone enlargement drill, a steel try-in, and placement of implant in the press-fit mode www.indiandentalacademy.com
  34. 34. Pilot drill, implant bur, trial fit gauge, implant placement www.indiandentalacademy.com
  35. 35. Friatec and Frialit 2  These are stepped screw or press-fit TPS- coated implants designed to increase primary stability in poor-quality bone  Available in 3.8, 4.5, and 5.5 mm diameter  Primary purchase point with a round drill  Spade drill or twist drill used to full depth  Enlarge receptor site to its final diameter using stepped drill  Place implant into receptor site, first with finger pressure and then ratchet them into deeper threaded environment www.indiandentalacademy.com
  36. 36. www.indiandentalacademy.com
  37. 37. Omni-R  Guide drill at potential implant site  Pilot drill to full predetermined depth  Intermediate drill  R2 Hand auger  Seat implant in flush with crest of the bone www.indiandentalacademy.com
  38. 38. www.indiandentalacademy.com
  39. 39. Oratronics Spiral  Guide drill used  Pilot drill or spade drill to its final pre- determined depth  Spiral tap is attached to hand ratchet  Enlarge the osteotomy to chosen length and width  Implant attached to titanium insert, placed in the hand wrench and rotated to its final seating position www.indiandentalacademy.com
  40. 40. SURGICAL PROCEDURES IN IMPLANTOLOGY  Stage I Surgery also known as fixture installation stage, is the procedure for installing Branemark system implants into bone. This procedure demands exacting, non-traumatic preparation of the recipient site and a specific insertion protocol. Variations in this procedure mainly depends on the quality and quantity of bone and also on the load demands on the final prosthesis www.indiandentalacademy.com
  41. 41. High speed hand piece geared up to run at high torque with a speed of 1500 to 2000 RPMs, and the slow speed hand piece at high torque with speed of approximately 15 to 20 RPMs www.indiandentalacademy.com
  42. 42. Drills used for bone preparation include: guide drill, 2 mm twist drill, pilot drill, the 3 mm twist drill, and countersink www.indiandentalacademy.com
  43. 43. Irrigation unit is used to deliver an even, steady flow of sterile water to the surgical site at all times during high and low speed preparation www.indiandentalacademy.com
  44. 44. Surgical guide stent is placed in the area to project the future position of the fixture www.indiandentalacademy.com
  45. 45. Guide drill is the first drill used in the bone preparation process. It is designed to penetrate the cortical layer of the bone www.indiandentalacademy.com
  46. 46. Initial penetration using surgical guide stent, is initiated using high speed guide drill at 1500 RPM. Copious saline irrigation used at all times www.indiandentalacademy.com
  47. 47. 2 mm twist drill is used second in the sequence to prepare the site to 2mm in diameter www.indiandentalacademy.com
  48. 48. Site is progressively enlarged to 2mm with a 2mm twist drill at 1500 RPM www.indiandentalacademy.com
  49. 49. Pilot drill is used next. Inferior portion of the drill is to engage the 2mm prepared site and superior portion begins the enlargement of the site www.indiandentalacademy.com
  50. 50. Final orientation and inclination of the fixture is by using the pilot drill at high speed, high torque. It has an 2mm non-cutting edge and a 3mm cutting edge www.indiandentalacademy.com
  51. 51. 3 mm twist drill is fourth drill in bone preparation. Its used to prepare bone to its final destination www.indiandentalacademy.com
  52. 52. Implant site is prepared to final length and width utilizing a 3mm twist drill operating at high speed www.indiandentalacademy.com
  53. 53. Countersink is the final drill used in the high speed drilling process. It is used to create a shelf in the prepared bony site www.indiandentalacademy.com
  54. 54. Crestal bone carefully prepared using countersink. Allows superior aspect of fixture to be placed crestally or sub-crestally, to avoid premature loading of the fixture during stage I healing www.indiandentalacademy.com
  55. 55. Bone tap is the first in the series of slow speed bone preparation. Made of titanium and used to thread the bone prior to implant placement www.indiandentalacademy.com
  56. 56. Receptor site is tapped utilizing a titanium tap operating at 15 to 20 RPMs along with copious irrigation www.indiandentalacademy.com
  57. 57. Fixtures are composed of commercially pure titanium and range in length from 7 to 20 mm and width of range 3.75 and 4.0 mm www.indiandentalacademy.com
  58. 58. Fixture mount is connected to the fixture www.indiandentalacademy.com
  59. 59. Connection to handpiece is used to connect the fixture mount to the handpiece www.indiandentalacademy.com
  60. 60. Fixture is connected to the handpiece, and inserted to the pretapped site at 15 to 20 RPMs www.indiandentalacademy.com
  61. 61. Fixture is in position with connection t handpiece still connected www.indiandentalacademy.com
  62. 62. Cylinder wrench used for final tightening of fixture www.indiandentalacademy.com
  63. 63. Open end wrench to stabilize the fixture during removal of fixture mount www.indiandentalacademy.com
  64. 64. Machine screwdriver used to unscrew the fixture mount from fixture www.indiandentalacademy.com
  65. 65. Subcrestal position of the fixture www.indiandentalacademy.com
  66. 66. Screwdriver, either hexagonal or slotted used to place cover screw into fixture www.indiandentalacademy.com
  67. 67. Cover screws are available either a hexagonal or slotted configuration www.indiandentalacademy.com
  68. 68. Coverscrew picked up in slow handpiece and placed into the fixture www.indiandentalacademy.com
  69. 69. Appearance of fixture after insertion of cover screw www.indiandentalacademy.com
