PERIO

1. HISTORY AND EVOLUTION OF
IMPLANTS

2. CONTENTS
oIntroduction
oDefinitions
oHistory and Evolution of implants can be
studied as -The ancient era
- The
Medieval period
- The foundational period
- The Premodern era
- The dawn of the
modern era -
Contemporary oral implantology
oSummary and Conclusion
oReferences.

3. o INTRODUCTION

4. oDef of Implant (GPT 8 )
oAny 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 experimental
purposes.
oDef of Implantology
oTerm historically conceived as the study or science of planning
and restoring dental implants.

5. oDef of Dental Implant
oA prosthetic device made of alloplastic material implanted into
the oral tissues beneath the mucosal or/ & periosteal layer &/or
within the bone to provide retention & support for a fixed or
removable dental prosthesis ;a substance that is placed into or /
& upon the jaw bone to support a fixed or removable dental
prosthesis.
oDef. Of Osseointegration
oThe apparent direct attachment or connection of osseous
tissue to an inert, alloplastic material without intervening
connective tissue.

6. oANCIENT ERA - 1000 A.D

7. oHistory of dentistry….3000 B.C .
oHISTORY TRACED IN MIDDLE EAST
oIn 1862 Gaillardot discovered a prosthodontic appliance near the ancient
city of Sidon. Appliance was dating 400 B.C period .
o Carved ivory tooth replacing the two missing incisors.

8. oHISTORY TRACED IN THE EGYPTIAN
DYNASTIES
oEvidences have shown the implantation of animal
teeth & artificial teeth carved of ivory .
oImplantation prior to mummification.

9. oIn 1981 evidences of oldest dental implant was found in
the Kalavak Necropolis, near Izmir , Turkey.
oThe discoveries were dated back to 550 B.C . A canine
tooth like object made of two piece of calcite having
hardness similar to natural teeth showing wear on the
chewing surface & secured with gold wires wrapped
around the neck of adjacent teeth.

10. oCranin suggested that earliest recorded dental implant specimen was
inserted during the PRE COLUMBIAN ERA.
oIn 1931 Wilson Popenoe discovered a skull in the Ulua river valley of
Honduras , dating to the period 600 A.D .
o Skull had an artificial tooth replacing lower left lateral incisor, carved of a
dark stone . Radiographs showed the evidence of compact bone around the
implant.
o The Mayans practiced the implantation of alloplastic materials in living persons.

12. oMEDIEVAL PERIOD (1000-1799 A.D)

13. oAllotransplantation (18 -19 Century) mainly in England &
Colonial America.
oAlbucasis de Condue ( 936- 1013 A.D) an Arab surgeon
described the transplantation procedures . He attempted to use
ox bone to replace missing teeth.

14. oIn Japan in the 15th & 16th C. Wooden
dowel & crown prosthesis was designed .
The pin inserted into the root canal of non
vial teeth.
oThis was an early ENDODONTIC IMPLANT
– SUPPORTED PROSTHESIS.

15. • Charles Allen in 1687 gave the first written work on
dentistry.
• He described the replanting of tooth into the same patient.
• Allen emphasized on transplantation of tooth using animal
tooth.
• In European sphere transplantation became the common
practice performed by barber surgeons of the Era.
• The tooth transplant could lead to transfer of diseases .
• Implants made from ivory, shells & bone were used.

16. • Ambroise Pare, a French physician , a surgeon to four kings of
France.
• He replaced the missing teeth with implants made up of bone &
ivory .
• He successfully replaced missing tooth of Princess by
transplanting.

17. oJohn Hunter in 1728 – 1793
A.D suggested the
possibility of transplanting.

18. o THE FOUNDATION PERIOD
(1800- 1910)

19. oThe endosseous oral implantology truly began in the 19th Century.
oMaggilio in 1809 , a dentist at the university of Nancy , France, author of
the book called “THE ART OF THE DENTIST”. The first reference to
modern style implants.
oHe has described the implant & placement.
oHe made the tooth root shaped implant with 18 carat gold with three prongs
at the end to hold it in place in the bone . The implant was placed in the
freshly extracted socket site retained with the prongs. After the tissues
healed the crown was attached with the help of post placed into the hole of
root section of the implant.
oHe placed the single stage gold implant.

