1.
Marwan M. El Said
BDS. MSc.

2.
History of dental implant
• 2500 B.C. the Egyptians used gold wire ligatures
to help stabilize damaged or loose teeth.
• The Mayans used the first known implants 400
years ago
• Maggiolo used gold implants in 1809
• Harris 1887 used porcelain implants
• Lambotte used gold, silver , brass, copper and
magnesium and identified corrosion of metal in
human tissue

3.
• The first root form two pieces implants used
by Greenfield made from iridoplatinum .
• Strock introduced cobalt chromium
molybdenum alloy in 1938 with 15 years
fowlloup .
• Strock reported direct bone implant interface
in 1940 and called it bone fusing or ankylosis
• Branemark began his studies in 1952 on bone
marrow healing
• 1960s 10 years animal studies o dogs revealed
complete implant integration

4.
• 1965 Branemark started human implant
clinical studies and the results were reported
in 1977
• In 1988 National institute of health recognized
dental implants and stressed the necessity for
advanced education

5.
• The term osseointegration was first described
to be direct bone to implant interface on the
microscopic level
• Now osseointegration described to be direct
bone to implant interface on the microscopic
level and rigid fixation “ no movement when
applying force of 1 to 500 g”
• modern dental implants : An endosteal
alloplastic material surgically inserted into
residual bone ridge

6.
Dental implant classification

7.
According to material
• Pure titanium (cpTi grade 4)
• Titanium alloy (Ti 6 Al 4V)
• Ceramic
• Polymers

8.
Pure titanium grade 4
 Grade is have the most oxygen content
(0.4%)
 Good Osseointegration
• Titanium oxide layer
 Low physical properties
• High corrosion, low strength ,difficult to
manipulate

9.
Titanium alloy (Ti 6 Al 4V)
 Aluminum increases the strength and decrease
the weight of the alloy.
 Vanadium acts as beta-phase stabilizer and
increase the strength

10.
Ceramic implants
• Advantages
Biocompatible made from Zirconia
More esthetic
All ceramic restorations and metal free dentistry
• Disadvantages
One pice implant only
No osseointegration
no alteration of the abutment portion
High cost

11.
Polymer implants
• methyl methacrylate resin
• Not biocompatible but biologically tolerable
• inferior mechanical properties
• lack of adhesion to living tissues
• adverse immunologic reactions.

12.
Implant design
• Macroscopic Features:
Body Design
Thread geometry
Platform
Crest module and abutment connection
Abutment
• Microscopic Features
implant materials
surface morphology
surface coatings

13.
Macroscopic Features
• Body Design
subperiosteal frame-like
transmandibular implants
endosseous
• Bladelike
• Pins
• Root form implants
cylindrical
tapered screw shaped

14.
subperiosteal frame

15.
subperiosteal frame

16.
subperiosteal frame

17.
transmandibular implants

18.
transmandibular implants

19.
Endosseous implants
• Bladelike

20.
pins

21.
Cortically fixed @ once

22.
Basal implants

23.
Cylindrical implant

24.
tapered screw shaped implant

25.
tapered screw shaped implant

26.
tapered screw shaped implant
Advantages of the tapered form implant :
allow for placement in narrow spaces
better stability for immediate placement
better distribution of compressive forces.

27.
• Tapered screw implants can be :
Two piece implant
Single piece implant

28.
Submerged
Non-submerged

29.
Solid
Hollow
Vented

30.
Thread geometry
• understanding of the forces an implant might
endure is essential to the concepts of implant
thread geometry
• three main types of load an implant may
endure at the interface between the implant
surface and bone.
• These three forces are compressive, tensile
and shear

31.
Forces distribution
Tensile and
shear forces
Compressive
forces
unfavorable
favorable

32.
• Thread pitch refers to the distance from the
center of the thread to the center of the next
thread .
• 𝒑𝒊𝒕𝒄𝒉 =
unit length
𝒏𝒖𝒎𝒃𝒆𝒓 𝒐𝒇 𝒕𝒉𝒓𝒆𝒂𝒅𝒔

33.
• If implant length is the same, a smaller pitch
means there are a greater amount of threads

34.
• Implants with more threads (i.e. smaller pitch)
were found to have a higher percentage of BIC
and increase resistance to vertical forces

35.
• The lead is the distance from the center of the
thread to the center of the same thread after
one turn.