  70. 70. Sutures placed www.indiandentalacademy.com
  71. 71. Osseointegration Osseointegration implies that “it is a contact established without interposition of non bony tissue between normal remodeled bone and an implant at the light microscopic level, entailing a sustained transfer and distribution of load from the implant to and within the bone tissue". (Strock & Branemark 1939) Osseointegration was defined as “a direct anchorage to an implant body; which can provide a foundation to support a prosthesis. It has ability to transmit occlusal forces directly to bone” (Branemark 1983) www.indiandentalacademy.com
  72. 72. Osseointegration can also be defined as “a direct structural and functional connection between ordered, living bone and the surface of a load carrying implant” (Branemark 1985) “Osseointegration is an apparent direct connection of an implant surface and host bone without intervening connective tissue” GPT 1987 Fibro-osseous Retention can be defined as “tissue-to-implant contact with interposition of dense, healthy collagenous tissue between the implant and bone” (Misch) www.indiandentalacademy.com
  73. 73. Mechanism of osseointegration  Similar to primary bone healing  Initially, blood present between fixture and bone  Blood clot formed  Blood clot is transformed by phagocytic cells such as polymorphonuclear leukocytes, macrophages etc  Most active during 1st and 3rd day of surgery  Procallus formed containing fibroblasts, fibrous tissue and phagocytes  This is differentiated into osteoblasts and fibroblasts www.indiandentalacademy.com
  74. 74. Photomicroradiographs showing bone ingrowths after 12 weeks www.indiandentalacademy.com
  75. 75.  This connective tissue is callus  Osteoblasts form osteogenic fibers which can calcify  New bone matrix is formed and is known as bone callus  Increase in density and hardness and remodeling takes place  Occlusal stresses stimulate surrounding bone to remodel and osseointegration takes place  Osseointegrated fixtures are surrounded by cortical and spongy bone www.indiandentalacademy.com
  76. 76. Photomicroradiographs showing bone ingrowths in HA coated and non-coated implants www.indiandentalacademy.com
  77. 77. Stage II surgery  Uncovering of implants may be after 3 to 4 months of healing in mandible and 5 to 6 months in case of maxillae www.indiandentalacademy.com
  78. 78. Cover screw is exposed after removal of overlying bone or soft tissue www.indiandentalacademy.com
  79. 79. Hexagon cover screw driver used to remove cover screw from implant from abutment connection www.indiandentalacademy.com
  80. 80. After 4 months of healing, cover screw removed www.indiandentalacademy.com
  81. 81. Selection of proper sized abutment for transmucosal connection www.indiandentalacademy.com
  82. 82. Abutment placed into fixture and secured with abutment screw www.indiandentalacademy.com
  83. 83. Small or large healing caps used to prevent debris collection in threaded portion of abutment screw www.indiandentalacademy.com
  84. 84. Surgical dressing during healing phase www.indiandentalacademy.com
  85. 85. Tissue response after two weeks www.indiandentalacademy.com
  86. 86. Hex abutment screwdriver to screw abutment screw into fixture www.indiandentalacademy.com
  87. 87. Abutment placed with help from screwdriver www.indiandentalacademy.com
  88. 88. Abutment clamp used to prevent transfer of torque to implant while connecting abutment screw www.indiandentalacademy.com
  89. 89. Abutment clamp in use www.indiandentalacademy.com
  90. 90. In case of multiple implants, same procedure is followed www.indiandentalacademy.com
  91. 91. Prosthetic rehabilitation in Implantology Components mainly used in fabricating prosthesis and making impression include the gold cylinder, the gold screw, the abutment replica, the index coping, and the index pin www.indiandentalacademy.com
  92. 92. Impression coping is designed with a machined surface to to fit precisely to the abutment replica. The central portion is undercut to facilitate retention of the impression material www.indiandentalacademy.com
  93. 93. Index pins are available in 10,15 and 20 mm lengths. These are used to secure the impression coping to the fixture in the mouth www.indiandentalacademy.com
  94. 94. Impression coping is placed on top of fixture and is secured by the index pin www.indiandentalacademy.com
  95. 95. Hole created in the tray for access to retrieve guide pin after impressioning www.indiandentalacademy.com
  96. 96. Impression made with an elastomeric impression material www.indiandentalacademy.com
  97. 97. Abutment replica is an brass analog of the abutment. Top surface is identical in shape and form to the abutment in the mouth www.indiandentalacademy.com
  98. 98. Abutment replica in position in the impression, secured by the guide pin www.indiandentalacademy.com
  99. 99. The gold cylinder is secured to the abutment replica with a slotted gold screw www.indiandentalacademy.com
  100. 100. Coping has been cast and resecured to the cast with a gold screw www.indiandentalacademy.com
  101. 101. A case of failing partially edentulous situation. Restored using 3 fixtures as anchorage www.indiandentalacademy.com
  102. 102. Impression made with a suitable impression material www.indiandentalacademy.com
  103. 103. Impression copings are in position www.indiandentalacademy.com
  104. 104. Wax-up is sprued and cast www.indiandentalacademy.com
  105. 105. Completed fixed prosthesis www.indiandentalacademy.com
  106. 106. The inferior surface of the prosthesis www.indiandentalacademy.com
  107. 107. Patient restored with mandibular and maxillary fixed prosthesis www.indiandentalacademy.com
  108. 108. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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