20. oIn mid 1800s advancement in the antiseptics & surgical
techniques , there were documentation of implanted materials.
oW. J . Younger of San Francisco introduced operations in
United States. In 1893 he wrote that his operation has
successfully entered 8th year of life.

21. oIn 1886 Harris treated a Chinese patient in Grass valley ,
California . He placed the tooth root shaped platinum post with
lead coating, lasted for 27 yrs Reported in Dental Cosmos in
1887.
oIn 1889 Edmunds of New York reported on March 12 ,1889
to the First District dental society of that city. He implanted the
metallic capsule.

22. oIn 1888 Berry reported about the root form implants made up
of lead.
oIn 1890 , a Massachusetts minister had his lower jaw
resected & was restored with an extensive system of gold
crowns soldered & joined to hinged device attached to the
remaining dentition .
oZnamenski in 1891 reported on implantation made of
Porcelain, gutta-percha & rubber.

23. oBonwill in 1895 reported on the implantation of one or two
tubes of gold or Iridium as a support for individual teeth or
crown.
o IN 1898 R. E Payne at the National Dental Association
meeting gave the first clinical demonstration by placing the
silver capsule in the extracted tooth socket.

24. oPREMODERN ERA ( 1910-1930)

25. oThe first two decades of 20th C. predominated by the clinicians
namely R.E Payne& E. J .Greenfield.
oR. E .Payne presented his technique of capsule implantation at
the clinics of Third international Dental Congress, reported in
the Dental Cosmos in 1901.
oTechnique- Extracting the root , enlarging the socket with
trephine, trial fitting of the capsule. He then placed grooves on
both sides of the socket & filled 2/3rds with rubber, fitted the
porcelain root into the capsule & set it with gutta-percha.
oIn 1903 Sholl in Pennsylvania , implanted porcelain tooth with
corrugated porcelain root.

26. oIn 1913 Dr. Edward J. Greenfield came up with the
surgical method to prepare osteotomy in the healed bone
using trephine.
oHe fabricated the hollow cylindrical basket root of 20
gauge iridioplatinum soldered with 24 carat gold.
Precursor of hollow basket design

27. oGREENFIELD EMPHASIZED ON
oThe importance of intimate contact between bone & implant.
Hollow implants facilitated growth of bone into implant body &
secure it.
o3 months period of unloading.
oImplants failures because of infection.
oHis techniques were similar to present concepts of osteotomy
preparation, restoring after healing time

28. oIn 1920s Leger- Dorez developed expansible root implant, was comparable
to a concrete expansion bolt.
oSmolon described the implant as a four part device with the shaft buried in
bone with the internal threads to receive a screw , fastening the neck into
the shaft. the post for attaching the prosthesis.
o The historical basis for the internal screws provided for the retention of
prosthetic devices similar to today’s implants.
oTomkin’s 1925 implanted porcelain teeth.
oBrill in 1936 inserted rubber pins in artificially prepared sockets.

29. oTHE DAWN OF THE MODERN ERA
1935-1978 A.D

30. o The modern era of implant dentistry most definitely began in
the late1930s with the work of Venable, Strock , Dahl ,
Gershkoff & Goldberg.
o Venable in 1937 developed the cast Co- Chr- Mo alloy known
as Vitallium.
o In 1939 Alvin & Moses Strock used the Venable screw type
implant.

31. oAdams in 1937 developed a submergible threaded
cylindrical implant with round bottom , smooth
gingival collar & healing cap. The ball head
screwed to the root was used to retain an
overdenture.
oThe components designed to flex vertically or
laterally similar to the IMZ intramobile element.

32. oIn 1938 Stock placed the threaded vitallium implant into the
extraction socket, the first long term endosseous implant.
oIt remained firm & asymptomatic for nearly 17 years.
oHe demonstrated that the Vitallium implants were well
tolerated.

33. oIn 1947, Formiggini developed a single
helix wire spiral implants made of stainless
steel or tantalum. Two ends of the wire were
soldered together to form a post or neck.
oChercheve Modified by increasing the
length of the neck & double helix out of
vitallium.
oHe developed the co-coordinated system of
instrumentation for implant insertion.

35. oMarziani’s use of porcelain &
acrylic roots to support full
dentures.
oIn 1950 Lee’s Post design i.e
central narrow post with
extensions.