36.
• this could be the distance the implant would
advance if it was advanced one turn

37.
• implant could have a single ,double or triple
thread design in which two or three threads
run parallel to each other

38.
• maintain a high level of resistance to vertical
forces and level of BIC at the same time as
allowing for increased speed of implant
insertion.

39.
• Thread depth the distance from the tip of the
thread to the body of the implant

40.
• A shallow thread will be easier to insert into
dense bone
• A deep thread will allow for much greater
primary stability specifically for situations such
as soft bone or immediate implant sites

41.
• Thread width is the distance in the same axial
plane between the coronal most and the
apical most part, at the tip of a single thread.

42.
• The face angle is the angle between the face
of a thread and a plane perpendicular to the
long axis of the implant.

43.
• A small face angle will increase tensile and
compressive type forces,
• while increasing the face angle has been
shown to result in an increase of shearing
forces.

44.
• Thread shape describes the geometry of the
implant thread
• five types of thread geometry V-shape,
square, buttress, reverse buttress and spiral

45.
Implant platform

46.
Implant platform

47.
Implant platform switching

48.
Implant abutment connection
• External hex
• Internal hex
• Mores taper

49.
Abutments

50.
Microscopic Features
• Implants can be
Smooth
Machined
 roughed
Coated

51.
Patient evaluation and treatment
planning

52.
Oral surgery
prosthodonticsperiodontics

53.
Extra oral examination
• Facial symmetry
• Mid line
• Occlusal plane
• Smile line
• Any other facial features
• Palpation of facial muscles and TMJ
• Palpation of regional lymph nodes
• Palpation of the thyroid gland

54.
Medical history
• Should be obtained for every implant
candidate
• It will set the tone fore the entire treatment
• Give the warm and caring impression
• The patient should understand medical history
value to appreciate your work

55.
The disease control is
more important than
the disease itself. (Dios y cols; 2013)

56.
contraindications to implant therapy
• Absolute contraindications: dental implants
cannot be considered
• Relative contraindications: dental implants
may be considered only after a specific
problem has been solved
• Local contraindications: dental implants may
be considered by taking extra precautions
regarding problems involving the mouth or
jaws

57.
Absolute contraindications
• Major allergies
(Specifically to the anesthetic used during surgery or titanium )
• Risks:
 post-operative swelling
 Anaphylactic shock
 Death.
• Solutions:
 Finding an anesthetic tolerated by the patient.
 Finding an alternative to conventional dental implants.

58.
Absolute contraindications
Young age
• Risks:
Not enough space to insert the implant in the alveolar
bone
Insufficient space for the artificial crown of the implant
Having to redo the procedure when growth is completed.
• Solutions:
Wait until the growth of the jaws is completed (at the age
of 17 or 18)
 Finding an alternative to conventional dental implants.

59.
Absolute contraindications
• Patients requiring organ transplant
• Risks:
Post-operative infection due to long-term treatment
with anti-rejection drugs that suppress or slow down
the immune system
Osseointegration failure.
• Solutions:
Finding an alternative to conventional dental
implants.

60.
Absolute contraindications
• Autoimmune diseases like AIDS
• Risks:
Osseointegration failure.
Post-operative infection.
• Solutions:
Finding an alternative to conventional dental
implants.

61.
Absolute contraindications
• Cancer
• that is not in remission, treated with bisphosphonates
or required radiotherapy treatments in the jaw area
• Risks:
Osseointegration failure.
Post-operative infection.
Altered or slow healing.
• Solutions:
Cancer with radiation therapy: use strict asepsis during the
procedure, under general anesthesia, and work together
with the radiotherapy team.
Finding an alternative to conventional dental implants.