36. oIn 1943 Dahl in Germany developed Intramucosal or
button implants – Mucosal inserts.

38. oSUBPERIOSTEAL IMPLANTS
oAn implant structure that covers the almost entire crestal surface of
maxillary & mandibular RAR under the soft tissue to include the
periosteum , with the four to six posts protruding out through gingiva and
on it the complete denture will be attached.
oIn 1943 Gustav Dahl placed the SP implant on maxillary RAR later on
mandibular.
oDahl & Izikowitz described the frames placed around the teeth in partially
edentulous patients termed as SUPERPLANTS.

39. FABRICATION OF SUB PERIOSTEAL
IMPLANT
o Goldberg & Gershkoff method
o Make an impression of the mucosa covering the RAR
o Make model & wire template made for radiography.
o Measurements of the soft tissue depth were derived from the
radiography and model was carved & casted to produce the
multifenestrated Co-Chr-Mo casting with four abutments.

40. o Berman introduced the Two stage surgical technique for sub
periosteal implant.
o First step was a direct impression of the surgically exposed bone
o Second was implanting the subperiosteal frame generated from
the stone cast.
o Kleinschmidt developed anterior single sub periosteal implant.
o Marziani reported on the fabrication of full upper & lower
subperiosteal implant.

41. oWeinberg sectional
subperiosteal implant.
oLew developed modified
technique for fitting upper
implants by extending the
implant frame further to the
periphery.

42. oLinkow developed Sub periosteal implant consisting of
three islands

43. oCT scan imaging technique used to obtain
three dimensional replica of the mandible
& CAD-CAM models used for fabricating
the frame work.
oLong term success only 50 to 60%.

44. ONE STAGE ENDOSTEAL PINS, SCREWS, &
CYLINDERS
oThe early 1960s marked the beginning of an active developmental
era in implant design.
oScialom developed a tantalum tripodal pin .
oThree intersecting pins were joined by acrylic to support the
crown. Difficulty in maintaining the trifurcation limited the
comfortable survival.

45. oIn 1960 Onlay developed
Virilium posts placed into
endodonticaly treated teeth
extending beyond the apex.

46. SCREW TYPE IMPLANT
o Tramonte introduced a stress resistant drive screw implant.
o Meglan & Lehman reported on the expandable implants.
o Lew introduced a self tapping Vitallium screw implant with
conventional threads & square post.
o Muratori & Pasquallini introduced hollow cores along with the
screw threads.
o The majority of these screw shaped implants were one piece &
were not submerged , did not osseointegrate .It was emphasized
that the fibrous peri implant membrane with its shock absorbing
feature preferred than bone fusing to implant.

47. oIn 1963 Dr. Linkow , American Dentist
developed first screw type of implant –
Vent Plant.
oThis was the first self tapping , self
threading implant . It had an open cage
like design that went into bone first , with
a few threads on solid body at the top. He
used Vitallium first latter on titanium.

48. BLADE IMPLANTS
oLinkow blade implants invented in 1967.
oLong thin blade that will be surgically inserted into the
groove in the bone .
oAbutment projecting out from the blade to this crown
or attachment for denture can be placed.
oIt required the shared support of natural teeth also.
oRestored within month so became most widely used in
united states.
oLinkow modified the design configuration for broad
applicability in maxilla & mandible, narrow ridges.

52. oIn 1970 Roberts & Roberts developed Ramus blade
implants .
oIt was to be positioned by anchoring distally
between the cortical plates in the ramus of the
mandible

54. oRAMUS FRAME IMPLANT developed
Roberts & Roberts in 1970 .
oThe endosseous implant received stabilization
from its anchorage in ramus area bilaterally &
in the symphyseal region.

57. TRANSOSTEAL IMPLANTS
oIn 1975 Small introduced the transosteal mandibullar
staple & bone plate, a reconstructive device placed
through a submental incision & attached to the
mandible with multiple fixation & two transosteal
screws to support a full arch prosthesis.
oHe presented 16 yrs evaluation,
oCranin developed single transosteal implant.

59. o In 1970 Kawahara was developing a ceramic
implant in Japan .
ofirst Aluminium oxide implant placed.
oIn 1970 Grenoble placed Vitreous Carbon
implant .

60. oCONTEMPORARY ORAL
IMPLANTOLOGY 1978 to present

61. oIn 1978 conference held at Harward ,
co- sponsored by NIH.
oThis was the milestone for further
research.

62. oIn 1976 Dr. Andre Schroeder in Switzerland
reported the bone growth into titanium
plasma sprayed hollow endosseous implants.
oAt the same time , Prof. Willischulte in
Germany reported the success with immediate
placement of Vitreous Carbon implant after
dental extraction & invented Frialit-2 implant.

63. oPer-Ingvar Branemark developed the two stage threaded titanium
endosseous root form implant in North America.
o“ Vital microscopy”…
o In 1960 at Gothenburg…
o Branemark noticed that there was no inflammatory reaction to the
titanium.

64. oHe started thinking about the potential of titanium to
act as an anchorage point, so the spur for the next
experiment whether titanium can be used as a bridge
in bone healing application.
oConcept of Osseo integration developed
oThe first clinical trail was done in 1965.
oIn 1971 surgical equipments.
oIn May 1982 Dr. George Zarb organized the
Toronto conference on osseointegration. Branemark
presented Two stage threaded root form implant
along with the 15 yrs research work & clinical trail.

66. BRANEMARK SYSTEM COMPONENTS
oFIXTURE –
opure titanium with machined
threads .
oThe top of the fixture has
hexagonal design & threads ..
o The apical portion tapered with
four vertical notches.
o COVER SCREW- seals the
coronal potion of fixture during
the interim period.

67. oABUTMENT- -made of titanium in a cylinder
shape. the apical portion has hexagonal shape
to fit the coronal portion of fixture.

68. oABUTMENT SCREW – insert through the abutment
& threads into the fixture to connect the two
components .
oGOLD CYLINDER- made of lAu , Pl, Pd. It is
machined to fit the coronal portion of the abutment. It
becomes integral part of final prosthesis.
oGOLD SCREW –inserted through the gold cylinder
& threads into the abutment screw to connect the gold
cylinder & abutment.

70. IMZ IMPLANT SYSTEM
oKirsch developed the IMZ implant system in 1974.
Since 1978 in clinical use.
oIntramobile cylinder endosseous two stage
osseointegrated implant.
oThe polyoxymethylene & polyacetal used as IME.
oAvailable in 3.5 to 4mm diameter and 8,10,13,15mm
length.
oSurface coating may be titanium plasma spray or
plasma sprayed HA coated surface.

71. IMZ IMPLANT SYSTEM
o Kirsch developed the IMZ implant system in 1974. Since
1978 in clinical use.
oIntramobile cylinder endosseous two stage osseointegrated
implant.
oThe polyoxymethylene & polyacetal used as IME.
oAvailable in 3.5 to 4mm diameter and 8,10,13,15mm length.
oSurface coating may be titanium plasma spray or plasma
sprayed HA coated surface.

73. LEDERMAN SCREW IMPLANT
oIn 1977 Dr. Philippe Lederman in collaboration with strauman
co. developed the Titanium plasma spraed screw type implant.
oIn 1989 Lederman developed the New Ledreman screw
implant Surface roughened by sand blasting & acid etching.

74. ITI BONE FIT IMPLANT SYSTEM
oDeveloped by ‘International Team for Implantology’.
oThree different types
oSingle stage & two stage.
oTransgingivally placed in healing phase so second surgical
procedure for uncovering the implant is avoided.

75. THE HAND-TITANIUM IMPLANT SYSTEM
oClinical use since 1985 at Switzerland & now in use world
wide ( Lederman 1986).
oA conical, step- screw, pure Ti implant with self thread.
oLength- 10 to 20mm.
oDiameter – 3.5 to 7mm.

76. oIn early 1980s Tantum introduced Omni R implant -
A Ti root form implant with horizontal fins.
oOmni S implant – for placing into bone grafted
maxillary sinus.

77. oIn 1983 EL Blasty & Kamel introduced the new
endosseous implant material i.e Poly acrylic acid
reinforced with ceramic alumina particles 0.3 microns.
oThe hydrophilic matrix swells in contact with aqueous
solution.
oThe gradual pressure on the surrounding bone
stimulates osseous activity.
oImplanted in canine, premolar sites with promising
results.

78. MINI DENTAL IMPLANT
o In 1985 Victor Sendax developed MDI.
oUltra – small diameter 1.8 mm, biocompatible Ti alloy implant
screws.
oBulard added single one piece `O- ball’ design .