62.
Absolute contraindications
• Cardiovascular disease
• recent myocardial infarction, valvular disease,
heart failure
• Risks:
Death
• Solutions:
Finding an alternative to conventional dental
implants.

63.
Relative contraindications
• Smoking, drug addiction, and alcoholism
• Risks:
Post-operative infection;
Longer healing time;
Decrease in the effectiveness of the immune system
to fight gum and bone diseases
Osseointegration failure.
• Solutions:
Stopping smoking, drinking alcohol or consuming
drugs before the procedure, at least a week after and
ideally during the convalescence and even beyond

64.
Relative contraindications
• Pregnancy
• Risks:
Parts of the procedure that can endanger the fetus
use of local or general anesthesia
 X-rays.
• Solutions:
Wait until after childbirth to perform implant surgery.

65.
Relative contraindications
• Uncontrolled diabetes
• Risks:
 Post-operative infection;
 Onset of periodontal or dental disease;
 Longer healing time.
• Solutions:
 Managing diabetes;
 Use strict asepsis during surgery;
 Take antibiotics before the procedure to reduce the risk of infection.

66.
Relative contraindications
• illness requiring anticoagulants
• Risks:
More abundant and uncontrollable bleeding (during
and after surgery).
• Solutions:
Consult the physician who prescribed blood thinners
to see if they can be stopped or changed before and
during surgery;
Take extra precautions during the procedure to
prevent bleeding.

67.
Relative contraindications
• Autoimmune disease (e.g.: lupus, rheumatoid
arthritis, etc.)
• Risks:
Post-operative infection;
Longer healing time.
• Solutions:
Take antibiotics before the procedure to reduce
the risk of infection;
Use strict asepsis during surgery.

68.
Relative contraindications
• Untreated psychiatric or psychological problems
• Risks:
Compromised security of the surgeon or the patient during
the procedure;
Patient dissatisfaction with the final result because of
unrealistic expectations.
• Solutions:
Evaluating the psychiatric or psychological problem to
determine if it can be controlled by medication (in
collaboration with the patient’s physician);
Finding an alternative to conventional dental implants.

69.
Relative contraindications
• Osteoporosis and other bone diseases
• Risks:
Osseointegration failure.
Premature loss of the implant.
Fracture of the jaw.
• Solutions:
Finding an alternative to conventional dental
implants.

70.
Relative contraindications
• Lack of motivation from the patient for the treatment
and postoperative follow-up
• Risks:
Osseointegration failure;
Post-operative infection;
Longer healing time.
• Solutions:
Making the patient aware of the rigorous discipline
required for a successful treatment;
Finding an alternative to conventional dental implants.

71.
Local contraindications
 Insufficient alveolar bone density or volume
 gingival recession or other periodontal disease
 Bruxism
 clenching
 Unfavorable position of the lower alveolar nerve and
other anatomical structures of the mandible
 Unfavorable maxillary sinus anatomy
 Poor oral hygiene or tooth infection near the site of the
implant
 Lesions in the mouth (oral dermatosis)
 Malocclusion

72.
Are orthodontic treatments a contraindication
to implants?

73.
Laboratory investigations
• Complete blood count “CBC”
• Bleeding profile
Platelet count
Bleeding time
Partial thromboplastin time “PPT”
International normalized ratio “INR”
• Glycosylated hemoglobin “HbA1c”

74.
Dental History
• Chief complaint
• Pain/emergency
• Past dental treatment
• Past dental experiences
• Previous dental prosthesis (How long?)

75.
intraoral evaluation and treatment
planning
• Bone width
• Bone height
• Bone type
• Number of missing teeth
• Important anatomical structures
• Inter occlusal space
• Opposing arch
• Crown root ratio
• Soft tissue
• Prosthetic option
• Patient expectation
• Financial considerations

76.
• What are the causes of increased failure
rates?
• Why is the patient seeking dental treatment?
• What are the patient priorities ?

77.
Biological risk factors
Vs
Biomechanical risk factors

78.
Implants success rate is about 97%
VS
implants are one of the treatment
modalities for replacement of missing
teeth