80. CORE VENT
oDeveloped by Dr. Gerald Niznick in 1986.
oHollow basket design made of Ti alloy.
oDifferent fixture designs Screw –Vent, Micro-Vent, Bio –Vent.

82. ENDOPORE
oA root form dental implant
developed by Doughlas et.al in
1996 made of Ti alloy & sintered
with same alloy producing porous
surface.
oBiological & clinical advantages.

83. STERI OSS SYSTEM
oIntroduced by Denar
oMade up of 99.9% Ti, tapered apex thread
design & the coronal 3rd highly polished
surface.
oAvailable in 3.5 to 4mm diameter, length 12
mm,16mm,20mm,&
miniseries8mm,10mm,12mm length.

84. NOVUM CONCEPT
o Branemark developed the concept of providing a
new set of teeth for the mandible in a single day.
oClinically implicated in 1996.
oThree titanium fixtures inserted , mucosa is closed
& base plate is placed over the fixtures & then the
prosthesis is placed.

86. ZYGOMATICUS FIXTURES
oBranemark.
oThe long fixture can be anchored in zygoma by approaching
through the sinus .
oSeverely resorbed maxilla.

87. o1984 – CT scan.
oBone augmentation techniques.
o1986 Tatum reported about Sinus lift / Bone graft
antroplasty.
o1988 Nerve transposition
o1989 Pterygoid implants .
o1991 Guided tissue regeneration using Gore-
Tex or resorbable Vicryl-Mesh used to augment
narrow & shallow ridges .
o1995 Distraction osteotomies & split ridge
technique.

88. o The screw type implants fabricated by
Hydroxy appatite based composites by
mixing HA with Al oxide coated Zr oxide
powder & compared with Cp.Ti implants.
oHA based composites showed better
mechanical properties & bioactivity.
o(Young Min Kong et.al 2002).

89. oDevelopment of implants coated with
Bioactive Alumina –based composite by
electrophoretic deposition method.
oAlumina is excellent biomaterial ,good
biocompatibility , highly corrosion resistance,
high wear resistance & strength.
oWollastonite has (CaO. SiO2) high apatite
forming ability deposited into the pores of
foamed Alumina by Electrophoretic
deposition.

90. BICORTICAL SCREW IMPLANT
oSelf tapping type
oDiameter 2.5, 3.5 ,4.5,5.5mm
oLength 21 -30mm
oPost extraction insertion for single
tooth replacement.

91. OSTEOPLATE 2000
oAtrophic RAR
oThe conical plate with
shoulder width 1.3 mm
& base 0.9 mm.

92. oHistorically dental restorations supported by Osseointegrated
implants evolved as
oFully ed. Mandibular arch -1980
oFully ed. Maxillary arch
oShort span ed. Segment -1990
oMissing single tooth – 1990
o1980s restorations were screw retained , 1990s cemented.

93. Summary
oBefore 1000 A.D tooth carved of stones , calcite, ivory
were implanted.
oIn the 1000 -1799 A.D mainly allotransplantation.
oIn the 1800-1910 period beginning of root form
endosseous implant of Au, Pt .
oIn the 1910-1935 Greenfeild designed hollow basket
implant.
oIn 1935- 1978 Root form implants of the pin & screw
type, Sub periosteal , Ramus blade, Ramus frame,
Transosteal.
oIn 1978 Branemark developed the Titanium implants,
latter on different surface treated Ti implants
developed.

94. IMPLANT ABUTMENTS

95. Introduction
oThe implant sucess depends on the prosthetic
phase as much as on the surgical phase.
oThe number and variety of abutments available
have been the direct result of the need to better
orient the implant to the occlusal plane to
facilitate prosthetic therapy.
oDifferent abutments are available for different
prosthetic applications
oImplant position and angulation may require
different abutments to allow optimum esthetics.
oLack of intermaxillary space may preclude
traditional abutments and require special or
custom abutments

96. Introduction
oIn all settings, clinicians pursue implant
protocols and materials that further expand
their use in the fixed replacement of natural
teeth.
oThis has contributed in part to the evolution of
“restoration-driven” implant dentistry.

97. Terminologies
oAbutment /abut·ment/ a supporting structure to
sustain lateral or horizontal pressure, as the anchorage
tooth for a fixed or removable partial denture.
Dorland's Medical Dictionary for
Health Consumers
oAbutment : that part of a structure that directly receives
thrust or pressure; an anchorage : a tooth, a portion of a
tooth, or that portion of a dental implant that serves to
support and/or retain a prosthesis usage.
GPT 8

98. oAbutment analog : a replica of the superior portion of
a dental implant. Usually used to provide an exact form of
the dental implant abutment within the dental laboratory
during fabrication of a prosthesis supported in part or
whole by the dental implant
oAbutment clamp ;any device used for positioning a
dental implant abutment upon the dental implant body
oAbutment driver : any hand instrument usually
specifically made to assist in insertion and securing of a
dental implant abutment to the superior portion of a
dental implant
GPT 8

99. oAbutment healing cap : any temporary cover used to
provide a seal over the superior portion of a dental implant;
most such covers are metallic and are intended for interim
usage following exposure of the dental implants superior
surface
oAbutment post : that component of a dental implant
abutment which extends into the internal structure of a dental
implant and is used to provide retention and/or stability to the
dental implant abutment
oAbutment screw : that component which secures the dental
implant abutment to the dental implant body
GPT 8

100. Implant components:
oTo understand the characteristics and function of
an implant, one must have knowledge of its
component parts. Although each implant system
varies the parts are basically consistence .
oThe system that pioneered clinical prosthodontic
applications with the use of commercially pure
titanium endosseous implants is that of
branemark and co-workers.

101. The component parts are:
1.Implant fixture
2.Cover screw
3.Trans mucosal abutment
4.Abutment screw
5.Healing abutment
6.Impression posts
7.Laboratory analog
8.Waxing sleeves
9.Prosthesis retaining screws
Implant restorations; A step by step guide, Carl drago

103. Implant Fixture:
oFixture is the component placed with in the bone
during the first stage surgery. It may or may not be
threaded and is normally made of titanium or titanium
alloy of varying roughnesses.
oAn implant provides the anchor or foundation for a
restoration. It is screwed into the bone of the jaw
providing a fixed platform on which an abutment can
be screwed.
oAll contemporary dental implants have an internally
threaded portion that can accept second stage screw
placements.
o These implants also may incorporate an
antirotational feature within the implant body which
may be internal or external.

104. Implant Fixture:
oDepending on the implant system, the fixture can
have different surfaces-threaded, grooved,
perforated, plasma sprayed or coated.
o Each surface type is meant for a particular
purpose such as increase surface area
enhances osseointegration or better cortex
engagement ensures immediate and long term
bone anchorage.
Implant restorations; A step by step guide, Carl drago

105. Cover screw
oThe cover screw acts as a seal on the coronal
portion of the fixture and fits into threads of the
internal channel over the hexagonal shape.
oThis is used during the interim period after the
first surgical procedure and before the second
surgery, it has a groove for screwdriver access
and is rounded on top prevent damage to soft
tissue.
o In the centre of the screw there is a depression
within the groove to accommodate the punch
blade; the blade is used for cutting soft tissue
located around the circumference of the cover
screw during second stage surgery.
Implant restorations; A step by step guide, Carl drago

106. Transmucosal abutment
oAbutments are component of the implant system
that is screwed directly into the implant.
oIt provides the connection between the fixture
and the prosthesis that will be fabricated. They
accept the retaining screw of the prosthesis.
oThe abutment is made of titanium or titanium
alloy.
oAbutments take many forms. Their wall is usually
smooth, polished, straight aided titanium or
titanium alloy.
Implant restorations; A step by step guide, Carl drago

107. Transmucosal abutment
oThe abutment screw has a silicone ring that
provides a seal to prevent microorganisms from
passing through the abutment to the fixture.
oAbutments can engage either an internal or
external hexagon on the fixture that serves as an
anti rotational device, which is particularly
important for single unit restorations.
Implant restorations; A step by step guide,
Carl drago

108. oAbutments are classified as temporary and
permanent abutments.
oTemporary are healing abutments which are
placed after second stage surgery. They will be
slightly larger than the permanent abutments.
oPermanent abutments are classified according to
length, angulations, material, implant system etc.
oAngled abutments are used in divergently placed
implants. Tapered and wide-base abutments
allow teeth with larger cross sectional diameter to
be restored with more physiologic contours.

109. Healing abutment
:
Healing abutments are available in heights of
3,4,5,7mm
Implant restorations; A step by step guide, Carl

110. oHealing abutments are dome shaped screws
placed after second stage surgery and before
insertion of the prosthesis
oThey can be screwed directly into the fixture or
onto the abutment immediately after second
stage surgery.
o Those that screw into the abutment are called
healing caps.

111. oHEALING ABUTMENTS
standard healing abutment
5.0mm height
standard healing abutment
4.0mm height
standard healing abutment
3.0mm height
standard healing abutment
2.0mm height

112. CUSTOMISED HEALING ABUTMENTS
Conical design
Tapered design
Standard design
Straight design

113. oHealing abutments are made of titanium or
titanium alloy.
oIn areas where esthetic is paramount healing
should be sufficiently completed around the
healing cap to stabilize the gingival margin.

114. Impression posts:
oImpression posts facilitate transfer of the intraoral
location of the implant abutment to a similar
position on the laboratory cast.
oThey may be screw into the implant or into the
abutment and are customarily subdivided into
fixture type or abutment type, with the transfer
post in place ,an impression is made intraorally.
oThese can be further subdivided into transfer
types(indirect) and pick up type(direct)after
radiographs are taken to confirm complete
engagement.
Implant restorations; A step by step guide, Carl

115. oWhen impression is removed from the mouth
impression post remains in place on the Implant
or the abutment.
oIt is removed and joined to the laboratory analog
before being transferred to the impression in the
proper orientation
oTo correct implant angulations in the cast flat
sided impression post is used. Completely
symmetrical impression posts are contraindicated
if angle correction is necessary.

117. oImpression posts can also be divided into one
piece or two piece type .
oOne piece type is screwed into the fixture or
the abutment and is used where there is no
need to change the abutment in the
laboratory cast.
o To transfer the orientations of an
antirotational feature from the mouth to the
cast the two piece Pick up (direct) impression
technique should be used.

118. o This requires a two piece impression post with a
removable guide pin that screws directly into the
abutment or onto the fixture.
o It uses a square coping with a long guide pin
and usually an open top tray to prevent rotation
in the impression material and to allow access to
the guide pin for unscrewing after the material
has set so that the copings can be picked up with
in the impression.

119. Laboratory analog:
oLaboratory analogs are made to represent
exactly the top of the implant fixture or the
abutment in the laboratory cast therefore they are
classified as fixture analog and abutment
analogs.
oBoth screw directly into the impression post after
it has been removed from the mouth and
returned to the impression before pouring.
oAbutment analogs are generally attached to an
implant impression post. Implant body impression
posts are normally attached to implant body
analogs.
Implant restorations; A step by step guide, Carl drago

120. Laboratory analog:
oThe advantage of using the implant body analog
is that the abutments can be changed in the
laboratory if the clinician is confident that the
appropriate abutment has been selected using
the abutment impression post and abutment
analog can simplify the procedure.

121. REFERENCES
oBlock & Kent’s Endosseous Implants For Maxillofacial
Reconstruction.
oElaine Mc Clarence ’s Close to the edge.
oHubertus Spikerman’s Color atlas of Dental medicine
(Implantology).
oMalvin E. Ring’s Dentistry An Illustrated History.
oSumiya Hobo’s oseointegration and occlusal rehabilitation.
oRalph V. McKinney, Jr’s endosteal dental implants.
oADA council on scientific affairs Dental endosseous implants.
An update. JADA, Vol. 135, January 2004.

122. o Richard M. Sullivan, Implant Dentistry and the Concept of
Osseointegration: A Historical Perspective .(2001) Journal of the
California Dental Association.
o Douglas A. Deporter “simplifying the treatment of edentulousness” JADA
Vol 121sept 1996:1343
o Young-Min Kong, Hydroxyapatite-Based Composite for Dental Implants:
an In Vivo Removal Torque Experiment. J Biomed Mater Res (Appl
Biomater) 63: 714–721, 2003
o M. A. EL BASTY and I. L. KAMEL.The Development of a Novel Tooth-
root Implant Material. J Dent Res 62(6):733-737, June 1983
o Management of atrophic mandibular ridges with Mini dental implant
systems- A case report J.IPS;2005;5;158.